Headline: Health professionals joining the frontline of sustainable development

There is no more pressing issue for today's development agenda than climate change, which touches on many issues of relevance to sustainability. There is a growing understanding that this global challenge can be better addressed through inter-sectoral work. This is something that has brought me – a health professional – from the seemingly distant field of public health to the IASS. Initially, IASS opened its doors to me for a three month fellowship in 2016 to prepare a literature review on the health impacts of nitrogen dioxide. This collaboration led eventually to a larger project, through which IASS gave me an opportunity to explore more deeply how air quality in Berlin is connected with the exacerbation of respiratory diseases like Asthma and Chronic Obstructive Pulmonary Disease (COPD), the project which I am currently pursuing in cooperation with Charité – Universitätsmedizin Berlin.

As an health professional, I see that health needs to be viewed in a much broader perspective than the mere absence of disease, and that well-being is clearly connected to the healthy planet we inhabit. My research on air pollution and health aims to reveal the extent to which our well-being is related to our environment, and to show how important it is that we care for the latter.

Humans cannot inhabit an unhealthy planet

Saying that, it is great to witness that doctors are encouraged to become champions in the “environmental battle”, as the health endpoints are the visible outcomes of environmental degradation. It was very noteworthy that major medical conferences that I visited recently served as platforms to encourage medical professionals to be aware of environmental challenges, and to advocate for the benefits for human health of preserving nature’s biodiversity.

Individuals and communities will play a larger role in shaping healthcare provision, but we must not focus only on human health. Humans cannot inhabit an unhealthy planet. And we are not doing a “favor” to the planet by protecting it; this action is reciprocal. These themes were communicated to the medical audience at two recent conferences on respiratory health: the 9th International Primary Care Respiratory Group (ICPRG) World Conference held in Porto, in May 2018, and 12th Global Alliance against Respiratory Diseases (GARD) General Meeting held in Helsinki, in August 2018.

The way forward: People-powered health

In Porto, I had the privilege to co-chair a session on Chronic Obstructive Pulmonary Disease (COPD) and the environment. The abstracts presented within the frames of the session aimed to share data on the health impacts of indoor pollution and on interventions for targeting chronic lung diseases in lower resource settings. Tackling Chronic Respiratory Diseases (CRDs) in low and middle income countries was a particular focus of the conference, where many speakers addressed the need to involve local stakeholders before planning public health interventions. As per their suggestion, this could be done through so called “prioritization processes”, which would provide an opportunity for the stakeholders on the ground to identify the local needs for health research.
From a public health perspective, the highlight of the congress was the plenary session, where presenters suggested that we reflect on why we need to be healthy in the first place. As public health professionals often do, I would quote Arthur Schopenhauer in this context, who said “health is not everything, but without health everything is nothing”. So, from a certain perspective health is needed in order to live “everything” – to be able to fully enjoy the moments with the ones we love, to be able to go to concerts or exhibitions and so on. In this context, well-being surpasses “ambitions of public health”, as stated at the ICPRG conference by science journalist and author Vivienne Parry. According to Parry, public health commonly pursues three goals: 1) domination over risk 2) organizing health systems and 3) reshaping humanity. She shared her outlook on the future of “people powered health”. Ms. Parry framed this shift as the “democratization” of health, and went on to explain how power would shift from health professionals to individuals and communities. According to Parry, in the near future patients will manage their own medical records containing patient-generated data in “the cloud” and will be supported by virtual health assistants, with a major focus on maintaining wellness rather than treating illness. As a result, hospital rooms will eventually be transformed into something akin to a bedroom. Ms. Parry’s final “projection” was that low income countries would become the leaders. In summary, the ICPRG conference suggests that in the future patients and communities will take a leading role in shaping healthcare provision.

Human health and planetary health

All this raises the question of whether individuals and communities must learn to care not just for their own health but also of the health of the planet. After all, we can’t live a healthy life on an unhealthy planet... These ideas are reflected in the notion of “planetary health”, an emerging concept in the medical field which, with the support of the Rockefeller Foundation and The Lancet, has become a focus of discussion at many medical conferences.

The GARD 12th General Meeting was held at the National Institute for Health and Welfare, in Helsinki, Finland on August 30 – September 1, 2018. The overarching theme of this meeting was “The Natural Step to Respiratory Health”, and the “planetary agenda” for respiratory health was a much discussed aspect of this.

Speakers Tari Haahtela and Nikolai Khaltaev reminded us of the potential health benefits and protective effects that we may get from nature. One of the main outcomes of the meeting was the adoption of the Helsinki Alert of Biodiversity and Health, which raised a number of points that are important for efforts to ameliorate respiratory health:

• the loss of nature’s protective effects as a result of urbanization;
• the important role of biodiversity in safeguarding human health;
• speakers emphasized the need for individuals, families and communities to engage in diverse activities in natural environments as this would lead to a range of health gains and increase overall well-being and mental health;
• the importance of activities such as gardening and access to green areas within or close to homes as a means to reduce allergies in children and strengthen immune systems.

The respiratory medical community was encouraged to reflect on environmental challenges such as global warming and air pollution as risk factors for respiratory health. And, on the other hand, to look at the common risk factors of human health, from the lens of the natural environment. Tobacco cultivation, for example, has been observed to drive desertification in numerous countries, while our unsustainable food systems require massive inputs of insecticides, herbicides, fungicides, fumigants and fertilizers, and deforestation causes to up to 20% of annual greenhouse gas increases.

A broader vision for public health

In summary, both conferences raised important issues which could and should shape future approaches to public health. As societies, we must begin to consider how our actions impact not only on human health, but on the health of our planet. Healthy humans cannot live on an unhealthy planet. As discussed at the GARD meeting, there are actions that are bad for human health and the planet (smoking, cars, chemicals), and there are actions that are equally good for human health and for the planet (physical activity, eating a sustainable diet), and lastly there are things that are good for human health and bad for the planet (antibiotics, health technologies, energy-intensive hospitals). It is therefore paramount that we are mindful in our everyday choices and remember that Earth is the best “tested” home for humans. We must not forget to cherish it, because we cannot be healthy (and happy) on an unhealthy planet.