It's the environment, stupid! Declining ecosystem health is THE threat to health in the 21st century

‘ … nature can be unforgiving. We learn to live within her increasingly unpredictable means, we move elsewhere, or we perish.’

Elizabeth Royte ‘The Last Drop’, National Geographic, April 2010, p 176

Twenty-five years ago, the Ottawa Charter included within the list of prerequisites for health ‘stable ecosystems and sustainable resources’, making it the first WHO document, as far as I know, to recognize what I will call here ‘ecosystem health’ as a basic determinant of health. This represents one of the most important—but also one of the most neglected—aspects of the Ottawa Charter.

The health of our ecosystems is in fact—and always has been—THE most important determinant of the health and wellbeing of the Earth's population. Hence my title, which mocks the famous (infamous?) slogan of Bill Clinton when he was running for US President: ‘It's the economy, stupid!’ Well, no, that is actually the problem; it isn't the economy, it's the people [as I have argued elsewhere, we should make human rather than economic development the central focus of society and governance (http://healthycommunities.uwaterloo.ca/forum/keynote.html)] and most profoundly, as I note here, it is the (natural) environment.

Today the WHO acknowledges that natural ecosystems—‘the planet's life-support systems—for the human species and all other forms of life’ are ‘indispensable to the wellbeing of all people, everywhere in the world’ (Millennium Ecosystem Assessment, 2005a). The goods (natural resources) and services (oxygen production, nutrient cycling, soil production etc.) that the planet's natural ecosystems provide, and thus the ‘health’ and productivity of those ecosystems, are fundamental determinants of the health of the population; human health absolutely depends on ecosystem health.

Thus there is nothing more important for population health promotion and public health professionals today (and in the coming decades) than to join forces with those who are fighting to shift our values, our culture and our socio-economic systems towards more sustainable—and that also means more equitable—pathways.

HUMAN AND ECOSYSTEM HEALTH: A VIEW FROM 1986

The relationship of human health to the environment has been a major focus of my work for the past 30 years or more. So, I was privileged not only to attend the First International Conference on Health Promotion in Ottawa in 1986 but to present one of the five theme papers, on the theme of ‘Supportive Environments for Health’ (Hancock, 1986). In that paper, I noted ‘the world-wide impact upon our planetary ecosystem and resource base of population growth and intensive consumption’; identified a number of pollution problems that, taken together, ‘pose a profound threat not merely to this but to future generations’; and suggested that the unsustainable depletion of both renewable and non-renewable resources meant that ‘inevitably, our descendants will have to make do with less, find substitutes or do without’.

I also, of course, suggested possible solutions, although I noted that

The sad part about this litany of problems is that the solutions are known to us. And in many cases they have been tried and shown to be feasible

But, I regretfully concluded,

What is lacking is the moral and ethical awareness needed to support change in our political, institutional and economic agendas and in the values that underpin them.

Twenty-five years later, it is worth reflecting on what has changed since then (not much, at least not for the better), and what our prospects are now (not cheery). Today, alarmingly, the health of the Earth's ecosystems is declining dramatically (especially in the lower and middle income countries of the ‘South’). This decline and potential collapse, which if it continues will almost certainly result in the decline and potential collapse of our industrialized civilization, represents by far the most important threat to human health today.

DECLINING ECOSYSTEM HEALTH

The UN's Millennium Ecosystem Assessment (2005b) noted that

Human activity is putting such a strain on the natural functions of Earth that the ability of the planet's ecosystems to sustain future generations can no longer be taken for granted… . Nearly two thirds of the services provided by nature to humankind are found to be in decline worldwide. (p. 5)

A simple but dramatic illustration of the extent to which ecosystem health has declined in the 25 years since the Ottawa Charter was approved in 1986—a very short time in evolutionary or geological time frames—is provided in data from the latest publication of the WWF's Living Planet Report (WWF, 2010) and related sources. The Report contains two synthesis indicators; the Living Planet Index (LPI), which measures changes in the populations of over 2300 vertebrate species (mammals, birds, reptiles, amphibians and fish, see http://www.bipindicators.net/lpi) in the world's terrestrial, marine and freshwater ecosystems (and can be further broken down into temperate and tropical zones) and the Ecological Footprint, which measures humanity's resource consumption demands and the planets productive bio-capacity (or regenerative capacity). So, if the whole world were to live at the same level of consumption as the high-income countries, we would need 3.4 (6.1/1.8) planets' worth of biocapacity to sustain the worlds population, and as Ilona Kickbusch wisely wrote many years ago, ‘good planets are hard to find’ (Kickbusch, 1989).

• In 1986, the year of the Ottawa Charter, the LPI was 0.87 (the baseline, which is 1, was in 1970). By 2007, a scant 21 years later and the latest year for which data were available, the LPI had declined to 0.72 [J. Loh, personal communication, 19 July 2011 (Mr Loh is the editor of the Living Planet Report for the WWF International and the Institute of Zoology, Zoological Society of London].

• Even worse, the Tropical LPI, which was 0.67 in 1986, had declined to a dismal 0.40 in 2007, while the Temperate LPI had actually increased from 1 in 1970 to 1.15 in 1986 and to 1.29 in 2007 (J. Loh, personal communication). In other words, it seems the countries in the temperate zones (largely the higher income, more ‘developed’ nations) have been able to maintain and even increase their consumption while protecting and indeed improving their ecosystems, while the ecosystems of the tropical zones (largely the middle and lower income countries) have been plundered, largely to support increasing consumption in the higher income countries.

• During much the same period (in this case, 1985–2007), humanity's total ecological footprint increased from 12.48 billion hectares in 1985 to 18.09 billion hectares in 2007, a 45% increase. Meanwhile, the planet's total productive biocapacity only increased marginally, from 11.52 billion hectares in 1985 to 12.06 in 2007; given population growth, this was in reality a decline from 2.4 to 1.8 hectares per person (HPP). As a result, the ‘footprint to biocapacity’ ratio increased from 1.07 in 1985 to 1.51 in 2007 (Global Footprint Network, 2010). In other words, at the time of the Ottawa Charter, our global footprint was about equal to the productive biocapacity of the earth, but 21 years later we need 1.5 times this one planet we inhabit to meet our current needs, never mind our growing demands (for a vivid illustration of this trend see Fig. 3, p. 16 of www.scribd.com/doc/27169436/The-Ecological-Footprint-Atlas-2009-Global-Footprint-Network).

• Further illustrating the inequity of the situation, in 2007 the EF of the high-income countries was 6.1 HPP while the EF of the middle-income countries, the world's emerging industrial economies, was 2.0 HPP and the EF of the low-income countries was 1.2 HPP (Global Footprint Network, 2010).

ECOLOGICAL DECLINE AND SOCIETAL DECLINE

Almost 40 years ago, at the time of the First UN Conference on the Environment in Stockholm in 1972, the Club of Rome published ‘The Limits to Growth’ (Meadows et al., 1972). It was based on the World3 computer model developed by a group at MIT to investigate five major trends of global concern—accelerating industrialization, rapid population growth, widespread malnutrition, depletion of nonrenewable resources and a deteriorating environment. One of its three general conclusions was:

If the present growth trends in world population, industrialization, pollution, food production, and resource depletion continue unchanged, the limits to growth on this planet will be reached sometime within the next 100 years. The most probable result will be a sudden and uncontrollable decline in both population and industrial capacity. (Meadows et al., 1972)

Their 30-year follow-up, noted that

Growth in the globe's population and material economy confronts humanity with this possibility [of overshoot and collapse] … We … believe that if a profound correction is not made soon, a crash of some sort is certain. And it will occur within the lifetimes of many who are alive today. [(Meadows et al., 2004) pp. 1–3]

The most exacting attempt to review our track record since the publication of the ‘Limits to Growth’ was undertaken by Turner (2008). He looked back at the original Club of Rome scenarios and the actual record since then and concluded that

thirty years of historical data compare favorably with key features of a business-as-usual scenario called the “standard run” scenario which results in collapse of the global system midway through the 21st century.

While this would not be the first time that ecological decline or collapse has led to societal decline and collapse—Jared Diamond documents a number of examples in his 2005 book ‘Collapse’—this would be different in scale. While previously ecological and societal declines and collapses have been localized, or regional at worst, this would be at a global scale, although undoubtedly worse in some regions than others.

This situation also challenges a central ethos of Western—and increasingly of our global civilization—which is that growth equals progress and that growth is therefore good. A corollary to this view is that ‘a rising tide lifts all boats’, and that thus the answer to the problems of poverty is growth, since everyone will get richer—including the already rich. And a corollary to that is that we do not need to worry too much about inequality, since the poor will eventually become materially wealthier (and thus healthier), so we do not need to address the issue of redistribution, since the pie is growing.

But what if the pie cannot grow, what if there are limits to growth? In that case, the answer to poverty (assuming the answer is not simply to ignore the issue, to say ‘no’ to the less wealthy!) is not growth, but redistribution within a finite pie, where the rich do not get richer, but in fact become (materially) poorer—not a popular option. Of course, if we (the rich, which means here the high income countries) do say no, then our growth will continue to outstrip that of the poor and the gap in wealth (and health) will widen, as wealthy nations, regions, groups and individuals would use their wealth and power to purchase or seize the resources they need, at the expense of the less wealthy and less powerful—a sort of ‘gated community’ or ‘survivalist’ approach, but at a national or a sub-national level. This would result in growing inequities in access to the basic determinants of health, and thus growing health inequity at a global scale (although interestingly, there is an argument that less wealthy communities and societies will in fact fare better if there are the sort of problems I anticipate, as they are already living with less and are reasonably well adapted to scarcity, whereas the richer societies and communities are more dependent on their wealth and more vulnerable to the loss of it). At worst, this would result in resource wars, thus adding growing violence to the mix (some have argued that the invasion of Iraq was really a resource war, one of the first). As the French philosopher Raymond Aron is said to have remarked, ‘when inequality becomes too great, the idea of community becomes impossible’.

MANAGING DECLINE: A HEALTHY RESPONSE?

All this may strike many readers as depressing, unnecessarily gloomy and very uncomfortable. Moreover, we are often told that negative messages that inspire fear do not work and should be avoided. Indeed, in my work as a health futurist, I have often observed that while a ‘decline and collapse’ scenario—a common scenario in alternative futures work—is ranked as quite plausible, it is also the one that people prefer not to examine too closely or seriously.

But I want to suggest another way of looking at this. I think we would mostly agree that a diagnosis of cancer (or any other long, slow, dangerous condition) should not be ignored, and indeed that it is unhealthy to do so. Well, in some respects, the ecosystems on which we depend—our life support systems—have cancer (or a parasite or a virus—in any case, us!) and it would be very unhealthy on our part to ignore this. Moreover, there are things we can do to slow the progression, and thus to prolong our survival, so we owe it to ourselves to face up to this problem in a healthy, adult way and deal with it. And that must begin with recognizing the enormity of the problem, its scale and the rapidity with which ecosystem change is occurring.

Addressing this massive threat to health will in many ways require a different approach from health promoters. Health promotion is generally seen as a positive concept, focused on improving the health of the population while at the same time reducing inequalities in health. It is thus part and parcel of a Western industrialized world view that is focused on ‘progress’, and largely equates progress with growth—in wealth, in material wellbeing or, in our terms, health, wellbeing and both length and quality of life.

But much though I hate to rain on anybody's 25th anniversary parade, I believe the information I present here shows that the implications of declining ecosystem health for our health means that among the key tasks for health promotion practitioners over the next 25 years will be to help to manage our way through this inevitable ecological decline, while working to reverse it and restore ecosystem health as soon as possible; the fact that the LPI has actually increased in the Temperate zones over the past 40 years shows this is possible. At the same time, we have to engage in managing the accompanying social and indeed societal decline, to prevent it sliding off into collapse. This means we need to: Think of it as harm reduction on a global scale! As part of that approach, we need to But harm reduction alone is not enough, we need to move beyond a ‘protection and prevention’ approach (remembering that these are legitimate public health strategies) and help people in a more positive way to learn how to adapt to and even benefit from these profound changes in their way of life. So, as a fourth objective Indeed, it is not all doom and gloom. As Poland, Haluza-Delay and Dooris discuss in their article, there is good reason to believe that while material wealth might decline, that does not mean health, life expectancy or quality of life will decline; we have decades of studies that show societies with much less GDP per capita having health status quite close to that of far wealthier societies.

• preserve as much of our level of health as we can, while protecting the health of the most vulnerable;

• prevent a rise in inequality and violence as a result of competition for scarce resources and conflict resulting from declining ecosystem health, and thus

• minimize the harm to human health that will result from the human-induced ecological decline that is now underway.

• Routinely monitor and report on ecosystem health status as part of all population or public health reports;

• Work collaboratively with the environmental movement to link health promotion and sustainable development at all levels from the very local to the global;

• Alert people of the need to plan for managing decline and making the transition to a human-centred, environmentally and socially sustainable future.

• we need to be part of the solution by working with those who are already working to manage the transition to a sustainable, post-industrial society.

This also raises the issue of how we define and measure ‘progress’ and ‘success’. For far too long, progress has been measured by growth in the GDP, which is in fact a very poor measure of progress, failing among other things to distinguish beneficial economic activity from harmful economic activity, or from economic activity that protects us from harm or repairs damage to people, communities and the environment arising from harmful activity. For example, the economic activity of the tobacco industry, or the expenses generated in clearing up the recent Gulf oil spill all ‘contribute’ to GDP! A number of alternative measures have been proposed over the years; two of the most promising are the Genuine Progress Index (see for example GPI Atlantic, www.gpiatlantic.org/) and the measurement of Gross National Happiness (www.grossnationalhappiness.com/).

So, a final challenge for health promotion over the coming years will be to

• help to develop and implement measures of societal progress that are more reflective of the human-centred, environmentally and socially sustainable future we need to create.

ACKNOWLEDGEMENTS

I am grateful to Randy Haluza-Delay for his helpful comments on an earlier draft.

REFERENCES