Good Health and Well-Being

Living Edition
| Editors: Walter Leal Filho, Tony Wall, Anabela Marisa Azul, Luciana Brandli, Pinar Gökcin Özuyar

Environmental Health and Sustainability

  • Justin T. LawsonEmail author
Living reference work entry




The combination of external conditions that influence the life of individual organisms. The external environment comprises the non-living, abiotic components and the inter-relationships with other living, biotic components (Jones et al. 1990: 145).

Environmental health

Comprises of those aspects of human health, including quality of life, that are determined by physical, chemical, biological, social, and psychosocial factors in the environment. It also refers to the theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that can potentially affect adversely the health of present and future generations (WHO 1993).


The measure of cumulative environmental influences and associated biological responses throughout the lifespan, including exposures from the environment, diet, behavior, and endogenous processes (HERC 2018: para. 3).

Precautionary principle

When human activities may lead to morally unacceptable harm that is scientifically plausible but uncertain, actions shall be taken to avoid or diminish that harm (UNESCO 2005: 14).


Transforming our ways of living to maximize the chances that environmental and social conditions will indefinitely support human security, well-being, and health (McMichael et al. 2003: 1919).

Systems approach

An approach to the study of physical and social systems which enables complex and dynamic systems to be understood in broad outline (Bullock and Trombley 1999: 855).


With an increase in population and an improved awareness of the associated impacts of that increase, the developments regarding environmental health cover an ever-expanding field of monitoring, assessment and evaluation, intervention, prevention, and education. This chapter will highlight a wide range of issues with respect to environmental health and sustainable development at local and global levels. A brief history of the subject is given before discussing the range of topics that are currently of concern and are directly linked to environmental health. Conclusions are given with points to consider for future improvements on sustainable development.


Environmental health covers a diverse range of factors that influence human health, as outlined by the World Health Organization (WHO):

Environmental health comprises of those aspects of human health, including quality of life, that are determined by physical, chemical, biological, social, and psychosocial factors in the environment. It also refers to the theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that can potentially affect adversely the health of present and future generations. (WHO 1993)

This is the third and most current definition provided by the WHO as a result of a consultation procedure held in Sofia, Bulgaria, but is also among dozens of other definitions provided by local, regional, and national authorities (ODPHP 1998), each with its own perspective and focus relevant to its location. Some of these definitions are very succinct and localized, such as Hawaii’s Department of Health (1970) enhancing “environmental quality for all people of Hawaii” (Environmental Quality Control Chapter 341 Section 1 – Findings and purpose), to the more comprehensive Environmental Health Australia’s definition:

Environmental health is the interaction between the natural, built and social environment and human health, including ecosystem health and sustainable development, the identification, assessment and control of occupational hazards, communicable disease control and prevention, and the general risk assessment and management of environmental health hazards. (EHA 2008: 2)

Considering the changing needs of the global population and the uncertainty of knowing what future generations truly need, it is perhaps with a full engagement of the precautionary principle, and with a keen awareness of the fluidity of ecosystems, that allowances need to be made within definitions to be reflective of the changes occurring. Emergency or disaster management and climate change are aspects of that change and yet are not directly mentioned in such definitions. Mention of such topics will be made briefly further below, considering the impacts they will have on vulnerable populations and on sustainable development.

Further to this, there are drivers and enablers that can improve populations’ health outcomes as a direct result of a healthy and safe environment. Such drivers can be found in the variety of charters that have come in existence, such as the Alma Ata (1978), Ottawa Charter (1986), Jakarta Declaration (1997), and the Bangkok Charter (2005). Clearly, the Millennium Development Goals (MDGs) (2000) were an overarching extension of those aforementioned principles, and the current Sustainable Development Goals (SDGs) (2015) are the next iteration to address the significant problems that face humanity as it progresses through the twenty-first century. While it can be argued that the goals are many and varied, and that there appears to be overlap in achieving the goals (for instance, environmental health could be positioned within SDGs 6, 11, 12, and 13), there is nonetheless a very comprehensive approach provided, which warrants a concerted effort from many stakeholders.

Considering the latter term in “Goal 3 Good Health and Well-Being for People,” discussion also must be focused on aspects of well-being, which significantly expands the scope of environmental health. Well-being depends not only on the natural environment, the human made environment, and social arrangements (families, social networks, associations, institutions, economies) but also on human consciousness (ABS 2001: 6). Well-being also includes satisfactory human relationships, meaningful occupation, as well as opportunities for contact with nature, creative expression, and making a positive contribution to human society (Furnass 1996). As such, considering “environment” as a determinant of health, environmental degradation and deprivation can have significant negative impacts on populations’ health and well-being. Environmental degradation relates to exposure to damaged environments (e.g., contaminated water, polluted air, etc.) that contributes to health problems, while environmental deprivation is also a health impact in which people are deprived of necessary access to the natural environment.

Humans are dependent physiologically on nature, and over 22% of world’s disease burden (in disability-adjusted life years) is attributable to modifiable environmental factors (Prüss-Üstün et al. 2016). At around the time of the MDGs being implemented, the global burden of disease attributable to environmental factors was estimated at 24% (Prüss-Üstün and Corvalán 2006); this figure was in accordance with earlier global studies, for example, 23% (WHO 1997) and ranging between 25% and 33% (Smith et al. 1999). The current study that Prüss-Üstün leads uses estimates of the burden of disease (BOD) from a much broader range of environmental risk factors and categories of diseases and health conditions affected. As a result, there are some significant differences among some of the categories, but overall the total burden has decreased only marginally.

In addition to the BOD from environmental risk factors, humans are psychologically dependent on nature, that is, humans require contact with nature (Wilson 1984; Kellert and Wilson 1993). This psychological dependency is explained by the “biophilia hypothesis” (Wilson 1984), where Wilson suggested an element of genetic inheritance was fundamental to humans’ relationship with the natural world. Kellert (1996) divided this biophilic affiliation to nature into nine tendencies or values: utilitarian, naturalistic, ecological–scientific, aesthetic, symbolic, humanistic, moralistic, dominionistic, and negativistic. To discuss these values further lay beyond the scope of this chapter but suffice to say, these values have connections to sections “Social, Psychosocial, Political, and Economic Environments,” “Health and Ecosystems,” and “Other Environments and Environmental Health Issues” below.

Brief History

Throughout humanity’s entire history, there has been the need to ensure humanity’s survival is not thwarted by threats from illness and disease. Whether an individual or a group is nomadic or sedentary, systems have been learned over time (no doubt through many unrecorded mistakes) to safeguard access to food, shelter, and other resources that enable survival and, as has occurred over recent centuries, a flourishing of the population. There are many examples of differing cultures adapting to changing environmental conditions, whether they be from the result of their actions or other circumstances not known to them. Some of those adaptations were successful and others were not. In South Africa, Zulus restricted their movement to new places in the belief that exposure to new disease would be detrimental to their health (Landon 2006), while in the Andes of Peru, Incas devised aqueducts to channel water from abundant areas to other areas, where rainfall was significantly lower thus improving their access to clean, potable water (Wright 2008). Similarly, in Mohenjo-Daro, Pakistan, some of the earliest examples of sanitation, water management, and urban planning exist (UNESCO 2018). Elsewhere, there have been modifications of the natural and built environment in order to guarantee a healthy society, as evidenced in Italy, when the Romans deemed the Tiber too polluted to use in 312 BC and constructed their own versions of aqueducts (Ponting 1991).

The challenge of maintaining a healthy and sustainable society has been well documented over time (e.g., Meadows et al. 1972, 1992; Schumacher 1973; Lappé 1982; Brown 1984; Ehrlich and Ehrlich 1990; McMichael 1993; Diamond 2005; Worldwatch Institute 2017), with successes and failures highlighting the need to be forever vigilant to potential threats and weaknesses in societal development. Some of those challenges have been in the effective monitoring, regulating, and policing environmental threats, with an early example of ineffective bylaws demonstrated in Foxton, UK; over numerous years between 1562 and 1698, penalties for breaches on discharges in the local stream were repeatedly issued (Ponting 1991). Early successes can be highlighted by the improved knowledge base of infectious diseases and the associated vectors, i.e., from ancient Greek miasmas to mid-nineteenth century European germ theory. The Broad Street pump is a watershed moment of understanding cholera as being a water-borne disease due to the painstaking work of John Snow pioneering epidemiological work in 1854. While his findings were not accepted until decades later, his meticulous recording and mapping of the cholera outbreak demonstrated a prescient approach to epidemiology in employing geographic information systems (GIS) to disease, which is becoming standard procedure now (Kirby et al. 2017).

Other examples throughout the world also show foresight in effective management of wastes and pollution; however, there are just as many where solutions were ineffective despite best intentions. Lack of information or conflicts with commercial interests compounded the ineffectual results. In China, for example, human waste was removed and used as fertilizer in rice fields, a technique remarked upon in the late eighteenth century (Ponting 1991). This was seen as a substantial improvement on how effluent was managed in Europe at the time; however, by the mid-twentieth century, 35–98% of the Chinese population in urban and rural settlements suffered from worm infestations, and by 1948 a quarter of all deaths were due to fecal-borne infestations (Winfield 1948). Significant improvements on these negative outcomes have been made of late in China with a coordinated public health campaign “Patriotic Public Health,” which has seen reductions in infectious disease (Zhang et al. 2002).

It is most unfortunate, then, that there are many instances where there have been ongoing struggles for residents to have the full support of municipal authorities and agencies when significant negative health impacts have occurred. Gibbs’ (1995) account of Love Canal, and in particular the “politics of dioxin,” is one of “pain, suffering, anger, and rage; of birth defects, cancer, and many other health problems [and] a story of money and power; of how corporations influence government actions and how this collusion affects the public” (Gibbs 1995: 1). Her observation “truth won’t stop the poisoning. But organizing will” (Gibbs 1995: 143) is testament that no amount of data collection, monitoring, and regulating will enable a healthy population unless inclusive and empathetic organizations are in place to serve the welfare of the wider community, independent of political and economic interests.

Thus, there is the ever-present need to adhere to the observation made by René Dubos:

The less pleasant reality is that in an ever-changing world each period and each type of civilization will continue to have its burden of diseases created by the unavoidable failures of adaptation to the new environment (1965: 346).

Environmental health is a complex mix of intervention and prevention programs that can operate upstream and downstream. The following sections highlight the range of environments that influence human health.

Physical, Biological, and Chemical Environments

The biosphere constitutes broadly three interlinked components, namely, the lithosphere (the soil and rock of the Earth’s crust), the hydrosphere (the water environment of Earth), and the atmosphere (the gaseous envelope surrounding the Earth) (Jones 1997). These components overlap three environments of interest in environmental health, namely, the physical, biological, and chemical environments. For the purpose of this chapter, the physical environment will focus on the soil and atmosphere component, the biological component will discuss disease via vectors in water and the air, and the chemical environment will address water and air pollution.


Soil contamination and pollution have been well known for over a century (Taylor 2012) yet, despite the awareness, are still little understood (SCU 2013). Understanding the difference between contamination and pollution appears to still be the difficulty, as contamination may not necessarily lead to pollution, and yet the “tipping point” between a non-biological effect to a negative biological effect could occur over a substantial period of time. Contamination may also occur through natural processes, yet pollution is generally anthropogenic (Jones 1997). However, considering that natural processes can be disrupted by anthropogenic influences, there is still the need to be aware that contamination by natural processes may have anthropogenic drivers. The link to health and well-being also needs to be strengthened as evidenced by the UNEP’s own website “Tackling the growing challenge of soil pollution” (Hammond 2017) while discussing pertinent issues relevant to human health, not making the connection to SDG 3 as a related sustainable development goal.

With the use of powerful data, provided freely by NASA and NOAA on websites such as and, anybody with Internet connection can obtain a comprehensive real-time analysis of atmospheric conditions in their local area and globally. This, combined with locally sourced data (e.g., in Australia, the Bureau of Meteorology), can assist greatly in a healthy population by enabling individuals and communities to make informed decisions about the appropriate action to be taken to minimize exposures. Whether this is the simple downstream approach of choosing not to be outside on a day of high risk, or wearing protective clothing when that choice is not available, or the more effective upstream approach of identifying point sources and removing the threat, the actions can be undertaken provided networked support is provided. The Montreal Protocol (1987) has been instrumental in the effective control of ozone depleting substances (ODS), and the UNDP has actively supported this in its efforts to transfer to low ozone depletion potential (ODP) and global warming potential (GWP) technologies within the refrigeration sector that employs cold chain management for medicines and vaccines (UNDP n.d.). In addition, the phasing out of chlorofluorocarbons (CFCs) from metered dose inhalers has ensured continued availability of chronic obstructive pulmonary disease (COPD) medication for asthma patients (UNDP n.d.).


The biological environment is one of the key areas of focus in SDG 3, with particular attention on Target 3.3, and the reduction of vector-borne diseases. Vector-borne diseases are human illnesses caused by parasites, viruses, and bacteria that are transmitted by mosquitoes, sandflies, triatomine bugs, blackflies, ticks, tsetse flies, mites, snails, and lice (WHO 2017b). Deaths from diseases carried by these vectors amount to almost 700,000 globally (WHO 2017b), and of concern is the rise of malaria cases from 210 million in 2013 to 216 million in 2016 (UN 2018a). The rise in cases indicates that the target of ending malaria by 2030 will not be met, should the current trend continue (UN 2018a). The WHO recognizes that distribution of vector-borne diseases is determined by complex demographic, environmental, and social factors and that a crucial element is behavior change (WHO 2017a).

The WHO’s Global vector control response 2017–2030 outlines a comprehensive framework of action, with the aim of reducing “the burden and threat of vector-borne diseases through effective locally adapted sustainable vector control” (WHO 2017a: viii). Opportunities for environmentally sustainable development, recognition of commitment, expansion of successful interventions, optimization of vector control programs, collaborations across various sectors and networks, adaptation of responses, innovation of tools and approaches, and advances in technology are all highlighted as being enablers of effective vector control (WHO 2017a: 10). These link with SDGs 1, 3, 6 11, 13, and 17 (WHO 2017a: 11); however, the challenges are formidable, with systemic, structural, informational, and environmental issues outlined and underpinned by a constant and increasing movement of humans and goods as well as political inertia and selective financial aid (WHO 2017a: 11–12).


The chemical environment is one that encompasses many other environments, as it influences the physical and biological environments as well as urban and rural environments. In this section, the focus will be on water and air pollution and associated adverse human health impacts. Water pollution can result from many diverse inputs: from oil, heavy metals (e.g., cadmium, mercury, and lead), hydrocarbons (e.g., propane, butane, and hexane), polychlorinated biphenyls (PCBs), and chlorofluorocarbons (CFCs) to pesticides, herbicides, other solvents, and feces. Industrial, municipal, and agricultural wastes contribute to these polluting products, and generally, there are systems and procedures in place to monitor outflows effectively. There are, however, instances where water contamination and pollution have occurred that have severely negatively affected the health of residents, e.g., in Basra, Iraq (Asharq Al-Awsat 2018), Niger Delta, Nigeria (Hodal 2017), and Sindh, Pakistan (Mughal 2018). These locations are in countries that are signatories of the SDGs, demonstrating that despite regulatory checks and balances being in place, when accidents or breaches occur, minimizing harm is still difficult to achieve (e.g., is a confronting mapping of current oil pollution in Nigeria). While Mughal (2018) cites the effectiveness of Canada’s range of acts and regulations from different agencies (i.e., health, water, councils, and fisheries), not all is well coordinated in high-income nations, as can be seen with the US Trump administration’s budgetary cuts on its own Environmental Protection Agency (Dennis et al. 2018). Currently of concern in the USA is the persistence presence of pharmaceuticals in municipal water supplies (Furlong et al. 2017). Thus, the differences between high-income and low-income countries may appear negligible, when each region has its own share of environmental health impacts.

Monitoring and controlling air pollution has come a long way since one of the first solutions during the Industrial Era was just to extend the height of polluting chimneys in the UK (Heidorn 1978). Air pollution can be broadly categorized into indoor (household) and outdoor (ambient) air pollution. Outdoor air pollution is indiscriminate (Landrigan et al. 2018); a quick glance at will demonstrate fine particulate matter (PM2.5) affecting over a dozen countries in northern Africa, as well as the majority of the Middle East region. While the majority of this can be attributed to natural processes such as dust storms, 10% can be attributable to anthropogenic sources (CCSP 2009). Household and ambient air pollution are considered separately in deriving estimates of disease burden; however, they are both comprised of many of the same pollutants and often coexist, such as household cooking in low-income and middle-income countries (Landrigan et al. 2018). Recently, Kenya’s Charlot Magayi was awarded second prize in the “SDGs & Her” Competition (TWBG 2018a) for her Mukuru Clean Stoves, which recycles waste metal to produce improved, reliable, and affordable cookstoves to reduce indoor air pollution. Not only was this set up to address SDG3 but also SDG1 and SDG8. Indoor pollution can represent a more significant threat to human health; as another example but from a high-income country, most Americans now spend 90% of their time indoors, and indoor air pollution levels can be higher than outdoor levels (NASEM 2018a). Indoor carbon dioxide levels in office buildings, conference rooms, and even cars can easily exceed 1000 parts per million (NASEM 2018a). To address these concerns, the WHO facilitated the first global conference on air pollution and health in late 2018, demonstrating knowledge sharing and mobilizing action in such activities as the BreatheLife campaign (

Social, Psychosocial, Political, and Economic Environments

Adding a further complexity and challenge to the environments influencing human health are the social, psychosocial, political, and economic environments. These environments may appear beyond the usual environments discussed above; however, when assessing risk and making decisions based on physical, biological, and chemical environmental data, judgments based on psychological, social, cultural, and political factors need to be made (Finucane 2006). There are also significant impacts on the achievement of the SDGs, should these environments not be considered. They also directly relate to SDGs 1, 5, 8, 10, 11, and 16.


The “social environment” is defined as “the structure and characteristics of relationships among people in a community” (Galea and Vlahov 2005: 397). Components of the social environment include social networks, social capital, segregation, and the social support that interpersonal interactions provide. As such, social environments can both support and damage health. Galea and Vlahov (2005) highlight the impacts that can occur because of social norms (which are elements, along with social networks, of “social capital”), social supports, and social segregation. Social norms are the unplanned, unexpected result of individuals’ interactions; however, many aspects of social norms and practices perpetuate poverty (Grootaert and van Bastelaer 2001). A supportive environment, i.e., social supports, may increase people’s access to health-promoting goods and services such as housing, food, and care. Stansfield (2008) notes that the arrangement and design of the physical environment can influence social support and health. Considering that people who obtain less social and emotional support from others are more likely to experience less well-being and more depression (Stansfield 2008), it is of concern that social capital is considered a “forgotten dimension” of the SDGs (Verbeek and Dill 2017). Verbeek and Dill (2017) highlight a World Social Capital Monitor in use that allows stakeholders to score eight characteristics of social capital; however there are criticisms about its theoretical underpinnings and operationalizing (Stone 2001; Haynes 2009).


A further extension of the physical environment, in particular the workplace, can have significant influences on physical and mental illness (Marmot et al. 2008). The challenges of the assessment of various elements of exposure to physical, chemical, and biological agents notwithstanding, assessment of hazardous psychosocial exposures in the workplace is also challenging, with the potential for health impacts related to work organization, job demands, job control, and fair treatment (NASEM 2018b). LaMontagne et al. (2016) note that universal occupational exposures can occur in any work context, and as such, psychosocial working conditions have emerged as leading contributors to work-related illness. Thus, Target 3.4 of Goal 3 is clearly set for a third reduction of premature mortality and the promotion of mental health and well-being, yet it is acknowledged that to achieve this, considerable input from civil society, academia, and non-government organizations is required (Votruba et al. 2016).


Underpinning many of these environments under discussion is the political will to ensure that the various environments influence humanity’s health in positive ways. With each country having its own political structure and governance, and differing range of environmental influences, the engagement from the political sector varies widely with regard to Goal 3 and in particular, environmental health. As indicated earlier, in Basra, Iraq, with problems of cholera outbreaks occurring, protests in the streets have had to be undertaken to hold the government to account (Asharq Al-Awsat 2018). This is not an isolated occurrence; there is an extensive history of protest, based on environmental health concerns throughout the world (Hutton and Connors 1999; Rootes 2007; Egan and Crane 2009). This unfortunately highlights the gap between policy, policy makers, and the communities for whom the policies are meant to serve.

It is most unfortunate then that the political environment can operate within a timeframe that is at odds to the other environments. Again, in many cases, there are decisions made that benefit the current generation for a brief period during its lifespan, while health concerns and diseases may not be made apparent until several years or a generation later. Minamata disease is the classic example of a corporation and government hindering proper due process of monitoring, evaluation, and remediation of an environmentally degraded site (i.e., toxic methylmercury effluent in Minamata Bay, Japan) that affected the lives of thousands, spanning over 30 years (Harada 1995). Improvements have been made since that time, yet the timely responses, effective implementations, and the scaling up of government-led initiatives addressing a range of health-related problems vary substantially across nations (GBD 2016 SDG Collaborators 2017). The GBD 2016 SDG Collaborators (2017) further state that there is the need for long-term, sustained political commitment alongside establishing adequate financing and policies that cover services.


Quite often viewed as the “bottom line,” the economic dimension is critical to the functioning of a healthy society and a healthy planet. As stated above, “adequate financing” is often lacking in many instances to prevent or ameliorate environmental hazards or risks that impact on human health. Recent trends highlight a growth in liberal-democratic governments since the 1980s, a decline of socialism, a move toward economic rationalism, a growth of privatization, and an increase in economic, political, and technological globalization (Baum 2016). The impacts of these changes can be extremely significant, effectively creating a world of “haves” and “have nots” and undermining the intentions of the SDGs. Baum (2016) notes that one of the direct consequences of individualism for public health is a tendency to blame victims for their ill health. For example, the success of wealthy, employed people is attributed to their individual efforts, rather than being affluent and having access to education, resources, health care, etc.

Thus, economic rationalism and managerialism appear to be in terms of applying market logic to public and environmental health, which are essentially nonmarket activities and the emphasis on short-term measurable outcomes. Deregulation has seen the negative impact on work conditions and an undermining of occupational health and safety standards. Globalization has a number of positive and negative implications for environmental health, opening up communication for information, strategies, and techniques to be shared and the provision of a variety of consumer goods that enrich people’s lives. Economic growth serves for the production of “goods” and “wealth”; however, the production of “bads” and “illth” are the true costs, where “[w]hat used to be economic growth could become uneconomic growth – that is, growth in production for which marginal costs are greater than marginal benefits, growth that in reality makes us poorer, not richer” (Daly 2011: para.1).

The economic dimension to the SDGs is covered explicitly in goals 1, 8, and 12, yet with USD300 billion in losses attributed to disasters in 2017 (UN 2018a), there is a clear indication that environmental factors have significant costs that need to be considered. The high cost was a result of three major hurricanes affecting the USA and several countries across the Caribbean. Further to that, in the Asia-Pacific region, between 1990 and 2014 natural disasters affecting 4.5 billion people caused USD1076 billion economic losses (UNEP 2016). While anthropogenic global warming and its association to climatic events lie beyond the scope of this chapter, suffice to say that the health impacts and associated costs affect numerous vulnerable communities and are within the remit of environmental health issues (Woodward and McMichael 2006).

Health and Ecosystems

The true bottom line are the ecosystem services, namely, provisioning services (products obtained from ecosystems), regulating services (benefits obtained from regulation of ecosystem processes), cultural services (nonmaterial benefits), and supporting services (those necessary for the production of all other ecosystem services) (Corvalán et al. 2005). These services are fundamental to humanity’s existence, and the threats to them are not to be taken lightly. Diminished human health and well-being tend to increase the immediate dependence on ecosystem services. The resultant additional pressure can (further) damage the ecosystems’ capacity to deliver services. As well-being declines, people’s options for regulating their use of natural resources at sustainable levels are reduced. Immediate needs inevitably take priority, increasing the pressure on ecosystem services, and can create a downward spiral of increasing poverty and further degradation of ecosystem services.

In principle, two courses of action are available, whereby disease and injury caused by ecosystem disruption may be avoided. One avenue is the prevention, limitation, or management of environmental damage (mitigation strategies). A second course of action involves making necessary changes to protect individuals and populations from the consequences of ecosystem change (adaptation strategies). Clearly, the SDGs have been set up to enact on these strategies, building on from the foundational work of the MDGs. As highlighted by Wood et al. (2018), 44 of the 169 SDG targets focus directly on improving the environment and human well-being.

There is, however, evidence still of science and policy gaps in the effective management of ecosystems services, in particular the Asia-Pacific Region and strategies for community participation (i.e., failings in the social environment) (Avishik et al. 2012; UNEP 2016; Thwaites 2018). McCartney et al. (2014) note that there is “no blueprint” for achieving a balance between maintaining ecosystem services and sustainable development with the associated environmental health impacts; however, empowering local people is seen as a critical tool.

Other Environments and Environmental Health Issues

The abovementioned environments link with other environments and environmental health issues discussed briefly here. The shifting populations from a wider, dispersed population to densely populated urban centers, where now, almost 55% of the world’s population reside (TWBG 2018b) is of major concern. The built environment thus experiences increased demands and pressures on its roads, transport systems, water, sewer, electrical, digital, and other services. The associated water, solid, and hazardous wastes as well as air and noise pollution are all increased in urban environments. Clearly, the differences between urban and rural environments are made even more so when reviewing high- and low-income countries (Boateng et al. 2016). However, while the types of infectious and noncommunicable diseases can differ between urban and rural environments, the incidence and prevalence of diseases among rural and urban populations can be inconsistent to make direct comparisons (Eberhardt and Pamuk 2004; Kalkonde 2018). Nevertheless, a concerted effort has been undertaken by WHO (2018) through the Urban Health Initiative, which addresses a suite of SDGs and targets, namely, 1, 3, 4, 5, 7, 8, 9, 10, 11, 12, and 13.

Many of the environments discussed above can be heavily impacted by climate change, which indirectly affects water quality, air pollution, land use change, ecological change, the spread of disease vectors, and food security that then impacts the health of vulnerable populations (Watts et al. 2015). Policies and strategies to manage the direct and indirect impacts have not been consistent across all levels of government within and across nations as evidenced by the Paris Agreement, with 195 countries as signatories in December 2015, yet by September 2018, 15 nations had not ratified the Agreement (UN 2018b). Further to this, in July 2017, the US Trump administration announced its intention to withdraw, effective in November 2020, but currently implementing a series of rollback policies with direct impacts on air pollution regulation (Lipton 2018).

Despite the financial limitations imposed by government, there is institutional backing for deeper and wider studies of environmental health effects and impacts, namely, in the concept of the exposome, first proposed in 2005 (Wild 2005) and finding further support in the National Institute of Environmental Health Sciences in the USA (NIEHS 2018), as outlined in its strategic plan. Exposome research investigates the impact of all the environmental exposures of an individual over the person’s lifetime, and how the exposures relate to health. Current internationally collaborative projects in Europe include HELIX (2018), EXPOsOMICs (2018), and HEALS (CORDIS 2018) as well as the US-based initiative HERCULES (HERC 2018), which have made advances in exposure science and the development of new technology to identify exposures.


When reviewing environmental health in the context of sustainable development goals, there are many considerations: the variety of environments that constitute the discipline and the range of the SDGs that are linked beyond Goal 3. Increasingly, a “systems approach” to working through the issues needs to be applied, and organizations, such as the UN and WHO, are very cognizant of this requirement. Despite the organizational support for such an approach, there is still a disjuncture within political entities and a lack of financial commitment to ensure the optimum levels of health for the planet and the population are maintained. Indeed environmental health is a topic that requires deep thinking, as highlighted by Hawaii’s (now defunct, due to US Federal budget cuts) Environmental Planning Office (“Hōhonu no ke kawa”), and yet Dubos’ timeless axiom of thinking globally and acting locally still needs to be applied (Dubos’ 1972). That action, while increasingly being manifest through an engaged locally based populace, still needs higher levels of support.



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Authors and Affiliations

  1. 1.Health Nature Sustainability Research Group, School of Health and Social DevelopmentDeakin UniversityMelbourneAustralia

Section editors and affiliations

  • Masoud Mozafari

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