Health and the Environment Belong in the Same Box: Why Health Impact Assessments Belong in Environmental Assessments

Perhaps because we mostly work inside boxes—hospitals, clinics, universities, and office buildings—it has taken the world’s health community far too long to realize that human health belongs in the same box as what we call “the environment.”

These ideas have been part of other thought systems, including Aboriginal concepts of wellness, for generations—but until recently they have been largely neglected within Western medical thought, other than in the realm of public health and environmental medicine.

As health professionals, it is not actually easy to admit that what happens outside our clinics and hospitals has a greater impact on overall health status than what happens inside them. We have put a lot of time and effort into learning what to do in our boxes. But as professionals who have committed a lifetime to the pursuit of optimal health for the people and populations we serve, we recognize that when the evidence demands it, we must peek over the edges of our boxes, open the windows, and let in new ideas and collaborations.

As with many diagnoses, however, the connection between health and the environment is becoming more obvious as ecological decline gets worse. Happily, the narrow perspective of health professionals is beginning to change. The past 5 years have seen the World Health Organization call climate change the “greatest threat to global health in the 21st century,” and the Canadian Public Health Association (CPHA) tell us that “the ultimate determinant of human health (and that of all other species) is the health of the Earth’s life-supporting systems.” Also last year the prestigious medical journal The Lancet published the report of its Commission on Planetary Health, defining planetary health as “the health of human civilization and the state of the natural systems on which it depends.”

In response, a Planetary Health Alliance has been launched out of Harvard, funded by the Rockefeller Foundation, the world’s first Chair in Planetary Health has been established at the University of Sydney, and health professionals are mobilizing worldwide to ensure that our growing understanding of the linkage between human health and the natural environment is integrated into policy.

Here in Canada, the Minister of Environment and Climate Change Canada has established an Expert Panel Review of Environmental Assessment (EA) Processes that is soliciting submissions and touring Canada to hear from community members about how the EA process can better function. This is a critical opportunity to connect the health box and the environmental box. We urge the Federal Government to do so by integrating health impact assessments into its environmental assessment processes.

To that end, the Canadian Association of Physicians for the Environment (CAPE), the CPHA, key academics, other health organizations, and individual health professionals and advocates have submitted a letter asking that comprehensive human health impact assessments be integrated into the Federal Environmental Assessment process.

This idea is now well-accepted in Canadian medical circles. In 2012 the Canadian Medical Association General Council passed a motion supporting a comprehensive federal environmental review process, including health impact studies, for all industrial projects and the CPHA proposed in 2015 applying “comprehensive impact assessments that address the ecological, social, health and economic impacts of all major public policies and private sector developments.”

Comprehensive human health impact assessments include an assessment of the impact of a project on the social determinants of health such as housing and income, as well as the ecological determinants of health including greenhouse gas emissions. This will allow health authorities to recognize and consider potential positive and negative health impacts of projects on their communities, to plan and fund healthcare provision services to address those impacts, and, to suggest modifications to plans in order to mitigate negative health impacts.

This integration has the potential to save not only lives but also money as it is well-recognized that preventative medicine is cheaper than acute care.

Prepared by Dr. Courtney Howard, Dr. Trevor Hancock, and Robert Rattle

The full letter to the MoECC calling for the integration of health impact assessments into federal environmental impact assessment processes and a list of signatories can be found here.

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