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Ecosystems and human well-being: Health synthesis HA-5-1-06


Review of the WHO Report


1. Ecosystems are the planet's life-support systems - for the human species and all other forms of life. The needs of the human organism for food, water, clean air, shelter and relative climatic constancy are basic and unalterable. That is, ecosystems are essential to human well-being and especially to human health – defined by the World Health Organization as a state of complete physical, mental and

social well-being.  There is an observable tendency for powerful and wealthy societies eventually to over-exploit, damage and even destroy their natural environmental support base. The agricultural-based civilizations of Mesopotamia, the Indus Valley, the Mayans, and (on a micro-scale) Easter Island all provide well-documented examples. Industrial societies, although in many cases more distant from the source of the ecosystem services on which they depend, may reach similar limits. Ecosystem services are indispensable to the wellbeing of all people, everywhere in the world. The causal links between environmental change and human health are complex because they are often indirect, displaced in space and time, and dependent on a number of modifying forces


2. There are two routes to avoiding disease and injury caused by ecosystem disruption. One is to prevent, limit or manage environmental damage; the other way is to make whatever changes will protect individuals and populations from the consequences of ecosystem change. Two aspects need to be considered to understand the potential negative health impacts of ecosystem change: the current (and likely

future) vulnerability of populations and their future capacity for adaptation. These two aspects are closely related. The forces that place populations at risk (such as poverty and high burdens of disease) in many cases also impair the capacity of these populations to prepare for the future.


3. Over 1 billion people lack access to safe water supplies; 2.6 billion people lack adequate sanitation. This has led to widespread microbial contamination of drinking water. Water-associated infectious diseases claim 3.2 million lives each year, approximately 6% of all deaths globally. The burden of disease from inadequate water, sanitation and hygiene totals 1.7 million deaths and the loss of more than 54 million healthy life years.  Investments in safe drinking-water and improved sanitation show a close correspondence with improvements in human health and economic productivity. Every day each person requires 20-50 litres of water free of harmful chemical and microbial contaminants for drinking, cooking and hygiene. Globally, the amount of fresh water available per person decreased from 16 800 m3 in 1950 to 6800 m3 in 2000, as a result of population growth.  Aggregate food production currently is sufficient to meet the needs of all, yet of the present world population of over 6 billion, over 800 million consume insufficient protein or calories to meet daily minimum requirements.  Worldwide, under-nutrition accounts for nearly 10% of the burden of disease.


4. Human activities are responsible for an annual emission of an estimated 7.9 billion tonnes of carbon dioxide to the atmosphere. Reforestation and changes in agricultural practices in temperate regions in the past few decades have enhanced global capacity to absorb this carbon, but not sufficiently to halt climate change. Reducing anthropogenic carbon emissions is critical to the mitigation of climate change. Enhancing or maintaining the capacity of ecosystems to absorb carbon is similarly important. The generation of power causes a range of health impacts. Outdoor air pollution aggravates heart and lung disease. Indoor air pollution, most typically from the combustion of bio-fuel in poorly ventilated heating and cooking environments causes a major burden of respiratory diseases amongst adults and children. About 3% of the global burden of disease has been attributed to indoor air pollution from this source. In areas where the demand for wood has surpassed local supply, and where people cannot afford other forms of power, there is increased vulnerability to illness and malnutrition from consuming microbiologically- contaminated water, from exposure to cold, and from a lack of properly cooked food.

Poor women and children in rural communities are often the most affected by wood fuel scarcity. Many must walk long distances searching and carrying firewood (and often, water) and therefore have less

time and energy for tending crops, cooking meals or attending school. For these reasons, adequate energy supplies are fundamental for sustainable development.


5. The structure and functioning of the world’s ecosystems changed more rapidly in the second half of the twentieth century than over any comparable period in human history.


More land was converted to cropland in the 30 years after 1950 than in the 150 years between 1700 and 1850.   


Roughly 20% of the world’s coral reefs were lost and an additional 20% degraded in the last several decades of the twentieth century


The amount of water impounded behind dams has quadrupled since 1960; reservoirs now hold three to six times as much water as natural rivers.


Water withdrawals from rivers and lakes have doubled since 1960. Most water use (70% worldwide) is for agriculture.


Since 1960, flows of reactive (biologically available) nitrogen in terrestrial ecosystems have doubled and flows of phosphorus have triple


Since 1750, the atmospheric concentration of carbon dioxide has increased by about 32% (from about 280 ppm to 376 ppm in 2003).


6. Management of an ecosystem to achieve a particular goal (such as food, timber production or flood control) generally results in changes to other ecosystem services. These changes are not always taken into account in planning, but they sometimes have significant impacts on human health. Global estimates for the year 2000 indicated that among the poorest countries with the highest mortality rates, between one-sixth and one quarter of the disease burden was attributable to childhood and maternal under-nutrition. Over 1 billion people survive on incomes of less than US$ 1 per day, mostly in rural areas where they are highly dependent on agriculture, grazing and hunting for subsistence.  About 1 billion people are affected by land degradation caused by soil erosion, water logging or increased salinity of irrigated land.  In Africa, Asia and Latin America, 25–50% of the population lives in informal or illegal settlements around urban centres with few or no public services and no effective regulation of pollution or ecosystem degradation


7. Land degradation refers to the loss of primary production, often through soil erosion but also through changes in vegetation and through processes such as salinization and shifting sand. Approximately 10–20% of dry lands suffer from one or more forms of land degradation.  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).


8. The UN Millennium Development Goals are explained:


Goal 1. Eradicate extreme poverty and hunger


Target 1: Halve, between 1990 and 2015, the proportion of people whose income is less than US$ 1 per day. The Millennium Declaration identifies global poverty as the most daunting of all global problems. A clear understanding of the complex and dynamic relationship between poverty and the environment is required in order to address this. Numerous interventions, many with ecosystem implications, are possible to halt the negative spiral of poverty and environmental degradation. Many of these interventions have positive impacts for health, education and other goals. For example, granting land or resource tenure to poor rural people can increase conservation incentives, capital investment in production and livelihood security.


Target 2: Halve, between 1990 and 2015, the proportion of people who suffer from hunger. FAO estimates that 840 million people go to bed hungry each night. Hunger is at least as much of an economic (income) and social (equity and distribution) issue as it is an issue related to ecosystem services. Access to adequate food is particularly important for poor rural populations.  Interventions that increase agricultural yield and area have significant implications for ecosystem services. The MA findings illuminate many aspects of these complex and dynamic relationships. The way that ecosystems are managed has a significant impact on the availability and price of food and thus on the achievement of this target.


Goal 2. Achieve universal primary education


Target 3: Ensure that by 2015 children everywhere, boys and girls alike, will be able to complete a full course of primary schooling.  The expansion of primary education is likely to have many long-term positive impacts for ecosystem services, especially by enhancing human capital and individual and social capability. Yet better education fosters increased hope, expectations and capacity that some could view as potentially increasing the short- to mid-term pressure on ecosystem services by increasing the per capita ecological footprint. In the long run, however, education is likely to reduce the total size of this footprint. A better-educated population is likely to be in a stronger position to protect, preserve and restore essential ecosystem services, including by accelerating the demographic transition in countries where fertility rates remain high or above replacement level.


Goal 3. Promote gender equality and empower women


Target 4: Eliminate gender disparity in primary and secondary education preferably by 2005 and at all levels of education no later than 2015.  Gender equity is an essential goal in itself and critical for meeting the other MDGs. The date set for achieving gender parity in primary and secondary education is 2005 - 10 years before the other goals. Among the more than 780 million adults who cannot read or write, nearly two thirds are women. Many poor populations are particularly dependent on locally available ecosystem services for their health and other elements of well-being (R19). Women and girls are especially vulnerable. Often they lack not only proportionate access to already limited economic resources but also frequently bear disproportionate responsibility for providing the human services that partially compensate for diminished local ecosystem services, such as collecting water and fuel wood from often increasing distances. Such heavy labour constrains the ability of girls to attend school and can sap energy and concentration even when they do.


Goal 4. Reduce child mortality


Target 5: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate.  Despite progress in some countries reducing child mortality in children less than five years old, still more than 10 million children die unnecessarily each year, almost all in poor countries. In many countries, infant and childhood mortality rates are falling more slowly, in some countries rates have stagnated or are rising. Under-nutrition is the underlying cause of a substantial proportion of all child deaths. The systematic application of an ecosystems approach to the MDGs, as well as synergies from the other goals, will benefit reduction of the under-five mortality rate, including through improved nutrition of children and mothers.  Unhygienic and unsafe environments place children's health at risk. The causal links


Goal 5. Improve maternal health


Target 6: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio.  Maternal mortality can be reduced by increasing health and gender equity through the provision of knowledge about reproductive alternatives, antenatal care, nutrition and disease. Ensuring that women have greater control over their reproductive health, including access to family planning, can help reduce population growth and consequent pressures on ecosystems.


Goal 6. Combat HIV/AIDS, malaria and other diseases


Target 7: Have halted by 2015, and begun to reverse, the spread of HIV/AIDS.  Most of the interventions needed to address HIV/AIDS are medical, educational and political rather than ecological. Reduced poverty and improved gender equity will reduce livelihood choices, including prostitution, that increase the risk of HIV/AIDS. In some countries where the HIV/AIDS epidemic is very severe, such as parts of sub-Saharan Africa, the disease is having a direct impact on ecosystems, such as by lowering agricultural production. HIV/AIDS also has a direct impact on the economy by cutting production, earnings and taxes, thereby eroding the resources needed to deal with the epidemic.


Target 8: Have halted by 2015, and begun to reverse, the incidence of malaria and other major diseases.  One billion people live in malaria endemic areas and malaria is responsible for over a million deaths annually. Malaria alone is responsible for 11% of the disease burden in Africa. Ecosystem change, including forest clearance and irrigated agriculture, often is responsible for increasing the incidence of malaria. Better ecosystem management, in conjunction with primary and secondary prevention, is central to addressing this problem.  Integrated vector management provides a range of environmental management tools within an ecosystem framework, including modification of the environment, biological and chemical controls.


Goal 7. Ensure environmental sustainability


Target 9: Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources.  There is growing appreciation that the value of the human economy is subsidized by innumerable ecosystem services. As the ecological footprint of the human economy grows, thresholds of ecosystem service loss and degradation draw inexorably nearer, placing at risk the sustainability of human wellbeing and development. Preserving and restoring environmental integrity while reducing poverty when the global population continues to grow is an immense challenge. Improved ecological valuation methods that better account for the economic values of ecological goods and services ignored by markets are an important tool for meeting this challenge.


Target 10: Halve, by 2015, the proportion of people without sustainable access to safe drinking-water and basic sanitation.  During the 1990s, around 80 million people per year, on average, gained access to an improved drinking water supply; and a similar number, to improved sanitation. Still, in order to meet Target 10 of the MDGs, this achievement needs to be scaled up, so that an additional 100 million people per year, on average, gain access to an improved drinking water supply, and an additional 140 million people per year, on average, gain access to improved sanitation. In many regions, achieving the targets on water and sanitation without parallel investments in water treatment can threaten freshwater and coastal ecosystems and the services they provide.


Target 11: By 2020, achieve significant improvement in the lives of at least 100 million slum dwellers.  Urbanization is transforming the world fundamentally. Close to 50% of the world population lives in urban areas, compared with only 15% in 1900. Currently it is estimated that over 900 million people live in slums, roughly one third of the world's urban population. More than 70% of the urban population in the least developed countries and sub-Saharan Africa live in slum-like conditions. This number is set to increase to roughly 2 billion by 2020 unless current trends change substantially. The challenge is particularly acute in sub-Saharan Africa, where urbanization proceeds at a very high pace. The most extreme forms of environmental degradation tend to be found in slums. Chronic pollution of water sources, high disease prevalence and deterioration of public health conditions are common features in many of these unplanned urban settlements. This target has a limited overall impact on rates of urbanization and total urban demand for ecosystem services, since the targeted 100 million slum dwellers account for only a relatively small share of the total urban slum population.


Goal 8. Develop a global partnership for development


Target 12: Develop further an open trading and financial system, including a commitment to good governance, development and poverty reduction, nationally and internationally.  Globalization is a multifaceted collection of processes, a central part of which is the expansion of world trade. The MDGs aim to better harness globalization to reduce poverty. Goal 8 complements the first seven. It calls for an open, rule-based trading and financial system and increased aid and debt relief to countries committed to poverty reduction. There are significant opportunities to integrate aid and debt relief with innovative "debt for MDG" swaps


Targets 13-15: Address the special needs of least developed countries, landlocked and small island developing states and highly indebted poor countries.  Many landlocked, small island and highly indebted nations lack the basic health, education and infrastructure capacities needed to gain adequate access to expanded markets and make the most of more open trade regimes.  Therefore, special terms of trade, official development assistance and debt relief are required to finance new infrastructure and to address land and water sustainability issues.


Targets 16-18: In cooperation with developing countries and the private sector, address youth unemployment, access to affordable essential drugs and access to the benefits of new technologies.  In harnessing globalization to reduce poverty and achieve sustainable development, the implications for ecosystems and their services must be a primary consideration. Recent estimates place the value of the world's ecosystems at more than the total value of the world's economy, taking into account the value of freshwater purification, pollination, clean air, flood control, soil stability and climate regulation. Nevertheless, recognition of ecosystem services seldom penetrates policy debates. In making trade-offs between progress on human development goals and maintenance of ecosystem services, and in order to make better choices possible, improved ecological valuation methods need to be used to take more account of the economic values of ecological goods and services ignored by markets.


World Health Organization. Ecosystems and human well-being: Health synthesis.  53 pg.