The environment at the heart of health and wellbeing

We benefit much more from clean air, pure water, good food, exercise and strong communities than we do from hospitals, medicines and clinics. Yet discussion of health in this country and others is mostly about the prevention, detection and treatment of disease.

Consultant microbiologist Prof Martin Cormican points out that an overwhelming preoccupation with disease is an expensive and inefficient way to pursue health.

Health is achieved and sustained not through medicine, he observes, but through our interaction with the world around us – air, water and food, the people, the footpaths, the hurling pitches, night clubs and countryside.

“In recent decades, we have seen major improvements in outdoor air quality through control of emissions from coal and motor vehicles, improvements in indoor air quality through changes in cigarette smoking, improvements in water quality through control of discharges into rivers and lakes and we’ve witnessed important social changes that promote acceptance of diversity in communities,” he says.

The new centre for health from environment (CHFE) at NUI Galway, headed up by Cormican, will work to place sustaining health through environmental stewardship at the centre of public policy through teaching, research and advocacy.

The centre is based on a recognition of the dependence of health on the environment and on the concept of health as the most important resource that human society takes from our environment.

Former secretary general of the UN and Nobel Peace Prize laureate, Kofi Anan, noted that one of the main reasons the world faces a global environmental crisis is the belief that we human beings are somehow separate from the natural world in which we live.

Disease burden
The World Health Organisation defines health as "a state of complete physical, mental and social wellbeing, and not merely the absence of disease".

From a global perspective, it is estimated that about one-quarter of the global disease burden, and more than one-third of the burden among children, is due to modifiable environmental factors.

Cormican remarks: “When people talk about the environment, it’s as if it’s to do with red squirrels, endangered snails and coral reefs. It’s as if the environment is something divorced from us, as opposed to something that we live in and that is all around us.

“It’s the air that we breathe and the communities we live in. If we want to be healthier people with more fulfilled lives, we need to address the whole space in which we all live our lives, not just Killarney National Park. Some would say the environment is ‘everything outside myself’ and some would go even further to say the environment is ‘everything including myself’.”

As a consultant microbiologist at University Hospital Galway and professor of bacteriology at NUIG, Cormican admits he is a “hygiene nut” in the hospital and is all about infection control in that setting.

However, he points out that our homes are very different from hospitals and he is critical of the multinational companies who “cynically manipulate our fear of germs” to sell their products.

“We are told there are germs everywhere and we need to buy this or that product that kills 99.9 per cent of all germs, but there is actually very little evidence to show that these products enhance our health and lives.

“Meanwhile, a lot of money is being made out of them and a lot of chemicals are going into the environment. Not only is this obsession unnecessary, taken too far it can be downright harmful. We are persuaded that we need to disinfect our toilets every day but this is totally unnecessary – unless we intend to drink from them. It would do you far more good to hug your child than disinfect your toilet.”

It’s hugely reassuring to hear a consultant microbiologist admit to having changed a nappy with one hand while eating a sandwich with the other when his kids were younger. “We all share the same bacteria,” he says.

“The perception is that we need to go around killing these micro-organisms that are in us and all around us but most do no harm and the planet could not survive without them. The best way to protect ourselves from infection and illness is to lead a healthy lifestyle – to eat well, take regular exercise and not smoke. A healthy body is the greatest defence against infection.”

Important step
The Parma Declaration on Environment and Health endorsed by 53 European states in March 2010 represents an important step towards a policy approach that places greater emphasis on the environment. The importance of health from environment is also reflected in the growing emphasis at EU level on the requirement for health impact assessment in addition to a general environmental impact assessment for major policies and projects.

Cormican points out that much of the gain in life expectancy over the past 100 years worldwide reflects improvements in stewardship of the physical environment (sanitary disposal of waste, provision of potable water, management of urban air pollution, improved housing road design) and social environment (reduction of poverty, inequality and discrimination) that reflect changes in political, social and economic conditions.

He notes: “Many contemporary health challenges can likewise be addressed through further improvements in management of the environment at national, European and global level.

“Nationally, the ban on indoor smoking of tobacco introduced in March 2004 represented an outstanding example of how public policy and effective public engagement can improve the environment in ways that contribute to improvement in wellbeing and disease prevention. Government policy, over more than 20 years, to control the marketing and sale of bituminous coal in urban areas is an another important example.”

However at national, EU and global levels, the challenges that remain are formidable. The WHO highlights that "environmental hazards to human health include climate change, stratospheric ozone depletion, changes in ecosystems due to loss of biodiversity, changes in hydrological systems and the supplies of freshwater, land degradation, urbanisation, and stresses on food-producing systems".

Uphill battle
Based in the Ryan Institute at NUIG, the CHFE involves more than 20 permanent academic members from five schools and is one of a number of such centres in this area emerging across Europe.

Those involved in this work face something of an uphill battle though as Cormican explains: “There’s so much money to be made out of things that are supposed to make us healthy, whether it’s toilet cleaner or tablets.

“We’re bombarded with messages that the way to fulfilment, health and purpose in life is to buy stuff. I prescribe medication and, in lots of cases, it’s great but in lots of other cases, it’s not needed.

“Antibiotics are given in many cases when what’s needed is rest and fluids. We have become accustomed to taking pills for all sorts of things, including unhappiness, and are encouraged by people who make a lot of money out of this. I think the idea of the Green prescription which they are doing in Donegal is a great idea, joining a local walking group, for example, might do you a lot better than taking a tablet for certain ailments.”