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2005; Rockström et al. 2009; Intergovernmental Panel on Climate Change 2014; Steffen et al. 2015; Whitmee et al. 2015; Ceballosa, Ehrlichb and Dirzob 2017; IPBES 2018; see Part A of this report).


The Healthy Planet, Healthy People approach is key to promoting stewardship of the air, biodiversity, oceans, land and freshwater that are essential for supporting human well- being and the sustainability of Earth systems for current and future generations. Central to this approach is taking a holistic and systemic approach, whereby the identified challenges for all aspects of Earth’s life-support system (e.g. clean air, freshwater, food production from oceans and land, habitats for species) are pursued together with the socioeconomic and health dimensions (e.g. gender, equity, poverty) (Commission on Social Determinants of Health [CSDH] 2008; Gordon et al. 2017; Dye 2018). The complex interlinkages between the different aspects of environmental change are illustrated by the 12 selected cross-cutting issues described in Chapter 4 and the synergies and trade-offs analysed in Section 22.4.2.


24


About a quarter of annual deaths globally are caused by modifiable environmental factors (Prüss-Ustün et al. 2016). Human health depends on much more than a healthy planet though. Even if it were desirable and feasible to attain a healthy, sustainable planet without addressing socioeconomic issues and the associated determinants of health, it would still leave humanity far short of the goal of healthy people (see also Section 22.2.5, on achieving the SDG target on child mortality). Socioeconomic and cultural factors have significant health impacts, through lifestyle choices, inequalities and damaging practices such as war, violence, unsafe working conditions and child labour (CSDH 2008; see Section 4.1). Therefore, the social determinants of health, including social and wealth inequalities, must also be addressed effectively (Camfield, Møller and Rojas 2015; Donkin et al. 2017).


As reported in Section 4.1, human health is mediated by multiple factors in the natural, social and built environments, including our perceptions of equity and safety as well as equitable access to environmental resources and human contact with nature (CSDH 2008). This perspective complements the classical definition of human health as “a


state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization 1948), and the practice of using well-being (Camfield Møller and Rojas 2015; Maggino 2015) together with health to incorporate the psychological, emotional and social dimensions. The multiple relationships between planetary and human systems link health and well-being directly and indirectly to the majority of the SDGs. As such, the SDGs offer the opportunity to approach human health systemically, unlike other major health initiatives that are often focused on a given disease or pandemic event.


Several frameworks have been developed in recent years to help ensure that research and policy development take account of the complex interrelations between health, socioeconomic and environmental factors (Buse et al. 2018). However, much of the scientific evidence about the effect of the environment on human health has a narrower focus, on pollution and disease (i.e. mortality and morbidity), with limited attention to the wider concept of well-being or to the social determinants of health. Within this narrower classical framework of environmental health, the commission on pollution and health of the journal The Lancet (Landrigan et al. 2017) estimated that environmental pollution caused about 9 million premature deaths in 2015; mainly from outdoor and indoor air pollution, which together caused 6.4 million deaths (Cohen et al. 2017). Also, environmental pressures and their impacts on health and well-being are not equitably distributed (see Part A). They especially hit groups that are already vulnerable or disadvantaged, such as younger, older and female demographic groups, poor people, those with chronic health conditions, indigenous people and those targeted by racial profiling (Solomon et al. 2016; Landrigan et al. 2017).


The cost of failing to address the challenges of poor environmental conditions must be examined and communicated widely (Haines 2017; see the example in Box 24.1). Such costs are pervasive, through the loss of life and property; disability; the costs incurred from cardiovascular and respiratory diseases; the costs of health damages due to the multiple stresses of extreme weather events, to conflicts over food and water insecurity; gross inequality and poverty; and the tragic plight of refugees around the world.


Box 24.1: The health benefits outweigh the costs of implementing the Paris Agreement


The costs of implementing the Paris Agreement (UNFCCC 2015) between 2020 and 2050 could be outweighed by the health benefits of reductions in air pollution-related diseases and deaths alone, according to one modelling study (Markandya et al. 2018). The study modelled emission levels under various scenarios and estimated the costs of the consequent air pollution-related deaths (as a result of respiratory diseases ranging from acute lower respiratory tract infections to chronic obstructive pulmonary disease and heart disease, stroke and lung cancer), and compared this with the costs of climate-change mitigation by country or region (the People’s Republic of China, the European Union, the Republic of India, the United States of America and the rest of the world). The scenarios include doing nothing, continuing current country-level policies, and three different strategies for implementing and funding the agreement towards the 2°C and 1.5°C warming limits.


Depending on the scenario used, the health benefits from reduced air pollution were estimated to be, at the global level, 1.4 to 2.5 times greater than the costs of mitigation. The highest benefit-to-cost ratio was for the emission strategy to reach the 2°C target: global health savings were estimated to be US$54.1 trillion, dwarfing the global policy costs of US$22.1 trillion.


Under all the scenarios examined, the countries likely to see the biggest health savings from improved emission-reduction measures were China and India. The cost of implementing climate-mitigation policies in China and India would be fully compensated for by the health savings under most scenarios, and the added costs of pursuing a 1.5°C target instead of 2°C could generate substantial benefits (for India, about US$3.3-8.4 trillion and for China, about US$0.3-2.3 trillion). For the European Union and the United States, the health savings would be large, but not enough to fully compensate the costs.


588 Outlooks and Pathways to a Healthy Planet with Healthy People


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