More on the human-ecological topic – Chris Baker

The role of sustainability in dietary guidelines

As individuals we no longer live in isolation. In our world, which is being exponentially populated, the impact of the actions of one group is increasingly felt by another. Furthermore, there may be inequitable distribution of consequences from the actions of one population as felt by other communities. This is unjust and unfair.

This article seeks to document a student’s journey in understanding the importance of the health sectors acceptance and recognition that environmental health and sustainability is a fundamental determinant of health outcomes. This article discusses the importance of recognition that social determinants of health arising from the environmental sector are of equal significance to those arising from the economic and social spheres [1]. Such issues will be specifically viewed through the lens of the Australian Dietary Guidelines, and will include discussion on the role of such recommendations, specifically in offering a systemic view that fosters sustainability and equity.      

The evidence base for the interconnected nature of human health and environmental viability is building. From an epidemiological perspective; it is sometimes challenging to define causality and effect when considering ecological damage as determinants of human health. Often, this is due to the myriad of confounders and variables. A case in point is the current estimate by the World Health Organisation that annually 154 000 deaths occur and 5.5 million DALYs are lost due to climate change [2]. However, this mortality and morbidity arises from a diverse set of sub-causes which are enhanced by a changing climate. These causes include increased prevalence of heat waves and cold snaps, loss of food and water security and enhanced range and distribution of communicable disease vectors, such as the female Anopheles mosquito which transmits malaria larvae. Hence, it is impossible to say whether an individual has died as a direct result of climate change. Rather, complex modelling must be undertaken to attribute death across populations [3].

While climate change is a clear example of how anthropogenic impacts on the biosphere can negatively impact on human health, the relationship is by no means limited to this. Other clear examples include excess mortality attributable to urban air pollution, of which an example is particulate pollution associated with cardiovascular and respiratory disease [4] [5]. Loss of food security through desertification of arable lands due to poor agriculture practice and disruption of water supply is a further example. A recent paper by Quinn and Bencko acknowledged the multitude of factors that contribute to global food insecurity (which in 2008-2009 left 1 billion people with inadequate food) including inequity in world trade and economics, insecure state regulation and disparity in food distribution. However, the point was also made that at a grass roots level, ecologically viable soil and access to water are fundamental needs for food production [6].

While there are many factors that influence desertification, some include overstocking of pastures and improper irrigation practice. Overstocking in particular has further effects on human health through generation and magnification of some zoonotic diseases and may include generation of resistant pathogens through the liberal use of antibiotics in animal husbandry [7].  Further, irrigation practice and the associated infrastructure required (such as damming of rivers) are often associated with acute increases in agricultural productivity, often resulting in economic benefits which may or may not be equitably distributed. While these impacts may be sustainable, there is always ecological disruption and often associated human health impacts. Examples of the later are again varied, but range from disruption of safe potable water sources, changed disease vector patterns (increased schistosomiasis transmission [8]) and disruption of fisheries.

A fishery disturbance caused by altered irrigation practice is exemplified by the retreat of the Aral Sea due to diversion of water from the Amu Darya and Syr Darya Rivers in Asia for irrigation of fibre production land. The results were twofold in that the sea retreat caused the collapse of a 50 000 tonne per annum fishery, and  poor irrigation practice resulted in broad scale desertification, eutrophication of water run-off and  increased dust with associated human disease [8].

These examples only scrape the surface of the interconnected nature of ecological and human health. The evidence base for this connection is rapidly growing and is outlined in the WHO Human Health and the Rio Convention summary; Our Planet, Our Health, Our Future [5]. However, due to the aforementioned intertwining of human and environmental wellbeing and the implicit requirement of epidemiological modelling to develop association patterns, there is often inherent variability in establishment of causality. This means that while from a holistic perspective the evidence base for a human and ecological health connection is strong, at an individual scale, it is impossible to say; ‘that particular person died from climate change’. Furthermore, the impetus for action for improvement of the social determinants for health arising from the environmental sector is clouded by industry interests, national priorities (often to support industry) and our society’s highly individualistic nature. Hence, the question becomes; how do we make meaningful change to the state of our environment and implicitly, our health, in a globally equitable manner?

Several studies have looked at this issue and promoted action through national guidelines as one means to progress human and ecological health equity. The Australian dietary guideline, for example, are set of recommendations that a founded on a plethora of evidence and provide best practice guidelines for the optimal diet. Additionally, the guidelines are dynamic and allow for adjustment and development as new evidence is submitted or old evidence is debated. They provide a solid foundation on which the medical profession can provide uniform, logical and equitable dietary advice.

Equity in health can be fostered through generic, societal wide adoption of dietary guidelines. Health equity can be broadly defined as the societal absence of avoidable factors that cause disparity in health. In other words, health equity is the capacity of an individual to obtain the highest level of health outcome that is biologically possible [9]. As Rice stated, systemic health interventions are more equitable, as they reach more of the population and in particular those at greatest disadvantage. This is in contrast to agentic interventions that demand agency of the target population and which can forest disparity, as only the more affluent may access services. An example of the later is breast screening which is may be well used by affluent, educated women, but underutilised by those from socioeconomic disadvantage. An example of the former is mandatory iodine fortification of table salt, which reaches all populations more equally [10]. Thus, the uniform, societal wide scope of the Australian Dietary Guidelines offers effective means to address inequity, especially if equity issues are implicitly constructed into the recommendations. Clearly though, recommendations alone cannot provide adequate access to the required foods, and a host of societal factors including economic status and geographical constrains may be greater determinants of health outcomes. This alludes to the role of the social determinants of health, of which environmental factors are dominant [11].

World trade agreements also impact directly on what food individuals are capable of obtaining, and more generally influence what crops or land use practices landholders are encouraged to adopt. Hence, Trade agreements can clearly impact on environmental health. For example, free trade agreements may make energy dense, nutrition poor foods in a developing country cheap compared to the traditional, often more nutritious food staples. Additionally the capacity of individual communities to obtain food security may decrease as a result of shifting to a monoculture crop to supply foreign markets (such as rice, bananas or coffee) [12].

One could imagine, for example, the global equity implications of recommendations in a developed nation to eat more fish. It is well recognised that fish is a nutritious addition to any diet. Recommendations in the current Australian Guidelines is to eat 2 serves of fish a week [13]. As pointed out by Selvey and Carey, this equates to a 40% increase in fish intake at a national level, which is unsustainable within Australian fisheries [14].  Thus, adherence with this guideline would demand increased imports of fish and disruption of fisheries abroad. The ethical issue here is that while many Australians already enjoy a varied, nutritious diet with multiple sources of essential macronutrients, many residents of developing nations depend on fish as a fundamental dietary source of protein and fat. The combination of dietary guidelines that promote unsustainable ecological practice (such as over fishing) and relaxed free trade agreements, encourage globally disadvantaged groups to meet Australia’s nutrition requirements at the expense of the health of their own ecosystems and communities. The inequity is exacerbated as many of these communities and individuals who are fundamentally being exploited lack the agency to protect their source of fish and maintain the ecological sustainability that often supports their livelihoods [15].

An issue highlighted by Selvey and Carey is that ecological considerations are afforded limited consideration in the Australian dietary guidelines, and the brief mention of the dietary guideline environmental impacts is relegated to the appendix [14]. Even here, there is limited discussion of the global environmental impact of our food. Also confined to the appendix is a brief discussion of the health equity implications of the guidelines, although again, there is no mention of our ethical position as global citizens or the impact on the globally disadvantaged [13].

Herein lies a huge human and environmental inequity that must be address. It is critical that the dietary guidelines are founded not just on the best scientific basis, but also on an ecological and health equity risk impact assessment. It must be acknowledged that in a world that is becoming rapidly populated, the impacts of individual nation and political sector actions are no longer only felt domestically. It is clear that inequity and ecological degradation is being exported, and that our ecological deficit will increasingly generate intergenerational health inequity as future populations have reduced capacity to ensure their food security.

This is a massive issue, and the subjects address here are limited in scope. However, there needs to be a response from the health sector that promotes the adoption by the Australian National Guidelines of a clear, meaningful and holistic equity and ecological risk impact assessment. Strengthen this argument is the fact that what is good from the environment and for health equity often parallels the recommendations already touted in guidelines; namely, eat less red meat, saturated fats and processed foods, and eat more vegetables and fruit. All of society is responsible for the social determinants of health, which often lie outside the traditional health sector. However, there is a fundamental ethical responsibility of health professionals and promoters to portray clear messages that ecological health is a essential human health determinant and that in all our actions, policies and guidelines; human health, health equity and ecological sustainability must be fostered equally. 

     

Bibliography [16]

 

[1]

R. Labonte, “A holosphere of healthy and sustainable communities.,” Aust J Public Health, vol. 17, no. 1, pp. 4-12, 1993.

[2]

K. L. Ebi, “Adaptation costs for climate change-related cases of diarrhoeal,” Globalization and Health, vol. 4, p. 9, 2008.

[3]

J. Patz, D. Campbell-Lendrum, T. Holloway and J. Foley, “Impact of regional climate change on human health,” Nature, vol. 438, no. 17, pp. 310-317, 2005.

[4]

J. Langrish, S. Wang, M. Lee, G. Barnes, M. Miller, F. Cassee , N. Boon, K. Donaldson, J. Li, L. Li, N. Mills, D. Newby and L. Jiang, “Reducing personal exposure to particulate air pollution improves cardiovascular health in patients with coronary heart disease.,” Environmental health perspective, vol. 120, no. 3, pp. 367-72, 2012.

[5]

J. Patz, C. Corvalan, H. P. and D. Campbell-Lendrum, “Our Planet, Our Health, Our Future,” World Health Organisation, Geneva, 2012.

[6]

J. Quinn and V. Bencko, “Food insecurity: How to orchestrate a global health,” Health, vol. 5, no. 6, pp. 1055-1061, 2013.

[7]

R. S. N. A. R. Hassan, Ecosystems and Human Well-Being-Current State and Trends. Chapter 4. Human Health: Ecosystem Regulation of Infectious, Angel Martorell, 2005.

[8]

I. Small, J. van der Meer and R. Upshur, “Acting on an Environmental Health Disaster: The Case of the Aral Sea,” Environmental Helath Perspective, vol. 109, no. 6, pp. 547-549, 2001.

[9]

P. Braveman and S. Gruskin, “Defining equity in health,” J Epidemiol Community Health, vol. 57, no. 4, pp. 254-8, 2003.

[10]

R. Wendy , “Health promotion Through an Equity Lens,” Wellesley Institute, 2009.

[11]

R. Wilkinson and M. Marmot, “Social Determinants of Health: The Solid Facts,” World Health Organisation, Copenhagen, 2003.

[12]

R. Patel, Stuffed and Starved: Markets, Power and the Hidden Battle for the World Food System, Portobello Books Ltd , 2008.

[13]

National Health and Medical Research Council, “Australian Dietary Guidelines,” Communwealth of Australia, Canberra, 2013.

[14]

L. Selvey and M. Carey, “Australian dietary guidelines and th enironmental impact of food “from paddock to plate”,” MJA, vol. 198, no. 1, 2013.

[15]

E. Brunner, P. Jones, S. Friel and M. Bartley, “Fish, human health and marine ecosystem,” International Journal of Epidemiology, vol. 38, pp. 93-100, 2009.

[16]

W. M. O. E. L. E. L. K. Ståhl T, “Health in All Policies,” Prospects Potentials Hels Finn Minist Soc Aff Heal, 2006.

[17]

W. Rees and M. Wackernagel, “The Shoe Fits, but the Footprint is Larger than Earth,” PLOS Biology, vol. 11, no. e1001701, 2013.

 

 

 

2 thoughts on “More on the human-ecological topic – Chris Baker

  1. Pingback: Equality and Equity | STEM women

  2. Pingback: Equality and Equity - Clare Rudo

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