Can Public Health and Planetary Health Coexist?

by Jay Maddock, PhD


The Dean’s Perspective focuses on issues pertinent to the relationship between academic public health and the practice community.

health planet

Jay E. Maddock, PhD, FAAHB

Recently, I was hiking through the forest on a bird-watching trip with my colleagues from our Center for Health and Nature. This center was developed over the past year between Texas A&M, Houston Methodist Hospital, and Texan by Nature to advance our scientific understanding of the relationships between exposure to natural environments, health, healing, and preventive medicine. Our bird-watching tour was led by Jim Stevenson, Executive Director of the Galveston Ornithological Society. Jim founded the society over 20 years ago and was an avid birder in Florida prior to coming to Texas. As we learned the call of the Eastern Phoebe, a bird which kindly says its own name, one of our group asked Jim if the populations of birds were doing well in the Gulf Coast. He responded that they were not. He was seeing deep declines in their populations. He was also seeing birds at different times of the year and different species that had not been seen before in the region. This was literally the canary in the coal mine.

The next day as I took the long drive back to College Station past the oil refineries that surround Houston, this statement came back to me.  E.O. Wilson’s biophilia hypothesis was that man was innately connected to nature. Demonstrating this and its effect on health was one of the goals of our center. As I mulled this over, a thought came to me. Could improving the public’s health actually harm the natural environment and our planet’s health? Over the last century, public health has contributed to increased lifespan, reduced childhood mortality, new vaccines and antibiotics to prevent and treat diseases. The effect of this was clear. Today’s global population is over 7.6 billion people. There were only 900 million people in 1800 and 1.65 billion in 1900. This incredible increase in population is only speeding up, with the global population expected to exceed 10 billion in the next 50 years. Also, through the Millennium Development Goals and increased prosperity in China and India, many people are transitioning out of dire poverty into middle-class life styles. Transition to a middle-class lifestyle usually includes increased meat consumption, motor vehicle ownership, and other forms of increased consumption, contributing to climate change, ocean acidification, deforestation, and other forms of environmental degradation.

Can we continue to improve the public’s health while also protecting the planet? In essence, can we create a sustainable public health? The One Health movement examines health through a lens that considers human, animal, and environmental health. While this movement has seen great strides in connecting human and animal health and the veterinary, medicine, and public health communities, less progress has been made on the environment. Creating a sustainable public health requires addressing tough issues like population growth and consumption. Fertility rates vary widely across the world from less than two children born to women in Albania, Austria, Bahrain, Belgium, Bhutan, Brazil, Canada, China, Costa Rica, Germany, Iran, and many other countries to more than five in Afghanistan, Angola, Burundi, Burkina Faso, Mali, Uganda, and others. In general, fertility rates drop as under-five infant mortality decreases. However, there is a lag. Understanding how to decrease this lag is essential as low-income countries become middle-income countries. Globally, the replacement fertility rate is about 2.3, meaning that globally we need to get close to that number to slow the increase in population. Lower fertility rates are linked to access to contraception, female education levels, income and career potential. This is too complex of an issue to cover here, but an issue that needs strong research and thoughtful policy discussions to address it adequately.

Consumption also needs to be considered. Per capita carbon dioxide emissions vary widely, even across high-income nations. In 2016, in the US it was 14.95 metric tons per capita. This was similar to Australia (16) and Canada (14.91). However, this was dramatically different in Germany (8.88), New Zealand (6.45), France (4.38), and Italy (5.37). Dietary choices can drive a lot of difference in consumption. Beef which requires a lot of energy and water to produce ranges widely across the world, including high-income countries. In the US, we consume almost 80 pounds a year per person, twice as much as people living in New Zealand and 4 times as much as the Japanese. The number of automobiles by country has a similar trend with 910 motor vehicles per 1,000 people in the US compared to 555 in Germany and 469 in the United Kingdom. Similar consumption patterns can be found for water use, electricity, plastics, and other consumables.

Across the country, we have had some small wins. Single-use plastic bag bans. Restaurants that stopped using straws. But the clock is ticking a lot faster than we are making progress. George Lueddeke covers many of these topics in his new book and ways that we can address them. As public health professionals, we need to embrace a sustainable public health. The future of our planet depends on it.


Jay E. Maddock, PhD is the Dean of the School of Public Health at Texas A&M University. He is internationally recognized for his research in social ecological approaches to increasing physical activity. He has served as principal investigator on over $18 million in extramural funding and authored over 100 scientific articles. [Full Bio]

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