The health and well-being of people, indeed their survival, depends
fundamentally on a healthy environment: clean atmosphere and water,
fertile soils, pollution-free oceans and biological diversity.
Nurses believe that everyone has an obligation to protect and preserve
the environment for the benefit of human health.
Nurses have a shared responsibility to sustain and protect the
environment, whilst fulfilling their role of promoting, restoring and
maintaining health in people.
Nurses have a role in protecting the health of individuals by:
• Seeking to preserve a healthy environment which is fundamental to
the health of all communities and future generations;
• Utilising expertise and providing leadership to assist communities
to apply the principles of public health in building healthy
• Participating in partnerships to lobby and advocate for actions to
reduce impacts on health through environmental changes.
The interdependence and the interconnectedness of human health
with the health of the natural environment is a relationship formally
acknowledged by the World Health Organization (WHO) as interrelated
with the conditions and resources needed for health. The Ottawa
Charter for Health Promotion states that; “The fundamental conditions
and resources for health are peace, shelter, food, income, a stable
ecosystem, sustainable resources, social justice and equity” (World
Health Organization 1986, Prerequisites for Health, para. 4).
In 2012, 12.6 million deaths, representing 23% of all deaths and 22% of
the disease burden were attributable to modifiable environmental risks
(World Health Organization 2016a).
The WHO has identified that changes in climatic conditions can have
three types of health impacts:
- direct impacts e.g. heat waves
- health consequences of changes to ecosystems and biological
processes e.g. mosquito borne infections, agricultural food yields
- health consequences of populations who are disrupted or
The threat from environmental degradation to human health and survival
has been recognised and expressed by the scientific community
(Union of Concerned Scientist) and by the United Nations Environment
Programme (UNEP). Human activity is the main cause of environmental
Changing landscape patterns and biodiversity may be a key contributor
to the outbreak of disease. Human-induced land use changes are
primary drivers of a range of infections, and land use changes, food
production and agricultural changes account for almost half of all global
infectious disease emergencies that are transmitted from animals to
people (World Health Organization 2016a). Stable ecosystems are
vital to sustaining human life. The loss of biodiversity and changes to
ecosystems can result in outbreaks of infectious diseases, risk food and
nutrition security as well as protection from natural disasters (Romanelli
et al. 2015).
Described as the biggest reserve of biodiversity on the planet, oceans
and other waterways provide food, medicines, biofuels and other
products. They support the breakdown and removal of waste, support
climate change mitigation and are valuable resources for tourism and
recreation. The Food and Agriculture Organization stated, “the health of
our planet as well as our own health and future food security all hinge on
how we treat the blue world” (Food and Agriculture Organization of the
United Nations 2014, Foreward, para. 4).
Just as humans impact the environment, the environment impacts
humans. Human activity influences the physical environment with
resultant impact on peoples’ health. Higher temperatures increase both
mortality and morbidity (Australian Institute of Health and Welfare 2011).
Australia is already the driest inhabited continent on Earth and drought
is an important feature of its highly variable climate (Steffen 2015). The
relative risk of suicide can increase by up to 15 percent for rural males
aged 30–49 as the severity of drought increases (Steffen 2015). The
number of weather related natural disasters has tripled since the 1960s
and these disasters claim 60,000 deaths each year (World Health
Organization 2016b). The environmental influences on the determinants
of health include the natural environment, the built environment and the
individual’s responses to environmental influences (Veitch 2009).
The design and structure of the built environment is an important
determinant of lifestyle and health. There are direct associations with
illness and mortality, such as motor vehicle accidents, as well as
indirect associations, such as encouraging physical activity. The built
environment may also affect mental health and child development
through a lack of green space, overcrowding and environmental noise
(Australian Institute of Health and Welfare 2011).
That humans impact the environment is undeniable. This impact can
be both positive and negative. We have a responsibility to affect the
environment in a positive way when possible and reduce our negative
impact at every opportunity.
Health in All Policies (HiAP) is an approach to public policies across
sectors to improve population health and health equity that takes into
account the health implications of decisions, seeks synergies, and
avoids harmful health impacts. It provides a means for considering the
impact of policies on people’s health and health equity regardless of the
primary aim of the policy in concern. Good health enhances the quality
of life, improves workforce productivity, increases capacity for learning
and strengthens families and communities. In an HiAP approach,
the aim is that health is an outcome of all policies (World Health
The link between increasing air pollution and mortality has been
well-documented (Cohen et al 2005; Xu et al. 1994). Air pollution is an
important global risk factor for disease, with ambient particulate matter
ranking 5th on the global ranking of risk factors for total deaths from
all causes in 2015 (Health Effects Institute 2017). The United Nations
Sustainable Development Goal 3 refers to improving health through
improving environmental conditions. Specifically, target 3.9 states “By
2030, substantially reduce the number of deaths and illnesses from
hazardous chemicals and air, water and soil pollution and contamination”
(United Nations Statistics Division n.d., p. 4).