The Natural Environment & Health in Africa

Human development has largely come at the expense of nature — undermining ecosystems, fragmenting habitats, reducing biodiversity, and increasing our exposure and vulnerability to diseases.

As we push deeper into tropical forests, and convert more land to agriculture and human settlements, the rate at which people encounter new pathogens that may trigger the next public health, social and economic crisis, is likely to increase.

Pandemics such as COVID-19 are just one of a growing number of health challenges that humanity is facing as a result of our often one-sided relationship with nature.

However, our understanding of the intricate connections between the natural environment and health is poor. As such, health policy does not adequately ‘price in’ the importance of ecosystems in promoting health, and the negative effects that their disruption can have on human health.

Expanding and strengthening understanding of the connections between the natural environment and human health is especially important in Africa, where the combined effects of sub-optimal human and ecosystem health place a significant burden on rural and urban economies that can restrict equitable, sustainable development efforts.

1. Inform readers on how health outcomes emerge from human interactions with the natural world.
2. Identify how efforts to preserve the environment and sustainably manage natural resources can have an impact on human and animal health.
3. Highlight the limitations that weak evidence, lack of metrics, and educational gaps pose to achieving desired health outcomes for humans and animals through the sustainable management of ecosystems.

 The report's  intended audience are researchers, decision-makers working in the environment and public health sectors, educators, and interested individuals, including those who may not be familiar with the interdependence between the natural environment and health.

For academic readers... it highlights cross-disciplinary links between sectors, critical knowledge gaps, and makes a series of recommendations that should help define research priorities moving forward.

For decision-makers and planners... it provides a high-level overview of how efforts to conserve species and their habitats, and reverse environmental degradation, could impact human and animal health, and the practical barriers that currently stand in the way of achieving desired health outcomes for humans and animals through the sustainable management of ecosystems.

For interested individuals and educators... it is a resource to learn more about the potential connections between their health and the natural environment.

When considering disease emergence from a systems perspective, it is useful to think “bottom up”, where health outcomes emerge from three core underlying drivers – cultural practices, human population growth, and climate change. The impacts of these anthropogenic drivers on terrestrial and aquatic ecosystems occur at local to regional scales and are collectively referred to as land-use change.

The report examines geographic patterns in the distribution of research effort across Africa, which likely reflect differing levels of investment in research activities (with roots in historical inequality and societal stability) and public health priorities.

Particularly striking are the geographic gaps where little research effort is being made to understand connections between health and the environment. Large parts of south-western Africa, central Africa and the Sahel – all areas that contain biodiversity hotspots, human populations vulnerable to environmental change, and landscapes known to harbour emerging pathogens – are underrepresented across thematic areas.

Similar disparities are seen in publication of scientific research articles, across physics, biology, chemistry, mathematics, clinical medicine, biomedical research, engineering and technology, and earth and space sciences.

Using the results of our review, the report assesses how existing work being conducted to protect and restore terrestrial and aquatic ecosystems can have direct, or indirect, impact on human and ecosystem health.

These efforts are split into the six ‘impact areas’ depicted to the right – broad topics on which those working in the environment sector might aim to have impact on health.

For impact area, we estimate strength of evidence for mechanisms connecting the natural environment to health in Africa, and give real-world examples.

The report identifies four key challenges that must be overcome for the natural environment to be appropriately valued for the role it plays in supporting health on the Africa continent, and present recommendations as to how they could be addressed.

Strong, evidence-based data linking environmental change to human, animal and ecosystem health is lacking. Geographically fragmented research efforts make it difficult to study processes that occur across landscapes and assess the risks faced by people who live in different settings.

The report recommends that efforts initially focus on identifying research priorities and mobilizing resources (including donor funds) to establish coordinated experimental and field studies that provide mechanistic and causal inference on the impacts of environmental degradation and biodiversity loss on health. African institutions should be at the forefront of these efforts, which would also help to support scientific decolonialization and balance the geopolitics of research on the continent. Efforts should also focus on integrating indigenous and localised knowledge and expertise to better understand connections between human health and the natural environment, and increase the inclusivity of policy formulated using this evidence. 

Specifically, evidence is required to:

The report recommends that research should be accompanied by development of a standardized metrics catalogue that consists of data that can be used to measure key components of environmental change and human and animal health, and composite measures for the impacts of environmental change on health.

Once metrics have been developed, a clearly defined framework for monitoring changes in environmental conditions and associated health outcomes is required, consisting of goals, targets and indicators.

If linked to global monetary and non-monetary benchmarks for human health (such as Disability Adjusted Life Years), indicators could allow returns on investment in ecosystems to be directly linked to human health and economic development. The incorporation of DALYs and other metrics of disease burden both in humans and domesticated (farmed) animals into sustainability standards would connect sustainable management practices in the agricultural, fishing, forestry, mining and textile production sectors that support positive human health outcomes through maintaining ecosystem integrity, to consumers.

Connections between the natural world and human health are complex and highly variable, making it difficult to communicate the broad value of the natural environment to health, to civil society. This is compounded by people losing their ancestral connections with the natural environment through societal changes and the exclusion of local communities from conservation programs.

To address this, the report recommends that:

• Advocacy groups engage networks of supporters on the African continent, who are already engaged in environmental concerns, and leverage this as a platform on which to advocate for the importance of the natural environment in supporting human health to the general public.

• Indigenous and rural communities are recognized as stewards of the natural environment, and supported to play an active role in natural resource management. Indigenous knowledge should also be integrated into solutions aimed at improving health.

• Stakeholders working in the environmental, public health and animal health sectors engage with and broaden educational networks to provide more in-depth professional training on the environmental and ecological components of health. 

These activities would put African society in a strong position to raise global awareness for the connections between the natural environment and human health.

In Africa, efforts to integrate the natural environment into public health policy have mostly centered on veterinary and public health activities – with particular focus on forecasting and control of the risks posed by zoonotic disease in production animals (and to a limited extent wildlife). This has been compounded by donor funding that is primarily designed to address high-visibility, single-issue topics, often aligned with specific issues or diseases. By promoting specific health outcomes rather than common drivers, this approach hinders formation of the interdisciplinary partnerships that are required to tackle complex, multi-pronged health challenges that emerge from environmental change. 

The report recommends that mechanisms are established by which scientific evidence and reliable metrics can be effectively communicated to decision-makers.

Multi-sectoral platforms are also required so that decision-makers can engage stakeholders working at the interface between the natural environment and human health to test and scale interventions. For example, methodological frameworks that incorporate the ecological impacts on animal and human health into the design and evaluation of blue and green sustainable development programs would be particularly impactful.