Thanks very much indeed. And good afternoon,
I think it’s just afternoon now.
I would just like to thank Laura and Stephanie
and the other organisers for giving me the opportunity to be here today.
Often at the meetings that I go to I am the only person
talking about the inter-connections between environment and human health.
But we have had four absolutely excellent talks this morning
that have said pretty well all the things that I would normally say.
So my little contribution today is going to be much more about
throwing ideas out and trying to give some different perspectives
on the inter-connections between the environment and human health,
and where we might go, how we might think of developing
this whole area as we go forward.
In particular I think that it would be nice
if we can change the perspective that people in western Europe
have about the environment and human health, a small ambition,
but I think it’s something that maybe we can get going.
And it seems to me that Ireland, and hopefully the UK as well,
are two places where there is an appetite to make these kind of changes.
As Jock pointed out, I am an ageing professor,
and I have been messing about in the area of
environment and human health for almost 40 years.
I started life as a marine biologist
and then meandered into medical research working on leukaemia and so on,
and I have been working backwards and forwards between the two.
But my ambition, when I left being Chief Scientist of the Environment Agency in the UK,
was to bring together all the things that I had learned
to try and create an inter-disciplinary centre,
hugely important to tackle this in an inter-disciplinary manner,
and to bring together an inter-disciplinary team
to look at the intimate inter-connections
between the environment and human health.
And in order to do that,
we have to consider the threats from the environment to health and wellbeing,
and that’s typically what environment centres do.
But also to look at the opportunities the environment provides
to foster improvements in health and wellbeing.
So I’m going to say a little bit about that today.
So benefits, more than one, I think it said benefit in the programme.
But benefits of a clean environment,
let’s meander through and see what we can find out
about how the environment influences what we do.
This is my favourite slide, that I show in nearly all presentations.
It’s really to make the point that during human evolutionary history,
if you look along the bottom scale, it’s time,
over the last 80,000 years there have been human beings
they have been living in intimate contact with nature.
They wake up in nature every morning,
they live their lives in nature and they go to sleep in nature.
And actually from that time, let’s say 80,000 years ago,
but maybe some of the positive recognition of humans as being human beings
was perhaps 40,000 years ago,
when you see the first cave paintings and those sort of things.
Those people were living in intimate contact with the environment,
and there about 0.5 billion of them on planet earth.
And you can see that that went all the way through,
right up until actually 1804
when there were 1 billion people on the planet for the first time.
Now for most of that time one could argue that the environment was clean.
It wasn’t heavily impacted by industrial pollution
or pharmaceuticals leaking into the environment
or any other kind of environmental contamination due to man.
Although clearly there would be natural toxins
and hot spots of metal pollution naturally occurring.
So really the concept of a clean environment is something
that’s really emerged with the modern development of humans,
really in the last couple of hundred years.
And it’s taken quite a while I think to really get into
the general parlance of the medical and health communities
that the environment really really is
hugely important for health and wellbeing and in the avoidance of disease.
If you had asked the question,
how important is the environment in influencing the diseases
that we get across the life course 10 years ago,
you would have been told that well maybe about 40% of the diseases
that we get and the illness we get in our lifetime
are due to environmental exposures,
and the rest of it though is embedded in your genes.
It’s determined through your genetic make-up.
But now I think we have a much clearer idea
that at least 75% of the influence is from the environment,
perhaps through the epigenetic effect of environmental stresses,
chemicals and so on, on gene expression
and 25% is the congenital abnormalities and so on.
So here’s evidence that things are moving along
and that the environment really is now being recognised
as an incredibly important factor in our health and wellbeing.
The other thing I would like to point out
is that the diseases that people have these days
are very different to those that were around just over 100 years ago.
So the column on, it must be on your left,
1900 those were the kind of diseases that people were getting.
And there were about 1.5 billion people on the planet at that time.
And if you look at the column on the right in 2010
those were the prevalence of diseases,
quite a major change in pattern.
And there were about 7 billion people on the planet then,
perhaps just over that.
And the issue for me that I think we ought to be thinking about
when we are considering this whole area of environment and human health is: what next?
What will the pattern look like in another 20 or 30 years?
And what role will the environment have played in it?
I was talking to Jock earlier, and we were discussing the fact that
the European Union, European Commission has run a number of workshops
where they have looked at future scenarios for Europe.
What will it be like? What would happen if we had a
business-led economy and community,
and attitudes of: drive business forward,
compared with an environment in which
we were much more altruistic and shared things much more,
and all these different kinds of scenarios.
So the EU looked at that, and nearly all the scenarios
ended up as looking quite horrible.
But what they didn’t do was think about the vision
of what kind of environment we would like.
And so I really think that,
I would like to propose that we think about
creating a manifesto for the future environment of Europe,
and perhaps more broadly, maybe a future environment of the world,
in relation to health and wellbeing.
And in a way the sustainable development goals
are part of that journey,
but they don’t really articulate very clearly, in my mind anyway,
what kind of world we would really like to live in,
what are we aiming at and what kind of policies do we need
to have to deliver that world?
Now I mentioned the whole issue of what can the environment do for you?
It’s not just about threats,
and I will deal with threats a little bit later in this talk.
But what can the outdoors actually do for you?
I use the word outdoors to really avoid having to get into definitions
of what green space, blue space, white space and any other space are.
But once you are outdoors you are outdoors.
And I think that there are automatically a number of benefits that you get.
For example, when you are outdoors you tend to be walking around a bit more,
and you are moving around a bit more, you are using more energy,
and consequently you are reducing your risk slightly
of becoming obese and overweight.
And when you are outdoors, especially in green and blue environments
you are getting much more mental stimulation.
And we know that this reduces the risk of psychiatric disorders
and other kinds of mental health issues.
And there’s not many of us I should imagine in this room
that when you are feeling really really stressed out and anxious
that if you go for a walk in the park or on a seashore
or in the forest you usually feel a bit better.
And so I think these kinds of things are built into our make-up
and certainly it’s more evidence that the outdoors benefits us.
If you do enjoy being outdoors then it keeps motivating you to keep going outdoors
and doing some more.
So you can develop beneficial habits
that keep you moving and keep you in contact
with psychologically beneficial situations.
And usually when you go outdoors you go with other people very often,
go for a nice walk together. So it builds social cohesion.
And in terms of economic aspects
you don’t need a lot of money to be able to go outdoors.
Most people can find some access to
a green or a blue environment
walking by the side of a canal or walking through a park
– not everyone but most people.
And there are an increasing number of scientific studies.
Ten years ago when I set up the European Centre for Environment and Human Health
in our University of Exeter Medical School
I hired a guy to work with us called Dr William Bird, who is inspirational.
I don’t know if any of you know him,
but he created a thing called the Green Gym
in which he was getting his patients to go out into their gardens at home
and mow the lawn and prune the roses and just be outdoors
and tried to capture the evidence that this was beneficial to their health.
And these green gyms as they were called
became formalised and set them up all over the UK
and in other parts of the world.
The interesting thing about green gyms though
was that the studies that were done to capture the evidence
it genuinely improved health and wellbeing were not very good.
And indeed 10 years ago the whole evidence,
scientific evidence that the natural environment is really really good for you
was very very poorly put together, very poor studies.
And so when you go along to government and say,
well I really think that we ought to foster the use of parks and green spaces
and forests and access to nature,
government would turn around and say,
yeah, but where’s the scientific evidence?
We can see from the drug companies that we can help people
over depression by giving them various pills,
but we can’t really see robust scientific evidence
that sending them out for a walk in the park
is going to reduce their mental health problems.
So one of the things we did was, we have set about,
as many other people have done, in trying to get that evidence.
And this was a study that you can see before you
where we looked to try and see in a very robust way
whether outdoor exercise is better for you
than indoor exercise of the same amount.
And we found 384 scientific papers within the last five or 10 years
and we compared them in a very rigorous way
with a set of criteria that would tell you
whether these studies had been done well,
whether they were biased in any way,
whether they had the right statistical power
to be able to say anything at the end of it,
and out of the 384 studies
we found 11 that had been done well enough to be considered science.
And those 11 did demonstrate that there are some psychological benefits
to doing your running outdoors compared with doing it in a gym.
Didn’t tell us anything about whether it helps
with tackling obesity in a robust scientific way.
So my point is here that to do systematic reviews of scientific evidence
that’s the procedure I just described is very very important.
If we are going to make the case for the benefits
of the natural environment to health and wellbeing
then we need to do incredibly robust science
of the same quality that is done by the drug companies
and those offering other kinds of cures or treatments or preventative measures.
And we have cracked on and done a whole load of this.
This was a study trying to look at the
benefits of different kinds of environments
in terms of reducing stress, spending time in there.
And we certainly found out that green environments
and blue environments seem to be perhaps the most powerful,
the most effective.
The most recent study that we have done,
was looking at physical activity in natural environments.
Because we know that an increased amount of physical activity
benefits your health and reduces your risk
of all kinds of things, including diabetes, cardiovascular disease and so on.
So this study is a population-based cross-sectional study in England.
The idea was to see where adults do their recreation
and to see to what extent the natural environment in England
is a place where people do their recreation.
So we did a cross-sectional analysis of
six waves of a nationally representative sample from this MENE survey,
that’s Monitoring Engagement with the Natural Environment.
And we had 280,790 people in it.
And looking at weekly quota samples and population weighting
and so on to estimate the number of visits they made to nature.
And we had details of the kind of visits that they made,
including how much time they spent in these natural settings,
when they were outdoors, how much activity they did there,
what kind of activity, and what the environment was like,
was it heavily wooded or was it an open park or whatever it was.
So we looked through all this and on a population level,
UK population level, we reckoned that 8.23 million adults,
that’s about 20% of the population,
made one or more active visits of duration more than 30 minutes
to a natural environment during any previous week.
That means it’s about 1.23 billion active visits
to green and blue spaces during the year.
So 3.2 million people, we think, in the country,
based on these sampling procedures,
also met the recognised physical activity guidelines,
which are that you should do five times of 30 minutes exercise a week.
So this access to nature was
facilitating people meeting their basic exercise requirements.
And there are things called qalys, quality adjusted life years,
that many of you will know about,
and these active visits seem to be associated with about 110,000 qalys annually.
And since a qaly is meant to be worth about £20,000 annually
that means that providing green and blue spaces
that people can go and do their physical exercise in
actually saves about £2.18m a year.
So this I think is the kind of evidence that
if you want to convince economists and government officials
and so on that the natural environment is worth something,
this is the kind of route that you might want to go down.
So natural environments do provide these opportunities
for a large proportion of the British population, the English population,
for recreational physical activity,
and I think it just highlights the need to protect these kinds of areas.
One of our obsessions in south-west Britain in the centre,
the European Centre for Environment and Human Health,
is water, because we are surrounded on three sides
on the south-west peninsula by water.
And as I say I started life as a marine biologist,
so I’m really interested in water.
And all my staff seem to be surfers. So we do water.
And one of the things we did was another survey with Natural England
and we had the post-codes of people and we had their self-reported health
in relation to their post-codes.
And when you plot it out, like this graph shows,
you find that people’s self-reported health is much better
if they live within one kilometre of the coast.
Not only that, we found that people from the lower socio-economic groups,
the differential between their self-reported health
if they lived in Birmingham compared with living on the coast
was much much greater than wealthy people.
So if you are wealthy and live on the coast
and wealthy and live inland your self-reported health isn’t that much different.
But if you are poor and live in Birmingham,
away from the coast and poor and live on the coast,
your health is much better if you live on the coast.
And we know that self-reported health correlates
very well with your actual health.
So I think this is a pretty interesting indication.
This whole idea of looking at coastal environments
actually goes back a wee bit further.
I started a programme back in 2008 called the Blue Gym,
which was helping to foster the use of coastal environments
for swimming, sailing, surfing, kayaking,
anything else you could think of to with the coast,
among socio-economic groups that would not typically do that kind of thing.
And then we were trying to see does that
reduce the number of visits people make to the doctors?
Does it reduce the amounts of pharmaceuticals that people use in a year?
So that’s where Blue Gym started.
I actually regretted calling it Blue Gym
because that implied that we were going to be athletes or you know sports people.
And I think we have to get away from that.
What we are really talking about is just getting people
to be outdoors and a little bit more active.
We have now moved on. We have a programme called Horizons 2020: Blue Health,
so it’s funded by Horizons 2020.
And it’s to develop inter-sector interventions and/or policy initiatives
to promote health and prevent disease in relation to known environmental stressors.
And we have got about 14 countries involved in that.
And I would be happy to tell people more about it.
But there are about 194 coastal cities
around Europe and we are extremely interested to know
what threats are being posed to those cities
to people’s health and wellbeing,
and what opportunities there are to improve people’s health
and make them more resilient as they live in those European coastal cities.
And indeed this project has now gone global,
because we are collaborating with people in Hong Kong,
up in the arctic and I just got back from Tazmania,
so I’m slightly jetlagged, and we are going to do studies down there as well.
One issue that did drift by us this morning
was this whole issue of inequality.
And the picture in the top right, you can see,
is actually the village where I live.
And some people have access to those sort of places on the top
and some people only have access to the places shown on the bottom line.
And I think this whole issue of inequality must be one of our key priorities
that we wrap up in the whole environment and human health agenda.
We know, and this is very old data,
but there are lots of studies showing this,
that when people feel hopeless,
if you measure degrees of hopelessness
and look at that in relation to the disease they get,
then the more hopeless you are,
living in those horrible environments,
with little access to nature, with a bad diet,
with exposure to air pollution, contaminated land and so on,
you are much more likely to get cardiovascular diseases
and a range of other diseases, cancers and so on.
So we know that.
So there is really an agenda I think to pursue
about what kind of ecosystems we want to have these days
and in the UK at least we have not had that discussion.
We talk about wanting to conserve nature,
we talk about wanting access to natural ecosystems,
we talk about aesthetically pleasing ecosystem for tourism and so on,
but we have no plan about what kind of ecosystems we want,
in what proportion, where we want them,
who has access to them, what the benefits are,
what the economic implications are.
So I really think that that’s something we should proceed more with.
I’m rapidly running out of time,
but I did want to just tell you about some new flavours
that we are trying to introduce.
One of them is the use of social media.
So in order to find out what people’s perceptions are
about the environment and about the environment
in relation to their health and wellbeing,
we want to start using social media.
And indeed we have been doing that, and you can look at twitter,
but it’s much better to look at blogs and there’s a range of things that you can do.
You can look at where people have been spending their time
through looking at their use of credit cards and,
how they use their mobile phones.
And I already feel uncomfortable saying that in this room,
because this data that’s out there is personal data.
And even though you can’t necessarily identify individuals it’s still personal data.
So there’s some national, international debate
we need to have about how we use data.
But nonetheless most of the major international companies
in the world are using this data right now
to plan what they are going to sell you in the supermarkets next week.
And when they get these messages, these tweets, these blogs,
they are using natural language processing
which can reveal a huge amount of information about what your intentions are
in terms of where you are going to be, what you want,
what you need, what you are going to buy,
whether you are going to have a barbecue on Friday night,
you know whatever it happens to be, you can glean that from these messages.
But what we have been trying to do is working with a commercial company
that was called Black Swan
we have created a not-for-profit charity called White Swan,
which is somehow poetic.
And the object of White Swan, not-for-profit,
is to use big data of the kind I have been talking about
to foster improvements in health and wellbeing.
And now this example isn’t terribly environmentally related,
but it is one example where we have shown that this can work.
So what we were trying to do with this study
was to predict who would turn up at accident and emergency in hospitals
on the day before they actually turned up there.
And we have actually been able to do that with 86% accuracy in a hospital in Birmingham.
And we are trying to try this out in other places now.
And we know that a lot of those admissions were due to flu
and pneumonia admissions, some to trauma and some to alcohol poisoning.
It’s really interesting that when people get drunk and hurt themselves
and end up in accident and emergency
the first thing they do is tweet and say, I’m in hospital, I’m pissed,
I have hurt myself, which is slightly alarming.
But anyway they do that.
And so we have been looking at that kind of information and can predict with,
as I say, great accuracy what’s going on.
And we can look at other factors, like we can look at seasonality,
we can look at what the climate is doing.
And when you do that, these are yearly trends
that you can find out from this kind of information,
looking at who goes into accident and emergency
with what at different times of the year.
And you can see you know with flu in the winter months,
flus going up, you can see with trauma it’s more in the summer,
and you can see what’s happening with alcohol poisoning and so on.
So the overall idea of this social marketing
to foster improvements in health and wellbeing
in a not-for-profit way is to try and create the first
and biggest patient generated health library in the world,
and relate that to environmental quality, to climate,
to changes in the environment,
to what people are thinking about the environment,
what they are intending to do in it,
what benefits they get from it.
But also the physical things,
like what’s the pollen count doing to their health and wellbeing?
And what’s the weather doing to their behaviours?
Are they spending less time outdoors if it’s raining more?
Or are they outdoors more if it’s warmer with climate change and so on?
So I think this is a really interesting area to pursue.
We have also been looking at pro-environmental behaviour.
It seems that when people spend more time in nature, #
in natural environments, they get to care more about that nature,
they start to be more receptive to environmental messages
and look after things more.
But I think the opposite is also interesting to explore.
So I’m interested in looking at contra-environmental behaviour.
If you put people in cities and 85% of the UK population now live in urban environments,
then do they start to care less about nature?
Do they just chuck their rubbish out?
And do they not bother about bird song?
Do they not want to see animals?
We don’t know the answer to this,
but I think it’s an interesting research agenda.
And then there’s communicating all of this.
And we have played around with it, and this is my favourite example.
This was with one of my former post-docs, Will Stahl Timmins.
And we kept seeing all these adverts for drugs for tablets
that would cure you of this that and the other.
So we thought, couldn’t we put nature inside one of these pills and advertise it?
So we invented this drug Salutogen,
which is all beautiful sunny spaces by rivers and so on.
And it lowers your blood pressure.
It lowers your heart rate. And it promotes wellbeing.
And it’s available from all parks, seashores, forests, countryside near you.
So I think there’s a public engagement issue
that we have to make a step change in what we actually do.
Things to guard against.
Nearly everyone in this room I guess wants nature to be beneficial to us.
And that’s fine, but that isn’t science.
So I think what we have to do is put our feelings aside
and really adopt the null hypothesis
which is nature doesn’t benefit you at all,
and try and prove that nature doesn’t benefit you at all.
And if we happen to find out that we are wrong – great.
But I think that’s the way to think about it,
if you are going to do really good science.
I think we need to think about nature in the context of other things.
If you like shopping and you go and walk around a shopping mall
a lot are you getting enough physical exercise?
Are you doing it with friends?
Are you getting mental stimulation?
Is that better than going for a walk in the park?
I hope not, but it might be.
And until we do the studies we don’t know.
And failing to recognise that different cultures in the world
also have different ways of perceiving nature.
And as I say, I’m just back from Australia,
and the aborigines do not get a distinction between the environment and human health.
It’s just not part of the agenda.
And I suspect that 500 years ago people
didn’t think of the environment as being separate from themselves.
It wasn’t a government department 500 years ago.
It was just intimately involved in their lives.
And what I would like to do is see if we can get back to that kind of arena.
Very quickly, I’m going to race through a few slides about,
what are the consequences of losing the attributes of these clean, nice environments?
And I think they are these.
The planetary boundaries idea many of you will know about,
which is where, if you take things like biodiversity,
climate change and put them outside of limits
that allow people to live in a safe operating space,
then we get into all kinds of trouble.
So our job is…part of our job is to keep families safe in this safe space for living.
The point is, it’s not enough.
Because if you look at human boundaries,
even if you are in a safe place from the point of view of environment,
if you have a lousy family life and a lousy working life,
and you have no hopes and aspirations,
and your physical health is gone off,
then your human boundaries are really limiting you too.
So I think this is just another way of framing the idea
that as well as having a safe, healthy environment in which to live,
we need to pay a lot of attention to how people are living within it,
and how it affects them.
Climate change, massive effects, a huge number of things to impact on us.
And we know that climate change is probably the biggest threat
to health and wellbeing in the 21st century.
That’s about losing a safe space to live,
but lots of co-benefits of dealing with climate change.
I wanted to rush on to this though.
This is a chemical array that we are exposed to,
pesticides, fertilisers, industrial chemicals, pharmaceuticals, gases, particulates.
At the moment I think we have an inadequate system
for dealing with these complex mixtures of chemicals that accumulate in our bodies.
This red spot in the middle represents global chemical production in 1940.
How many dots do you think would represent global chemical production today?
That many. We didn’t plan that. That’s just happened.
What will it be in another 75 years? Heaven knows.
We need to think about these things.
Jock talked about the European bio-monitoring programme.
I have been talking with many other academic colleagues
about body burdens of environmental chemicals for many years.
Pharmaceuticals in the environment, another massive problem.
Once you are over 50 your pharmaceutical use goes through the roof.
You are talking about an ageing population in Ireland.
Pharmaceutical use in Ireland is going to rocket
as your population ages and many of these drugs will be peed
and pooed into the environment through the sewage system.
I better make this my last slide.
I just wanted to point out though that
we have an infrastructure for health and wellbeing,
sorry an infrastructure for health.
Actually it’s an infrastructure for treating disease.
And we have all of these things. We have surgeons.
We have pharmaceuticals. We have experts in chemotherapy,
radiotherapy, all of these different things.
And all of those things are done to you by experts to make you better.
Health is a different thing. You have to do it yourself.
You have to have a healthy diet, physical activity,
time spent in nature, all of those things on the left side.
Quite a lot of medical things are damaging to the environment.
It’s one of the greatest sources of radiation in the environment
for example, and we are pumping pharmaceuticals
into the environment after they have been through our bodies.
But our health depends on their being good environmental quality.
And what I would like to finally argue is that,
well public health agencies are really working hard
on the health side of this equation,
which we have neglected massively.
Only 3% of medical research budgets are spent on health,
on preventing illness, 96% are spent on treating disease.
So you know this is a big issue for us.
And I think in future we are going to have to develop
an infrastructure that fosters improvements
in health and wellbeing, and preventing illness,
that’s similar but different to the infrastructure we have for treating disease.
So I will stop there. Thank you very much.
0:00:00 / 0:00:00
Professor Michael Depledge PhD, DSc FRCP, University of Execeter Medical School
Environment & Human Health: Benefits of Cleaner Environment