October 2021
abstract
Responsabilité & Environnement
Environnement et santé : quels impacts, quelles gouvernances ?
Issue editor:
Robert BAROUKI, Anneliese DEPOUX et Maud DEVÈS
Issue 104
Genealogy of the relation between health and the environment
Public authorities and environmental health in France: Long-run disruptions and changes
By Pascal GRISET
Professeur d’histoire contemporaine à Sorbonne Université
The issue of environmental health has a long history. Three periods can be distinguished in order to understand how, at the convergence of multiple spheres, this question became a major societal issue. First of all, the time of industrialization and the ‟Pastoral Revolution”, which saw a symmetrical development of knowledge and a stronger perception of pollution and of the dangers linked to the use of certain products. The second half of the XXth century, when the affirmation of techno-sciences, allows to consider human health in a different way. With vaccines and antibiotics, medicine seems to enter a golden age. Environmental issues, which are increasingly taken into account, are only rarely connected explicitly to public health issues. From the 1980s onwards, this ‟environmental turnaround” increasingly concerned health. What was not previously detected or was neglected is now studied and quantified. Medicine is increasingly integrating environmental risks in all living spaces, including the workplace.
Toward a medicine grounded on the idea of planetary health
By Marie GAILLE
Directrice de recherche en philosophie, SPHERE (UMR 7219), Université de Paris-CNRS
This article explores the way in which contemporary medicine is confronted with environmental health issues. While considering that the health professional cannot act alone in the face of these issues for the benefit of human health, it questions the modalities of his/her action and the orientation to be given to medicine. It analyses some of the answers formulated on this subject in relation to the health impacts of global warming. Then, in a second step, it examines to what extent medicine should not reorient its action on the basis of an ecological conception of health. It formulates the hypothesis that a shift to a medicine based on the idea of global health is necessary.
The environment, ecosystems and the impact on human health
By Serge MORAND
Directeur de recherche CNRS
This article deals with the evolution of approaches linking health, environment and ecosystems, starting from a fixist view to a dynamic view of the environment. The ongoing global changes and to their impacts require the implementation of renewed approaches able to respond to new health challenges. These ecosystem-based approaches are promoted by new initiatives led by international organizations.
The environment’s known or suspected effects on health
The environment’s beneficial effects on health in urban areas
By Denis ZMIROU-NAVIER
Professeur de santé publique honoraire, Université de Lorraine, Nancy, et ex-directeur du département Santé-Environnement-Travail de l’École des hautes études en santé publique, Rennes
The environment is an important determinant of health. This paper exposes the contribution of good quality housing, of green or blue spaces, to health and physical, mental and social wellbeing of urban areas inhabitants. Its conclusion underlines that urban policies aiming at strengthening these positive impacts should pay attention to a fair spacial distribution of these environmental amenities.
From proven to suspected risks: Atmospheric particulates and manufactured nanoparticles
By Francelyne MARANO
Professeur émérite Université de Paris, Haut Conseil de la santé publique
Research has a key place in the environment-health equation. It should help us understand the very complex relations between multiple exposures, low doses with hard-to-determine effects, and the pathologies that often occur long after exposure. This research is necessarily multidisciplinary, thus implying a dialog between physicists/ chemists, meteorologists, epidemiologists, toxicologists, clinicians or even specialists in the human sciences. The effects on health of particles were first studied in mines and then in the atmosphere during multiple episodes of pollution; more recently, their chronic effects have come under examination. As shown by the study of the changes in this store of knowledge during the 20th century, the conjunction of all these data is what has led national and international authorities to react and regulate. At the start of the 21st century, research accelerated on the health effects of the nanoparticles produced by industry; but it has now stalled given the complexity of nanosubstances and the difficulty of conducting epidemiological studies. Health authorities thus face a tough problem: how to manage a risk under conditions of scientific uncertainty?
The risk assessment of pesticides: Between regulatory know-how and academic science
By Laurence HUC
Directrice de recherche à l’INRAE
and Jean-Noël JOUZEL
Directeur de recherche au CNRS
Since the mid-20th century, pesticides have come under regulation. The marketing of this category of products is now subject to administrative authorizations based on an assessment of their efficiency and risks to human health and the environment. Light is shed on the discrepancy that might exist between, on the one hand, the guidelines for regulatory risk assessments of pesticides and, on the other hand, the changing data resulting from academic research on this topic. Attention is paid to the two fundamental phases of the regulatory risk assessment of these products: on the one hand, identifying and measuring the dangers for human health, and, on the other hand, estimating and calculating exposures.
Environment and epidemics
The impact of environmental pressures and climate changes on the spread of infectious diseases and exposure to them
By Sébastien DENYS
Directeur Santé-Environnement-Travail de Santé publique France
and Robert BAROUKI
Directeur de l’unité Inserm 1124 à l’Université de Paris et chef de service à l’Hôpital Necker Enfants malades
Epidemics of infectious diseases break out owing to complex processes stemming both from the environmental conditions conducive to the development of the disease and the spread of its infectious agents and from multiple technological, social and demographic changes. These interactions are analyzed from two angles. The first, based on the epidemic cycle’s global dynamics, inquires into the impact of human activities on the outbreak and spread of an epidemic. The second focuses on interactions between pressures on the environment and the increased exposure of the population to epidemics. An argument is made for reinforcing the actions that take into account the protection of the environment, the sustainability of our modes of production, and the quality of relations with nature. All of this, if taken into account, would have major benefits for public and global health.
Atmospheric pollution and viral infections
By Jorge BOCZKOWSKI
Professeur de pneumologie, Université Paris Est Créteil (UPEC) et Assistance Publique ‒ Hôpitaux de Paris
Air pollution, defined as a change in the composition of the air by pollutants that are harmful to health and the environment, is the largest environmental cause of illness and premature death in the world today. Although initially overlooked as an adverse effect of air pollution, the relationship between pollution and the occurrence and/or severity of respiratory infections has become a growing public health concern in recent years. Regarding viral infections, which constitute the majority of respiratory infections, different studies show that their incidence and/or severity can be correlated to concentrations of air pollutants such as nitrogen dioxide (NO2), ozone (O3) and particulate matter. The underlying mechanisms are not fully elucidated at present, but probably involve facilitation of virus transmission and/or increased susceptibility to virus effects. Although further studies are needed to better understand these phenomena, the available data should prompt action to reduce the concentration of pollutants in the air to combat pollution-related excess mortality including viral infections.
Climate or global change ‒ The choice must be made for health’s sake!
By Jean-François GUÉGAN
UMR MIVEGEC, IRD, CNRS, Université de Montpellier et UMR ASTRE, INRAE
Climate changes are a major aspect of global changes. However their specific effects on the trends of the diseases caused by germs and parasites are hard to evaluate. Other factors (demographic, environmental, socioeconomic and societal) come into play and, in most situations, are predominant for the current and future evolution of these diseases.
Health and the environment: Which governance?
Toward developing an environment conducive to health in the sense of the international concept ‟One Health”
By Cédric BOURILLET
Directeur général de la Prévention des risques au ministère de la Transition écologique
Health and the environment are closely linked fields. Environmental degradation resulting from human activities exposes environments (water, air, soil), ecosystems and even human populations to health damage. The consequences on global warming as well as the destruction of ecosystems notably favor the emergence of infectious diseases transmissible to humans. Environmental health policies must henceforth be fully in line with the international concept of ‟one health” by adopting a systemic approach and by working in particular to reduce environmental exposures when they present risks to human health, animal health or ecosystem health.
Should the ministries of the Environment and of Health be merged? An analysis in the light of the merger in 2007 of the ministries of the Environment and of Energy
By Richard LAVERGNE
Ancien membre permanent du Conseil général de l’économie
Some observers have seen COVID-19 as an accumulation of several crises, including a health and environmental crisis. As we are beginning to catch sight of the end of this epidemic, we might be tempted to think that the administrative organization of Health and the Environment should be overhauled along the lines of the 2007 merger of the ministries of Energy and the Environment. In effect, health and energy policies have some points in common with environmental issues. With reference to this earlier merger that, decided by President Nicolas Sarkozy, led to setting up a big ministry in charge of Energy and the Environment, the author thinks that health policy would have nothing to gain from such a merger.
The management of health risks in France: The challenge of uncertainty
By William DAB
Professeur émérite du Cnam (Laboratoire MESuRS)
The management of risks related to health and the environment encounters various difficulties in France. The current organization of this public sector is incapable of effectively responding to the challenges of environmental health. The capacity for making decisions in a situation of uncertainty is a key point that cannot be fittingly handled by invoking the precautionary principle. Turning health risks into a global public policy issue is a prerequisite for drafting a coherent policy.
The role of a health agency given the COVID-19 pandemic
By Roger GENET
Directeur général de l’Anses
During the COVID-19 pandemic, the French Agency for Food, Environmental and Occupational Health and Safety (ANSES) quickly contributed to the scenarios of human exposure to the new coronavirus (for which food-, animal-or environment-borne transmission was suspected). It placed its scientific competence at the service of the arrangements set up to manage the crisis and protect the population, while maintaining its usual activities and continuing to provide support to the management of other health problems. The experience of the pandemic has drawn attention to the importance of relations between health agencies, a factor that serves as the grounds for an international network of health security. It also tends to accelerate the adoption of an integrative, globalized approach to health risks. Scientific expertise is a necessary but not sufficient condition for effectively preventing and managing these risks. Better protection calls for improving our capacity for research and preparedness in order to handle risks that are emerging or are still uncertain, and to raise questions collectively and constructively about our choice of a society.
Environmental health: The opportunity for a multidimensional, integrated governance of risks
By Florence CARRÉ
INERIS
Jacques GARDON
IRD
Maud DÉVÈS
IPGP
Laure GIAMBERINI
Université de Lorraine
Christian MOUGIN
INRAE Versailles
Nicolas ECKERT
INRAE Grenoble
and Gilles GRANDJEAN
, BRGM
Realizing how important environmental factors are in relation to health, the WHO broadened, in 1999, its definition of environmental health to cover the aspects of human health, including quality life, that are determined by physical, chemical, biological, social, psychosocial and aesthetic factors in our environment. Environmental health also has to do with managerial policies and practices for reabsorbing, controlling and forestalling the environmental factors likely to have an impact on the health of current and future generations. Starting from the observation of how the quality of ecosystems affects human health, the concept of exposome has been defined as the total of all exposures to environmental factors that a human being experiences from fertilization till the end of life. In addition, the concept of ‟One Health” worked out by Zindsstag et al . (2011) has insisted on the bidirectionality of relations and calls for developing integrated approaches for guaranteeing global environmental health: humans, plants, animals and ecosystems. Different examples are used to inquire into the level of disciplinary and spatiotemporal integration necessary for taking the concept of global environmental health into account and making it operational. Environmental health provides a framework for actions in response to the urgent need to develop a multidimensional, integrated governance of risks.
Toward an ‟ecologization” of health governance
By Nathalie BLANC
Centre national de la recherche scientifique (CNRS), Centre des politiques de la Terre, Laboratoire LADYSS UMR 7533
This article focuses on the changing relation between nature and the urban environment during the 19th et 20th centuries (and even until the 21st) in Europe and the United States, a relation described mainly in terms of public health. Territorial planning and development along with the rules of urbanism have long been the means for political interventions interested in dimensions for the purpose of monitoring and controlling violations and ultimately preserving life. Taking account of the environmental dimensions in urban health policies leads us to re-examine the relations between territorial planning and nature as well as the role played by various stakeholders in the health policy field.
An international opening
To recover from Covid-19, we need to invest in a healthy and green future
By Dr Maria P. NEIRA
Director of Environment, Climate Change and Health at the World Health Organization
In this year of unprecedented change, advanced economies have a once in a generation opportunity to demonstrate true global solidarity. Governments can lead the way by investing in pandemic recoveries that improve the long-term public health populations, both within and outside of their borders. For this, stimulus packages need to be pollution-free and climate-safe, while avoiding locking in economic development patterns that will do permanent and escalating damage to the ecological systems that sustain all human health and livelihoods. It is the only way for us to get out of the current health crisis and prevent future ones.
Regulating chemicals: Science and decision-making, slowness and confusion
By Laurence HUC
Directrice de recherche à l’INRAE
and Robert BAROUKI
Directeur de recherche Inserm, Unité 1124 Toxicité environnementale, cibles thérapeutiques, signalisation cellulaire et biomarqueurs (Inserm/Université de Paris)
The regulation of chemicals has a noteworthy place in the complex relations between science, society and public decision-making. Through examples about the carcinogenicity of chemical substances, endocrine disruption and the concept of an exposome, the relations between science and regulation are brought under discussion. Attention is drawn to the apparently very long lag between the acquirement of scientific knowledge and its integration in regulatory texts.
Health environment: An illustration of the Ministry of Health’s policy about protecting the population’s health
By Pr. Jérôme SALOMON
Directeur général de la Santé ‒ Ministère des Solidarités et de la Santé
Joëlle CARMÈS
Sous-directrice de la Prévention des risques liés à l’environnement et à l’alimentation ‒ DGS
and Mathilde MERLO
Chargée de mission Plan national santé-environnement ‒ DGS
For more than 100 years, the Ministry of Health has been protecting the health of populations through a policy of prevention, promotion and access to healthcare for all. Environmental health is one of the priorities of this policy. It is characterized by increasingly strong societal expectations, constantly evolving lifestyles and scientific knowledge, particularly in the context of climate change. Through four examples, this article illustrates this policy in permanent adaptation to meet the challenges of our society as close as possible to the territories and the close interactions between our health and our environment, including animal health and that of ecosystems.