Geography and Sustainability 2 (2021) 298–303

Contents lists available at ScienceDirect

Geography and Sustainability

journal homepage: www.elsevier.com/locate/geosus

Perspective

A holistic framework for facilitating environmental and human health ✩

Yihe Lü 1,2,∗, Da Lü 1,2, Guangyao Gao 1, Bojie Fu 1,2
1
State Key Laboratory of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, PO Box 2871, Beijing 100085,
China
2
University of Chinese Academy of Sciences, Beijing 100049, China

h i g h l i g h t s g r a p h i c a l a b s t r a c t
• Human health, environmental health,
and ecosystem health are closely con-
nected.
• A holistic framework for characterizing
the complex health issues is formulated.
• Human and eco-environment interac-
tions are indispensable for health solu-
tions.
• Transdisciplinary research is necessary
to advance health science.
• Health can be improved by multi-
sectoral and stakeholder collaborations.

a r t i c l e i n f o a b s t r a c t

Article history: In the Anthropocene, health is necessary to achieve global sustainable development. This is a challenge because
Received 6 May 2021 health issues are complex and span from humans to ecosystems and the environment through dynamic interac-
Received in revised form 10 December 2021 tions across scales. We find that the health issues have been mainly addressed by disciplinary endeavors which
Accepted 10 December 2021
unfortunately will not result in panoramic theories or effective solutions. We recommend focusing on the intri-
Available online 26 December 2021
cate interactions between humans, ecosystems and the environment for developing common theoretical under-
Keywords: standings and practical solutions for safeguarding planetary health, with human health as the key indicator and
Health science endpoint. To facilitate this paradigm shift, a holistic framework is formulated that incorporates disturbances from
Surface earth system inner Earth and our solar system, and accommodates interactions between humans, ecosystems and the environ-
Human environment interactions
ment in a nested hierarchy. An integrative and transdisciplinary health science is advocated along with holistic
Environmental pollution, Sustainable
thinking to resolve our current health challenges and to achieve the health-related sustainable development goals.
development

1. Introduction icant progress has been made, in part, due to more interdisciplinary
research (Orimoloye and Ololade, 2020), however our understanding
Because health is critical to global human population growth and ur- of these relatioships is still inadequate to support effective policies and
banization, human health and environmental health were incorporated practical solutions (Haines, 2016).
in the recent United Nations (U.N.) Sustainable Development Goals As the critical component of the environment, ecosystems support
(SDGs) (Hussain et al., 2020). Human and environmental health are the sustainable development of the world’s economy and human wellbe-
closely related and that makes their safeguarding a complex research ing. At the same time, humans exert significant impacts on ecosystems.
problem and a practical real world challenge (Norris et al., 2016). Re- The highly dynamic and spatially variable interactions between humans
search on the relationships between environmental health degradation and ecosystems and their effects on ecosystem health and human well-
and anthropogenic activities have been increasing since 1990. Signif- being are still not well understood scientifically (Leviston et al., 2018).

✩
Given his role as Editor-in-Chief of this journal, Bojie Fu had no involvement in the peer-review of this article and has no access to information regarding its
peer-review. Full responsibility for the editorial process for this article was delegated to Junguo Liu.
∗
Corresponding author: Prof. Yihe Lü, University of Chinese Academy of Sciences, Beijing 100049, China.
E-mail address: [email protected] (Y. Lü).

https://doi.org/10.1016/j.geosus.2021.12.001
2666-6839/© 2021 The Authors. Published by Elsevier B.V. and Beijing Normal University Press (Group) Co., LTD. on behalf of Beijing Normal University. This is
an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
Y. Lü, D. Lü, G. Gao et al. Geography and Sustainability 2 (2021) 298–303

Climate change and environmental pollution are the most impor-

tant environmental factors that can increase human health burdens. Re-
search on climate change impacts on human health have focused on
four main themes: 1) climate change and infectious diseases; 2) cli-
mate change, food security and human health; 3) causal links among
extreme climate events, mortality and non-infectious diseases; and 4)
relationships between climate change, air pollution, allergies and res-
piratory health (Sweileh, 2020). Anthropogenic greenhouse gas emis-
sions accelerate climate change, such as global warming, and increase
extreme climate events (Power and Delage, 2019). However there is
still a great deal of uncertainty on the impact of climate change on
human health. Therefore, more research is needed on the multidimen-
sional and complex mechanisms facilitating capacity building on the
adaptation and preparedness of climate change-related human health
risks (Sweileh, 2020; Rahman and Zafarullah, 2020). Excessive release
of chemicals from production to waste disposal has been the main cause
of environmental pollution. Polluted soil, water and air increase hu-
man health risks through direct or indirect connection to food webs
(Prabhakar et al., 2012; Tariq et al., 2020). Thus effective and efficient
methods for regulating, monitoring and assessing health risks of chemi-
cals and other environmental pollutants will be critical for safeguarding
Fig. 1. The multidimensional diagnostic framework for human health. human health (Skouloudis and Kassomenos, 2014; Neris et al., 2019).

3. Ecosystem health
Health as one of the fundamental conditions for human wellbeing is
closely connected to ecosystem health (Breslow et al., 2016; Spano et al., The impacts of environmental change and human disturbances have
2020), thus current health challenges require more holistic and transdis- thrust ecosystems into degenerative processes, similar to human health
ciplinary approaches (Spano et al., 2020; Clark et al., 2018). We there- problems. However, they are much more complex than human health
fore analyze the multi-dimensional characteristics of health and propose diagnoses and treatments. Ecosystem health as an academic research
a holistic perspective for research and applications on human health and theme dates back to the 1980s with the concept rooted in the 1940s. But
the environment. We believe this is necessary for advancing transdisci- the theories and methodologies of ecosystem health are still immature.
plinary health science and providing practical solutions for achieving Ecosystem health has been used in the scientific literature (Wiegand
health-related SDGs. et al., 2010) as the conditions and capabilities of ecosystems to maintain
their functions, structures and organizations subject to natural and an-
thropogenic stresses (Rapport et al., 1998; Yang et al., 2019). Therefore,
2. Human health a vigor-organization-resilience (VOR) framework has been formulated
and advocated to mainstream the diagnoses and assessments of ecosys-
Human health has been defined as a state of complete physical, tem health (Costanza, 2012; Rapport et al., 1998). At the same time,
mental and social wellbeing (Brinkel et al., 2009). Using this per- other operational frameworks such as the pressure-state-response (PSR)
spective, we formulate a multidimensional diagnostic framework (see and its various derivatives have also been investigated (Harwell et al.,
Fig. 1) for human health, including three dimensions(social, mental, 2019).
and physical) and eight factors( environment, diet, physical exercise, Research advances have enriched our scientific understandings
work/rest, feelings, thinking, mission, and destination). Of these eight so that ecosystem services are now considered key indicators of
factors, four (feelings, thinking, mission, and destination) belong to per- ecosystem health (Costanza, 2012; O’Brien et al., 2016; Atak and
sonal psychological constructs that can have long-term health effects Tonyaloglu, 2020). Unfortunately, human health issues and their mech-
(Clark et al., 2014). Two (work/rest and physical exercise) relate to be- anistic links with ecosystems have rarely been incorporated into ecosys-
havioral preferences and habits that have long-lasting impacts on health tem service frameworks (Ford et al., 2015). Ecosystems and their
(Atkinson and Davenne, 2007). However the focus of this paper is on the changes can have positive or negative human health effects through
two factors (environment and diet) that are directly relevant to ecosys- ecosystem services or disservices (Myers et al., 2013; Sandifer et al.,
tem and environmental issues. 2015). Typical examples include insect-sting-induced health risks, and
Diet is a bridging factor that connects human health and the en- the effects of green spaces on cardiovascular disease and heat morbidi-
vironment. What people eat and drink come from ecosystems and the ties (Weinstein, 2010; Crespo and Fulford, 2018). To facilitate ecosystem
environment, thus when the environment and its ecosystems are de- and human health management interventions we propose advancing the
graded human health is impacted. Increasing affluence and growing ur- ecosystem health research framework by including human health risks
banization are driving shifts in human diet, diet-related diseases and and outcomes as important indicators for monitoring and endpoints for
environmental degradation resulting in what Clark et al. (2018) termed assessments.
as a “trilemma”. Intelligent selection and use of foods can significantly
reduce disease risks and simultaneously alleviate environmental degra- 4. Environmental health
dation (Clark et al., 2019). Diet choice should consider the triple ben-
efits of the environment, health and cultural acceptability (Yin et al., Environmental health considers the conditions and processes of the
2020a). Diets with a high proportion of processed foodstuffs, can in- environment that impact the health of ecosystems and humans. It is
crease health risks due to chemical additives and plastic packaging ma- hard to define absolute borders between ecosystem and environmental
terials (Groh et al., 2019; Rather et al., 2017; Eskola et al., 2020). A health because ecosystems and the environment are dynamically inter-
cross-disciplinary approach needs to be adopted when assessing and weave into the Earth’s surface systems. For example, soil nutrients and
managing chemicals used in food production to protect and improve disturbance are environmental drivers for the variability of ecosystem
diet-related human health (Dorne and Fink-Gremmels, 2013). properties at the plot scale (Lienin and Kleyer, 2012). Here, we consider

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environmental health as a relative and macroscopic concept constituting and the inner Earth. As Earth has evolved into the Anthropocene, hu-
the context and conditions for ecosystem and human health. The study mans have more power to change ecosystems and the environment for
of environmental health covers the physical aspects of natural and built- resource exploitation and waste disposal, in part due to the continu-
up environments. The components of the physical environment, such as ous advancement of science and technology. Resource exploitation, con-
water, air, soil and chemicals, have been investigated to improve en- sumption and waste disposal activities have undermined the health of
vironmental health (Orimoloye and Ololade, 2020). Scientific evidence ecosystems and the environment, posing challenges for improving hu-
has found that anthropogenic activities cause most of the environmen- man health (Haines, 2016). This is the anthropogenic cascade of health
tal pollution that negatively impact on human populations as well as problems.
consumption-oriented and market-based economies (McKinney, 2019). Disturbances from outer space, such as the anomaly of solar activities
More specifically, resource-exploitive land uses, such as mining, trans- and cosmic rays can bring about changes to ecosystems and the envi-
portation, built-up land expansion and industrialized or intensive agri- ronment and impose increased health burdens on humans (Vieira et al.,
culture, can deteriorate environmental health across various spatiotem- 2018). The Earth revolves around the sun and on its axis dictating daily
poral scales (McKinney, 2019; Caravanos et al., 2013; Emenike et al., and seasonal rhythms in earth surface systems with phenology and the
2020; Grout et al., 2018). At the same time, numerous chemicals and biological clock as typical ones, with subtle and profound implications
material outputs from the industrial processes are alien to the natural on ecosystem and human health. The branch of theory recorded in tra-
environment (e.g., plastics and nanomaterials) and pose serious health ditional Chinese medicine, the theory of “Five Yun and Six Qi” in Huang
risks (Karbalaei et al., 2018; Liu and Xia, 2020; Yuan et al., 2020). Even Di Nei Jing, provides the principles and methods to forecasting human
the pharmaceutical products used to treat diseases of plants, animals diseases resulting from climate change driven by the rhythms of the
and humans can induce pollution and health risks to the environment Earth’s astronomical environment (Zhang et al., 2011; Zhang et al.,
and humans (Simu et al., 2020). 2015; Gocheva et al., 2019).
The smart and effective management of such pollution-contributing Similarly, disturbances from the inner Earth in forms such as earth-
human activities are critical for safeguarding the environmental health quakes and volcano eruptions, damage ecosystems and the environment
that underpins ecosystem and human health. This is still a challenging to a degree that triggers human health problems related to direct dam-
task because it requires multi-sectoral coordination and collaboration age (from earthquakes) and the release of toxic elements (from vol-
of the civil society and effective international cooperation for practical canos) (Gallardo et al., 2016; Linhares et al., 2019; Candeias et al.,
and effective solutions. To facilitate the implementation of this chal- 2022). Some processes of the Earth’s surface systems, such as floods
lenging task, multidisciplinary and transdisciplinary research is a neces- and landslides also negatively impact human health and the environ-
sity that calls for holistic scientific perspectives (Aronson et al., 2016; ment (Kennedy et al., 2015; Dell’Aringa et al., 2018; Aly et al., 2021).
Cannon, 2020). Based on the above analyses, we argue that the expanded holistic
framework (Fig. 2) facilitates open systems thinking on health issues in
5. A holistic conceptual framework the surface arth environment. This open systems thinking can be critical
to finding solutions to health problems for humans, ecosystems and the
As discussed above, ecosystem and environmental health have many environment that have traditionally been considered conceptual chal-
similarities and differences because there is no clear and absolute bor- lenges (Haines, 2016). While health risks brought about by the distur-
der between ecosystems and the environment. The differences between bances from the outer space seem mysterious and difficult to under-
ecosystems and the environment are conceptual and scale dependent. stand, recent research supports the subtle relation between these distur-
Both ecosystem and environmental health point to the status or capabil- bances and human health.
ity of ecosystems or the abiotic environment to support processes and The sun and the moon are probably the most important celes-
functions free of health risks to the organisms, biological systems and tial bodies of the solar system, and they may have important im-
human populations. But there are significant differences in the meth- pacts on the health of the Earth’s living organisms, including humans.
ods and indicators used in assessing and diagnosing ecosystem and For example, solar radiation decreases productivity of rice but in-
environmental health. For assessing ecosystem health, more compre- creases its heavy metal contents (e.g., Cu and Mn; Fang et al., 2021).
hensive frameworks and indicators, such as the classical VOR frame- Solar activity has also been reported to significantly impact ambi-
work (Rapport et al., 1998; Costanza, 2012), and indicators of biolog- ent concentrations of ultrafine particles and bacterial/fungal aerosols
ical, chemical and physical domains have been used (O’Brien et al., affecting human health (Kowalski and Pastuszka, 2018; Vieira and
2016). Environmental health usually targets the physical environment Koutrakis, 2021). Moderate solar ultraviolet radiation exposure is bene-
with soil, water and air as main components to accommodate pollu- ficial to human health, including facilitating vitamin D synthesis, reduc-
tants. Accordingly, indicators of air quality, water quality, environmen- ing blood pressure and maintaining good mental health. In contrast, ex-
tal noise and soil health are usually used in diagnosing environmental cessive solar ultraviolet radiation exposure is harmful to human health
health (Lee et al., 2013; Orozco-Medina et al., 2020). But we haven’t resulting in erythema, photoimmunosuppression, photoageing, photo-
found an integrated framework like the VOR in environmental health carcinogenesis, cataracts and photokeratitis (Juzeniene et al., 2011;
research. The close connections between ecosystem, environmental and Lucas et al., 2019).
human health have been recognized and accepted since the last decade A survey of 4,634 adults (>18) indicated that blood pressure
(Lee et al., 2013; van Bruggen et al., 2019). Therefore, a systems-based tended to correlate with latitude and solar radiation (Cabrera et al.,
approach has been suggested for facilitating actions to reduce health 2016). Furthermore, a statistical analysis also showed that geomag-
risks (Sleeman et al., 2017). netic storms influence vegetative regulation of cardiac rhythms and
A fundamental step for the systems approach is to develop a holistic vascular tones posing risks of cardiovascular system-related diseases
framework for investigating health issues for both humans and the envi- (Gadzhiev and Rakhmatulin, 2013). A higher risk of acute myocardial
ronment (Fig. 2). This framework acknowledges the multi-dimensional infarction was detected to be positively associated with active/stormy
and multi-scale nature of human health issues, ecosystems and the en- geomagnetic activity, solar wind dynamic pressure and solar wind speed
vironment. Humans are a highly active and innovative species em- (Vencloviene et al., 2020). Ten years of monitoring showed that solar
bedded as an integral component of ecosystems in the Anthropocene terms including the spring equinox, the autumn equinox, the summer
(Monsarrat et al., 2019). Both humans and ecosystems depend on the solstice, and the winter solstice were peak times for numerous common
environment for survival and development. Therefore, humans, ecosys- diseases in Beijing (Hao and He, 2017). The analysis of 49,892 cases
tems and the environment exhibit a nested configuration with distur- of out-of-hospital cardiac arrest revealed that 20% of the cases were
bances from outer space (i.e., the earth’s astronomical environment) attributable to solar radiation (Onozuka and Hagihara, 2017). The in-

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Fig. 2. Holistic framework for systematic investiga-

tion on health issues of humans and the environment.
Dashed lines symbolize an open system configuration.

cidence of coronavirus disease 2019 (COVID-19) is also related to solar and the environment that cause their degradation. This can be accom-
radiation (Guasp et al., 2020; Isaia et al., 2021). plished by strengthening ecological and environmental restoration ac-
An investigation on 795 Danish children aged 8 to 11 years indicated tions. For these restorative actions to be realized, a stepwise restoration
that they tended to be less active, sleep longer, have higher blood pres- approach should be adopted that integrates environmental quality im-
sure during the period around a full moon than those during new moon provement, ecological rehabilitation and nature-based restoration. The
and half-moon periods (Sjodin et al., 2015). For mentally ill people, an ecological and environmental diagnoses and the restoration targets can
analysis revealed that those diagnosed with schizophrenia were signifi- be informed by traditional Chinese medicine theories (Gocheva et al.,
cantly impacted by moon phases in three areas of psychopathology and 2019).
one area of quality of life (Barr, 2000). From these cases, we can see that The second step towards improving planetary health involves revers-
health issues are complex and beyond the scope of a single discipline. ing current trends of unsustainable resource consumption patterns and
Transdisciplinary research programs are needed to addressing the technological development (Haines, 2016). More specifically, smart sci-
complexities embedded in the interactions among the various compo- ence, technologies and policies are urgently needed to effectively control
nents of Earth’s surface and the outside disturbances (see Fig. 2). Geo- the production, use and release of chemical, biological, radiological, nu-
logical and geographical sciences can contribute to projecting damaging clear and explosive materials (Trump et al., 2020) that are harmful to
disturbances from inner Earth and the Earth’s surface processes. Astron- human and environmental health. These actions will not happen auto-
omy can provide support to understand the dynamics of significant dis- matically, nor unilaterally. Governments need to take the leading role
turbances from the astronomical environment that can potentially drive for facilitating multi-sectoral and multi-stakeholder collaborations to-
changes in the Earth’s surface environment (Vieira et al., 2018). This wards a healthy and sustainable world (Hussain et al., 2020).
can help society to improve the capacity building for disaster prepared- Many chronic diseases, including cancer and infectious diseases
ness (Haines, 2016) and adaptation for the health-related environmental are connected to ecological and environmental health degradation
changes. (Colao et al., 2016; Hochberg and Noble, 2017; Konduracka, 2019;
Human behavioral, environmental, medical and socio-economic sci- Lewandowska et al., 2019; Yin et al., 2020b). The COVID-19 pan-
ences are indispensable for addressing the health-related issues resulting demic further highlights the difficulty of current and future health chal-
from the interactions between humans, ecosystems and the environment lenges (Zhou et al., 2020). With increasing interactions between hu-
at different spatiotemporal scales. Microplastics and antibiotics are ex- mans, ecosystems, and the environment, due to increasing globaliza-
amples of the health interactions between humans, ecosystems and the tion, health will become more multi-faceted. This urgently calls for
environment. Plastics and antibiotics are produced by humans and re- holistic approaches to advance transdisciplinary-based health sciences
leased to the environment after use as wastes, elevating health risks and collaboration-based actions for improving human health, ecosys-
of humans, ecosystems and the environment (Hernando-Amado et al., tem, and environmental health from local to global scales. Wide partic-
2020; Iossa and White, 2021; Xiang et al., 2022). Transdisciplinary re- ipation and engagement among science, policy, industry, stakeholders,
search could result in more insightful policy and decision-making and communities are necessary for a healthy and sustainable global future.
improved health for humans, ecosystems and the environment.
Collaborations must be enhanced among sectors and stakeholders Acknowledgments
to address mounting health challenges more effectively in the Anthro-
pocene. This is necessary from the holistic conceptual framework and This work was financially supported by the Strategic Priority
transdisciplinary scientific advancement to practical solutions for im- Research Program of the Chinese Academy of Sciences (Grant No.
proving health for humans, the environment and ecosystems. Humans XDA23070201) and The Science-based Advisory Program of the Alliance
are the starting and ending nodes of health-relevant networks in the of International Science Organizations.
Earth’s surface systems from an anthropocentric perspective. Thus, the
regulation of human behavior plays a pivotal role in human, ecosystem Declaration of Competing Interests
and environmental health (McMichael and Butler, 2011; Rainham et al.,
2013). The first step involves smart diagnoses of ecological and envi- The authors declare that they have no known competing financial
ronmental health problems (Liu et al., 2020). The second step involves interests or personal relationships that could have appeared to influence
reducing the intensity and extent of human appropriation of ecosystems the work reported in this paper.

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