Rini Dass, B.ScN., M.ScN., Adult-N.P., Ana Hategan, M.D.
 Assistant Clinical Professor, Adult-Nurse Practitioner, McMaster School of Nursing, McMaster University, St. Peter’s Hospital, Hamilton, ON, Canada.
 Clinical Professor, Geriatric Psychiatrist, Division of Geriatric Psychiatry, Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
World Health Organization (WHO) defines health as a state of complete physical, mental, and social wellbeing (Government of Canada, 2010). It does not only represent the absence of disease or disability (Government of Canada, 2010). Health promotion and disease prevention and environmental sustainability are interconnected. An environmentally sustainable health system has the responsibility to conserve natural resources and protect global ecosystems to support health and wellbeing of current and future generations (WHO, 2017). Consumption of energy and other resources, production of greenhouse gas (GHG) emissions, use and disposal of toxic chemicals, and production of medical waste and wastewater are among the major impacts that healthcare can have on the environment (WHO, 2017). There appears to be a positive correlation between health and environment. Healthier the population, lesser disease burden, and lesser waste and impact on the environment. Vice versa, healthier the environment, healthier the population (Fuller et al., 2022).
It is well recognized that pollution is a planetary threat, with impacts on health that transcend local and national boundaries, and that it affects us worldwide (Fuller et al., 2022). Global action on all major modern pollutants including GHGs is needed. An all-hands-on-deck approach to transitioning away from fossil fuels to a clean, renewable energy is an effective strategy for mitigating pollution and slowing down climate change, while benefitting planetary health (Fuller et al., 2022). In this vein, active travel, such as walking and cycling, not only results in fewer GHG emissions that are warming the atmosphere but is increasingly recognized as an important source of physical activity (Pucher et al., 2010). Encouraging such health promotion activities has shown to improve management of many diseases such as diabetes mellitus and cardiovascular health, and decrease rates of premature death, among multiple other health benefits, while also contributing to reducing the environmental pollution (Fuller et al., 2022; Patterson et al., 2020; Pucher et al., 2010).
Personalized preventive healthcare delivering individualized care focused on lifestyle behaviour modification and disease prevention has been found to reduce cost of healthcare due to less disease burden, and subsequently reducing medical waste and improving equity in care (Hughes & Meadows, 2020; Musich et al., 2016). Preventive healthcare is essential at any stage of life. Measures should start as early as childhood. It should be integrated in day-to-day activities in environments such as schools and workplaces. Examples of such measures include adopting a healthy diet, encouraging physical activity, and implementing programs to promote good mental health and wellbeing and, eventually, integrating practices that affect both the overall health and the environment.
Support from government and healthcare leaders is needed to fund programs focused on health promotion and disease prevention, especially on preventable chronic diseases, with an eye on environmental sustainability. Support and funding is needed for more “green space activities” (e.g., walking, cycling, running, playing ball games) in communities, homes, schools, and workplaces. In 2021, hospitals (25%), pharmaceuticals (14%), and physicians (13%) were still the three largest shares of health dollars (over 50% of total health spending) (Canadian Institute for Health Information, 2021). Therefore, it is the hope that implementing programs for health promotion and disease prevention will hopefully decrease this healthcare spending while improving the environmental determinants of health (e.g., air pollution, chemical safety, lack of access to healthcare, poor water quality, climate change and natural disasters).
Canadian Institute for Health Information. (2021). National Health Expenditure Trends, 2021 — Snapshot. https://www.cihi.ca/en/national-health-expenditure-trends-2021-snapshot. Accessed August 29, 2022.
Fuller, R., Landrigan, P. J., Balakrishnan, K., Bathan, G., Bose-O'Reilly, S., Brauer, M., Caravanos, J., Chiles, T., Cohen, A., Corra, L., Cropper, M., Ferraro, G., Hanna, J., Hanrahan, D., Hu, H., Hunter, D., Janata, G., Kupka, R., Lanphear, B., Lichtveld, M., … Yan, C. (2022). Pollution and health: a progress update. Lancet. Planetary health, 6(6), e535–e547. https://doi.org/10.1016/S2542-5196(22)00090-0
Government of Canada (2010). Creating a Healthier Canada: Making Prevention a Priority. https://www.canada.ca/en/public-health/services/health-promotion/healthy-living/creating-a-healthier-canada-making-prevention-a-priority.html. Accessed August 29, 2022.
Hughes, D. L., & Meadows, P. D. (2020). Reducing Medical Waste to Improve Equity in Care. American journal of public health, 110(12), 1749–1750. https://doi.org/10.2105/AJPH.2020.305962
Musich, S., Wang, S., Hawkins, K., & Klemes, A. (2016). The Impact of Personalized Preventive Care on Health Care Quality, Utilization, and Expenditures. Population Health Management, 19(6), 389–397. https://doi.org/10.1089/pop.2015.0171
Patterson, R., Panter, J., Vamos, E. P., Cummins, S., Millett, C., & Laverty, A. A. (2020). Associations between commute mode and cardiovascular disease, cancer, and all-cause mortality, and cancer incidence, using linked Census data over 25 years in England and Wales: a cohort study. Lancet. Planetary Health, 4(5), e186–e194. https://doi.org/10.1016/S2542-5196(20)30079-6
Pucher, J., Buehler, R., Bassett, D. R., & Dannenberg, A. L. (2010). Walking and cycling to health: a comparative analysis of city, state, and international data. American Journal of Public Health, 100(10), 1986–1992. https://doi.org/10.2105/AJPH.2009.189324
WHO (2017). Environmentally sustainable health systems: a strategic document. https://www.who.int/publications/i/item/WHO-EURO-2017-2241-41996-57723. Accessed August 29, 2022.