SPROWT Article | Maricy Vieira

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An Ecological and Sustainable Approach in Public Health

In 50 years, the world’s population has more than doubled, and we’ve gained at least 20 years of life expectancy. The world population was projected to reach 8 billion on November 15, 2022. The latest United Nations projections suggest that the global population may grow to about 8.5 billion by 2030, 9.7 billion by 2050, and 10.4 billion by 2100. This population growth is partly caused by a decrease in mortality levels, reflected in increased life expectancy at birth. Globally, life expectancy reached 72.8 years in 2019, an increase of almost 9 years since 1990. It is predicted that further reductions in mortality will result in an average global longevity of about 77.2 years by 2050.

Therefore, the elderly live longer and with a better quality of life thanks to various achievements in the field of medicine, such as the successful treatment of many types of cancer, improvement in the treatment of chronic diseases, and the decreasing mortality rate of children under 5 with the advent of vaccines.

Undoubtedly, one of the variables with a significant impact on public health was sanitation, access to clean water. Another variable was protecting individuals and preventing the onset of diseases with antibiotics and immunization. Access to information favoring sociobehavioral change and the establishment of important guidelines in public health policies also made all the difference. Therefore, the combination of these variables, from technologies to social changes, increasingly allows us to envision a prosperous and distant future. But is it really?

Have we stopped to reflect on “the price paid” to envision this prosperous and distant future?

We are emerging from a pandemic with vaccines and medications obtained thanks to science, the tireless work of healthcare professionals, and the collective effort of the entire planet; this is indisputable. On the other hand, we are causing an impact on the environment that we have not even been able to measure. Every mask thrown away, every input used, the logistics of ensuring vaccines for remote populations—in short, we have created unprecedented pressure on natural resources. We have reached the point where unsustainability is becoming a threat to human health. The air we breathe, the food we eat, and the water we drink are the basic conditions we need to ensure for our health. And we are not even putting the weight of conflicts, refugee crises, housing losses, poverty, natural disasters, and many other challenges worldwide that devastate community health into this balance.

We know that Public Health has always advocated for health and universal access to it. This has always been the goal of any health strategic plan, from the fight against malaria to the eradication of polio or the cure of a disease. And now, more than ever, it must consider a component that has not always been at the forefront of health programs: SUSTAINABILITY. What I want to emphasize is that sustainability must be considered paramount in any health intervention or program to be planned. A routine example for me, as a pharmacist, was the surplus of paper packaging that needed to be removed from antiretroviral medications before delivering them to patients at a Health Unit Pharmacy. Otherwise, the patient often threw it away, creating a significant impact on cleanliness in the surroundings of the Health Center and their community. Optimizing drug packaging and recycling strategies are essential, especially when we know that the patient will take the medication for life. Another simple and applicable example in our daily lives would be to associate healthy eating with sustainability: reevaluate the recommendation of a protein source (of bovine origin) in the diet not only because of cholesterol and fat intake but also considering the importance of reducing greenhouse gases. At the same time, do not excessively increase the consumption of white meat, keeping in mind the moderate consumption of fish to avoid scarcity. Can we do that?

The challenge is significant, but public health must anticipate and predict what the priorities of action will always be, but without ever disregarding sustainability at every stage outlined in a health promotion program or strategy. And what is our role in this process? Civil society must reorganize in its favor as well, in different spheres, change the short-termist behavior, and be permanent watchdogs of governmental actions to reshape the organizational system of cities. We have to be active members in a process of reeducation and also disseminators of sustainability.

We must be aware that it is not the suffix -itis, of diseases (gastritis, sinusitis, poliomyelitis) that threatens us but rather the prefix -in, of unsustainability! And the remedy for the cure will be the COMMITMENT of each of us to have a promising future.