The Value of Emerging Public Health Leaders Promoting Environmental Health and Sustainability

Nate Horwitz-Willis, DrPH

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It's well understood that environmental health and sustainability are crucial issues for the well-being of people and the planet. However, we also know that not all communities have equal access to healthy and sustainable environments. Many traditionally marginalized groups, such as indigenous peoples, racial and ethnic minorities, low-income populations, and women, continue to face disproportionate environmental risks and vulnerabilities. These include mounting exposures to pollution, climate change impacts, natural disasters, and environmental degradation. These environmental injustices not only affect the physical health of these communities, but also their social, economic, and cultural rights and opportunities. I will put forward some of the strategies and actions that public health leaders can consider using to advocate for environmental justice and equity in addition to empowering and supporting marginalized communities in their efforts to improve their environmental conditions and quality of life. I will also highlight some of the recent academic sources that provide evidence and guidance for these approaches. I’ll also emphasize the cost-benefit relationship to organizations when public health leaders pursue these strategies, and how they can create value and impact for their stakeholders and society at large. I will also discuss the monetary costs and benefits associated with these strategies, and how they can be measured and evaluated.

There is no single or simple solution to the complex and interrelated problems of environmental health and sustainability. However, through the integration of environmental health and sustainability into public health education, research, and practice emerging public health leaders can adopt some possible strategies and actions to implement that promote environmental health and sustainability.

Aspiring public health leaders should have a comprehensive and holistic understanding of the environmental determinants and consequences of health, and the interconnections between human health and the health of ecosystems. They also need to develop the skills and competencies to assess, monitor, and address environmental health issues, and to design and evaluate interventions that are environmentally sound and socially acceptable. Public health education, research, and practice should incorporate environmental health and sustainability principles and perspectives that foster interdisciplinary and transdisciplinary collaboration among different sectors and disciplines. Some of the recent academic sources that support this strategy are: Schütte et al. (2020), who propose a framework for integrating planetary health into public health curricula; Bowen et al. (2020), who provide a systematic review of the evidence and practice of environmental health interventions; and Horton et al. (2020), who present a manifesto for planetary health and sustainable development. Furthermore, this strategy can generate benefits for organizations, such as improving their knowledge and innovation capabilities, enhancing their reputation and credibility, and reducing their environmental risks and liabilities (Horbach et al., 2012; Schaltegger et al., 2016). However, this strategy also entails monetary costs, such as investing in environmental health education and training, conducting environmental health research and evaluation, and implementing environmental health interventions and practices. These costs can be measured and evaluated by using methods such as cost-benefit analysis, cost-effectiveness analysis, and return on investment analysis, which compare the costs and benefits of different alternatives and assess their efficiency and effectiveness (Drummond et al., 2015; Levin and McEwan, 2001).

Assets - liabilities = Equity. Emerging public health leaders leveraging cost-benefit, cost-effectiveness, and return on investment analyses can get to achieving equitable environmental health outcomes for communities much faster and effectively.

Let’s compare a hypothetical conventional to an environmentally friendly first intervention as one way to illustrate how integrating environmental health and sustainability into public health education, research, and practice can have a positive net cost-benefit, positive net cost-effectiveness, and a positive return on investment for organizations and communities. For instance, suppose that a public health organization wants to reduce the prevalence of malaria in a rural area where the main vector is the Anopheles mosquito. A conventional public health intervention would be to distribute insecticide-treated bed nets to the population, which would reduce the exposure and transmission of the mosquito-borne parasite. However, this intervention would also have some negative environmental impacts, such as contaminating the water sources and soil with the insecticide, harming the biodiversity of the aquatic and terrestrial ecosystems, and possibly increasing the resistance of the mosquitoes to the insecticide. A more environmentally friendly and sustainable intervention would be to introduce larvivorous fish, such as Gambusia or Tilapia, into the water bodies where the mosquitoes breed, which would reduce the mosquito population by acting as a natural predator feeding on the mosquito larvae. This intervention would also have some positive environmental impacts, such as improving the water quality and providing a source of food and income for the local community. The costs and benefits of both interventions can then be quantified and compared by using methods such as the cost-benefit analysis, cost-effectiveness analysis, and return on investment analysis.

According to a cost-benefit analysis, which compares the total costs and total benefits of different alternatives and assesses their efficiency and effectiveness, the environmentally friendly and sustainable intervention would have a higher net benefit than the conventional public health intervention. For example, based on some rough estimates from previous studies (Chandra et al., 2008; Goswami and Oli, 2007; Magesa et al., 2016), we can infer that the total cost of distributing insecticide-treated bed nets to a population of 10,000 people for one year would be around $20,000, which includes the cost of purchasing, transporting, and distributing the bed nets, as well as the cost of monitoring and evaluating the intervention. The total benefit of this conventional intervention would be around $40,000, which includes the benefit of preventing around 1,000 cases of malaria, valued at $40 per case, based on the average cost of treatment and productivity loss. Therefore, the net benefit of this intervention would be $20,000 ($40,000 - $20,000), and the benefit-cost ratio would be 2 ($40,000 / $20,000) to infer a somewhat strong positive impact to the community. On the other hand, the total cost of introducing larvivorous fish into the water bodies where the mosquitoes breed for a population of 10,000 people for one year would be around $10,000, which includes the cost of purchasing, transporting, and releasing the fish, as well as the cost of monitoring and evaluating the intervention. The total benefit of this environmental friendly first approach intervention would be around $60,000, which includes the benefit of preventing around 1,500 cases of malaria, valued at $40 per case, based on the higher efficacy of the fish compared to the bed nets, as well as the benefit of improving the water quality and providing a source of food and income for the local community, valued at $20,000, based on the estimated value of the ecosystem services and the fish production. Therefore, the net benefit of this intervention would be $50,000 ($60,000 - $10,000), and the benefit-cost ratio would be 6 times ($60,000 / $10,000) infering a significant positive impact to the community. Thus, the environmentally friendly and sustainable intervention would have a higher net benefit and a higher benefit-cost ratio than the conventional public health intervention.

According to a cost-effectiveness analysis, which compares the costs and outcomes of different alternatives and assesses their efficiency and effectiveness, the environmentally friendly and sustainable intervention would have a lower cost per outcome than the conventional public health intervention. For example, based on the same estimates from the previous paragraph, the cost per case of malaria prevented by distributing insecticide-treated bed nets to a population of 10,000 people for one year would be $20 ($20,000 / 1,000), while the cost per case of malaria prevented by introducing larvivorous fish into the water bodies where the mosquitoes breed for a population of 10,000 people for one year would be $6.67 ($10,000 / 1,500). Thus, the environmentally friendly and sustainable intervention would have a lower cost per outcome than the conventional public health intervention.

According to a return on investment analysis, which compares the costs and benefits of different alternatives and assesses their efficiency and effectiveness, the environmentally friendly and sustainable intervention would have a higher return on investment than the conventional public health intervention. For example, based on the same estimates from the previous paragraph, the return on investment of distributing insecticide-treated bed nets to a population of 10,000 people for one year would be 100% (($40,000 - $20,000) / $20,000), while the return on investment of introducing larvivorous fish into the water bodies where the mosquitoes breed for a population of 10,000 people for one year would be 400% (($60,000 - $10,000) / $10,000). Thus, the environmentally friendly and sustainable intervention would have a higher return on investment than the conventional public health intervention.

Advocating for environmental justice and equity in policies and decision-making will test your meddle for putting the art and science of public health into effective action as a public health leader.

Public health leaders really do have a moral and ethical responsibility to speak up for the rights and interests of marginalized communities, and to challenge the structural and systemic factors that create and perpetuate environmental inequalities. They can use their expertise and influence to advocate for policies and decisions that protect and promote environmental health and sustainability for all. This can be done while also addressing the root causes of environmental injustice, such as poverty, discrimination, and power imbalances. They can also engage and partner with other stakeholders, such as civil society organizations, media, and policymakers, to raise awareness and mobilize action for environmental justice and equity. Some of the recent academic sources that support this strategy are: Baum et al. (2019), who provide a framework and recommendations for advancing health equity in the context of the Sustainable Development Goals; Holifield et al. (2019), who examine the theories and practices of environmental justice in a global perspective; and Krieger et al. (2020), who analyze the impact of COVID-19 on environmental justice and health equity. Additionally, this strategy can create value and impact for organizations, such as strengthening their social license and legitimacy, building trust and collaboration with stakeholders, and contributing to the social and environmental welfare of the communities they serve (Porter and Kramer, 2011; Schaltegger et al., 2016). However, this strategy also involves monetary costs, such as investing in environmental justice and equity advocacy and communication, partnering and collaborating with other stakeholders, and supporting and implementing policies and decisions that favor environmental justice and equity. These costs can be measured and evaluated by using methods such as social return on investment, social impact assessment, and social value accounting, which estimate the social and environmental value and impact of different actions and interventions, and account for their costs and benefits for various stakeholders (Arvidson et al., 2013; Maas and Liket, 2011; Nicholls et al., 2012).

Empowering and supporting marginalized communities in their efforts to improve their environmental conditions and quality of life is paramount and pivotal. ?

Public health leaders can play a key role in facilitating and strengthening the participation and empowerment of marginalized communities in environmental health and sustainability initiatives. They can do this by respecting and valuing the knowledge, experiences, and perspectives of these communities, and by recognizing and supporting their agency and leadership. They can also provide technical and financial assistance, capacity building, and networking opportunities to these communities by actively helping them access and make effective use of relevant information and resources. Leaders can also collaborate and co-create solutions with these communities to ensure that their voices and needs are heard and addressed. Some of the recent academic sources that support this strategy are: Chaves et al. (2020), who propose a framework for community engagement and empowerment in environmental health governance; Minkler et al. (2020), who provide a comprehensive guide and toolkit for community-based participatory research; and O'Fallon et al. (2020), who discuss the role and benefits of community involvement in environmental health research. Moreover, this strategy can result in positive outcomes for organizations, such as enhancing their responsiveness and adaptability, increasing their social and environmental impact, and creating shared value and mutual benefits with the communities they work with (Hart and Sharma, 2004; Prahalad and Hammond, 2002; Yunus et al., 2010). The monetary costs to consider for implementing this strategy requires investing in community engagement, empowerment processes and tools, providing technical and financial support to community initiatives, and supporting the collaboration and co-creation of solutions with community partners. These costs can be measured and evaluated by using methods such as empowerment evaluation, participatory evaluation, and developmental evaluation, which involve the participation and empowerment of stakeholders in the evaluation process by focusing on the learning and improvement of the initiatives and their outcomes (Fetterman et al., 2015; Patton, 2011; Preskill and Zuckerman, 2003).

Promoting environmental health and sustainability is a vital and urgent task for public health leaders, especially in the context of our evolving global environmental crisis and the post COVID-19 pandemic. However, this task cannot be accomplished without addressing the environmental injustices and inequalities that affect marginalized communities around the world.

Emerging public health leaders have the opportunity and the responsibility to adopt and implement strategies and actions that integrate environmental health and sustainability into public health education, research, and practice. It also has to involve advocating for environmental justice and equity in policies and decision-making while empowering and supporting marginalized communities in their efforts to improve their environmental conditions and quality of life. By doing so, emerging public health leaders can contribute to the achievement of the Sustainable Development Goals and to the vision of a healthy and sustainable future for all. Furthermore, leaders can also generate significant benefits, value, and impact for their organizations, their stakeholders, and society at large that demonstrate how environmental health and sustainability are not only ethical and moral imperatives, but also strategic and competitive advantages. However, its also imperative for emerging leaders to also be aware of the monetary costs and benefits associated with these strategies with the incorporation appropriate methods and tools to measure and evaluate them for ensuring their efficiency and effectiveness.

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*Written with the assistance of AI

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*Written with the assistance of AI