Nino Künzli Comments

Gerding et al. (p. 288) describe the initiative Understanding the Needs, Challenges, Opportunities, Vision, and Emerging Roles (UNCOVER) in Environmental Health. This is a timely effort that addresses needs shared by many countries. The persisting lack of awareness of the environmental health (EH) profession, including its benefits and contributions to public health, is a phenomenon known to many in the public health community. The initiative proposes, among other things, a repository of success stories. Indeed, the EH community may have failed to communicate in this regard in the past.

Success stories could strengthen the field of EH and reduce the risks of delays and workforce reductions. Success stories and related trainings—with a particular focus on “low-hanging fruits”—could assist the UNCOVER initiative in a crucial domain—namely, the adoption of an international, global (or “planetary”) perspective. An expanded perspective also could make EH more attractive for the future workforce. The current initiative maintains a US focus, yet EH needs and challenges have no borders. In fact, EH strategies and policies in the countries with the biggest success stories in EH foster both opportunities for global solutions and prime challenges in EH—namely, an ever-increasing global environmental inequity.¹ This dichotomy is not addressed in the initiative.

The “wealthy North” has glamorous EH success stories to tell. Such stories have created a major risk (also addressed in UNCOVER) that governments reduce the EH workforce, believing that “there is no need for EH anymore.” Northern successes have also contributed to an unacceptable global divide in environmental health—in part caused by the countries with the best EH records. Let me take the example of ambient air pollution, which has the largest environmental health burden,² with enormous potential for success stories.³ Throughout “the North,” air quality is the best it has been in centuries.⁴ The associated improvements in public health are among the biggest and most cost-effective successes of science-based environmental policymaking. However, many lower-income countries in Asia, Africa, and South America not only suffer from much higher levels of air pollution but also have seen their air quality deteriorate over the last decades.⁴

Instead of globalizing and scaling up EH expertise, including related technologies, policy experience, monitoring techniques, and clean air management expertise, the Western world has outsourced pollution to lower-income countries where they produce the goods that guarantee the Western lifestyle.⁵ The lack of environmental policies in lower-income countries makes production (and, thus, pollution) there much cheaper than in the “clean West.” Moreover, wealthy countries are often the cause of dirty businesses elsewhere.

Let me offer just three examples. First, EH strategies in the global North consist of tightening emissions standards for trucks and cars (e.g., requiring particle filters). As a result, heavily polluting second-hand vehicles—and their associated health effects—are exported to the global East and South. Second, a major EH success is a law requiring very low sulfur content in diesel fuel. However, more than 120 countries still neglect this low-hanging policy fruit. For example, globalized Swiss commodity traders with a high market share in Africa integrate the heterogeneity in sulfur regulations into their business model.⁶ They blend more than 40 qualities of diesel. The dirtiest possible is sold to Africa and has a sulfur content up to 630 times higher than that legally allowed in Switzerland. This dirty fuel contributes to extremely high levels of sooty air, with all its related health problems and its effects on climate change. Third, a car maker from Germany—again, a country with an excellent EH record—negotiated with a country in the Middle East to sell trucks without particle filters, knowing that they would cause cancer and other health problems and contribute to climate change for decades.

The world is full of globalized EH scandals that amplify both the global inequity in environmental quality and the need for a well-trained EH workforce that collaborates globally. Such a workforce initiative may also help the World Health Organization overcome one of its biggest challenges, namely that governments largely ignore the proposed science-based air quality standards.⁷ A globalized UNCOVER initiative may strengthen the EH profession and foster EH trainings and capacity building. This is needed to tackle EH inequity not only within our communities and across regions but also on a global scale.