Developing a modified conceptual model for health impact assessment towards Ecological Public Health

Abstract

Background Methodologies for risk and impact assessment of human and environmental health effects often incorporate the use of conceptual models for problem framing and for the identification and evaluation of interventions. As the understanding of the intricate relationships between human health and the environment grows - particularly with regard to humans as part of ecosystems - the need for integration across scientific and professional disciplines and policy communities increases. Aims Through linking environmental health and ecosystem services, we aim to address inefficiencies introduced by discipline and policy barriers and so foster mutual understanding and improvements to human health and well-being. Methods/Results We propose the “Ecosystem-Enriched Driver-Pressure-State-Exposure-Effect (eDPSEEA) model,” to overcome the fragmentation of scientific disciplines and policy areas. It recognises positive and negative connections between the health of both humans and the environment. eDPSEEA incorporates socio-economic and other contextual modifiers of exposure and exposure-effect relationships, and recognises the importance of feedback-loops, trade-offs, and synergies between actions. As an illustration, we discuss how air pollution effects on human health and wider implications can be addressed using eDPSEEA. Conclusions Using the example of air pollution, we highlight the need to account for second order effects on human health via ecosystem services. Furthermore, we show socio-economic context is vital to account for distributional effects and modifiers for exposure-effect-relationships. We also recognise the potential for positive health and well-being effects (e.g. through green or blue space). Quantifications of effects which omit these positive aspects are potentially misleading, wrongly implying an overall reduction in societal welfare. Also it is vital to considerwhere measures to address an issue may create new problems.