Last summer was bad for our health. We breathed hazardous air, watched our rivers dry up, lived in towns without water, suffered through scorching heat with record-breaking temperatures, and many people survived intense experience of fire.
Yet our death records for 2020 won’t record this. Death certificates will reflect the heart attacks or lung failure, the injuries and the organ failure that occur at the end of life. They do not record the environmental factors that contribute to these fatal events.
Human health is complex. At its core there is the biology and science of how our bodies work, and how diseases take hold. It is this biology that we record on death certificates with descriptions such as heart attack, stroke, infection and cancer.
Other factors have a strong influence on health and wellbeing. The social determinants of health – factors like education, economics, geography and relationships – have a deep influence on how diseases progress. This often has a powerful influence on life expectancy.
But despite this strong influence, it is much less often reflected in our mortality data. Doctors are increasingly literate in understanding the consequences of these social determinants, yet they often still see these factors as secondary and not worthy of the same attention.
The natural environment in which we live is the other dominant influence on our health and wellbeing. Temperature, weather and the climate have always affected our health, even as we have become better at building shelters and homes to protect ourselves from the elements.
Visionary physicians including Tony McMichael, Bob Douglas and David Shearman have called for years for environmental factors to be given recognition in our understanding of health and wellbeing. And yet in hospitals and medical practices, we are really only just beginning to appreciate the immense influence of the environment on our health.