This 2020 has led us to reflect on the value of health , a precious heritage that can never be taken for granted. But this does not authorize us to let the other crises that characterize our age, above all the climatic and environmental ones, slip into oblivion . On the contrary: if we find ourselves immersed in a pandemic , it is also because the balance between man and the environment has been broken. We talk about it with Roberto Romizi , president of Isde Italia – Doctors for the environment . 

Authoritative scientific studies claim that the pandemic was also triggered by the destruction of ecosystems. How?

This pandemic is closely linked to this environmental imbalance, urbanization, loss of biodiversity, deforestation, intensive farming and the incorrect relationship between man and animal that has favored the spillover, i.e. the passage of the virus from animal to man. . 

Now rightly we are talking about the ongoing pandemic which, described in medical terms, is an acute or subacute situation that sooner or later we will put under control through a vaccine . But it must not be all-encompassing because environmental criticality must also be taken into account. The climate crisis is the main global threat and, once a certain threshold is exceeded, it becomes irreversible. And there are no vaccines.

She stated that “we cannot go back to the way we did things before”. What is our weak point right now?

International, national and local institutions are at a crossroads . The risk is to return not only to the pre-crisis but to an even worse situation , due to the economic criticalities that will lead to a relaxation of environmental safeguards. 

For example, some politicians are asking for building amnesties, new roads and highways. They mainly focus on technological innovation and on the simplification of administrative procedures to speed up what has not worked so far. 

At the international level, the responsibility for this pandemic, but also socio-environmental and climatic crisis is the current development model . Because this is connected to a linear economy that shifts resources in a very short-term view, aimed at maximizing profits.

Agricultural and industrial cycles are ever faster, more intensive and contaminating, depleting natural and energy resources , compromising soil fertility and biodiversity, increasing waste and pollution. What we call “the great distraction” also has something to do with it : peoples are distracted by fake emergencies. In short, the heart of the problem is the economic-utilitarian approach . 

The current development model is linked to a consumerism determined in turn by incorrect lifestyles and environmental deterioration. These factors have caused not only the coronavirus but also obesity and metabolic, respiratory, cardiovascular, neoplastic, neurodegenerative pathologies . It is all connected to these improper behaviors. 

How should our development model evolve?

We must abandon the linear economy and take the path of the circular economy . In addition to reviewing the development model, it is necessary to reaffirm the policies of the common good and focus on the structural causes of the pandemic, the climate crisis and the environmental crisis, initiating radical change. 

This means, for example, that it is necessary to secure existing infrastructures , redevelop polluted areas , promote urban regeneration, provide for the seismic adaptation of buildings , protect the forest and woodland heritage.

It is essential to take into account the role of young people . The European strategy is called Next Generation Eu, but it seems to me that in this phase the new generations have not been involved enough. The contribution developed by Fridays for future is very valid.

Should the approach to prevention and treatment also need to be rethought?

In the medical world , primary prevention must be encouraged in the environmental and lifestyle fields and public service must be relaunched . Medicine must waste fewer resources and limit the so-called ” health consumerism ” made up of useless tests and inappropriate therapies; it is a cultural question.

Who is responsible for guiding this change?

At the international level, the contribution of the United Nations is fundamental on the climate also in view of COP 26 in Glasgow next year. 

European, national and local governments should act with a view to integration . Integration with respect to the various levels but also to the various issues. They should follow the WHO One Health approach which aims to design programs, policies and research in synergy between various sectors: environment, public health, animal health, agriculture, transport, energy … 

There is also a responsibility on the part of doctors who must become increasingly aware of these aspects of primary environmental prevention. 

Could you mention any significant projects in the medical field?

At the beginning of the year , Isde Italia, FNOMCeO (National Federation of Orders of Surgeons and Dentists), Cipomo (Italian College of Primary Medical Oncologists in Hospital) and Slow Medicine drafted a document to which various scientific societies adhered. 

These realities are committed to identifying, implementing and disseminating good professional practices capable of influencing the general population. Specifically, avoiding waste related to improperly prescribed diagnosis and treatment projects, promoting the good use of sanitary material , ensuring correct exposure to ionizing radiation .

A novelty lies in taking action against the dispersion of pollutants into the environment, particularly in the field of drugs. The concept of ” ecological prescription ” refers to the environmental impact of drugs in the production, distribution, prescription and intake phases and to the analysis of their degree of biodegradability and bioaccumulation. 

Already in the 1990s, Isde, on an international level, had developed a project that had led to the preparation of a handbook that linked each drug to its biodegradability and its possible harmful effects on the environment . For some categories, such as antihypertensives, there are equivalent drugs that are less harmful to the environment than others and should therefore be favored. We are developing a white list based on biodegradability criteria. 

To enter the political level, according to Isde, the public health service and prevention should be financed more by eliminating differentiated regionalism . Another project we are carrying out is the network of sentinel doctors for the environment – RIMSA. 

Among the environmental risks, one of the main is air pollution. In addition to lung cancer, is it also related to other diseases?

Air pollution causes 36% of lung cancer deaths but also 34% of those from stroke and 27% of those from heart disease . Today, over 90% of the world’s population breathes polluted air. 

To have an overview, globalization, industrialization and consumerism lead to two levels of criticality: the social one but also the environmental one , with the increase of dangerous chemicals, the pollution of air, water and soil and the loss of biodiversity. 

All these situations lead to chronic-degenerative, immunological, endocrine, neoplastic diseases, but also reproductive dysfunctions, mental illnesses, etc. If we change the development model, the positive consequences will manifest themselves at all levels, including health care.

Many choices depend on politics and health systems. But what can we, as citizens, do to protect our health?

All citizens can and must do something . Trivially, if everyone moves by car, the administrators will think of solving their problems by building roads and parking lots. If, on the other hand, individuals prefer bicycles and public transport, the opposite will happen. This principle applies to any industry , from clothing to food. 

Citizens certainly have a fundamental role, because they can give a strong message that politics must take note of. It is also true, however, that they cannot do it alone: without regulations, you cannot reach the finish line.

Since primary environmental prevention is particularly difficult, administrations have so far focused on educational campaigns related to smoking, nutrition, alcohol and so on. These are all very right initiatives, but the responsibility for public health cannot be passed on to citizens alone , minimizing that of political decision-makers.