The environment and its impact on mental health

Health is a universal good and right, yet we are not always aware of this concept, and very often, the impact of human activities on health is underestimated or ignored. Environmental factors include air pollution and poor air quality in general that contribute to climate change, which can contribute directly and indirectly to the onset and course of chronic degenerative diseases. The Health-Environment relationship is fundamental and is also at the heart of the 'one health' approach. Numerous physical and chemical agents, both natural and man-made, can cause direct and indirect damage to our organs and systems and their functioning. Climate change contributes to the increase of harmful chemical and physical agents in the environment. Some of them may play a role in causing a number of chronic degenerative diseases such as cancer, diabetes, neurodegenerative and neurodevelopmental disorders. The World Health Organization (WHO) estimates that more than 25% of diseases in adults and more than 33% in children under five are environmental and that about 13 million deaths per year can be attributed to environmental exposures, of which more than 7 million are associated with air pollution alone. We explore this issue with Emiliano Albanese, Professor of Public Health at USI Institute of Public Health, Faculty of Biomedical Sciences.

How much does the state of the environment affect mental health?

It is not easy to quantify the impact of environmental conditions on mental health. It is primarily an indirect but important effect. Mental health has numerous determinants, both positive and negative. They interact with each other throughout the course of life, and some of them are changing rapidly. They include social determinants, inequalities, economic insecurity, urbanisation and anthropisation of land, and environmental threats related to natural disasters co-caused by climate change. It is perhaps more important (and interesting) to ask how rather than how much. 

It has been said that degenerative diseases, including mental illness, are rising. What tools are available in medicine to curb or mitigate this trend?

Few 'mental' disorders are of neuro-degenerative nature. The increase in mental illness in the general population must be addressed first by promoting mental health throughout the course of life, from before birth. And then by investing in prevention, i.e., removing the causes, making timely diagnoses, improving the clinical course, and mitigating the severity of symptoms and their duration, and thus the impact of a disease on, for example, self-sufficiency and mental and physical well-being.

More and more young people and children suffer from anxiety, distress, panic attacks, psychological discomfort. What are the reasons? And what data are available to us in Ticino and Switzerland? Can you draw a picture of the situation?

The increase of an illness (prevalence) may be due to the fact that, compared to the past, a higher percentage of people are falling ill (incidence) but also that the average duration of the illness is extending (duration). It is not easy to measure the prevalence of anxiety disorders or their change over time. Estimates from the Global Burden of Disease (GBD) tell us that globally the impact on disability and reduced life expectancy of anxiety disorders is substantial. Still, it has not increased over the past 10 years. In contrast, some estimates during the pandemic indicate that anxiety disorders have substantially increased compared with the pre-pandemic period. It is not surprising because anxiety disorders are marked by excessive fear and worry that last for several months, and their resulting behaviour. Anxiety is a form of anticipation of a future threat that is overestimated. The pandemic is a tangible and present threat, and the fear is therefore justified. It is unclear whether, how much, and how the pandemic also contributed to a disproportional perception of future dangers or threats. Data from the Corona Immunitas Ticino study show that anxiety symptoms nearly doubled in Ticino (from 4.8 to 8.1%) between August 2020 and May 2021. But changes fluctuate over a few months and vary across age groups. Estimates among youth suggest the presence of predisposing factors and conditions in subgroups of youth and children, on whom social isolation and many other aspects of the pandemic have had a more significant impact than on others. 

How can health and the environment coexist?

From a public health perspective, the answer lies in the Sustainable Development Goals, the United Nations' global 2030 agenda. It is a broad and structured framework within which the objectives of health and well-being (area 3) can and must be placed in direct relation not only with health (area 6) and climate (area 13) but also with sectors and areas of human activity and organisation. Paraphrasing the Latins, we could say that the motto is no longer just "mens sana in corpore sano" (a healthy mind in a healthy body), rather "...in res sanitas" (in a healthy environment). 

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