Book Review

Sustaining Life: How Human Health Depends on Biodiversity

N Engl J Med 2009; 360:1578-1579April 9, 2009

Article

Sustaining Life: How Human Health Depends on Biodiversity
Edited by Eric Chivian and Aaron Bernstein. 542 pp., illustrated. New York, Oxford University Press, 2008. $34.95. ISBN: 978-0-19-517509-7

Sustainable health, which mirrors the concept of sustainable development, is about good health for the current generation that does not come at the expense of good health for future generations. This theme is central to Sustaining Life, which illustrates how the management of natural resources and the preservation of biodiversity can sustain health across the globe.

Sustaining Life covers the links between biodiversity and public health. There are chapters on most areas that are involved in efforts to cope with the complex health problems that are linked to degraded ecosystems. Written by top international scientists, the book is rich with scientific evidence of the interdependence of human and ecologic health. The book clearly demonstrates the concept of “ecosystem services” — how intact ecosystems benefit the health and well-being of humans. Selected case studies come from around the globe and include multicultural perspectives.

The book begins with a foreword by ecologist E.O. Wilson and a prologue by former United Nations Secretary-General Kofi Annan. There are valuable appendixes for further reading, including one on treaties, conventions, and intergovernmental organizations that exist for the conservation of biodiversity as well as one on nongovernmental organizations with the same purpose.

Worldwide, approximately 9 million hectares of tropical forests were cleared during the 1990s; at this rate, the world's rainforests could disappear by the end of the 21st century. The importance of forests in the preservation of biodiversity across species is well recognized, but intact ecosystems also provide health benefits for our own species. Malaria, for example, has been associated with changes in land use and resettlement throughout the tropics. In Africa, deforestation promotes a major disease vector — the Anopheles gambiae mosquito. Malaria has also become more widespread in the Amazon region, where deforestation creates suitable breeding sites for A. darlingi mosquitoes.

As natural environments decline, so can our health — particularly the health of communities that depend on the supporting services of intact forests. Sustaining Life covers well the human dimension of the degradation of ecosystems and realistically blurs the distinction between human and nonhuman natural systems, which are inextricably coupled. Trade-offs obviously exist between the short-term profits that can be made through the extraction of materials and the long-term sustainability of communities that rely on the functioning of natural systems.

The challenge is to identify and promote policies that are geared toward the sustenance of both human health and the environment and that benefit the maximum number of people — including people of future generations. (Other species should benefit from these policies as well.) For example, wood products are usually deemed the resource with the highest value in a forest, but would this valuation be the same if all the resources of that forest were recognized? Are plant pharmaceuticals, local food production, sequestration of carbon dioxide, maintenance of biodiversity, cultural value, or the suppression of infectious diseases taken into account? There is growing awareness of the linkages between human well-being and ecosystem services. As part of this growing awareness, the International Association for Ecology and Health was recently established, along with its peer-reviewed scientific journal, EcoHealth.

Sustaining Life blends scientific content with relevant figures and stunning photographs, making the book reader-friendly. Considering the wealth of information in this book, another very attractive feature is its low price, which is likely thanks to the many humanitarian foundations that supported the research that went into it. The book is perfect for undergraduate students in any biologic field, or as supplemental reading for a large number of graduate students in areas ranging from public health and medicine to ecology or biologic sciences. I also highly recommend it for physicians, scientists, policymakers, and the general public.

Jonathan Patz, M.D.
University of Wisconsin, Madison, WI 53726
patz@wisc.edu