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  • The Sustainable Development Goals can be achieved through en

    2019-05-13

    The Sustainable Development Goals can be achieved through environmental prevention of diseases without an additional burden on resources. The WHO avoidable early environmental exposures initiative emphasises that the unrecognised health risks are most damaging to the human population. An absence of overt developmental abnormalities, however, does not necessarily imply all is well. Recognition of the importance of exposure to hazardous environmental factors should be a core component of the training of health-care professionals. This training should be coupled with primary prevention measures set by governments to protect populations and public education to reduce individual exposure, which are essential to ensure the future health of the global population.
    The vision presented by planetary health is one of holistic harmony of interdependent social, health, and environmental systems, which remain in peril. Whitmee and colleagues identified that the challenges to realising this vision are pervasive and complex, and cannot be addressed independently of each other. Traditional approaches to leadership are increasingly poorly matched to the scope of problems that we face in a globalised world. A new approach to leadership as a next generation comes of age is required to realise planetary health.
    Transitions from rural to urban living are often prompted by promises of increased economic opportunities and cheaper health care, education, and transportation. However, these rural-to-urban transitions are often chaotic. Megacities, defined as rapidly developing urban centres with populations of 10 million or more, present a unique opportunity to study the future of planetary health and how to build a more resilient globe (). By 2030, two-thirds of the world\'s SCR7 will reside in urban areas and there will be 41 megacities, of which over 80% will be in low-income and middle-income countries. Megacities are characterised by substantial cultural, socioeconomic, and racial diversity, as well as environmental heterogeneity. We propose that future comprehensive studies of megacities should move beyond commonly identified single issues to consider the complex health sequelae of the natural and built environmental landscapes. For example, urban-built environments are often poorly equipped to provide stable sources of food for sustaining massive populations. In low-income and middle-income megacities, such as Dhaka, Bangladesh, food shortages and poverty result in increasing food prices and malnutrition. Additionally, many megacity inhabitants exhibit a shift towards more sedentary lifestyles and a western diet, leading to increased body-mass indices (BMIs) and instances of obesity and diabetes. As urban residents transition from diets sustained on home gardens to rely on cheaper, processed foods, lymphatic system are at a greater risk of developing obesity and other non-communicable diseases. Studies in China and Egypt have shown that breast cancer incidences—controlled for screening biases—were substantially higher among urban women than among rural women. This difference in breast cancer incidences is postulated to be caused by increased exposure to xeno-oestrogens from processed foods, and higher BMIs and alcohol consumption in urban areas. Megacities are also linked with increased instances of violent victimisation and gender-based violence. Urban women, in many instances the victims of violence, are at a higher risk of contracting sexually transmitted infections and HIV than their rural counterparts. The increased instances of violence in megacities can also contribute to deteriorating mental health within the population. A mental-health survey of the residents in the metropolitan area of São Paulo, Brazil, found a higher prevalence of mental disorders than that found with similar surveys of residents in non-megacities. Anxiety, mood, impulse-control, and substance-use disorders were all associated with crime-related traumatic events, particularly in women. Augmented violence in megacities results in increased imprisonments, leading to crowded epicentres for disease proliferation that pose a threat to adjacent populations. A study from 2015 reported that urban centres near prisons are at increased risk of contracting tuberculosis strains developed within those prisons. The indirect influence of megacity violence highlights the impact of megacities not only on their inhabitants, but also on the surrounding populations.