Belgium et al. Citation of the article:
this article was cited: 2002. Polyfunctional role of biodiversity in processes leading to water purification: current conceptualizations and concluding remarks. Hydrobiologia. 469: 203–204;
http://5bio5.blogspot.com/2013/05/belgium-et-al-citation-of-article.html
Cited by scientists of 22 institutions: Belgium; Ireland;
Sweden; France; Germany; The Netherlands; Czech Republic
Full text of the cited paper, online free:
http://ru.scribd.com/doc/52627327/
Citation context:
By underpinning certain critical ecosystem
services, biodiversity also plays a role in safeguarding air
quality and access to fresh water (see for example: Rockstrom¨
et al 1999, Ostroumov 2002, Melillo and Sala 2008, Cardinale
2011);
This article was cited in the paper
'Science–policy challenges for biodiversity, public health and urbanization: examples from
Belgium'
by scientists of 22 institutions: Belgium; Ireland;
Sweden; France; Germany; The Netherlands; Czech Republic:
1 Research Institute for Nature and Forest (INBO), Kliniekstraat 25, B-1070 Brussels, Belgium
2 Belgian Biodiversity Platform, Belgium (www.biodiversity.be/)
3 Faculty of Applied Economics, University of Antwerp, Prinsstraat 13, B-2000 Antwerp, Belgium
4 naXys, Namur Center for Complex Systems, University of Namur, 8 rempart de la vierge, B-5000,
Belgium
5 Co-Operation On Health And Biodiversity (COHAB), COHAB Initiative Secretariat, PO Box 16,
Tuam, Co. Galway, Ireland;
6 Biological Control and Spatial Ecology Lab, Universite libre de Bruxelles, CP160/12, ´
50, av FD Roosevelt, B-1050 Brussels, Belgium
7 Federal Public Service Health, Food Chain Safety and Environment, Eurostation II, Place Victor Horta,
40 Box 10, B-1060 Brussels, Belgium
8 Agriculture and Veterinary Intelligence and Analysis (Avia-GIS), Risschotlei 33, B-2980 Zoersel,
Belgium
9
Institute for Housing and Urban Research, Uppsala University, PO Box 514, SE-75120 Uppsala,
Sweden
10 Agency for Nature and Forest (ANB), Koning Albert II-laan 20 bus 8, Graaf de Ferrarisgebouw 1000,
Brussels, Belgium
11 Royal Belgian Institute of Natural Sciences (RBINS), Rue Vautier 29, B-1000 Brussels, Belgium
12 Research Institute for Agriculture and Fisheries (ILVO), Burgemeester Van Gansberghelaan 96 Bus 1,
B-9820 Merelbeke, Belgium
13 Department of Geography, Universite catholique de Louvain, 2, Place des Sciences, ´
B-1348 Louvain-la-Neuve, Belgium
14 DIVERSITAS, c/o Museum National d’Histoire Naturelle, 57 rue Cuvier, CP 41, F-75231 Paris Cedex 05, France;
15 Helmholtz Centre for Environmental Research (UFZ), Permoserstrasse 15, D-04318 Leipzig, Germany;
16 International Centre for Integrated Assessment and Sustainable Development (ICIS), Maastricht
University, PO Box 616, 6200 MD Maastricht, The Netherlands;
17 Division of Agricultural and Food Economics, K U Leuven, Celestijnenlaan 200e—Box 2411,
B-3001 Heverlee, Belgium
18 Laboratory for Tropical and Subtropical Agriculture and Ethnobotany, Ghent University, Coupure
Links 653, B-9000 Gent, Belgium
19 Faculty of Tropical Agrisciences, Czech University of Life Sciences Prague, Kamycka 129,
Prague 6—Suchdol, 165 21, Czech Republic
20 Ecology, Evolution and Biodiversity Conservation Section, K U Leuven, Charles Deberiotstraat
32—Box 2439, B-3000 Leuven, Belgium
21 Military Hospital Queen Astrid, Bruynstraat 1, 1120 Neder-over-Heembeek, Belgium
22 Institute for Environmental Management and Land-use Planning, Universite libre de Bruxelles, ´
Campus du Solbosch, Batiment D—6 ˆ eme niveau, Local DB6.246, Avenue Depage, 30, `
B-1050 Bruxelles, Belgium
This article was cited in:
http://iopscience.iop.org/1748-9326/8/2/025015/pdf/1748-9326_8_2_025015.pdf
Science–policy challenges for biodiversity, public health and urbanization: examples from
Belgium
This article has been downloaded from IOPscience. Please scroll down to see the full text article.
2013, Environ. Res. Lett., 8, 025015
(http://iopscience.iop.org/1748-9326/8/2/025015)
Download details:
IP Address: 188.123.231.45
The article was downloaded on 14/05/2013 at 05:56
Please note that terms and conditions apply.
View the table of contents for this issue, or go to the journal homepage for more
Home Search Collections Journals About Contact us My IOPscienceIOP PUBLISHING
ENVIRONMENTAL RESEARCH LETTERS
(Environ. Res. Lett.) 8 (2013) 025015 (19pp) doi:10.1088/1748-9326/8/2/025015
Science–policy challenges for biodiversity,
public health and urbanization: examples
from Belgium
Hans Kuene:
authors of the paper:H Keune1,2,3,4, C Kretsch5, G De Blust1, M Gilbert6, L Flandroy7,
K Van den Berge1, V Versteirt8, T Hartig9, L De Keersmaecker10,
H Eggermont2,11, D Brosens1,2, J Dessein12, S Vanwambeke13,
A H Prieur-Richard14, H Wittmer15, A Van Herzele, C Linard6,
P Martens16, E Mathijs17, I Simoens1, P Van Damme18,19, F Volckaert20,
P Heyman21 and T Bauler22
Email of some of the authors:
hans.keune@inbo.be
conor.kretsch@cohabnet.org
tbauler (at) ulb.ac.be
1 Research Institute for Nature and Forest (INBO), Kliniekstraat 25, B-1070 Brussels, Belgium
2 Belgian Biodiversity Platform, Belgium (www.biodiversity.be/)
3 Faculty of Applied Economics, University of Antwerp, Prinsstraat 13, B-2000 Antwerp, Belgium
4 naXys, Namur Center for Complex Systems, University of Namur, 8 rempart de la vierge, B-5000,
Belgium
5 Co-Operation On Health And Biodiversity (COHAB), COHAB Initiative Secretariat, PO Box 16,
Tuam, Co. Galway, Ireland
6 Biological Control and Spatial Ecology Lab, Universite libre de Bruxelles, CP160/12, ´
50, av FD Roosevelt, B-1050 Brussels, Belgium
7 Federal Public Service Health, Food Chain Safety and Environment, Eurostation II, Place Victor Horta,4 0 Box 10, B-1060 Brussels, Belgium
8 Agriculture and Veterinary Intelligence and Analysis (Avia-GIS), Risschotlei 33, B-2980 Zoersel,
Belgium
9. Institute for Housing and Urban Research, Uppsala University, PO Box 514, SE-75120 Uppsala,
Sweden
10 Agency for Nature and Forest (ANB), Koning Albert II-laan 20 bus 8, Graaf de Ferrarisgebouw 1000,
Brussels, Belgium
11 Royal Belgian Institute of Natural Sciences (RBINS), Rue Vautier 29, B-1000 Brussels, Belgium
12 Research Institute for Agriculture and Fisheries (ILVO), Burgemeester Van Gansberghelaan 96 Bus 1,
B-9820 Merelbeke, Belgium
13 Department of Geography, Universite catholique de Louvain, 2, Place des Sciences, ´
B-1348 Louvain-la-Neuve, Belgium
14 DIVERSITAS, c/o Museum National d’Histoire Naturelle, 57 rue Cuvier, CP 41, F-75231 Paris Cedex ´
05, France
15 Helmholtz Centre for Environmental Research (UFZ), Permoserstrasse 15, D-04318 Leipzig, Germany
16 International Centre for Integrated Assessment and Sustainable Development (ICIS), Maastricht
University, PO Box 616, 6200 MD Maastricht, The Netherlands
17 Division of Agricultural and Food Economics, K U Leuven, Celestijnenlaan 200e—Box 2411,
B-3001 Heverlee, Belgium
18 Laboratory for Tropical and Subtropical Agriculture and Ethnobotany, Ghent University, Coupure
Links 653, B-9000 Gent, Belgium
19 Faculty of Tropical Agrisciences, Czech University of Life Sciences Prague, Kamycka 129,
Prague 6—Suchdol, 165 21, Czech Republic
20 Ecology, Evolution and Biodiversity Conservation Section, K U Leuven, Charles Deberiotstraat
32—Box 2439, B-3000 Leuven, Belgium
21 Military Hospital Queen Astrid, Bruynstraat 1, 1120 Neder-over-Heembeek, Belgium
22 Institute for Environmental Management and Land-use Planning, Universite libre de Bruxelles, ´
Campus du Solbosch, Batiment D—6 ˆ eme niveau, Local DB6.246, Avenue Depage, 30, `
B-1050 Bruxelles, Belgium
H Keune1,2,3,4, G De Blust1,
K Van den Berge1, D Brosens1,2,
I Simoens1,
Research Institute for Nature and Forest (INBO), Kliniekstraat 25, B-1070 Brussels, Belgium info@inbo.be
M Gilbert 6, C Linard 6,
Biological Control and Spatial Ecology Lab, Universite libre de Bruxelles, CP160/12, ´
50, av FD Roosevelt, B-1050 Brussels, Belgium webmaster@ulb.ac.be
Content from this work may be used under the terms of the Creative Commons Attribution 3.0 licence. Any further distribution of this work
must maintain attribution to the author(s) and the title of the work, journal citation and DOI.
C19$33.00 11748-9326/13/025015
c 2013 IOP Publishing Ltd Printed in the UKEnviron. Res. Lett. 8 (2013) 025015 H Keune et al
E-mail: hans.keune@inbo.be
Received 2 January 2013
Accepted for publication 5 April 2013
Published 9 May 2013
Online at stacks.iop.org/ERL/8/025015
**
Abstract
Internationally, the importance of a coordinated effort to protect both biodiversity and public
health is more and more recognized. These issues are often concentrated or particularly
challenging in urban areas, and therefore on-going urbanization worldwide raises particular
issues both for the conservation of living natural resources and for population health strategies.
These challenges include significant difficulties associated with sustainable management of
urban ecosystems, urban development planning, social cohesion and public health. An
important element of the challenge is the need to interface between different forms of
knowledge and different actors from science and policy. We illustrate this with examples from
Belgium, showcasing concrete cases of human–nature interaction. To better tackle these
challenges, since 2011, actors in science, policy and the broader Belgian society have launched
a number of initiatives to deal in a more integrated manner with combined biodiversity and
public health challenges in the face of ongoing urbanization. This emerging community of
practice in Belgium exemplifies the importance of interfacing at different levels. (1) Bridges
must be built between science and the complex biodiversity/ecosystem–human/public
health–urbanization phenomena. (2) Bridges between different professional communities and
disciplines are urgently needed. (3) Closer collaboration between science and policy, and
between science and societal practice is needed. Moreover, within each of these communities
closer collaboration between specialized sections is needed.
Keywords: biodiversity, ecosystem services, public health, urbanization, science–policy
interface, community of practice, complexity
1. Introduction
The major challenges facing humanity in the 21st century
are closely interlinked and increasingly globalized. At local,
regional and global scales the crises in health, food and
nutrition security, water, energy, climate change, biodiversity
loss and poverty frequently overlap in both root and proximate
causes, in their various impacts, and in terms of the policy
and practical approaches needed to address them and to effect
sustainable long term solutions (e.g. UN 1992, McMichael
1993, MA 2005, Dreher et al 2008). Walker et al (2009) have
highlighted deficiencies in global institutional approaches
to these issues, and have called for greater collaboration
and cross-linking between actors in civil society, business
and governance, supported by greater ‘local appreciation of
shared global concerns’. This is a fundamental challenge
for sustainable development, demanding improved dialogue
between sectors and the integration of perspectives, policies
and strategies between social, environmental, economic and
cultural arenas, and creation of new institutional frameworks.
Against this background the linkages between the
biosphere and human health and well-being have become
of increasing importance in international science and policy
in the past two decades, with new interdisciplinary and
‘transdisciplinary’ fields emerging to address the gaps in
knowledge and action based on ecosystem approaches
to health (or ecohealth), (e.g. Lebel 2003, de Plaen
and Kilelu 2004). This includes the concepts of One
World, One Health (Wildlife Conservation Society) and
conservation medicine, and initiatives such as the EcoHealth
Alliance (EcoHealth Alliance), Co-operation on Health,
and Biodiversity (COHAB) and the DIVERSITAS ecoHealth
project (DIVERSITAS ecoHealth). These approaches build
on the concept of the ecosystem approach to biodiversity
conservation promoted by the UN Convention on Biological
Diversity (CBD), which aims to account for the interactions
between various levels of biological complexity and
recognizes that ‘humans, with their cultural diversity,
are an integral component of ecosystems’ (CBD COP
Decision V/6); as such, ecosystem approaches to health
are systemic approaches to population health that recognize
intimate links between the health of the biosphere and the
health of human communities, and frequently incorporate
perspectives of ecology, human and veterinary medicine,
agriculture, economics, sociology, and aspects of risk
assessment, engineering, and conflict resolution. To date
much of this work has, for the most part, been led from
within the environment and conservation biology disciplines,
fronted by environmental research institutes and NGOs,
and intergovernmental environmental agencies, frequently
building on the findings of the Millennium Ecosystem
Assessment (MA) (MA, MA 2005, Hales et al 2004, Hales
and Corvalan 2006) and related processes. However, as
2Environ. Res. Lett. 8 (2013) 025015 H Keune et al
the science on these issues has progressed, so too has the
understanding within the medical science and healthcare
community of how major public health issues and emerging
health threats may be associated with global environmental
change, and how interactions with ecological systems affect
disease risks, health outcomes and the efficacy of public health
management strategies (see for example Dobson and Carper
1993, Soskolne and Bertollini 2002, WHO 2005, Chivian and
Bernstein 2008a, WHO 2011).
In 2000, a commentary in The Lancet medical journal (as
part of a special series on future health challenges) highlighted
the many challenges facing healthcare in the new century,
arguing that partnerships with actors outside of the health
sciences would be critical, and calling for commitment to
‘a broader view of public health, and to values of equity
and ecological sustainability’ (Beaglehole and Bonita 2000).
The constraints to such systemic and cross-sector approaches
are numerous and complex. These include cultural, resource
and political barriers, knowledge gaps, and differing temporal
scales of operation. Campbell-Lendrum (2005) identified
three core difficulties that hinder such engagement by the
health sector on environmental issues—a lack of awareness
of the relevance to health, a methodological approach
focused on discrete cause–effect relationships rather than
systemic issues, and little input to processes addressing the
environmental root causes of health problems. Therefore,
realizing these approaches requires development of a strong
evidence base, a mutual understanding of perspectives
between sectors, common frameworks for assessment, and
practical collaborative strategies based on an appreciation
of shared risks and opportunities. The concept of ecosystem
goods and services(referring to the benefits which ecosystems
provide to society, and often considered together simply as
ecosystem services) has been important in helping to bridge
these gaps, and serves as a framework on which to build
ecosystem approaches to health and well-being. In particular,
the outputs of the MA have helped to conceptualize the
links between ecosystem services and well-being (Alcamo
et al 2003, MA 2005), highlighting current knowledge,
identifying risks of ecosystem change, and suggesting areas
for future research. Whilst the precise relationship between
biodiversity and the delivery of ecosystem services is not
always clear and is often contentious, not least in terms of
the precise connections between biodiversity and services
relevant to health, in a general sense it is widely accepted
that biodiversity is important for the key traits of resistance
and resilience in ecological systems and as such underpins
ecosystem services (CBD 2010). Although the attribute of
‘diversity’ is not necessarily essential to the delivery of
certain ecosystem services in every scenario—for example,
a monoculture forest plantation might perhaps supply as
much or more timber as a native mixed woodland of similar
size—diversity helps to secure the sustainability and flow
of multiple ecosystem services, and supports adaptation
to environmental change (that same monoculture might be
more susceptible to disease or drought, and provide less
in terms of other services such as pollination and food
resources; see for example Gamfeldt et al 2013). Whilst still
a very young and evolving field, the study of ecosystem
services is progressing rapidly, with particular attention paid
in recent years to the economic aspects of ecosystems,
and the economic policy implications of ecosystem change
and biodiversity loss. This has included global assessments
(TEEB 2011) as well as regional and national scale studies
including several within Europe (e.g. Bullock et al 2008,
Ticker et al 2010; Bateman et al 2011, ten Brink et al
2011). In contrast, despite the growing awareness of linkages
between biodiversity, ecosystem services and public health,
the health dimension remains comparatively undervalued in
policy and practical contexts, even within recent economic
studies (the above referenced works, for example, pay little
attention to economic aspects of biodiversity-related health
issues, though Bateman et al (2011), for the UK National
Ecosystem Assessment, attempt to link the two fields for some
health issues).
However, in recent years there have been some significant
developments in international policy and in local, regional and
global responses towards the integration of biodiversity and
human health. In 2010, the 10th Conference of the Parties
(COP) to the Convention on Biological Diversity adopted a
decision mandating direct interaction between the Secretariat
of the Convention and the World Health Organization (CBD
COP Decision X/27), committing for the first time to forging
a partnership with the WHO. Also, in outlining a new strategy
for the period 2011–2020, the COP urged that National
Biodiversity Strategies and Action Plans should work to
enhance the contribution of biodiversity to human health and
well-being. Further decisions to build upon this action were
taken at the 11th CBD COP meeting in 2012. That year also
saw the links between health and biodiversity recognized at
the Rio C20 UN Conference on Sustainable Development,
where a discussion document titled Our Planet, Our Health,
Our Future (jointly prepared by WHO and the secretariats of
the three Rio Conventions—the CBD, the UN Convention to
Combat Desertification and the UN Framework Convention
on Climate Change) was presented by the WHO Director
General Margaret Chan, highlighting the links between global
environmental agreements and global health concerns (WHO
2011). The same year, the UN-mandated Intergovernmental
Platform on Biodiversity and Ecosystem Services (IPBES)
was launched, with a specific remit of strengthening the
science of biodiversity and ecosystem services and their
importance to human well-being, including health, in order
to facilitate informed decision making in environmental,
economic and social policy. However, the involvement of the
health sector in progressing sustainable development is still
poor (Langlois et al 2012); critically, leadership from global
institutions such as the World Health Assembly, to promote
dialogue with the biodiversity sector and greater integration
of health and biodiversity concerns from local to regional
levels, is lacking (COHAB 2010). Clearly, many barriers to
mainstreaming an ecosystem approach to health remain.
In this paper we illustrate the challenges of integrating
efforts to address problems involving biodiversity, public
health and urbanization. To do this, we take examples from
Belgium, one of the most densely populated and urbanized
3Environ. Res. Lett. 8 (2013) 025015 H Keune et al
countries in the world. Going on, we discuss an emerging
community of practice in Belgium. Since 2011, actors in
science, policy and the broader Belgian society have launched
a number of initiatives to deal in a more integrated manner
with combined biodiversity and public health challenges in
the face of on-going urbanization. First, though, we provide
additional background on the interfaces among these sets of
challenges.
A note on definitions: Arriving at a precise definition for
biodiversity that can meet the current range of scientific,
economic and policy needs has proved difficult, compounded
by the fact that much of the world’s biodiversity has yet
to be discovered or described (e.g. Swingland 2001, Feest
et al 2010). In this paper, we follow the definition provided
in the text of the UN Convention on Biological Diversity
(CBD) and now widely accepted and used in policy contexts,
i.e. the variability among living organisms from all sources
including inter alia terrestrial, marine, and other aquatic
ecosystems and the ecological complexes of which they
are a part, including diversity within and between species,
and of ecosystems. We also acknowledge recent debate on
what constitutes a useful definition of health. The widely
utilized definition from the Constitution of the WHO is ‘a
state of complete physical, mental and social well-being,
and not merely an absence of disease or infirmity’; some
commentators have questioned whether this definition is still
sufficient in an increasingly globalized world and in the face
of pervasive human impacts on the global environment, and
have advocated that the definition should also account for the
ability to adapt to health challenges (e.g. Lancet 2009, Huber
et al 2011). This focus on adaptation has strong correlations
with the concept of ecosystem health, with its notions of
resistance and resilience (Costanza 1992, Rapport et al 1998),
and can be particularly useful in terms of understanding the
importance of biodiversity to sustaining health and well-being
in the context of global change.
1.1. Biodiversity and public health
According to McMichael (2009), ‘Human population health
should be the central criterion, and is the best long
term indicator, of how we are managing the natural
environment’. Environmental philosophers and others may
question the valuation of human life over all other life in
this assertion, as well as the implicit assumption that ‘we’
can truly manage the natural environment. Human population
health nonetheless is an important criterion for efforts by
institutional and other actors to guide human action in
the natural environment. Whereas human health and social
well-being were once largely seen as an aim and outcome
of economic growth, today they are more broadly understood
as a prerequisite and fundamental principle of sustainable
development (McMichael 2002, 2006, von Schirnding 2002,
Martens 2002).
New types of diseases and public health issues have
appeared in the last century, including the emergence or
re-emergence of pathogens, new environmental hazards and
increased risks of natural disasters, and changes in food
regimes. The WHO has estimated that one quarter of the
global burden of disease in humans, disproportionately felt
in the developing world, is due to environmental change
(Pruss- ¨ Ust ¨ un and Corval ¨ an´ 2006). The MA synthesis report
for the health sector (WHO 2005) outlines several linkages
between ecosystems and health, providing a review of the
health implications of ecosystem changes identified in the
MA, and the actions required to address these.
However, the links between biodiversity and human
health are varied and complex and not always certain.
Some clear linkages can be demonstrated, for example
the importance of biodiversity to traditional and modern
medicinal practice, and the utility of various species for
medical research, as sentinels of emerging health risks, and
as models for investigating human disease (Harvey 2008,
Newman et al 2008, Tabor and Aguirre 2004, Chivian
and Bernstein 2008b, Cox 2009, Li and Vederas 2009).
Genetic and species diversity is also the cornerstone of food
production, and can play an important role in addressing
issues of nutrition security including certain disease risks
(e.g. obesity, diabetes and other diseases of affluence)
through dietary improvements (Wilby et al 2009, Johns 2003,
Frison et al 2006, Toledo and Burlingame 2006, Hillel and
Rosenzweig 2008, Burlingame et al 2009, Burlingame and
Dernini 2012). By underpinning certain critical ecosystem
services, biodiversity also plays a role in safeguarding air
quality and access to fresh water (see for example: Rockstrom¨
et al 1999, Ostroumov 2002, Melillo and Sala 2008, Cardinale
2011); and plays a role in disaster risk reduction and
in supporting the response to emergencies and climate
change adaptation (Sudmeier-Rieux et al 2006, Colls et al
2009, Parmesan and Martens 2009). Furthermore, diversity
of life in natural environments may enhance experiences
that promote stress reduction, support the development of
cognitive resources, stimulate social contacts, attract people
for physical activity, and support personal development
throughout an individual’s lifespan (Kaplan and Kaplan 1989,
Kellert 2008, Skevington 2009, Hartig et al 2011). Moreover,
recent studies show that declining (contact with) some forms
of life may contribute to the rapidly increasing prevalence
of allergies and other chronic inflammatory diseases among
urban populations worldwide (Rook 2010, von Hertzen et al
2011, Hanski et al 2012). Biodiversity thus can have an
important contribution to both public health related ecosystem
services and in reduction of health risks.
One area of intense scrutiny is the relationship between
biodiversity and infectious disease, and how ecosystem
change and biodiversity loss may affect the ecology of disease
organisms and the dynamics of pathogen–host interactions.
The emergence and spread of certain pathogens from wildlife
to livestock and/or humans, and related social and economic
costs, has been well documented—these diseases include
HIV, hanta virus, avian influenza, Lyme disease, malaria,
Dengue fever, Leishmaniasis, Nipah virus and Ebola (Peixoto
and Abramson 2006, Molyneux et al 2008, Marsh Inc.
2008, Thomas et al 2009, Lindgren et al 2012). Several
studies have determined that biodiversity reduces the risk
of infectious disease emergence or spread, while its loss
4Environ. Res. Lett. 8 (2013) 025015 H Keune et al
or unsustainable exploitation can increase such risks (e.g.
Pongsiri et al 2009, Keesing et al 2010, Johnson et al
2013). The dynamics, however, are complex and probably
system-dependent, and high biodiversity does not necessarily
reduce disease risk in all situations (e.g. Randolph and
Dobson 2012, Kilpatrick and Randolph 2012). Nevertheless,
land-use change and ecosystem disruption are well recognized
factors influencing disease emergence. In a study examining
incidences of disease emergence worldwide, Jones et al
(2008) established that there has been an increase in disease
emergence and an increasing prevalence of zoonotic diseases
since 1940. They also established that areas of likely high-risk
for novel emerging infectious diseases correlated with areas
of high biodiversity, and with areas of high human population
density. Another issue associated with population density is
the significant health threat posed by antimicrobial resistance.
Amongst the risk factors for emergence of resistance is
pollution from agriculture and from urban areas. Drug
resistant organisms present in the environment can be picked
up and carried by wildlife and by feral animals, potentially
increasing human health risks in urban areas (e.g. Radimersky
et al 2010, Allen et al 2010).
Whilst providing a compelling public health incentive
for collaboration, the importance of biodiversity to health
also presents an important argument for nature conservation.
Chivian and Bernstein (2008a) have reasoned that the
human health dimension—which impacts widely on social,
economic, cultural and environmental arenas—represents a
significant opportunity to push for more effective public and
political engagement in conservation. This also, by extension,
presents a significant opportunity for sharing of ideas and
resources across sectors, with the potential for integrated
policies and strategies that can more effectively achieve and
sustain multiple goals. From the perspective of adaptation,
the loss of biodiversity, by affecting the sustainability and
flow of ecosystem services, can be said to limit our capacity
to adapt to future health challenges, whether they arise from
novel pathogens, emerging non-communicable disease threats
or natural hazards, whilst its conservation and sustainable use
may be seen as an insurance policy against such challenges.
1.2. The interplay between biodiversity, public health and
urbanization
Whilst the root causes of ecosystem change impacting on
health are varied, population growth and related demand for
land and natural resources are certainly primary amongst
them. The related on-going trend towards urbanization
worldwide makes the challenge of linking biodiversity and
public health even more difficult, and presents certain unique
challenges for science and governance. Urbanization has
significant impacts on biodiversity (Rees 1997, Barton and
Grant 2006, Seto et al 2012), an issue which receives specific
focus at the CBD COP meetings and other policy arenas;
(de Oliveira et al 2010, EEA 2009), with suggestions that
more than 60% of the area projected to be under urban
infrastructure by 2030 has yet to be built (CBD 2012).
Cities and other densely populated urban areas are net
Figure 1. The ‘settlement health map’. Reproduced with
permission from Barton H and Grant M 2006 A health map for the
local human habitat J. R. Soc. Promot. Health 126 252–3. See also
Dahlgren G and Whitehead M 1991, version published in
Whitehead M 2005 Tackling inequalities: a review of policy
initiatives Tackling Inequalities in Health: An Agenda for Action
ed M Benzeval, K Judge and M Whitehead (London: Kings Fund).
importers of ecosystem services—e.g. for food, water, and
for assimilation of wastes including emissions associated
with climate change. Urbanization has been described as
both inherently unsustainable and the greatest opportunity for
sustainable development (Rees and Wackernagel 2008)—so
how can both nature and human well-being be sustained when
more and more people live in cities placing increasing demand
on finite living resources (see also Soskolne and Bertollini
2002, Stephens 2012)? What conceptual frameworks should
be utilized to connect the range of disparate disciplines
involved whilst also accounting for various societal choices
and cultural diversity within urban areas?
By 2035 a majority of people on all settled continents
are expected to live in urban areas, due to greater
migration inwards and the physical expansion of those
areas to accommodate natural outward growth (United
Nations Population Division 2010). The links between human
settlements and public health are of long standing interest in
land use planning and social policy (see figure 1), though it has
been argued that these linkages have been largely overlooked
by planning systems and related health and environmental
assessments in recent decades (Barton and Grant 2006, Barton
2009, Carmichael et al 2012). Similar to Campbell-Lendrum’s
reasoning (2005), Barton (2009) contends that the reasons
for this include the failure of planning systems to consider
the perspectives of public health practitioners, and a lack
of engagement of public health practitioners in planning
policy. Therefore, considering the current and projected future
rates of urbanization and migration to cities, the specific
dependences of urban communities on external biodiversity
and the impacts which urban biodiversity can have on the
5Environ. Res. Lett. 8 (2013) 025015 H Keune et al
health of urban citizens, the need for an integrated approach
to the development and management of urban infrastructure,
including living natural resources, is pressing. The concept
of ‘green infrastructure’ (the managed and unmanaged
biodiversity within urban areas that may provide ecosystem
services) has emerged as an attempt to help address this point.
This field has evolved rapidly with significant developments
in concept and practice in recent years, including efforts to
ensure that urban green spaces contribute to improving human
health, e.g. through improved water quality management
associated with sustainable drainage systems, by providing
opportunities for recreation and social interaction, as well
as through development of urban food gardens (Bolund and
Hunhammar 1999, Tzoulas et al 2007, Wittmer et al 2012,
Niemela¨ et al 2011, Grant 2012).
1.3. Scientific challenges
Whilst the need for integrating biodiversity and ecosystem
approaches into the health sector is evident, it is equally
important that the biodiversity sector for its part recognizes
the potential impacts—positive and negative—of conservation
policies and activities on human well-being. Lyytimaki and
Sipila (2009) have argued that it may be counterproductive
to frame ecosystem services for green planning and
management only in positive terms, without paying due
attention to negative impacts—or ecosystem disservices—that
biodiversity may produce in urban areas. For example, pollen
spreading from urban vegetation may trigger distress in some
with allergies, whilst urban tree planting can cause nuisance
e.g. with damage to infrastructure caused by invasive roots.
It may be argued, however, that these concerns are not
necessarily a result of diversity per se, and may be an outcome
either of specific choices in the design or management of
urban areas and/or their green infrastructure (comprising
as they do entirely artificial ecosystems), or simply a
consequence of exposure to inherent natural nuisances not
unique to urban areas. Regardless, habitat management
in urban areas should take into account both ecosystem
services and potential nuisances and consider trade-offs where
appropriate.
Interdisciplinary science can provide options for such
management, and society at large can then take informed
decisions in choosing among those options. Ernstson (2013)
states that these decisions must also account for issues of
social justice—e.g. the need to ensure equity in decision
making, accounting for varying costs and benefits of urban
resource management that may be experienced by different
urban communities—and has highlighted issues of conflicting
societal choices in terms of how urban ecosystems and
associated benefits may be valued. Cutts et al (2009) have
also highlighted the issue of equity and justice in terms of
access to urban ecosystem services. Considering how specific
patterns of urban design can restrict access to ecosystems that
may support health, or make their availability more important,
this is surely another important dimension to be addressed.
Additional scientific research will inevitably be needed
to better understand the interplay between urbanization,
biodiversity and public health. For example, knowledge
about how urban landscapes affect the interaction between
wildlife and pathogens is not well established (Bradley and
Altizer 2007); and though the value of green care approaches
to public health are more and more investigated, the
effectiveness of green care interventions is still controversial
(Sempik et al 2010). Addressing these challenges will require
further research, greater use of conceptual models that cross
disciplinary agendas (e.g. figure 1), and greater involvement
of practitioners in urban planning and associated assessments.
1.4. New institutional science–society arrangements
Whilst there are specific barriers that hinder the natural
cross flow of ideas between various scientific disciplines
concerned with health-biodiversity linkages, there are also
particular issues at the interface of science and public policy.
How should scientific assessments be translated into effective
public policy? How should societal choices account for issues
of scientific complexity and uncertainty? How can valuation
methodologies (e.g. of the importance of biodiversity to health
and well-being) account for differing cultural perspectives,
differing policy goals, and a variety of potentially conflicting
community needs? The challenge at the science–society
interface consists in developing adequate interfaces, but also
in dealing with its intrinsic complexity as a social interface.
Long (2001) defines a social interface as ‘a critical point
of intersection between different life worlds, social fields
or levels of social organization, where social discontinuities
based upon discrepancies in values, interests, knowledge
and power, are most likely to be located’. Interfaces lead
to realities that have to be recognized as complex by
practitioners, scientists, policy makers and funding bodies.
According to Ernstson et al (2010a), not only does the
scientific understanding of urban ecosystem services need
further development, but so also do the governance aspects:
‘In contrast to other urban services like medical care and
public transport, there has been a deep neglect of research
and theorization regarding the governance of ecosystem
services in urban landscapes’. There is an urgent need for
multi-scale and multi-actor collaboration as it concerns a
complex process in which ‘no actor, or set of actors, can
have full knowledge or full control’ (Ernstson et al 2010b).
This requires experts to take up another role in relation to
policy making, to leave their comfort zones as data and
knowledge providers, and to become ‘connective actors across
scales and sectors’, a process which also requires incentives
from funding agencies to allow scientists to shift focus
from traditional scientific routines to more practice-oriented
collaborative research. Ernstson et al (2010b) refer here to
developments in modern governance, in which traditional
science ‘speaking truth to power’-approaches (Jasanoff 1990)
are no longer the only option for addressing complex societal
sustainability challenges.
An important aspect of ecosystem governance and a
strong rationale for the further development of science–policy
interfaces is the need for policy to incorporate different types of knowledge in decision-making processes.
6Environ. Res. Lett. 8 (2013) 025015 H Keune et al
A ‘science–policy interface’ (SPI) can be defined as: ‘relations
between scientists and other actors in the policy process which
allow for exchanges, co-evolution, and joint construction of
knowledge with the aim of enriching decision making’ (Van
den Hove 2007, Sarkki et al 2012). The most prominent
example in the field of biodiversity is the current institutionalization of the IPBES. There has been some concern that the
range of knowledge and stakeholders in these international
efforts should be broadened to include voices outside of
strict boundaries of peer-reviewed science and policy making
communities—what Turnhout et al (2012) in a comment in
Nature referred to as ‘elite actors, from natural scientists to
national governments’—to reflect (for example) experiences
and knowledge from local and indigenous communities
and other local actors from non-environment sectors. Such
concern raises questions regarding value judgements and
the role of science in policy making, and connects to
issues highlighted by Lang et al (2012) and Ernstson
(2013)—e.g. how do we address differences in perspectives
on the value of natural assets between communities? How or
to what extent do we consider lessons or perspectives from
local knowledge if they are not verified by scientific methods?
And how far should science go towards supporting specific
values? Addressing such questions requires new approaches
to knowledge sharing, and development of frameworks for
open dialogue that promote mutual understanding of various
concerns, drivers, values and needs. Centring the dialogue
on the concept of human health and well-being, supported
by more robust science on the linkages between biodiversity
and health, may be one important means of addressing these
issues.
Adaptive co-management (Armitage et al 2007, 2008)
is a new example of governance related to ecosystem
management. The core idea of adaptive co-management is
that ecological and social complexity make it difficult if
not impossible to identify a priori ‘the’ best management
approach. Learning by doing is crucial in adaptive comanagement, as are experimenting and adjusting management
practice based on experience and knowledge gained along
the way. In addition, adaptive co-management favours the
inclusion of multiple actors.
2. The example of Belgium
Nature conservation presents huge challenges in a country
like Belgium, because of its complicated governmental
policy landscape (appendix A), but especially because of
its extensive urbanization. Belgium has one of the world’s
most dense road networks, and it is in the top 30 of
most densely populated countries (United Nations Population
Division 2010). High urbanization rates pose several different
challenges to biodiversity and public health, particularly
regarding infectious diseases, as illustrated by the three
examples that follow. High urbanization also implies that
the population has relatively limited access to the natural
environment, and this has consequences for public health that
will be discussed below.
2.1. Of urban foxes, mosquitoes, and avian influenza
2.1.1. Urban foxes as disease vectors. Recent concerns
about the spread of disease organisms by foxes (Vulpes vulpes)
in Belgium provide a useful example of the interactions
between biodiversity, health, urban management and land use
planning. At the end of the twentieth century, European fox
populations increased remarkably both in area and in density
(Chautan et al 2000). In Belgium, this evolution was most
striking in Flanders as in this region foxes had been totally
absent in many areas for several decades (Van Den Berge and
De Pauw 2003). The new and quite surprising appearance of
foxes in a region with a very high human population density
soon gave rise to increasing concern (Van Den Berge 1995).
In addition to damage to poultry and game stocks, foxes are
widely associated with certain zoonotic diseases, with rabies
risk being one issue of particular public concern; however,
thanks to successive rabies vaccination campaigns by oral
immunization from 1989 that disease was eradicated from
Belgium (Van Gucht and Le Roux 2008), the country being
officially declared rabies free in 2001 (Brochier et al 2001).
In the meantime, however, another and frequently more
dangerous zoonosis directly linked to foxes appeared to
emerge: alveolar echinococcosis, caused by the larval stage of
the small fox tapeworm Echinococcus multilocularis. Foxes,
domestic dogs and other canids are definitive hosts for the
parasite, carrying the adult stage in their intestines. Worm
eggs are released into the environment with the faeces,
and they can then be taken up by an intermediate host,
such as one of several rodent species, especially Microtidae.
(e.g. grassland voles, muskrats). Humans also can become
infected through the oral ingestion of E. multilocularis
eggs. If untreated, the continuous larval cyst development of
the parasite within the human body can be fatal—making
alveolar echinococcosis one of the most dangerous zoonoses
in Europe. Since the growth of the European fox populations,
it seems that also the parasite has extended its range.
Flanders cannot be considered as an endemic region yet
(Van Gucht et al 2010), but the threat posed by infected foxes
seems specific to Flanders for two reasons. First, it seems
quite plausible that the further spread of E. multilocularis
will be hampered by a relative rareness of Microtidae as the
most appropriate intermediate host species. Muskrats have
nearly been eradicated thanks to the implementation of an
efficient pest control technique, whereas grassland voles can
hardly find a suitable habitat in the intensively cultivated
Flemish agricultural areas. Indeed, contrary to fox diet studies
done in other countries, in Flanders the genus Microtus
appears not to be the main food item but is instead replaced
by the brown rat (Rattus norvegicus) (unpublished data
from 1996–2005). The latter species, living close to human
settlements, is omni-present in Flanders as a consequence
of extensive settlements even in relatively rural areas. This
brings us to the second reason why situation may be specific
to Flanders. When foxes are present, they quickly become
well adapted to an urbanized environment and often dwell
in close proximity to residences and gardens, facilitating the
potential transmission of zoonoses. ‘Urban foxes’, however,
7Environ. Res. Lett. 8 (2013) 025015 H Keune et al
seem to pose little risk, due to an almost complete absence
of appropriate intermediate hosts where they live, while ‘rural
foxes’ pose little risk due to the limited contact they have with
humans. Instead, the so called ‘village and small town foxes’
generate the most critical situation for transmission of E.
multilocularis (Janko et al 2011). In Flanders, the fox habitat
and human habitat are nearly entirely overlapping. Therefore,
in the case of strongly increasing E. multilocularis prevalence
in foxes, actions to prevent human infection are called for.
These could include large scale baiting with a convenient
vermicide product
It is important, however, to address the problem (E.
multilocularis) and not kill the messenger, so to speak. The
overlap of fox habitat and human settlement potentially also
has positive health related implications in Flanders, as foxes
help to control the populations peaks of brown rats, and
other small rodents, and this may in turn help to prevent
possible emergences of Lyme disease, for which ticks act as
the vector and small rodents act as reservoir hosts (Levi et al
2012). Furthermore, the recent findings of E. multilocularis
infections in other wild species in Europe, including beaver
and wild boar, indicate that other species may introduce,
maintain or re-establish the parasite in areas which may
lead to transmission to people, pets or foxes and thus may
ultimately influence the disease cycle (e.g. Boucher et al
2005, Barlow et al 2011). Another important consideration is
that urbanization of foxes and associated zoonoses is in large
part related to encroachment of human settlement on wildlife
habitat and to urban environmental health management. For
example, Rabinowitz and Gordon (2004) have reported on
a case of zoonotic scabies infection (Sarcoptes scabiei) in
the United States, associated with interactions with wild
foxes originating with a sick fox found on a golf course.
They suggest that identification of initial infection ahead of
an outbreak—e.g. in this case an initial human case and a
noted increase in infections in domestic dogs—could serve as
‘sentinel’ events, indicating a possible increased likelihood of
infection in a community, from which appropriate public and
veterinary health announcements or other measures could be
taken.
In the case of echinococcosis in Belgium (and
elsewhere), greater interaction amongst veterinary and public
health practitioners, environmental health officers and urban
managers could help to not only manage outbreak risks but
also serve as an indicator for monitoring the effectiveness of
preventative strategies (e.g. see Hegglin and Deplazes 2013).
Furthermore, the inclusion of ecologists and urban planners
could help identify areas where new or revised approaches
to ecosystem management, in order to limit human–wildlife
interaction, might be warranted. Integrated multidisciplinary
approaches may be particularly important in the forward
planning process, including in health-inclusive Environmental
Impact Assessment, identifying where particular development
may lead to increased human–wildlife interaction and related
health risks, and helping to identify appropriate measures to
avoid or reduce zoonoses risk.
2.1.2. Mosquitoes. After the eradication of malaria in
northern Europe in the mid-20th century, little attention has
been paid to the distribution and biodiversity of mosquitoes
despite their importance in disease transmission (WHO2004).
While the number of mosquito-borne diseases and their
incidence in Europe remain quite low, there are upward trends
in incidence and geographical spread of several of these
diseases (Hendrickx and Lancelot 2010). Over the last years,
autochthonous transmission events of Chikungunya, Dengue,
West Nile and malaria have been reported from Europe.
Increased globalization, changing landscape management and
changing socio-economic behaviour create suitable conditions
for the (re)emergence of mosquito-borne diseases across
Europe (Tatem et al 2006, Lines 2007, Pysek et al 2010);
factors which affect the occurrence, distribution or density of
mosquito vectors—including climate change and ecosystem
change—are also of particular interest (e.g. Arinaminpathy
et al 2009, Bezirtzoglou et al 2011, Rohr et al 2011).
To remedy the limited knowledge on current mosquito
biodiversity and distribution in Belgium, a national inventory
was started in 2007 (MODIRISK). This inventory is based
on a specific sampling strategy that allows a rapid overview
of mosquito diversity (Versteirt et al 2012). The acquired
knowledge on local species occurrence has been used to
develop mosquito species distribution models and to assess
the actual countrywide transmission risk of mosquito-borne
diseases, taking into account possible interference by several
ecological, biological and socio-economic factors. Ultimately
species co-occurrence maps were created that can be used
to delineate zones of higher risk on nuisance and/or disease
transmission.
The study highlighted a number of important events.
First, an increased distribution range and adaptation to a more
urbanized environment was observed for several indigenous
vector mosquitoes such as the common house mosquito
(Culex pipiens) and Anopheles plumbeus. The latter species
is highly anthropophilic and in some urbanized areas, high
abundances are causing severe nuisance with highly allergic
skin reactions due to the bite of the species. Moreover,
recent outbreaks of West Nile in Greece, Romania and Spain
(Papa et al 2010, Santa-Olalla Peralta et al 2010, Sirbu
et al 2011) and autochthonous cases of malaria in Belgium,
Germany and the UK (Blacklock 1921, Shute 1954, Kruger ¨
et al 2001), indicate the potential for both mosquitoes to
transmit diseases. Secondly, wetland re-alignment (as part
of large scale flood risk management) has created suitable
habitats for mass emergence of nuisance and/or vector species
such as Ochlerotatus caspius and Coquillettidia richiardii.
These newly created habitats are potential breeding sites for
anopheline mosquito populations, leading to an increased
chance of malaria transmission.
The MODIRISK project proposes a targeted costeffective monitoring regime of these species (Versteirt
et al 2009, 2012). One of the direct outcomes of this
multidisciplinary project has been the increased awareness of
the authorities on the risk posed by exotic and indigenous
vector species, which has led to the establishment of an
inter-ministerial working group ‘Exotic Mosquitoes’ (federal
environmental department).
8Environ. Res. Lett. 8 (2013) 025015 H Keune et al
This project highlights the importance of ecosystem
approaches to vector-borne disease risks around human
settlements, and suggests several other important areas for
further research. For example, the precise links between
host and vector diversity, landscape management and human
health risks in Europe are unclear and require detailed study.
Work in the United States has highlighted links between
mosquito-borne disease risk and biodiversity in the wider
landscape: research by Ezenwa et al (2006) has suggested
that diversity of passerine bird species reduces circulation
of West Nile virus in the wild and therefore could reduce
human disease risk, while Zielinski-Gutierrez and Hayden
(2006) suggest that changes in urban and periurban landscapes
(e.g. through new development) can affect the geographical
distribution of West Nile virus, and that underlying attitudes
towards natural landscapes and biodiversity should be taken
into account when considering disease risk and response
strategies.
2.1.3. Avian influenza. The relationship between biodiversity and the emergence of infectious diseases in domestic
animals is as yet poorly described, but it is particularly
important when those diseases have the potential to harm
humans. The example of avian influenza is illustrative.
Low pathogenic avian influenza viruses (LPAIV) are
naturally present in the wild avifauna with a high diversity
of types and subtypes. Diverse bird species therefore suffer
infections that have a low clinical impact. Highly pathogenic
avian influenza viruses (HPAIV), in contrast, have a low
diversity, with epidemics usually involving only one subtype
and usually affecting a limited number of domestic species,
though with a high clinical impact. This epidemiological
system thus shows a high stability and a low impact when
there is both a high diversity of hosts and pathogens.
Epidemiological problems arise when diversity in hosts
and pathogens become reduced. When an LPAIV is
introduced into intensive poultry production systems, it goes
through fast selection. Within the high-density, genetically
similar, susceptible host populations of poultry production
systems fast selection can amplify virulent pathogen strains
(Mennerat et al 2010). A new, virulent pathogen can then
escape the leaky confines of the intensive production units to
invade other livestock and wild species, and potentially infect
human populations. It has been shown that HPAIV can be
produced from low pathogenic strains following consecutive
passages through genetically homogenous chickens (Ito et al
2001). Panzootic HPAI H5N1 emerged in China in 1996
(Li et al 2004) following several years of intensification
of chicken and duck production. Closer to Belgium, an
HPAIV H7N7 virus emerged in the Netherlands in 2003 and
spread to Belgium, both countries having very intensified
poultry production systems. Whilst HPAI H5N1 continues to
circulate in several countries in Asia, the 2003 H7N7 epidemic
was quickly controlled in Belgium and the Netherlands.
Nonetheless, the example highlights the fact that the risk
of emergence of novel HPAIV subtypes is far from being
limited to Asian contexts. Whilst the specific roles of
intensive production systems in the emergence of novel
strains of pathogen are not well understood and would need
further investigation, CAST (2005) concluded that intensified
livestock production systems, characterized by a low diversity
of hosts, created ideal conditions for rapid selection and
amplification of highly pathogenic strains of disease agents.
Ecosystem approaches have been particularly important
in identifying the risks of spread of HPAI in Europe.
Kilpatrick et al (2006) found that identification of H5N1
in 20 of 23 European countries was most likely attributable
to migratory birds. Waterfowl, particularly ducks, have been
identified as major carriers, owing to their tendency to
congregate in large multi-species flocks on water bodies or
wetland where the virus can circulate, and the fact that
many species are resistant to HPAI infection, providing
opportunities for genetic recombination and widespread
dispersal (e.g. Rapport 2006, Kim et al 2009). The presence
of the virus in wildfowl also creates a risk of spread to other
wildlife species, with reports from Sweden and Germany
of infection in mink and pine marten following predation
of waterfowl (ECDC/Eurosurveillance, 2006a, 2006b). This
has led to intensified biosecurity concerns about interactions
between wild species and domestic poultry and livestock,
and in extreme cases there have been calls for large scale
culling of wildfowl. Conservation organizations, UNEP,
FAO and WHO have urged caution in restraint in this
regard (International Task Force on Avian Influenza 2006),
and it has been suggested that adopting the ecosystem
approach at the landscape level—preventing and reversing
degradation of habitats enhancing measures to segregate
wildfowl from domestic animals, and greater co-operation
between human health, veterinary and ecological agencies
in disease surveillance and land management, are key to
minimizing significant health and economic risks from the
disease (Rapport 2006). Such approaches may have particular
relevance in Belgium, owing to the particular structure of
the Belgian poultry sector, and the location of the country
on migratory pathways for large numbers of wildfowl
(Vandendriessche et al 2009). This raises additional concerns
about the spatial and ecological relationships between natural
and artificial water bodies (including lakes and ponds in public
parks), agricultural lands and human settlements., further
highlighting the need for ecosystem based approaches to
disease risk.
2.2. Urban green space and health
Access to green space can yield diverse benefits for public
health. For example, Van Herzele and de Vries (2012)
compared two neighbourhoods in the city of Ghent, and they
registered greater happiness and satisfaction in the greener
neighbourhood. Yet many urban residents may not be able
to realize such benefits. Van Herzele et al (2004) showed
that in six major Flemish city centres, more than one third
of the inhabitants did not have easy access to green spaces
(i.e. within 800 m distance). Access is partly limited due
to infrastructural barriers, such as highways. Access is also
unequally distributed amongst social classes; low income
groups have less access. The study also concluded that
9Environ. Res. Lett. 8 (2013) 025015 H Keune et al
although attention to the need for urban green space has
increased, existing urban green space is under pressure from
land conversion or decrease in natural quality. Accordingly,
initiatives have recently been taken to support urban planning
that enables and maintains contact with nature. Two of them
will be briefly outlined here.
In January 2011 the Flemish Agency for Nature and
Forest (ANB) started a strategic project, Green in the City,
manifesting the Flemish ambition to become a green and
dynamic urban region by 2020. The project hopes to instigate
knowledge-based networking, inspiring a diversity of actors
to establish more green space and other aspects of nature
in urban areas. A central part of the project is sharing the
knowledge on parks and green space management which has
been built up over the years, bundled in technical management
tutorials on a variety of topics, including but not limited
to trees, grassland, herbs, water, and paths and pavements.
Moreover, ANB has a history of promoting participatory
approaches to green space management (Van Herzele et al
2005). In the Green in the City project, ANB addresses
voluntary engagement and stimulates local authorities to adapt
their planning and management traditions and arrangements
regarding environmental and biodiversity issues in cities.
Every year ANB issues a call for projects that involve
experimental and innovative actions for a specific theme. Such
efforts support interested city authorities in designing greener
cities and also involve local inhabitants; however, to date
they do not have much experience in providing information
on any specific health related aspects. The ambition of
ANB to mainstream knowledge on the advantages of urban
green space and greenery is positive and may inspire local
institutions and actors, but this will not necessarily strengthen
the link between biodiversity, human health and well-being,
nor turn general concepts into effective measures and models
for healthy town development. Nevertheless, basic data and
knowledge regarding green space and health are being
developed for Belgian cities (Van Herzele et al 2004, Van
Herzele and de Vries 2012), in keeping with the development
of general knowledge regarding contact with nature and health
(Hartig et al 2011). It seems, however, that the Green in
the city strategic project has yet to take advantage of this
knowledge, and integrated programmes to ameliorate public
health problems through intelligent application of green space
and biodiversity remain to be developed.
The second example here involves a series of urban
sustainability initiatives started several years ago by
the Brussels Capital Region, in collaboration with local
organizations (appendix B). In addition to the role of urban
biodiversity as being a natural corridor of biodiversity
between neighbour regions, the importance of urban green
space and biodiversity for physical and mental health is
emphasized in these initiatives, as are other links between
ecosystem health, biodiversity, food security, human health
and the impact of citizen behaviour on environmental, social
and economic issues elsewhere in the world. Most of these
regional initiatives benefit from funding from the Capital
Region. However, the funds are too limited to fully address
the growing demand of citizens to participate in such projects.
As a result, these activities are largely based on the goodwill
of some motivated citizens, and they often lack scientific
and technical support and expertise (e.g. regarding potential
effects on emergent diseases). These initiatives nonetheless
contribute to urban social health through new collaborations
between different urban districts, the exchange of experience
among inhabitants, and renewed appreciation of traditional
knowledge.
2.3. Lessons and challenges
The example of foxes in Flanders shows that an increasingly
urbanized wild animal may bring with it the potential risk
of infectious diseases as well as the potential to reduce the
risk of other infectious diseases. The example also shows
that developments in neighbouring countries need not occur
the same way; local circumstances may differ substantially.
This means that detailed, location-specific knowledge needs
to be carefully monitored to help avoid outbreaks of diseases.
Moreover, the complexity of the ecological associations
between parasite, definitive host (canids and certain wild
mammals), secondary hosts (rodents) and ‘accidental’ hosts
(humans and domestic animals), and the interplay with land
use planning and environmental health issues, illustrates the
importance of integrated approaches.
The case of the mosquitoes and the avian flu also show
that biodiversity can play different roles in public health.
While an increase in diversity of mosquitoes also increases
the range of diseases potentially transmitted in Belgium, the
lack of diversity in commercial poultry production contributes
to the emergence of dangerous pathogens. Whilst associations
between European wild biodiversity and disease risk in West
Nile virus are largely unknown, it is clear that risks of highly
pathogenic avian influenza are closely associated with the
movements of migratory species, the status of ecosystems
they depend upon and their proximity to human settlement.
Linard et al (2007) illustrate that in order to understand the
spatial variation in disease risk of vector-borne and zoonotic
diseases in Belgium, both environmental and socio-economic
factors need to be taken into account, thus requiring an
integrated interdisciplinary approach.
The urban green space examples illustrate renewed
attention to the benefits of nature in the urban context,
complementing the sanitary–environmental and the technoeconomic models that have been dominant in shaping
urban public health over the last decades (Rayner and
Lang 2012). The changing role of the authorities becomes
apparent; giving incentives and providing examples of good
practice seem to be the favourite strategy, while imposing or
working according to a prescribed and comprehensive plan
receives less attention. Time will tell if efforts to inspire a
diversity of actors—not only by sharing information but also
by sharing responsibility through new, more collaborative,
governance arrangements—will yield durable improvements
in biodiversity and human health. Here also the need for
integrated approaches is evident, for among other things
taking both ecosystem services and potential disservices into
account.
10Environ. Res. Lett. 8 (2013) 025015 H Keune et al
The different examples together show the need for
integrated approaches to landscape planning that respect the
links among urban and periurban areas. The overarching
challenge is to plan public and private green spaces in densely
populated regions in such a way that they are sufficiently
diverse and accessible to humans and yet do not create
conditions that will lead to the proliferation of hosts or vectors
of diseases. This requires more background knowledge and
access to information than is currently available to city
planners. The fact that private green spaces also play a
role points to the need of better informing the public
and structurally supporting public–private collaborative
arrangements.
3. The emerging biodiversity–public health
community of practice in Belgium
The foregoing examples have shown that an integrated
approach is needed both to address each of the issues
separately but particularly when developing green space in
urban areas so as to ensure increase of ecosystem services
without creating or increasing potential health risks. An
analysis of the current research landscape (appendix C)
quickly revealed that there is little research on biodiversity
and public health in Belgium so far. Moreover different
policy communities who do not usually come together in their
work (health and planning) need to be brought together—by
increasing the evidence base on health-biodiversity linkages
in Belgium, by building communication networks across
disciplines, and by devising frameworks for on-going
collaboration and practical action.
Against this background and to raise awareness in
Belgium on the importance of the linkages between
biodiversity and public health, on 30 November 2011 the
Belgian Biodiversity Platform organized the first Belgian
Biodiversity and Public Health Conference 2011 (see www.
biodiversity.be/health). This conference, its outputs and
subsequent developments stand as constructive examples
of efforts to address issues at the biodiversity–public
health–urbanization interface.
3.1. The initial gathering: bringing different communities
together
The Belgian Biodiversity Platform encourages interdisciplinary co-operation among scientists and serves as an
interface between researchers and policy makers. The conference it organized in 2011 consisted of introductory keynote
speeches and five thematic workshops. The conference
brought together eighty one Belgian experts. Roughly 68%
of them were scientists (universities and governmental
scientific institutes; health-, ecological- and social-science),
16% represented policy interests (Federal, regions, provinces,
cities; health-, environmental-, nature- and land-planning
policy), and 16% came from consultancies (policy advice,
eco-therapy, education), NGOs (nature protection, landscape
development, ecological life and gardening, health insurance),
or media.
Discussions during the conference focused on scientific
priorities and policy challenges and resulted in the
identification of several issues of interest. The Infectious
Diseases Workshop identified the following priority issues:
(1) The need for biodiversity-related research on, for example,
the distribution and abundance of reservoir and host species,
the influence of host diversity on disease transmission, the
diversity of pathogens and their geographical distribution
patterns, and how the diversity of resources (e.g. food)
influences epidemiological cycles. (2) The need for more
collaboration amongst Belgian research teams and between
different policy fields, such as landscape management
authorities and public health agencies. (3) Disease Early
Warning Systems. (4) Eradication of invasive species.
The Food Workshop listed research priorities such
as genetic diversity, health related diversification of diet,
multifunctional agriculture, the ‘real’ price of food (including
social, environmental and other costs), and ways to
incorporate this knowledge into policy instruments. Raising
awareness among consumers and catering chains, the
relationship between social diversity and use of biodiversity,
and the potential of urban biodiversity (allotments, gardens)
for local food production were addressed as important
social/policy challenges.
The Nature Experience Workshop underlined the importance of involving different policy domains (agriculture,
nature, public health, education, spatial planning, and
mobility) to bring scientific insight closer to practice. In this
respect the challenge of fine tuning the generic policy level
to context specific needs was specifically underlined. For
example, generic policy (and the research which supports such
policy) addresses broad environmental categories (notably
natural and urban), and so does not provide adequate support
for the kind of specific design interventions that can reconcile
increasing urban population density with the values of contact
with nature (Van den Berg et al 2007).
The Spatial Tools Workshop highlighted data-related
issues such as open data access and data integration. The
importance and difficulty of scale coordination was addressed
(e.g. reconciling factors at different policy, geographic and
temporal scales). Also, the importance of communication
and collaboration among a diversity of experts from science,
policy and society was underlined. It was stressed that the
links between biodiversity and health in the landscape context
are often vague or uncertain and in need of further research,
and that spatial planning tools such as ecosystem service
mapping can be important in this regard.
The Ecosystem Services Workshop generally considered
the ecosystem services concept an opportunity to strengthen
linkages between public health and biodiversity. To take
this forward, preliminary steps were suggested, including (1)
development of a catalogue of linkages between biodiversity
and public health; (2) development of an overview of
existing data and indicators; and (3) reinforcement of
communication and collaboration among thematic experts and
policy representatives.
11Environ. Res. Lett. 8 (2013) 025015 H Keune et al
3.2. Next steps: movement towards a Belgian community of
practice on biodiversity and public health
One generic outcome of the conference was recognition of
the need for further capacity and network building. On the
one hand this implies a focus on generating further scientific
understanding in order to be able to provide policy makers
with robust knowledge. According to some participants this is
the prime challenge:
This obviously was a first attempt at bringing together
science and policy making. Much more effort will be
needed to achieve long term results. At this stage focus
should be on getting scientists to agree on the link
between biodiversity and public health. This was still
very unclear at this stage, and it may have confused
decision makers (Keune et al 2012a).
Others stressed that this was not only a scientific
challenge, but also a practical challenge, or as one participant
put it:
Involve more people from a diversity of contexts to
give presentations, not only scientists. Otherwise you
risk inward looking in academic circles, when the
outside world (reality) is not always in accordance with
scientific findings. The biodiverse system of humans
and nature is more than the sum of the parts, but
instead is an interactive interplay of many actors, not
only scientific research. My main message is: invite
more people from many contexts who are dedicated to
biodiversity, it is only then you can reach an integrated
full picture. A challenging opportunity (Keune et al
2012a).
Shortly after the conference, a policy brief was issued
in which science, policy, and other experts called for
support for the establishment of a Belgian Community of
Practice on Biodiversity and Public Health (Bauler et al
2012). A Community of Practice (CoP) is a network
made up of individuals and organizations that share an
interest and practice, who come together to address a
specific challenge, and who further each other’s goals and
objectives in the specific topic area (Wenger and Snyder 2000,
Meessen et al 2011). Inspiring international examples are the
Canadian Community of Practice in Ecosystem Approaches
to Health (COPEH) and the European Community of
Practice in Farming for Health (Dessein 2008). These
examples of Communities of Practice show how different
expert communities can connect by networking and capacity
building and hence contribute to more integrated approaches.
3.3. Further development: creating an inventory of research
needs
In 2012 the emerging Belgian Community of Practice on
Biodiversity and Public Health decided to organize an
inventory of research needs and ideas in order to get a
clearer view of relevant research topics and the potential for
collaboration (Keune et al 2012b).
The policy-driven research needs, articulated by diverse
policy representatives (both national and regional), cover a
wide range of topics and policy-relevant issues. There is a
general interest in integrated data assessment that couples
ecological and public health developments, as well as a
general interest in the relations among green space/nature, the
living environment, and public health. Some specific research
topics involve health risks or health benefits, or both. More
specific thematic focuses include links between biodiversity
and dietary health, medicines and medical research, and
emerging disease threats. Regarding the connections between
green space and public health, specific topics include
the social, mental and physical health benefits of green
space and other contact with nature, their accessibility for
residents, and the relation between ecosystem services and
non-communicable disease such as cancer and diabetes.
Research input has come from members of national,
Wallonian and Flemish research institutions representing
a wide range of expertise. Some of the research gaps
identified included a need for further work on vector-borne
diseases, including patterns and mechanisms of emerging
infectious diseases in domestic animals, further development
of surveillance and monitoring systems, the influence of
habitat and ecosystem change on pathogen ecology, the role
of land use management in vector control, and expanding
knowledge of the virome (the genomes within a viral
population existing in a given organism, a given population
or a given ecosystem) and its link with biodiversity and public
health. Several proposals draw attention to ecosystem health
services, for example in relation to a diversity of habitats,
landscape and species, urban greening and the demand for
ecosystem services and biodiversity.
The diversity of the proposals and of the scientific and
policy backgrounds and institutions involved illustrate an
emerging community of expertise and practice with both
the potential and the will to join forces and build capacity.
As one policy representative put it: ‘We found this exercise
of gathering ideas very interesting for the community of
stakeholders and it was a good opportunity for ourselves to
lay bridges between dossiers inside our own service’.
4. Conclusions
The challenges for research and policy on the issues of
biodiversity and human health in the context of urbanization
are substantial. The first Belgian Biodiversity and Public
Health conference discussed many of the barriers to
mainstreaming ecosystem approaches to human health, and
identified some key areas for action. Firstly the evidence
base on links between biodiversity and health in the context
of urbanization must be further developed so that areas
of overlap between various fields of research, policy and
practice can be better identified. More research is needed
to facilitate a better understanding of the connections,
and to support informed decision making and long term
assessment and monitoring. Secondly, bridges must be built
between different professional communities working within
the biodiversity-health-urban planning sphere, and at all
12Environ. Res. Lett. 8 (2013) 025015 H Keune et al
levels of policy, research and practice. At the Belgian
conference there was some notable friction between different
scientific and policy perspectives of the role of biodiversity
and ecosystems, to public health and more widely. The
ecosystem services community mainly highlighted the benefits
of biodiversity to human health, whereas the infectious
disease community to a large extent focused on the public
health risks of human contact with nature. Both communities
in a sense focus on the same human–nature interactions, but
from different perspectives based on different methodologies,
different realms of knowledge, widely divergent scales of
operation and different practical objectives. To some extent,
the problem is perhaps one of semantics (‘nature’ and
‘biodiversity’ do not necessarily equate), compounded by a
lack of clearly established definitions of core concepts (for
example, a negative outcome of human interaction with nature
may be attributable to certain aspects of ‘wildlife’ but may
not necessarily be a factor of ‘biological diversity’) and a
lack of understanding on each side of one another’s key
drivers (both in the policy and practical sense). Some of
this difficulty may perhaps be resolved by a more coherent
working definition for this kind of forum of what is meant by
biodiversity and ecosystem services, and by development of
a working conceptual model for Belgium that will facilitate
interdisciplinary and ultimately transdisciplinary approaches.
Such models may also benefit from a broader definition of
health, incorporating ‘the ability to adapt’ and recognizing
the value of health as an indicator of sustainability, which
promotes overlap with many aspects of the ecological sciences
and can serve to highlight areas of mutual concern. In
addition, it is important to look beyond ecology and public
health disciplines to ensure that the many other disciplines
affected by these issues are also closely involved, including
forestry, agriculture, fisheries management, economic and
social development, and so on. Thirdly, there is a need
for a practical framework for on-going communication and
collaboration, to enable exchange of ideas and experience and
to support capacity building. And finally there is the need for
better communication of the science of biodiversity and health
linkages to policy makers, and to the general public.
The Belgian Community of Practice on Biodiversity and
Public Health recognizes these challenges and is currently
working to support further collaboration and capacity building
to tackle these important sustainability challenges. In this
way the Belgian community also hopes to contribute to the
international body of knowledge and practice, such as the
IPBES and other relevant processes.
Acknowledgments
We sincerely thank the Belgian Federal Science Policy
department for their financial and logistical support that
made both the 2011 Belgian conference Biodiversity–Public
Health and this publication possible. We also sincerely thank
both anonymous reviewers for their thoughtful and inspiring
comments.
Appendix A. Belgian governmental policy landscape
The Belgian governmental policy landscape is quite
complicated due to its specific federal structure, in which the
federal level, the regional level and the community level play
a role regarding biodiversity (Belgium’s National Biodiversity
Strategy 2006–2016) and public health issues (National
Environmental Action Plan). In Belgium the three regions
(Flanders, Wallonia and Brussels) are responsible for all
territorial matters, including most biodiversity-related matters
and land use planning. The regions are also responsible
for the larger part of health policies, including health
prevention. At the federal level health policies mainly deal
with animal health and food safety. The three communities
(French, Flemish and German) deal with cultural matters
including culture and media, education, use of languages,
some aspects of health policy, youth protection and sport.
Certain collaborative and coordinating institutional structures
exist, in which representatives of the different federal, regional
and community policy level meet, in order to streamline the
Belgian position regarding international forums and policies
and to vice versa establish a coordinated implementation
by Belgium of the decisions and recommendations made in
international forums, such as e.g. European Union policies,
the National Environmental Action Plan initiative of the
World Health Organization, the Convention on Biological
Diversity or the recently established Intergovernmental
Platform on Biodiversity and Ecosystem Services. Still, apart
from the challenge of interfacing different policy fields such
as biodiversity and public health, also the federal structure of
Belgium imposes quite a challenge on fine tuning. To further
explain the historical roots of this fragmented governmental
landscape is beyond the aim of this letter, but it is a
complicating reality to be taken into account when dealing
with a combined focus on biodiversity, public health and
urbanization.
Appendix B. City green spaces initiatives in Brussels
For several years, the Brussels Capital Region has run a series
of initiatives, in collaboration with several local organizations
(Centre d’ Ecologie Urbaine, le Debut des Haricots, Apis ´
Bruoc Sella, Tournesol, Etopia, GASAP and others), exploring various aspects of urban sustainability. Several of these
projects seek to promote sustainable development through
educational and collaborative local projects for greening
public spaces (www.villedurable.be/thema/ville-verte), create
urban collective vegetable gardens (including on green
roofs of large buildings) (www.potagersurbains.be) and
orchards (www.gasap.be/des-vergers-collectifs-a-bruxelles),
placing beehives in the city (www.apisbruocsella.be), promoting sustainable food (www.rabad.be), developing Sustainable
Districts (‘Quartiers durables’) where local motivated citizens
organize activities to increase awareness within their neighbourhood on issues linked to sustainability, and to encourage
local projects to enhance urban spaces by tackling litter
and improving biodiversity (www.bruxellesenvironnement.
be/templates/particuliers/niveau2aspx?id=3204).
13Environ. Res. Lett. 8 (2013) 025015 H Keune et al
Some of these projects, like ‘Maillage vert’ (Green
Network), emphasize the potential obstacles which urban
spaces present to the passage of biodiversity and the
movement or flow of ecosystem services through the wider
landscape, and aim to develop a green infrastructure that
addresses this concept and provides wider benefits. Targeted
local actions include removing or avoiding exotic and
potentially invasive species or varieties of flora in favour of
indigenous plants, and encouraging use of native tree species
in urban planting. In all these projects, the value of urban
green space and biodiversity for physical and mental health
is also underlined, as well as the links between biodiversity
and ecosystem health, food production and nutrition security
etc (e.g. the Apis Bruoc Sella project shows pollinators as
indicators of ecosystem health and as examples of important
ecosystem benefits which urban greenspace can provide) as
well as highlighting the positive or negative potential impacts
which local citizen behaviours may have on environmental,
social and economic issues elsewhere in the world. For
example, the development of urban community vegetable
gardens is seen as a means of reducing the impacts of
community choices on ecosystems in other areas, encouraging
a degree of self-sufficiency and promoting healthy and diverse
food production whilst also promoting outdoor recreation,
social interaction and community cohesion.
Importantly, most of these regional initiatives benefit
from some funds of the Region, but that are still rather
limited for the growing demand of the citizens to participate
in such projects. As a result, these activities are largely based
on the good will of some motivated citizens, but they also
often suffer from lack of expert scientific and technical data
and support. Several of these urban projects are examples of
‘learning by doing’, experimenting and adjusting management
practice based on experience and knowledge gained along the
way. Whereas this could somehow be considered as risky,
it is also fostering a new kind of collaboration between
distant urban districts inhabitants exchanging experience and
revisiting traditional knowledge, improving by this way the
urban social health.
Appendix C. Project database screening
Research projects focusing on the link between biodiversity/ecosystems, human/public health and urbanization are
fairly rare in Belgium. To illustrate this, we screened five
databases collectively holding project information from the
Federal Authorities, Flemish Community and Francophone
Community for the past 12 years. When classifying each
of the 45 public health related research projects according
to their major research focus, the large majority seems
to target the effects of environmental hazards (such as
water and air pollution) on human health, exemplifying the
sanity–environmental approach (Rayner and Lang 2012) in
Belgian research policy. Projects studying the link between
biodiversity/ecosystem related issues and public health, on
the other hand, are clearly less common and of these, only
a very small number (5) also target urban issues. They are all
funded by federal funding sources, and three of these started
in 2009 illustrating increasing interest in this topic from 2006
onwards. Studies focusing on biodiversity/ecological aspects
of human/public health in Belgian urbanized areas are still in
their infancy; in the Walloon region, they are even completely
absent.
We screened five databases collectively holding project
information from the Federal Authorities, Flemish Community and French Community with focus on the past 12 years.
These include the INVENT database (from the Belgian
Science Policy office), the Flemish Research Information
Space (FRIS), the database from the Research Foundation
Flanders (FWO-Flanders), Vision on Technology (VITO), and
Table C.1. Number of public-funded research projects in Belgium on the link between biodiversity/ecosystems, human/public health and
urbanization (1998–2011).
FL FR FE 1998a 2000 2001
2002–
2005 2006 2007 2008 2009 2010 2011 Total
Biodiversity and
public health
1 4 1 1 3 5
Biodiversity and
public health and
urbanization
1 4 1 1 3 5
Environmental
hazards and public
health
15 3 19 1 1 1 6 7 6 10 5 37
Environmental
hazards and public
health and
urbanization
7 2 11 1 1 4 5 4 4 1 20
Urbanization and
public health
7 3 17 1 1 5 7 4 8 1 27
Biodiversity and
environmental
hazards and public
health
1 4 1 2 2 5
a Year a project started.
14Environ. Res. Lett. 8 (2013) 025015 H Keune et al
Agency for Nature and Forest (ANB). In order to select
from these a list of research projects focusing on public
health in Belgium, we used several keywords (biodiversity,
ecosystem, urban, city, environment, health) and several
combinations thereof. Abstracts were carefully screened to
exclude studies on ecosystem or animal health (if no link
with public health), and studies targeting regions outside
Belgium were also excluded. This resulted in a unique list
of 45 public health related research projects (table C.1), the
majority of which were funded by the Federal Authority
(FE: 24 projects); projects funded by the Flemish (NL)
and French (FR) community were less common (17 and 4,
respectively). The projects were subsequently classified into
six groups according to their major research focus. Some
of the categories had a broader focus than others, and as
a consequence projects often classified in more than one
group. Within each category, the start date of each project
was indicated to decipher trends in timing of funding. Project
databases from the Walloon region were not accessible,
but given that the screening of Flemish databases outside
INVENT revealed only three additional projects, we are
confident that the recovered trends are representative for the
post-2000 period.
References
Alcamo J, Ash N J, Butler C D, Callicot J B, Capistrano D and
Carpenter S R 2003 Ecosystems and Human Well-Being.
A Framework for Assessment (Washington, DC: Island)
Allen H K, Donato J, Huimi Wang H, Cloud-Hansen K A,
Davies J and Handelsman J 2010 Call of the wild: antibiotic
resistance genes in natural environmentsNature Rev.
Microbiol. 8 251–9
Arinaminpathy N, McLean A R and Godfray H C J 2009 Future UK
land use policy and the risk of infectious disease in humans,
livestock and wild animals Land Use Policy 26 S124–33
Armitage D, Berkes F and Doubleday N (ed) 2007 Adaptive
Co-Management: Collaboration, Learning, and Multi-Level
Governance (Vancouver: UBC Press)
Armitage D, Marschke M and Plummer R 2008 Adaptive
co-management and the paradox of learning Global Environ.
Change 18 86–98
Barlow A M, Gottstein B and Mueller N 2011 Echinococcus
multilocularis in an imported captive European beaver (Castor
fiber) in Great Britain Vet. Rec. 169 339
Barton H 2009 Land use planning and health and well-being Land
Use Policy 26 S115–23
Barton H and Grant M 2006 A health map for the local human
habitat J. R. Soc. Promot. Health 126 252–3
Bateman I J et al 2011 Economic values from ecosystems UK
National Ecosystem Assessment: Understanding Nature’s
Value to Society (Technical Report) (Cambridge: United
Nations Environment Program World Conservation Monitoring
Centre (UNEP-WCMC))
Bauler T et al 2012 Policy brief: the need for a community of
practice on biodiversity—public health in Belgium Belgian
Biodiversity Platform (www.biodiversity.be/health)
Beaglehole R and Bonita R 2000 Reinvigorating public health
Lancet 356 787–8
Belgian Biodiversity Platform www.biodiversity.be/
Belgium’s National Biodiversity Strategy 2006–2016 www.biodiv.
be/implementation/docs/stratactplan/national strategie
biodiversity en.pdf
Bezirtzoglou C, Dekas K and Charvalos E 2011 Climate changes,
environment and infection: facts, scenarios and growing
awareness from the public health community within Europe
Anaerobe 17 337–40
Blacklock B 1921 Notes on a case of indigenous infection with P.
falciparum Ann. Tropical Med. Parasitol. 15 59–72
Bolund P and Hunhammar S 1999 Ecosystem services in urban
areas Ecol. Econ. 29 293–301
Boucher J M, Hanosset R, Augot D, Bart J M, Morand M,
Piarroux R, Pozet-Bouhier F, Losson B and Cliquet F 2005
Detection of Echinococcus multilocularis in wild boars in
France using PCR techniques against larval form Vet.
Parasitol. 129 259–66
Bradley C A and Altizer S 2007 Urbanization and the ecology of
wildlife diseases Trends Ecol. Evol. 22 95–102
Brochier Bet al 2001 Elimination de la rage en Belgique par la
vaccination du renard roux (Vulpes vulpes) Ann. Med. V ´ et. ´
145 293–305
Bullock C, Kretsch C and Candon E 2008 The Social and Economic
Aspects of Biodiversity: Benefits and Costs of Biodiversity in
Ireland (Dublin: Government of Ireland/The Stationary Office)
Burlingame B, Charrondiere R and Mouille B 2009 Food
composition is fundamental to the cross-cutting initiative on
biodiversity for food and nutrition J. Food Compos. Anal.
22 361–5
Burlingame B and Dernini S (ed) 2012 Sustainable diets and
biodiversity—directions and solutions for policy, research and
action Proc. Int. Scientific Symp. Biodiversity and Sustainable
Diets: United Against Hunger (Rome, 3–5 November 2010)
(Rome: FAO)
Campbell-Lendrum D 2005 How much does the health community
care about global environmental change? Global Environ.
Change 15 296–8
Cardinale B J 2011 Biodiversity improves water quality through
niche partitioningNature 472 86–9
Carmichael L, Barton H, Gray S, Lease H and Pilkington P 2012
Integration of health into urban spatial planning through
impact assessment: Identifying governance and policy barriers
and facilitators Environ. Impact Assess. Rev. 32 187–94
CAST 2005 Global Risks of Infectious Animal Diseases (CAST
Issue Paper No. 28) (Ames, IA: Council for Agricultural
Science and Technology)
CBD (Convention on Biological Diversity)COP Decisions
(available via the CBD’s website at: www.cbd.int/decisions/)
CBD 2010 Global Biodiversity Outlook 3 (Montreal: Secretariat of
the Convention on Biological Diversity)
CBD 2012Cities and Biodiversity Outlook (Montreal: Secretariat of
the Convention on Biological Diversity)
Chautan M, Pontier D and Artois M 2000 Role of rabies in recent
demographic changes in Red Fox (Vulpes vulpes) populations
in Europe Mammalia 64 391–410
Chivian E and Bernstein A (ed) 2008a Sustaining Life—How
Human Health Depends on Biodiversity (Oxford: Oxford
University Press)
Chivian E and Bernstein A 2008b Threatened groups of organisms
valuable to medicine Sustaining Life—How Human Health
Depends on Biodiversity ed E Chivian and A Bernstein
(Oxford: Oxford University Press) pp 203–83
COHAB (Co-operation on Health and Biodiversity) www.cohabnet.
org/
COHAB 2010 Position Statement of the COHAB Initiative
Secretariat with regard to the draft text open for discussion in
relation to Item 4.9(a), Paragraph 8—Discussion document
prepared for the 10th Conference of the Parties to the UN
Convention on Biological Diversity, Nagoya, Japan, October
2010 (Galway: COHAB Initiative Secretariat)
(www.cohabnet.org/news/COP10-position-statement-on-COPdecisions-regarding-co-operation-with-the-health-sector.htm)
15Environ. Res. Lett. 8 (2013) 025015 H Keune et al
Colls A, Ash N and Ikkala N 2009 Ecosystem-Based Adaptation: a
Natural Response to Climate Change (Gland: IUCN)
COPEH (Canadian Community of Practice in Ecosystem
Approaches to Health) www.copeh-canada.org/index en.php
Costanza R 1992 Toward an operational definition of ecosystem
health Ecosystem Health: New Goals for Environmental
Management ed R Costanza, B G Norton and B D Haskell
(Washington, DC: Island) pp 239–56
Cox P A 2009 Biodiversity and the search for new medicines
Biodiversity Change and Human Health: From Ecosystem
Services to the Spread of Disease ed O Sala, L Meyerson and
C Parmesan (Washington, DC: Island) pp 269–80
Cutts B B, Darby K J, Boone C G and Brewis A 2009 City
structure, obesity, and environmental justice: an integrated
analysis of physical and social barriers to walkable streets and
park access Soc. Sci. Med. 69 1314–22
de Oliveira J A P, Balaban O, Doll C, Moreno-Penaranda R,
Gasparatos A, Iossifova D and Suwa A 2010Cities,
Biodiversity and Governance: Perspectives and Chellenges of
the Implementation of the Convention on Biological Diversity
at the City Level (UNU-IAS Policy Report) (Yokohama: United
Nations University)
de Plaen R and Kilelu C 2004 From multiple voices to a common
language: ecosystem approaches to human health as an
emerging paradigm EcoHealth 1 (Suppl. 2) 8–15
Dessein J (ed) 2008 Farming for Health, Proc. Community of
Practice Farming for Health (Merelbeke: ILVO)
DIVERSITAS ecoHealth www.diversitas-international.org/
activities/research/ecohealth
Dobson A P and Carper E R 1993 Climate and health: biodiversity
Lancet 342 1096–9
Dreher A, Gaston N and Mertans P 2008 Measuring
Globalisation—Gauging its Consequences (Berlin: Springer)
ECDC (European Centres for Disease Control) and
Eurosurveillance Influenza Team 2006a H5N1 infections in
cats—public health implications Euro Surveill 11 E060413.4
(available from: www.eurosurveillance.org/ew/2006/060413.
asp#4)
ECDC and Eurosurveillance Influenza Team 2006b Highly
pathogenic avian influenza A/H5N1—update and overview of
2006 Euro Surveill. 11 pii=3098 (available from: www.
eurosurveillance.org/ViewArticle.aspx?ArticleId=3098)
EcoHealth Alliance www.ecohealthalliance.org
EEA (European Environment Agency) 2009 Ensuring Quality of
Life in Europe’s Cities and Towns. Tackling the Environmental
Challenges Driven by European and Global Change (EEA
Report No. 5/2009) (Copenhagen: EEA)
Ernstson H 2013 The social production of ecosystem services: a
framework for studying environmental justice and ecological
complexity in urbanized landscapes Landsc. Urban Plann.
109 7–17
Ernstson H, Barthel S, Andersson E and Borgstrom S T 2010a ¨
Scale-crossing brokers and network governance of urban
ecosystem services: the case of Stockholm Ecol. Soc. 15 28
Ernstson H, van der Leeuw S E, Redman C L, Meffert D J, Davis G,
Alfsen C and Elmqvist T 2010b Urban transitions: on urban
resilience and human-dominated ecosystems AMBIO
39 531–45
Ezenwa V, Godsey M, King R J and Guptill S C 2006 Avian
diversity and West Nile virus: testing associations between
biodiversity and infectious disease risk Proc. R. Soc.B
273 109–17
Feest A, Aldred T D and Jedamzik K 2010 Biodiversity quality: a
paradigm for biodiversity Ecol. Indic. 10 1077–82
Frison E A, Smith I F, Johns T, Cherfas J and Eyzaguirre P B 2006
Agricultural biodiversity, nutrition, and health: making a
difference to hunger and nutrition in the developing world
Food & Nutr. Bull. 27 167–79
Gamfeldt L et al 2013 Higher levels of multiple ecosystem services
are found in forests with more tree speciesNature Commun.
4 1340
Grant G 2012 Ecosystem Services Come to Town: Greening Cities
by Working with Nature (Chichester: John Wiley & Sons)
Hales S, Butler C, Woodward A and Corvalan C 2004 Health
aspects of the millennium ecosystem assessment EcoHealth
1 124–8
Hales S and Corvalan C 2006 Public health emergency on planet
earth: insights from the millennium ecosystem assessment
EcoHealth 3 130–5
Hanski I et al 2012 Environmental biodiversity, human microbiota,
and allergy are interrelated Proc. Natl Acad. Sci. 109 8334–9
Hartig T et al 2011 Health benefits of nature experience:
psychological, social and cultural processes Forests, Trees, and
Human Health ed K Nilsson et al (Dordrecht: Springer)
pp 127–68
Harvey Al 2008 Natural products in drug discovery Drug Discov.
Today 13 894–901
Hegglin D and Deplazes P 2013 Control of echinococcus
multilocularis: strategies, feasibility and cost—benefit analyses
Int. J. Parasitol 43 327–37
Hendrickx G and Lancelot R 2010 A perspective on emerging
mosquito and phlebotomine-borne diseases in Europe Euro
Surveill. 15 pii=19503 (available online: www.
eurosurveillance.org/ViewArticle.aspx?ArticleId=19503)
Hillel D and Rosenzweig C 2008 Biodiversity and food production
Sustaining Life—How Human Health Depends on Biodiversity
ed E Chivian and A Bernstein (Oxford: Oxford University
Press) pp 325–81
Huber M et al 2011 How should we define health? Br. Med. J.
343 235–7
International Task Force on Avian Influenza 2006 Avian Influenza
and Wild Birds—What is their Actual Role in the Spread of the
Virus? (Bonn: UNEP/CMS Secretariat)
IPBES Intergovernmental Platform on Biodiversity and Ecosystem
Services: http://ipbes.net/
Ito T et al 2001 Generation of a highly pathogenic avian influenza A
virus from an avirulent field isolate by passaging in chickens
J. Virol. 75 4439–43 2001
Janko C, Linke S, Romig T, Thoma D, Schroder W and K ¨ onig A ¨
2011 Infection pressure of human alveolar echinococcosis due
to village and small town foxes (Vulpes vulpes) living in close
proximity to residents Eur. J. Wildl. Res. 57 1033–42
Jasanoff S 1990 The Fifth Branch. Science Advisers as Policymakers
(Cambridge, MA: Harvard University Press)
Johns T 2003 Plant biodiversity and malnutrition: simple solutions
to complex problems Afr. J. Food, Agric. Nutr. Dev. 3 45–52
Johnson P T J, Preston D L, Hoverman J T and Richgels K L D
2013 Biodiversity decreases disease through predictable
changes in host community competenceNature 494 230–3
Jones K E, Patel N G, Levy M A, Storeygard A, Balk D,
Gittleman J L and Daszak P 2008 Global trends in emerging
infectious diseasesNature 451 990–3
Kaplan R and Kaplan S 1989 The Experience of Nature: A
Psychological Perspective (Cambridge: Cambridge University
Press)
Keesing F et al 2010 Impacts of biodiversity on the emergence and
transmission of infectious diseasesNature 468 647–52
Kellert S R 2008 Biodiversity, quality of life, and evolutionary
psychology Biodiversity Change and Human Health: From
Ecosystem Services to Spread of Disease ed O Sala,
L Meyerson and C Parmesan (Washington, DC: Island)
pp 99–127
Keune H et al 2012a Report of the 2011 Belgian Biodiversity—
Public Health Conference, Belgian Biodiversity Platform
(www.biodiversity.be/files/1/4/3/1433.pdf)
16Environ. Res. Lett. 8 (2013) 025015 H Keune et al
Keune H et al 2012b Overview results of the inventory of scientific
research needs and ideas biodiversity—public health Belgian
Community of Practice Biodiversity—Public Health, Belgian
Biodiversity Platform (www.biodiversity.be/1996)
Kilpatrick A M, Chmura A A, Gibbons D W, Fleischer R C,
Marra P P and Daszak P 2006 Predicting the global spread of
H5N1 avian influenza Proc. Natl Acad. Sci. 103 19368–73
Kilpatrick A M and Randolph S E 2012 Drivers, dynamics and
control of emerging vector-borne zoonotic infections Lancet
380 1946–55
Kim J-K, Negovetich N J, Forrest H and Webster R G 2009 Ducks:
the ‘Trojan Horses’ of H5N1 influenza Influenza Other Respi.
Viruses 3 121–8
Kruger A, Rech A, Su X and Tannich E 2001 Two cases of ¨
autochthonous Plasmodium falciparum malaria in Germany
with evidence for local transmission by indigenous Anopheles
plumbeus Trop. Med. Int. Health 6 983–5
Lancet 2009 What is health? The ability to adapt Lancet 373 78
Lang D L, Wiek A, Bergmann M, Stauffacher M, Martens P,
Moll P, Swilling M and Thomas C J 2012 Transdisciplinary
research in sustainability science: practice, principles, and
challenges Sustain. Sci. 7 (Suppl. 1) 25–43
Langlois E, Campbell K, Prieur-Richard A-H, Karesh W and
Daszak P 2012 Towards a better integration of global health
and biodiversity in the new sustainable development goals
beyond RioC20 EcoHealth 9 381–5
Lebel J 2003 Health: An Ecosystem Approach (In Focus) (Ottawa:
International Development Research Centre)
Levi T, Kilpatrick A M, Mangel M and Wilmers C C 2012 Deer,
predators and the emergence of Lyme disease Proc. Natl Acad.
Sci. 109 10942–7
Li K S et al 2004 Genesis of a highly pathogenic and potentially
pandemic H5N1 influenza virus in eastern AsiaNature
430 209–13
Li J W-H and Vederas J C 2009 Drug discovery and natural
products: end of an era or an endless frontier? Science
325 161–5
Linard C, Lamarque P, Heyman P, Ducoffre G, Luyasu V,
Tersago K, Vanwambeke S O and Lambin E F 2007
Determinants of the geographic distribution of Puumala virus
and Lyme borreliosis infections in Belgium Int. J. Health
Geogr. 6 15
Lindgren E, Andersson Y, Suk J E, Sudre B and Semenza J C 2012
Monitoring EU emerging infectious disease risk due to climate
change Science 336 418–9
Lines J 2007 Chikungunya in Italy Br. Med. J. 335 576
Long N 2001 Development Sociology: Actor Perspectives
(New York: Routledge)
Lyytimaki J J and Sipila M 2009 Hopping on one leg—the
challenge of ecosystem disservices for urban green
management Urban For. Urban Green. 8 309–15
MA (Millennium Ecosystem Assessment) Full reports of the
Millennium Ecosystem Assessment, including synthesis
reports and related press materials (see www.maweb.org/en/
index.aspx)
MA 2005 Ecosystems and Human Well-Being: Synthesis
(Washington, DC: Island)
Marsh Inc. 2008 The Economic and Social Impact of Emerging
Infectious Disease (New York: Marsh Inc.)
Martens P 2002 Health transitions in a globalising world: towards
more disease or sustained health? Futures 34 635–48
McMichael A J 1993 Global environmental change and human
population health: a conceptual and scientific challenge for
epidemiology Int. J. Epidemiol. 22 1–8
McMichael A J 2002 Population, environment, disease, and
survival: past patterns, uncertain futures Lancet 359 1145–8
McMichael A J 2006 Population health as the ‘bottom line’ of
sustainability: a contemporary challenge for public health
researchers Eur. J. Public Health 16 579–82
McMichael A J 2009 Human population health: sentinel criterion of
environmental sustainabilityCurr. Opin. Environ. Sustain.
1 101–6
Meessen B, Kouanda S, Musango L, Richard F, Ridde V and
Soucat A 2011 Communities of practice: the missing link for
knowledge management on implementation issues in
low-income countries? Trop. Med. Int. Health 16 1007–14
Melillo J and Sala O 2008 Ecosystem services Sustaining
Life—How Human Health Depends on Biodiversity
ed E Chivian and A Bernstein (Oxford: Oxford University
Press) pp 75–115
Mennerat A, Nilsen F, Ebert D and Skorping A 2010 Intensive
farming: evolutionary implications for parasites and pathogens
Evol. Biol. 37 59–67
MODIRISK www.modirisk.be
Molyneux D H et al 2008 Ecosystem disturbance, biodiversity loss,
and human infectious disease Sustaining Life—How Human
Health Depends on Biodiversity ed E Chivian and
A Bernstein (Oxford: Oxford University Press) pp 287–323
National Environmental Action Plan 2013 Operational Report
2003–2008 (www.health.belgium.be/eportal/Aboutus/
relatedinstitutions/NEHAP/index.htm) (in Dutch)
Newman D J, Kilama J, Bernstein A and Chivian E 2008 Medicines
from nature Sustaining Life—How Human Health Depends on
Biodiversity ed E Chivian and A Bernstein (Oxford: Oxford
University Press) pp 117–61
Niemela J, Breuste J H, Guntenspergen G, McIntyre N E, ¨
Elmqvist T and James P (ed) 2011 Urban Ecology: Patterns,
Processes, and Applications (Oxford: Oxford University Press)
Ostroumov S A 2002 Polyfunctional role of biodiversity in
processes leading to water purification: current
conceptualizations and concluding remarks Hydrobiologia
469 203–4
Papa A et al 2010 Ongoing outbreak of West Nile virus infections in
humans in Greece, July–August 2010 Euro Surveill.
15 pii=19644 (available online: www.eurosurveillance.org/
ViewArticle.aspx?ArticleId=19644)
Parmesan C and Martens P 2009 Climate change, wildlife, and
human health Biodiversity Change and Human Health: From
Ecosystem Services to Spread of Disease ed O Sala,
L Meyerson and C Parmesan (Washington, DC: Island)
pp 245–66
Peixoto I and Abramson G 2006 The effect of biodiversity on the
hantavirus epizootic Ecology 87 873–9
Pongsiri M et al 2009 Biodiversity loss affects global disease
ecology Bioscience 59 945–54
Pruss- ¨ Ust ¨ un A and Corval ¨ an C 2006 ´ Preventing Disease through
Healthy Environments. Towards an Estimate of the
Environmental Burden of Disease (Geneva: WHO)
Pysek P et al 2010 Disentangling the role of environmental and
human pressures on biological invasions across Europe Proc.
Natl Acad. Sci. USA 107 12157–62
Rabinowitz P M and Gordon Z 2004 Outfoxing a rash: clinical
example of human–wildlife interaction EcoHealth 1 404–40
Radimersky T, Frolkova P, Janoszowska D, Dolejska M, Svec P,
Roubalova E, Cikova P, Cizek A and Literak I 2010 Antibiotic
resistance in faecal bacteria (Escherichia coli, Enterococcus
spp.) in feral pigeons J. Appl. Microbiol. 109 1687–95
Randolph S E and Dobson A D 2012 Pangloss revisited: a critique
of the dilution effect and the biodiversity-buffers-disease
paradigm Parasitology 139 847–63
Rapport D 2006 Avian influenza and the environment: an ecohealth
perspective Report Submitted to the UN Environment
Programme (available at: www.k4health.org/sites/default/files/
AvianFluEcoHealth.pdf)
Rapport D J, Costanza R and McMichael A J 1998 Assessing
ecosystem health Trends Ecol. Evol. 13 397–402
Rayner G and Lang T 2012 Ecological Public Health: Reshaping
the Conditions for Good Health (London: Routledge)
17Environ. Res. Lett. 8 (2013) 025015 H Keune et al
Rees W 1997 Urban ecosystems: the human dimension Urban
Ecosyst. 1 63–75
Rees W and Wackernagel M 2008 Urban ecological footprints: why
cities cannot be sustainable—and why they are key to
sustainability Environ. Impact. Assess. Rev. 16 223–45
Rook G 2010 Darwinian medicine and the ‘hygiene’ or ‘old friends’
hypothesisClin. Exp. Immunol. 160 70–9
Rohr J R, Dobson A P, Johnson P T J, Kilpatrick A M, Paull S H,
Raffel T R, Ruiz-Moreno D and Thomas M B 2011 Frontiers in
climate change—disease research Trends Ecol. Evol. 26 270–7
Rockstrom J, Gordon L, Folke C, Falkenmark M and Engwall M ¨
1999 Linkages among water vapor flows, food production, and
terrestrial ecosystem servicesConserv. Ecol. 3 5
Santa-Olalla Peralta P et al 2010 First autochthonous malaria case
due to Plasmodium vivax since eradication, Spain, October
2010 Euro Surveill. 15 pii=19684 (available online: www.
eurosurveillance.org/ViewArticle.aspx?ArticleId=19684)
Sarkki S, Niemela J, Tinch R and the SPIRAL team 2012 Criteria ¨
for science–policy interfaces and their linkages to instruments
and mechanisms for encouraging behaviour that reduces
negative human impacts on biodiversity Science–Policy
Interfaces for Biodiversity: Research, Action and Learning
(SPIRAL; FP7 EU research project) (www.spiral-project.eu/
sites/default/files/SPIRAL 3-1.pdf)
Sempik J, Hine R and Wilcox D (ed) 2010 Green Care: A
Conceptual Framework (A Report of the Working Group on the
Health Benefits of Green Care, COST Action 866, Green Care
in Agriculture) (Loughborough: Centre for Child and Family
Research, Loughborough University)
Seto K C, Guneralp B and Hutyra L R 2012 Global forecasts of ¨
urban expansion to 2030 and direct impacts on biodiversity and
carbon pools Proc. Natl Acad. Sci. USA 109 16083–8
Shute P G 1954 Indigenous P. vivax malaria in London believed to
have been transmitted by An. plumbeus Monthly Bull. Minist.
Health Public Health Lab. Serv. 13 48–51
Sirbu A, Ceianu C S, Panculescu-Gatej R I, Vazquez A, Tenorio A, ´
Rebreanu R, Niedrig M, Nicolescu G and Pistol A 2011
Outbreak of West Nile virus infection in humans, Romania,
July to October 2010 Euro Surveill. 16 pii=19762 (available
online: www.eurosurveillance.org/ViewArticle.aspx?
ArticleId=19762)
Skevington S M 2009 Quality of life, biodiversity and health:
observations and applications Biodiversity Change and Human
Health: From Ecosystem Services to Spread of Disease
ed O Sala, L Meyerson and C Parmesan (Washington, DC:
Island) pp 129–42
Soskolne C L and Bertollini R 2002 Global ecological integrity,
global change and public healthConservation Medicine:
Ecological Health in Practice ed A A Aguirre, R S Ostfeld,
G M Tabor, C House and M C Pearl (New York: Oxford
University Press) pp 372–82
Stephens C 2012 Biodiversity and global health—hubris, humility
and the unknown Environ. Res. Lett. 7 011008
Sudmeier-Rieux K, Masundire H, Rizvi I and Rietbergen S 2006
Ecosystems, Livelihoods and Disasters: An Integrated
Approach to Disaster Risk Management (Gland: IUCN)
Swingland I 2001 Biodiversity, Definition of Encyclopedia of
Biodiversity vol 1 (London: Academic) pp 377–91
Tabor G M and Aguirre A A 2004 Ecosystem health and sentinel
species: adding an ecological element to the proverbial Canary
in the mineshaft EcoHealth 1 226–8
Tatem A J, Hay S I and Rogers D J 2006 Global traffic and disease
vector dispersal Proc. Natl Acad. Sci. USA 103 6242–7
TEEB (The Economics of Ecosystems and Biodiversity) 2011 The
Economics of Ecosystems and Biodiversity in National Policy
and Decision Making (London: Routledge)
ten Brink P, Badua T, Bassi S, Gantioler S and Kettunen M 2011
Estimating the Overall Economic Value of the Benefits
Provided by the Natura 2000 Network (Brussels: Institute for
European Environmental Policy)
Thomas M B, Lafferty K D and Friedman C S 2009 Biodiversity
and disease Biodiversity Change and Human Health: From
Ecosystem Services to Spread of Disease ed O Sala,
L Meyerson and C Parmesan (Washington, DC: Island)
pp 229–44
Ticker G, Kuttinen M, McConville A, Cottee-Jones E, Ebert S,
Hulea O, Lucius I, Moroz S, Strobel D and Todorova M 2010
Valuing and Conserving Ecosystem Services: a Scoping Case
Study in the Danube Basin (Brussels: Institute For European
Environmental Policy)
Toledo A and Burlingame B 2006 Biodiversity and nutrition: a
common path toward global food security and sustainable
development J. Food Compos. Anal. 19 477–83
Turnhout E, Bloomfield B, Hulme M and Wynne B 2012
Conservation policy: listen to the voices of experienceNature
488 454–5
Tzoulas K, Korpela K, Venn S, Yli-Pelkonen V, Kazmierczak A, ´
Niemela J and James P 2007 Promoting ecosystem and human ¨
health in urban areas using Green Infrastructure: a literature
review Landsc. Urban Plann. 81 167–78
UN (United Nations) 1992 Report of the United Nations Conference
on Environment and Development (Rio de Janeiro, 3–14 June
1992) (New York: UN) UN General Assembly Document Ref:
A/CONF.151/26 (I)
United Nations Population Division 2010 World Population
Prospects: The 2010 Revision (New York: United Nations)
(available at: http://esa.un.org/wpp/)
Van Den Berge K 1995 De Vos Vulpes vulpes in Vlaanderen:
inventarisatie en synthese van de belangrijkste knelpunten
Mededelingen van het Instituut voor Bosbouw en Wildbeheer
1995/1 pp 71–100 (with English summary)
Van Den Berge K and De Pauw W 2003 Vos Vulpes vulpes
(Linnaeus, 1758) Zoogdieren in Vlaanderen. Ecologie en
verspreiding van 1987 tot 2002. Natuurpunt Studie en
JNM-Zoogdierenwerkgroep, Mechelen & Gent, Belgie¨
ed S Verkem, J De Maeseneer, B Vandendriessche,
G Verbeylen and S Yskout (with English summary)
Van den Berg A E, Hartig T and Staats H 2007 Preference for nature
in urbanized societies: stress, restoration and the pursuit of
sustainability J. Soc. Issues 63 79–96
Vandendriessche Y, Gellynck X, Saatkamp H and Viaene J 2009
Strategies to control high pathogenic avian influenza (HPAI) in
the Belgian poultry sector Biotechnol. Anim. Husb. 25 373–85
Van den Hove S 2007 A rationale for science–policy interfaces
Futures 39 807–26
Van Gucht S and Le Roux I 2008 Rabies control in Belgium: from
eradication in foxes to import of a contaminated dog Vlaams
Diergen. Tijds. 77 376–84
Van Gucht S, Van Den Berge K, Quataert P, Verschelde P and
Le Roux I 2010 No emergence of echinococcus multilocularis
in foxes in flanders and Brussels Anno 2007–2008 Zoonoses
Public Health 57 65–70
Van Herzele A, Collins K and Heyens V 2005 Interacting with
Greenspace: Public Participating with Professionals in the
Planning and Management of Parks and Woodlands (Brussels:
ANB)
Van Herzele A, De Clercq E M, Wiedemann T, De Bruyn L and
Degans H 2004 Stedelijk milieu MIRA-T 2004, Milieu-en
Natuurrapport Vlaanderen ed M Van Steertegem (Leuven:
Garant) pp 355–65
Van Herzele A and de Vries S 2012 Linking green space to health: a
comparative study of two urban neighbourhoods in Ghent,
Belgium Popul. Environ. 34 171–93
Versteirt V, De Clercq E, Dekoninck W, Damiens D, Ayrinhac A,
Jacobs F and Van Bortel W 2009 Mosquito vectors of disease:
spatial biodiversity, drivers of change, and risk MODIRISK
18Environ. Res. Lett. 8 (2013) 025015 H Keune et al
Final Report (Research Programme Science for a Sustainable
Development) (Brussels: Belgian Science Policy) p 152
Versteirt V et al 2012 Nationwide inventory of mosquito
biodiversity (Diptera: Culicidae) in Belgium, Europe Bull.
Entomol. Res. 103/2 1475–2670
von Hertzen L et al 2011 Natural immunity: biodiversity loss and
inflammatory diseases are two global megatrends that might be
related EMBO Rep. 12 1089–93
von Schirnding Y 2002 Health and sustainable development: can we
rise to the challenge? Lancet 360 632–7
Walker Bet al 2009 Looming global-scale failures and missing
institutions Science 325 1345–6
Wenger E and Snyder W M 2000Communities of Practice: The
Organizational Frontier (Boston, MA: Harvard Business
Review) pp 139–45
Whitehead M 2005 Tackling inequalities: a review of policy
initiatives Tackling Inequalities in Health: An Agenda for
Action ed M Benzeval, K Judge and M Whitehead (London:
Kings Fund)
WHO (World Health Organisation) 2004 The Vector-Borne Human
Infections of Europe—their Distribution and Burden on Public
Health (Geneva: WHO Regional Office for Europe)
WHO 2005 Ecosystems and Human Well-Being: Health Synthesis.
A Report of the Millennium Ecosystem Assessment (Geneva:
WHO)
WHO 2011 Our Planet, Our Health, Our Future: Human health
and the Rio Conventions (Geneva: WHO)
Wilby A et al 2009 Biodiversity, Food Provision, and Human Health
Biodiversity Change and Human Health: From Ecosystem
Services to Spread of Disease ed O Sala, L Meyerson and
C Parmesan (Washington, DC: Island) pp 13–40
Wildlife Conservation Society One World, One HealthTM (see www.
wcs.org/conservation-challenges/wildlife-health/
wildlife-humans-and-livestock/one-world-one-health.aspx;
also www.oneworldonehealth.org/)
Wittmer H, Berghofer A, Keune H, Martens P, F ¨ orster J and ¨
Almack K 2012 The value of nature for local development The
Economics of Ecosystems and Biodiversity in Local and
Regional Policy and Management ed H Wittmer and
H Gundimeda (New York: Routledge) pp 7–32
Zielinski-Gutierrez E C and Hayden M H 2006 A model for
defining West Nile virus risk perception based on ecology and
proximity EcoHealth 3 28–34
19
**
**
Evidence of merit of the cited paper in Hydrobiologia. Citation. Other examples of citation of this publications of this series:
Citation of: Polyfunctional role of biodiversity...
http://5bio5.blogspot.com/2013/06/one-of-best-cited-scientific.html
**
this article was cited: 2002. Polyfunctional role of biodiversity in processes leading to water purification: current conceptualizations and concluding remarks. Hydrobiologia. 469: 203–204;
http://5bio5.blogspot.com/2013/05/belgium-et-al-citation-of-article.html
Cited by scientists of 22 institutions: Belgium; Ireland;
Sweden; France; Germany; The Netherlands; Czech Republic
Full text of the cited paper, online free:
http://ru.scribd.com/doc/52627327/
Citation context:
By underpinning certain critical ecosystem
services, biodiversity also plays a role in safeguarding air
quality and access to fresh water (see for example: Rockstrom¨
et al 1999, Ostroumov 2002, Melillo and Sala 2008, Cardinale
2011);
This article was cited in the paper
'Science–policy challenges for biodiversity, public health and urbanization: examples from
Belgium'
by scientists of 22 institutions: Belgium; Ireland;
Sweden; France; Germany; The Netherlands; Czech Republic:
2 Belgian Biodiversity Platform, Belgium (www.biodiversity.be/)
3 Faculty of Applied Economics, University of Antwerp, Prinsstraat 13, B-2000 Antwerp, Belgium
4 naXys, Namur Center for Complex Systems, University of Namur, 8 rempart de la vierge, B-5000,
Belgium
5 Co-Operation On Health And Biodiversity (COHAB), COHAB Initiative Secretariat, PO Box 16,
Tuam, Co. Galway, Ireland;
6 Biological Control and Spatial Ecology Lab, Universite libre de Bruxelles, CP160/12, ´
50, av FD Roosevelt, B-1050 Brussels, Belgium
7 Federal Public Service Health, Food Chain Safety and Environment, Eurostation II, Place Victor Horta,
40 Box 10, B-1060 Brussels, Belgium
8 Agriculture and Veterinary Intelligence and Analysis (Avia-GIS), Risschotlei 33, B-2980 Zoersel,
Belgium
9
Institute for Housing and Urban Research, Uppsala University, PO Box 514, SE-75120 Uppsala,
Sweden
10 Agency for Nature and Forest (ANB), Koning Albert II-laan 20 bus 8, Graaf de Ferrarisgebouw 1000,
Brussels, Belgium
11 Royal Belgian Institute of Natural Sciences (RBINS), Rue Vautier 29, B-1000 Brussels, Belgium
12 Research Institute for Agriculture and Fisheries (ILVO), Burgemeester Van Gansberghelaan 96 Bus 1,
B-9820 Merelbeke, Belgium
13 Department of Geography, Universite catholique de Louvain, 2, Place des Sciences, ´
B-1348 Louvain-la-Neuve, Belgium
14 DIVERSITAS, c/o Museum National d’Histoire Naturelle, 57 rue Cuvier, CP 41, F-75231 Paris Cedex 05, France;
15 Helmholtz Centre for Environmental Research (UFZ), Permoserstrasse 15, D-04318 Leipzig, Germany;
16 International Centre for Integrated Assessment and Sustainable Development (ICIS), Maastricht
University, PO Box 616, 6200 MD Maastricht, The Netherlands;
17 Division of Agricultural and Food Economics, K U Leuven, Celestijnenlaan 200e—Box 2411,
B-3001 Heverlee, Belgium
18 Laboratory for Tropical and Subtropical Agriculture and Ethnobotany, Ghent University, Coupure
Links 653, B-9000 Gent, Belgium
19 Faculty of Tropical Agrisciences, Czech University of Life Sciences Prague, Kamycka 129,
Prague 6—Suchdol, 165 21, Czech Republic
20 Ecology, Evolution and Biodiversity Conservation Section, K U Leuven, Charles Deberiotstraat
32—Box 2439, B-3000 Leuven, Belgium
21 Military Hospital Queen Astrid, Bruynstraat 1, 1120 Neder-over-Heembeek, Belgium
22 Institute for Environmental Management and Land-use Planning, Universite libre de Bruxelles, ´
Campus du Solbosch, Batiment D—6 ˆ eme niveau, Local DB6.246, Avenue Depage, 30, `
B-1050 Bruxelles, Belgium
This article was cited in:
http://iopscience.iop.org/1748-9326/8/2/025015/pdf/1748-9326_8_2_025015.pdf
Science–policy challenges for biodiversity, public health and urbanization: examples from
Belgium
This article has been downloaded from IOPscience. Please scroll down to see the full text article.
2013, Environ. Res. Lett., 8, 025015
(http://iopscience.iop.org/1748-9326/8/2/025015)
Download details:
IP Address: 188.123.231.45
The article was downloaded on 14/05/2013 at 05:56
Please note that terms and conditions apply.
View the table of contents for this issue, or go to the journal homepage for more
Home Search Collections Journals About Contact us My IOPscienceIOP PUBLISHING
ENVIRONMENTAL RESEARCH LETTERS
(Environ. Res. Lett.) 8 (2013) 025015 (19pp) doi:10.1088/1748-9326/8/2/025015
Science–policy challenges for biodiversity,
public health and urbanization: examples
from Belgium
Hans Kuene:
authors of the paper:H Keune1,2,3,4, C Kretsch5, G De Blust1, M Gilbert6, L Flandroy7,
K Van den Berge1, V Versteirt8, T Hartig9, L De Keersmaecker10,
H Eggermont2,11, D Brosens1,2, J Dessein12, S Vanwambeke13,
A H Prieur-Richard14, H Wittmer15, A Van Herzele, C Linard6,
P Martens16, E Mathijs17, I Simoens1, P Van Damme18,19, F Volckaert20,
P Heyman21 and T Bauler22
Email of some of the authors:
hans.keune@inbo.be
conor.kretsch@cohabnet.org
tbauler (at) ulb.ac.be
1 Research Institute for Nature and Forest (INBO), Kliniekstraat 25, B-1070 Brussels, Belgium
2 Belgian Biodiversity Platform, Belgium (www.biodiversity.be/)
3 Faculty of Applied Economics, University of Antwerp, Prinsstraat 13, B-2000 Antwerp, Belgium
4 naXys, Namur Center for Complex Systems, University of Namur, 8 rempart de la vierge, B-5000,
Belgium
5 Co-Operation On Health And Biodiversity (COHAB), COHAB Initiative Secretariat, PO Box 16,
Tuam, Co. Galway, Ireland
6 Biological Control and Spatial Ecology Lab, Universite libre de Bruxelles, CP160/12, ´
50, av FD Roosevelt, B-1050 Brussels, Belgium
7 Federal Public Service Health, Food Chain Safety and Environment, Eurostation II, Place Victor Horta,4 0 Box 10, B-1060 Brussels, Belgium
8 Agriculture and Veterinary Intelligence and Analysis (Avia-GIS), Risschotlei 33, B-2980 Zoersel,
Belgium
9. Institute for Housing and Urban Research, Uppsala University, PO Box 514, SE-75120 Uppsala,
Sweden
10 Agency for Nature and Forest (ANB), Koning Albert II-laan 20 bus 8, Graaf de Ferrarisgebouw 1000,
Brussels, Belgium
11 Royal Belgian Institute of Natural Sciences (RBINS), Rue Vautier 29, B-1000 Brussels, Belgium
12 Research Institute for Agriculture and Fisheries (ILVO), Burgemeester Van Gansberghelaan 96 Bus 1,
B-9820 Merelbeke, Belgium
13 Department of Geography, Universite catholique de Louvain, 2, Place des Sciences, ´
B-1348 Louvain-la-Neuve, Belgium
14 DIVERSITAS, c/o Museum National d’Histoire Naturelle, 57 rue Cuvier, CP 41, F-75231 Paris Cedex ´
05, France
15 Helmholtz Centre for Environmental Research (UFZ), Permoserstrasse 15, D-04318 Leipzig, Germany
16 International Centre for Integrated Assessment and Sustainable Development (ICIS), Maastricht
University, PO Box 616, 6200 MD Maastricht, The Netherlands
17 Division of Agricultural and Food Economics, K U Leuven, Celestijnenlaan 200e—Box 2411,
B-3001 Heverlee, Belgium
18 Laboratory for Tropical and Subtropical Agriculture and Ethnobotany, Ghent University, Coupure
Links 653, B-9000 Gent, Belgium
19 Faculty of Tropical Agrisciences, Czech University of Life Sciences Prague, Kamycka 129,
Prague 6—Suchdol, 165 21, Czech Republic
20 Ecology, Evolution and Biodiversity Conservation Section, K U Leuven, Charles Deberiotstraat
32—Box 2439, B-3000 Leuven, Belgium
21 Military Hospital Queen Astrid, Bruynstraat 1, 1120 Neder-over-Heembeek, Belgium
22 Institute for Environmental Management and Land-use Planning, Universite libre de Bruxelles, ´
Campus du Solbosch, Batiment D—6 ˆ eme niveau, Local DB6.246, Avenue Depage, 30, `
B-1050 Bruxelles, Belgium
H Keune1,2,3,4, G De Blust1,
K Van den Berge1, D Brosens1,2,
I Simoens1,
Research Institute for Nature and Forest (INBO), Kliniekstraat 25, B-1070 Brussels, Belgium info@inbo.be
M Gilbert 6, C Linard 6,
Biological Control and Spatial Ecology Lab, Universite libre de Bruxelles, CP160/12, ´
50, av FD Roosevelt, B-1050 Brussels, Belgium webmaster@ulb.ac.be
Content from this work may be used under the terms of the Creative Commons Attribution 3.0 licence. Any further distribution of this work
must maintain attribution to the author(s) and the title of the work, journal citation and DOI.
C19$33.00 11748-9326/13/025015
c 2013 IOP Publishing Ltd Printed in the UKEnviron. Res. Lett. 8 (2013) 025015 H Keune et al
E-mail: hans.keune@inbo.be
Received 2 January 2013
Accepted for publication 5 April 2013
Published 9 May 2013
Online at stacks.iop.org/ERL/8/025015
**
**
 | Tom Baulertbauler (at) ulb.ac.be |
Tom Bauler is a Spring 2013 Visiting Research Fellow with the Program on Science, Technology and Society at the Harvard Kennedy School and Assistant Professor and Chair of Environment and Economics at the Université Libre de Bruxelles where he teaches ecological economics. His research focuses on the governance of alternative indicators for well-being, particularly on the dynamics of “beyond-GDP” indicators and the institutionalization of the policy agenda. Tom also conducts a series of research efforts on “governance of transitions” from the perspective of grassroots innovations. While at the STS Program, he will investigate the dynamics of current American actors in this domain with the objective to elaborate on a comparative analysis of the respective US and European policy agendas.
Tom received his PhD in Environmental Sciences from the Université Libre de Bruxelles in 2007. In his dissertation, he studied the usability of environmental indicators for policy making. He has continued to explore the domain via two consecutive European-FP7 projects (BRAINPOOL and POINT). Tom also received an MA in Economics from the Université Louis Pasteur and completed a post-graduate degree in STS from Ecole Polytechnique fédérale de Lausanne. More info: http://sts.hks.harvard.edu/people/fellows/tom-bauler/
**
Abstract
Internationally, the importance of a coordinated effort to protect both biodiversity and public
health is more and more recognized. These issues are often concentrated or particularly
challenging in urban areas, and therefore on-going urbanization worldwide raises particular
issues both for the conservation of living natural resources and for population health strategies.
These challenges include significant difficulties associated with sustainable management of
urban ecosystems, urban development planning, social cohesion and public health. An
important element of the challenge is the need to interface between different forms of
knowledge and different actors from science and policy. We illustrate this with examples from
Belgium, showcasing concrete cases of human–nature interaction. To better tackle these
challenges, since 2011, actors in science, policy and the broader Belgian society have launched
a number of initiatives to deal in a more integrated manner with combined biodiversity and
public health challenges in the face of ongoing urbanization. This emerging community of
practice in Belgium exemplifies the importance of interfacing at different levels. (1) Bridges
must be built between science and the complex biodiversity/ecosystem–human/public
health–urbanization phenomena. (2) Bridges between different professional communities and
disciplines are urgently needed. (3) Closer collaboration between science and policy, and
between science and societal practice is needed. Moreover, within each of these communities
closer collaboration between specialized sections is needed.
Keywords: biodiversity, ecosystem services, public health, urbanization, science–policy
interface, community of practice, complexity
1. Introduction
The major challenges facing humanity in the 21st century
are closely interlinked and increasingly globalized. At local,
regional and global scales the crises in health, food and
nutrition security, water, energy, climate change, biodiversity
loss and poverty frequently overlap in both root and proximate
causes, in their various impacts, and in terms of the policy
and practical approaches needed to address them and to effect
sustainable long term solutions (e.g. UN 1992, McMichael
1993, MA 2005, Dreher et al 2008). Walker et al (2009) have
highlighted deficiencies in global institutional approaches
to these issues, and have called for greater collaboration
and cross-linking between actors in civil society, business
and governance, supported by greater ‘local appreciation of
shared global concerns’. This is a fundamental challenge
for sustainable development, demanding improved dialogue
between sectors and the integration of perspectives, policies
and strategies between social, environmental, economic and
cultural arenas, and creation of new institutional frameworks.
Against this background the linkages between the
biosphere and human health and well-being have become
of increasing importance in international science and policy
in the past two decades, with new interdisciplinary and
‘transdisciplinary’ fields emerging to address the gaps in
knowledge and action based on ecosystem approaches
to health (or ecohealth), (e.g. Lebel 2003, de Plaen
and Kilelu 2004). This includes the concepts of One
World, One Health (Wildlife Conservation Society) and
conservation medicine, and initiatives such as the EcoHealth
Alliance (EcoHealth Alliance), Co-operation on Health,
and Biodiversity (COHAB) and the DIVERSITAS ecoHealth
project (DIVERSITAS ecoHealth). These approaches build
on the concept of the ecosystem approach to biodiversity
conservation promoted by the UN Convention on Biological
Diversity (CBD), which aims to account for the interactions
between various levels of biological complexity and
recognizes that ‘humans, with their cultural diversity,
are an integral component of ecosystems’ (CBD COP
Decision V/6); as such, ecosystem approaches to health
are systemic approaches to population health that recognize
intimate links between the health of the biosphere and the
health of human communities, and frequently incorporate
perspectives of ecology, human and veterinary medicine,
agriculture, economics, sociology, and aspects of risk
assessment, engineering, and conflict resolution. To date
much of this work has, for the most part, been led from
within the environment and conservation biology disciplines,
fronted by environmental research institutes and NGOs,
and intergovernmental environmental agencies, frequently
building on the findings of the Millennium Ecosystem
Assessment (MA) (MA, MA 2005, Hales et al 2004, Hales
and Corvalan 2006) and related processes. However, as
2Environ. Res. Lett. 8 (2013) 025015 H Keune et al
the science on these issues has progressed, so too has the
understanding within the medical science and healthcare
community of how major public health issues and emerging
health threats may be associated with global environmental
change, and how interactions with ecological systems affect
disease risks, health outcomes and the efficacy of public health
management strategies (see for example Dobson and Carper
1993, Soskolne and Bertollini 2002, WHO 2005, Chivian and
Bernstein 2008a, WHO 2011).
In 2000, a commentary in The Lancet medical journal (as
part of a special series on future health challenges) highlighted
the many challenges facing healthcare in the new century,
arguing that partnerships with actors outside of the health
sciences would be critical, and calling for commitment to
‘a broader view of public health, and to values of equity
and ecological sustainability’ (Beaglehole and Bonita 2000).
The constraints to such systemic and cross-sector approaches
are numerous and complex. These include cultural, resource
and political barriers, knowledge gaps, and differing temporal
scales of operation. Campbell-Lendrum (2005) identified
three core difficulties that hinder such engagement by the
health sector on environmental issues—a lack of awareness
of the relevance to health, a methodological approach
focused on discrete cause–effect relationships rather than
systemic issues, and little input to processes addressing the
environmental root causes of health problems. Therefore,
realizing these approaches requires development of a strong
evidence base, a mutual understanding of perspectives
between sectors, common frameworks for assessment, and
practical collaborative strategies based on an appreciation
of shared risks and opportunities. The concept of ecosystem
goods and services(referring to the benefits which ecosystems
provide to society, and often considered together simply as
ecosystem services) has been important in helping to bridge
these gaps, and serves as a framework on which to build
ecosystem approaches to health and well-being. In particular,
the outputs of the MA have helped to conceptualize the
links between ecosystem services and well-being (Alcamo
et al 2003, MA 2005), highlighting current knowledge,
identifying risks of ecosystem change, and suggesting areas
for future research. Whilst the precise relationship between
biodiversity and the delivery of ecosystem services is not
always clear and is often contentious, not least in terms of
the precise connections between biodiversity and services
relevant to health, in a general sense it is widely accepted
that biodiversity is important for the key traits of resistance
and resilience in ecological systems and as such underpins
ecosystem services (CBD 2010). Although the attribute of
‘diversity’ is not necessarily essential to the delivery of
certain ecosystem services in every scenario—for example,
a monoculture forest plantation might perhaps supply as
much or more timber as a native mixed woodland of similar
size—diversity helps to secure the sustainability and flow
of multiple ecosystem services, and supports adaptation
to environmental change (that same monoculture might be
more susceptible to disease or drought, and provide less
in terms of other services such as pollination and food
resources; see for example Gamfeldt et al 2013). Whilst still
a very young and evolving field, the study of ecosystem
services is progressing rapidly, with particular attention paid
in recent years to the economic aspects of ecosystems,
and the economic policy implications of ecosystem change
and biodiversity loss. This has included global assessments
(TEEB 2011) as well as regional and national scale studies
including several within Europe (e.g. Bullock et al 2008,
Ticker et al 2010; Bateman et al 2011, ten Brink et al
2011). In contrast, despite the growing awareness of linkages
between biodiversity, ecosystem services and public health,
the health dimension remains comparatively undervalued in
policy and practical contexts, even within recent economic
studies (the above referenced works, for example, pay little
attention to economic aspects of biodiversity-related health
issues, though Bateman et al (2011), for the UK National
Ecosystem Assessment, attempt to link the two fields for some
health issues).
However, in recent years there have been some significant
developments in international policy and in local, regional and
global responses towards the integration of biodiversity and
human health. In 2010, the 10th Conference of the Parties
(COP) to the Convention on Biological Diversity adopted a
decision mandating direct interaction between the Secretariat
of the Convention and the World Health Organization (CBD
COP Decision X/27), committing for the first time to forging
a partnership with the WHO. Also, in outlining a new strategy
for the period 2011–2020, the COP urged that National
Biodiversity Strategies and Action Plans should work to
enhance the contribution of biodiversity to human health and
well-being. Further decisions to build upon this action were
taken at the 11th CBD COP meeting in 2012. That year also
saw the links between health and biodiversity recognized at
the Rio C20 UN Conference on Sustainable Development,
where a discussion document titled Our Planet, Our Health,
Our Future (jointly prepared by WHO and the secretariats of
the three Rio Conventions—the CBD, the UN Convention to
Combat Desertification and the UN Framework Convention
on Climate Change) was presented by the WHO Director
General Margaret Chan, highlighting the links between global
environmental agreements and global health concerns (WHO
2011). The same year, the UN-mandated Intergovernmental
Platform on Biodiversity and Ecosystem Services (IPBES)
was launched, with a specific remit of strengthening the
science of biodiversity and ecosystem services and their
importance to human well-being, including health, in order
to facilitate informed decision making in environmental,
economic and social policy. However, the involvement of the
health sector in progressing sustainable development is still
poor (Langlois et al 2012); critically, leadership from global
institutions such as the World Health Assembly, to promote
dialogue with the biodiversity sector and greater integration
of health and biodiversity concerns from local to regional
levels, is lacking (COHAB 2010). Clearly, many barriers to
mainstreaming an ecosystem approach to health remain.
In this paper we illustrate the challenges of integrating
efforts to address problems involving biodiversity, public
health and urbanization. To do this, we take examples from
Belgium, one of the most densely populated and urbanized
3Environ. Res. Lett. 8 (2013) 025015 H Keune et al
countries in the world. Going on, we discuss an emerging
community of practice in Belgium. Since 2011, actors in
science, policy and the broader Belgian society have launched
a number of initiatives to deal in a more integrated manner
with combined biodiversity and public health challenges in
the face of on-going urbanization. First, though, we provide
additional background on the interfaces among these sets of
challenges.
A note on definitions: Arriving at a precise definition for
biodiversity that can meet the current range of scientific,
economic and policy needs has proved difficult, compounded
by the fact that much of the world’s biodiversity has yet
to be discovered or described (e.g. Swingland 2001, Feest
et al 2010). In this paper, we follow the definition provided
in the text of the UN Convention on Biological Diversity
(CBD) and now widely accepted and used in policy contexts,
i.e. the variability among living organisms from all sources
including inter alia terrestrial, marine, and other aquatic
ecosystems and the ecological complexes of which they
are a part, including diversity within and between species,
and of ecosystems. We also acknowledge recent debate on
what constitutes a useful definition of health. The widely
utilized definition from the Constitution of the WHO is ‘a
state of complete physical, mental and social well-being,
and not merely an absence of disease or infirmity’; some
commentators have questioned whether this definition is still
sufficient in an increasingly globalized world and in the face
of pervasive human impacts on the global environment, and
have advocated that the definition should also account for the
ability to adapt to health challenges (e.g. Lancet 2009, Huber
et al 2011). This focus on adaptation has strong correlations
with the concept of ecosystem health, with its notions of
resistance and resilience (Costanza 1992, Rapport et al 1998),
and can be particularly useful in terms of understanding the
importance of biodiversity to sustaining health and well-being
in the context of global change.
1.1. Biodiversity and public health
According to McMichael (2009), ‘Human population health
should be the central criterion, and is the best long
term indicator, of how we are managing the natural
environment’. Environmental philosophers and others may
question the valuation of human life over all other life in
this assertion, as well as the implicit assumption that ‘we’
can truly manage the natural environment. Human population
health nonetheless is an important criterion for efforts by
institutional and other actors to guide human action in
the natural environment. Whereas human health and social
well-being were once largely seen as an aim and outcome
of economic growth, today they are more broadly understood
as a prerequisite and fundamental principle of sustainable
development (McMichael 2002, 2006, von Schirnding 2002,
Martens 2002).
New types of diseases and public health issues have
appeared in the last century, including the emergence or
re-emergence of pathogens, new environmental hazards and
increased risks of natural disasters, and changes in food
regimes. The WHO has estimated that one quarter of the
global burden of disease in humans, disproportionately felt
in the developing world, is due to environmental change
(Pruss- ¨ Ust ¨ un and Corval ¨ an´ 2006). The MA synthesis report
for the health sector (WHO 2005) outlines several linkages
between ecosystems and health, providing a review of the
health implications of ecosystem changes identified in the
MA, and the actions required to address these.
However, the links between biodiversity and human
health are varied and complex and not always certain.
Some clear linkages can be demonstrated, for example
the importance of biodiversity to traditional and modern
medicinal practice, and the utility of various species for
medical research, as sentinels of emerging health risks, and
as models for investigating human disease (Harvey 2008,
Newman et al 2008, Tabor and Aguirre 2004, Chivian
and Bernstein 2008b, Cox 2009, Li and Vederas 2009).
Genetic and species diversity is also the cornerstone of food
production, and can play an important role in addressing
issues of nutrition security including certain disease risks
(e.g. obesity, diabetes and other diseases of affluence)
through dietary improvements (Wilby et al 2009, Johns 2003,
Frison et al 2006, Toledo and Burlingame 2006, Hillel and
Rosenzweig 2008, Burlingame et al 2009, Burlingame and
Dernini 2012). By underpinning certain critical ecosystem
services, biodiversity also plays a role in safeguarding air
quality and access to fresh water (see for example: Rockstrom¨
et al 1999, Ostroumov 2002, Melillo and Sala 2008, Cardinale
2011); and plays a role in disaster risk reduction and
in supporting the response to emergencies and climate
change adaptation (Sudmeier-Rieux et al 2006, Colls et al
2009, Parmesan and Martens 2009). Furthermore, diversity
of life in natural environments may enhance experiences
that promote stress reduction, support the development of
cognitive resources, stimulate social contacts, attract people
for physical activity, and support personal development
throughout an individual’s lifespan (Kaplan and Kaplan 1989,
Kellert 2008, Skevington 2009, Hartig et al 2011). Moreover,
recent studies show that declining (contact with) some forms
of life may contribute to the rapidly increasing prevalence
of allergies and other chronic inflammatory diseases among
urban populations worldwide (Rook 2010, von Hertzen et al
2011, Hanski et al 2012). Biodiversity thus can have an
important contribution to both public health related ecosystem
services and in reduction of health risks.
One area of intense scrutiny is the relationship between
biodiversity and infectious disease, and how ecosystem
change and biodiversity loss may affect the ecology of disease
organisms and the dynamics of pathogen–host interactions.
The emergence and spread of certain pathogens from wildlife
to livestock and/or humans, and related social and economic
costs, has been well documented—these diseases include
HIV, hanta virus, avian influenza, Lyme disease, malaria,
Dengue fever, Leishmaniasis, Nipah virus and Ebola (Peixoto
and Abramson 2006, Molyneux et al 2008, Marsh Inc.
2008, Thomas et al 2009, Lindgren et al 2012). Several
studies have determined that biodiversity reduces the risk
of infectious disease emergence or spread, while its loss
4Environ. Res. Lett. 8 (2013) 025015 H Keune et al
or unsustainable exploitation can increase such risks (e.g.
Pongsiri et al 2009, Keesing et al 2010, Johnson et al
2013). The dynamics, however, are complex and probably
system-dependent, and high biodiversity does not necessarily
reduce disease risk in all situations (e.g. Randolph and
Dobson 2012, Kilpatrick and Randolph 2012). Nevertheless,
land-use change and ecosystem disruption are well recognized
factors influencing disease emergence. In a study examining
incidences of disease emergence worldwide, Jones et al
(2008) established that there has been an increase in disease
emergence and an increasing prevalence of zoonotic diseases
since 1940. They also established that areas of likely high-risk
for novel emerging infectious diseases correlated with areas
of high biodiversity, and with areas of high human population
density. Another issue associated with population density is
the significant health threat posed by antimicrobial resistance.
Amongst the risk factors for emergence of resistance is
pollution from agriculture and from urban areas. Drug
resistant organisms present in the environment can be picked
up and carried by wildlife and by feral animals, potentially
increasing human health risks in urban areas (e.g. Radimersky
et al 2010, Allen et al 2010).
Whilst providing a compelling public health incentive
for collaboration, the importance of biodiversity to health
also presents an important argument for nature conservation.
Chivian and Bernstein (2008a) have reasoned that the
human health dimension—which impacts widely on social,
economic, cultural and environmental arenas—represents a
significant opportunity to push for more effective public and
political engagement in conservation. This also, by extension,
presents a significant opportunity for sharing of ideas and
resources across sectors, with the potential for integrated
policies and strategies that can more effectively achieve and
sustain multiple goals. From the perspective of adaptation,
the loss of biodiversity, by affecting the sustainability and
flow of ecosystem services, can be said to limit our capacity
to adapt to future health challenges, whether they arise from
novel pathogens, emerging non-communicable disease threats
or natural hazards, whilst its conservation and sustainable use
may be seen as an insurance policy against such challenges.
1.2. The interplay between biodiversity, public health and
urbanization
Whilst the root causes of ecosystem change impacting on
health are varied, population growth and related demand for
land and natural resources are certainly primary amongst
them. The related on-going trend towards urbanization
worldwide makes the challenge of linking biodiversity and
public health even more difficult, and presents certain unique
challenges for science and governance. Urbanization has
significant impacts on biodiversity (Rees 1997, Barton and
Grant 2006, Seto et al 2012), an issue which receives specific
focus at the CBD COP meetings and other policy arenas;
(de Oliveira et al 2010, EEA 2009), with suggestions that
more than 60% of the area projected to be under urban
infrastructure by 2030 has yet to be built (CBD 2012).
Cities and other densely populated urban areas are net
Figure 1. The ‘settlement health map’. Reproduced with
permission from Barton H and Grant M 2006 A health map for the
local human habitat J. R. Soc. Promot. Health 126 252–3. See also
Dahlgren G and Whitehead M 1991, version published in
Whitehead M 2005 Tackling inequalities: a review of policy
initiatives Tackling Inequalities in Health: An Agenda for Action
ed M Benzeval, K Judge and M Whitehead (London: Kings Fund).
importers of ecosystem services—e.g. for food, water, and
for assimilation of wastes including emissions associated
with climate change. Urbanization has been described as
both inherently unsustainable and the greatest opportunity for
sustainable development (Rees and Wackernagel 2008)—so
how can both nature and human well-being be sustained when
more and more people live in cities placing increasing demand
on finite living resources (see also Soskolne and Bertollini
2002, Stephens 2012)? What conceptual frameworks should
be utilized to connect the range of disparate disciplines
involved whilst also accounting for various societal choices
and cultural diversity within urban areas?
By 2035 a majority of people on all settled continents
are expected to live in urban areas, due to greater
migration inwards and the physical expansion of those
areas to accommodate natural outward growth (United
Nations Population Division 2010). The links between human
settlements and public health are of long standing interest in
land use planning and social policy (see figure 1), though it has
been argued that these linkages have been largely overlooked
by planning systems and related health and environmental
assessments in recent decades (Barton and Grant 2006, Barton
2009, Carmichael et al 2012). Similar to Campbell-Lendrum’s
reasoning (2005), Barton (2009) contends that the reasons
for this include the failure of planning systems to consider
the perspectives of public health practitioners, and a lack
of engagement of public health practitioners in planning
policy. Therefore, considering the current and projected future
rates of urbanization and migration to cities, the specific
dependences of urban communities on external biodiversity
and the impacts which urban biodiversity can have on the
5Environ. Res. Lett. 8 (2013) 025015 H Keune et al
health of urban citizens, the need for an integrated approach
to the development and management of urban infrastructure,
including living natural resources, is pressing. The concept
of ‘green infrastructure’ (the managed and unmanaged
biodiversity within urban areas that may provide ecosystem
services) has emerged as an attempt to help address this point.
This field has evolved rapidly with significant developments
in concept and practice in recent years, including efforts to
ensure that urban green spaces contribute to improving human
health, e.g. through improved water quality management
associated with sustainable drainage systems, by providing
opportunities for recreation and social interaction, as well
as through development of urban food gardens (Bolund and
Hunhammar 1999, Tzoulas et al 2007, Wittmer et al 2012,
Niemela¨ et al 2011, Grant 2012).
1.3. Scientific challenges
Whilst the need for integrating biodiversity and ecosystem
approaches into the health sector is evident, it is equally
important that the biodiversity sector for its part recognizes
the potential impacts—positive and negative—of conservation
policies and activities on human well-being. Lyytimaki and
Sipila (2009) have argued that it may be counterproductive
to frame ecosystem services for green planning and
management only in positive terms, without paying due
attention to negative impacts—or ecosystem disservices—that
biodiversity may produce in urban areas. For example, pollen
spreading from urban vegetation may trigger distress in some
with allergies, whilst urban tree planting can cause nuisance
e.g. with damage to infrastructure caused by invasive roots.
It may be argued, however, that these concerns are not
necessarily a result of diversity per se, and may be an outcome
either of specific choices in the design or management of
urban areas and/or their green infrastructure (comprising
as they do entirely artificial ecosystems), or simply a
consequence of exposure to inherent natural nuisances not
unique to urban areas. Regardless, habitat management
in urban areas should take into account both ecosystem
services and potential nuisances and consider trade-offs where
appropriate.
Interdisciplinary science can provide options for such
management, and society at large can then take informed
decisions in choosing among those options. Ernstson (2013)
states that these decisions must also account for issues of
social justice—e.g. the need to ensure equity in decision
making, accounting for varying costs and benefits of urban
resource management that may be experienced by different
urban communities—and has highlighted issues of conflicting
societal choices in terms of how urban ecosystems and
associated benefits may be valued. Cutts et al (2009) have
also highlighted the issue of equity and justice in terms of
access to urban ecosystem services. Considering how specific
patterns of urban design can restrict access to ecosystems that
may support health, or make their availability more important,
this is surely another important dimension to be addressed.
Additional scientific research will inevitably be needed
to better understand the interplay between urbanization,
biodiversity and public health. For example, knowledge
about how urban landscapes affect the interaction between
wildlife and pathogens is not well established (Bradley and
Altizer 2007); and though the value of green care approaches
to public health are more and more investigated, the
effectiveness of green care interventions is still controversial
(Sempik et al 2010). Addressing these challenges will require
further research, greater use of conceptual models that cross
disciplinary agendas (e.g. figure 1), and greater involvement
of practitioners in urban planning and associated assessments.
1.4. New institutional science–society arrangements
Whilst there are specific barriers that hinder the natural
cross flow of ideas between various scientific disciplines
concerned with health-biodiversity linkages, there are also
particular issues at the interface of science and public policy.
How should scientific assessments be translated into effective
public policy? How should societal choices account for issues
of scientific complexity and uncertainty? How can valuation
methodologies (e.g. of the importance of biodiversity to health
and well-being) account for differing cultural perspectives,
differing policy goals, and a variety of potentially conflicting
community needs? The challenge at the science–society
interface consists in developing adequate interfaces, but also
in dealing with its intrinsic complexity as a social interface.
Long (2001) defines a social interface as ‘a critical point
of intersection between different life worlds, social fields
or levels of social organization, where social discontinuities
based upon discrepancies in values, interests, knowledge
and power, are most likely to be located’. Interfaces lead
to realities that have to be recognized as complex by
practitioners, scientists, policy makers and funding bodies.
According to Ernstson et al (2010a), not only does the
scientific understanding of urban ecosystem services need
further development, but so also do the governance aspects:
‘In contrast to other urban services like medical care and
public transport, there has been a deep neglect of research
and theorization regarding the governance of ecosystem
services in urban landscapes’. There is an urgent need for
multi-scale and multi-actor collaboration as it concerns a
complex process in which ‘no actor, or set of actors, can
have full knowledge or full control’ (Ernstson et al 2010b).
This requires experts to take up another role in relation to
policy making, to leave their comfort zones as data and
knowledge providers, and to become ‘connective actors across
scales and sectors’, a process which also requires incentives
from funding agencies to allow scientists to shift focus
from traditional scientific routines to more practice-oriented
collaborative research. Ernstson et al (2010b) refer here to
developments in modern governance, in which traditional
science ‘speaking truth to power’-approaches (Jasanoff 1990)
are no longer the only option for addressing complex societal
sustainability challenges.
An important aspect of ecosystem governance and a
strong rationale for the further development of science–policy
interfaces is the need for policy to incorporate different types of knowledge in decision-making processes.
6Environ. Res. Lett. 8 (2013) 025015 H Keune et al
A ‘science–policy interface’ (SPI) can be defined as: ‘relations
between scientists and other actors in the policy process which
allow for exchanges, co-evolution, and joint construction of
knowledge with the aim of enriching decision making’ (Van
den Hove 2007, Sarkki et al 2012). The most prominent
example in the field of biodiversity is the current institutionalization of the IPBES. There has been some concern that the
range of knowledge and stakeholders in these international
efforts should be broadened to include voices outside of
strict boundaries of peer-reviewed science and policy making
communities—what Turnhout et al (2012) in a comment in
Nature referred to as ‘elite actors, from natural scientists to
national governments’—to reflect (for example) experiences
and knowledge from local and indigenous communities
and other local actors from non-environment sectors. Such
concern raises questions regarding value judgements and
the role of science in policy making, and connects to
issues highlighted by Lang et al (2012) and Ernstson
(2013)—e.g. how do we address differences in perspectives
on the value of natural assets between communities? How or
to what extent do we consider lessons or perspectives from
local knowledge if they are not verified by scientific methods?
And how far should science go towards supporting specific
values? Addressing such questions requires new approaches
to knowledge sharing, and development of frameworks for
open dialogue that promote mutual understanding of various
concerns, drivers, values and needs. Centring the dialogue
on the concept of human health and well-being, supported
by more robust science on the linkages between biodiversity
and health, may be one important means of addressing these
issues.
Adaptive co-management (Armitage et al 2007, 2008)
is a new example of governance related to ecosystem
management. The core idea of adaptive co-management is
that ecological and social complexity make it difficult if
not impossible to identify a priori ‘the’ best management
approach. Learning by doing is crucial in adaptive comanagement, as are experimenting and adjusting management
practice based on experience and knowledge gained along
the way. In addition, adaptive co-management favours the
inclusion of multiple actors.
2. The example of Belgium
Nature conservation presents huge challenges in a country
like Belgium, because of its complicated governmental
policy landscape (appendix A), but especially because of
its extensive urbanization. Belgium has one of the world’s
most dense road networks, and it is in the top 30 of
most densely populated countries (United Nations Population
Division 2010). High urbanization rates pose several different
challenges to biodiversity and public health, particularly
regarding infectious diseases, as illustrated by the three
examples that follow. High urbanization also implies that
the population has relatively limited access to the natural
environment, and this has consequences for public health that
will be discussed below.
2.1. Of urban foxes, mosquitoes, and avian influenza
2.1.1. Urban foxes as disease vectors. Recent concerns
about the spread of disease organisms by foxes (Vulpes vulpes)
in Belgium provide a useful example of the interactions
between biodiversity, health, urban management and land use
planning. At the end of the twentieth century, European fox
populations increased remarkably both in area and in density
(Chautan et al 2000). In Belgium, this evolution was most
striking in Flanders as in this region foxes had been totally
absent in many areas for several decades (Van Den Berge and
De Pauw 2003). The new and quite surprising appearance of
foxes in a region with a very high human population density
soon gave rise to increasing concern (Van Den Berge 1995).
In addition to damage to poultry and game stocks, foxes are
widely associated with certain zoonotic diseases, with rabies
risk being one issue of particular public concern; however,
thanks to successive rabies vaccination campaigns by oral
immunization from 1989 that disease was eradicated from
Belgium (Van Gucht and Le Roux 2008), the country being
officially declared rabies free in 2001 (Brochier et al 2001).
In the meantime, however, another and frequently more
dangerous zoonosis directly linked to foxes appeared to
emerge: alveolar echinococcosis, caused by the larval stage of
the small fox tapeworm Echinococcus multilocularis. Foxes,
domestic dogs and other canids are definitive hosts for the
parasite, carrying the adult stage in their intestines. Worm
eggs are released into the environment with the faeces,
and they can then be taken up by an intermediate host,
such as one of several rodent species, especially Microtidae.
(e.g. grassland voles, muskrats). Humans also can become
infected through the oral ingestion of E. multilocularis
eggs. If untreated, the continuous larval cyst development of
the parasite within the human body can be fatal—making
alveolar echinococcosis one of the most dangerous zoonoses
in Europe. Since the growth of the European fox populations,
it seems that also the parasite has extended its range.
Flanders cannot be considered as an endemic region yet
(Van Gucht et al 2010), but the threat posed by infected foxes
seems specific to Flanders for two reasons. First, it seems
quite plausible that the further spread of E. multilocularis
will be hampered by a relative rareness of Microtidae as the
most appropriate intermediate host species. Muskrats have
nearly been eradicated thanks to the implementation of an
efficient pest control technique, whereas grassland voles can
hardly find a suitable habitat in the intensively cultivated
Flemish agricultural areas. Indeed, contrary to fox diet studies
done in other countries, in Flanders the genus Microtus
appears not to be the main food item but is instead replaced
by the brown rat (Rattus norvegicus) (unpublished data
from 1996–2005). The latter species, living close to human
settlements, is omni-present in Flanders as a consequence
of extensive settlements even in relatively rural areas. This
brings us to the second reason why situation may be specific
to Flanders. When foxes are present, they quickly become
well adapted to an urbanized environment and often dwell
in close proximity to residences and gardens, facilitating the
potential transmission of zoonoses. ‘Urban foxes’, however,
7Environ. Res. Lett. 8 (2013) 025015 H Keune et al
seem to pose little risk, due to an almost complete absence
of appropriate intermediate hosts where they live, while ‘rural
foxes’ pose little risk due to the limited contact they have with
humans. Instead, the so called ‘village and small town foxes’
generate the most critical situation for transmission of E.
multilocularis (Janko et al 2011). In Flanders, the fox habitat
and human habitat are nearly entirely overlapping. Therefore,
in the case of strongly increasing E. multilocularis prevalence
in foxes, actions to prevent human infection are called for.
These could include large scale baiting with a convenient
vermicide product
It is important, however, to address the problem (E.
multilocularis) and not kill the messenger, so to speak. The
overlap of fox habitat and human settlement potentially also
has positive health related implications in Flanders, as foxes
help to control the populations peaks of brown rats, and
other small rodents, and this may in turn help to prevent
possible emergences of Lyme disease, for which ticks act as
the vector and small rodents act as reservoir hosts (Levi et al
2012). Furthermore, the recent findings of E. multilocularis
infections in other wild species in Europe, including beaver
and wild boar, indicate that other species may introduce,
maintain or re-establish the parasite in areas which may
lead to transmission to people, pets or foxes and thus may
ultimately influence the disease cycle (e.g. Boucher et al
2005, Barlow et al 2011). Another important consideration is
that urbanization of foxes and associated zoonoses is in large
part related to encroachment of human settlement on wildlife
habitat and to urban environmental health management. For
example, Rabinowitz and Gordon (2004) have reported on
a case of zoonotic scabies infection (Sarcoptes scabiei) in
the United States, associated with interactions with wild
foxes originating with a sick fox found on a golf course.
They suggest that identification of initial infection ahead of
an outbreak—e.g. in this case an initial human case and a
noted increase in infections in domestic dogs—could serve as
‘sentinel’ events, indicating a possible increased likelihood of
infection in a community, from which appropriate public and
veterinary health announcements or other measures could be
taken.
In the case of echinococcosis in Belgium (and
elsewhere), greater interaction amongst veterinary and public
health practitioners, environmental health officers and urban
managers could help to not only manage outbreak risks but
also serve as an indicator for monitoring the effectiveness of
preventative strategies (e.g. see Hegglin and Deplazes 2013).
Furthermore, the inclusion of ecologists and urban planners
could help identify areas where new or revised approaches
to ecosystem management, in order to limit human–wildlife
interaction, might be warranted. Integrated multidisciplinary
approaches may be particularly important in the forward
planning process, including in health-inclusive Environmental
Impact Assessment, identifying where particular development
may lead to increased human–wildlife interaction and related
health risks, and helping to identify appropriate measures to
avoid or reduce zoonoses risk.
2.1.2. Mosquitoes. After the eradication of malaria in
northern Europe in the mid-20th century, little attention has
been paid to the distribution and biodiversity of mosquitoes
despite their importance in disease transmission (WHO2004).
While the number of mosquito-borne diseases and their
incidence in Europe remain quite low, there are upward trends
in incidence and geographical spread of several of these
diseases (Hendrickx and Lancelot 2010). Over the last years,
autochthonous transmission events of Chikungunya, Dengue,
West Nile and malaria have been reported from Europe.
Increased globalization, changing landscape management and
changing socio-economic behaviour create suitable conditions
for the (re)emergence of mosquito-borne diseases across
Europe (Tatem et al 2006, Lines 2007, Pysek et al 2010);
factors which affect the occurrence, distribution or density of
mosquito vectors—including climate change and ecosystem
change—are also of particular interest (e.g. Arinaminpathy
et al 2009, Bezirtzoglou et al 2011, Rohr et al 2011).
To remedy the limited knowledge on current mosquito
biodiversity and distribution in Belgium, a national inventory
was started in 2007 (MODIRISK). This inventory is based
on a specific sampling strategy that allows a rapid overview
of mosquito diversity (Versteirt et al 2012). The acquired
knowledge on local species occurrence has been used to
develop mosquito species distribution models and to assess
the actual countrywide transmission risk of mosquito-borne
diseases, taking into account possible interference by several
ecological, biological and socio-economic factors. Ultimately
species co-occurrence maps were created that can be used
to delineate zones of higher risk on nuisance and/or disease
transmission.
The study highlighted a number of important events.
First, an increased distribution range and adaptation to a more
urbanized environment was observed for several indigenous
vector mosquitoes such as the common house mosquito
(Culex pipiens) and Anopheles plumbeus. The latter species
is highly anthropophilic and in some urbanized areas, high
abundances are causing severe nuisance with highly allergic
skin reactions due to the bite of the species. Moreover,
recent outbreaks of West Nile in Greece, Romania and Spain
(Papa et al 2010, Santa-Olalla Peralta et al 2010, Sirbu
et al 2011) and autochthonous cases of malaria in Belgium,
Germany and the UK (Blacklock 1921, Shute 1954, Kruger ¨
et al 2001), indicate the potential for both mosquitoes to
transmit diseases. Secondly, wetland re-alignment (as part
of large scale flood risk management) has created suitable
habitats for mass emergence of nuisance and/or vector species
such as Ochlerotatus caspius and Coquillettidia richiardii.
These newly created habitats are potential breeding sites for
anopheline mosquito populations, leading to an increased
chance of malaria transmission.
The MODIRISK project proposes a targeted costeffective monitoring regime of these species (Versteirt
et al 2009, 2012). One of the direct outcomes of this
multidisciplinary project has been the increased awareness of
the authorities on the risk posed by exotic and indigenous
vector species, which has led to the establishment of an
inter-ministerial working group ‘Exotic Mosquitoes’ (federal
environmental department).
8Environ. Res. Lett. 8 (2013) 025015 H Keune et al
This project highlights the importance of ecosystem
approaches to vector-borne disease risks around human
settlements, and suggests several other important areas for
further research. For example, the precise links between
host and vector diversity, landscape management and human
health risks in Europe are unclear and require detailed study.
Work in the United States has highlighted links between
mosquito-borne disease risk and biodiversity in the wider
landscape: research by Ezenwa et al (2006) has suggested
that diversity of passerine bird species reduces circulation
of West Nile virus in the wild and therefore could reduce
human disease risk, while Zielinski-Gutierrez and Hayden
(2006) suggest that changes in urban and periurban landscapes
(e.g. through new development) can affect the geographical
distribution of West Nile virus, and that underlying attitudes
towards natural landscapes and biodiversity should be taken
into account when considering disease risk and response
strategies.
2.1.3. Avian influenza. The relationship between biodiversity and the emergence of infectious diseases in domestic
animals is as yet poorly described, but it is particularly
important when those diseases have the potential to harm
humans. The example of avian influenza is illustrative.
Low pathogenic avian influenza viruses (LPAIV) are
naturally present in the wild avifauna with a high diversity
of types and subtypes. Diverse bird species therefore suffer
infections that have a low clinical impact. Highly pathogenic
avian influenza viruses (HPAIV), in contrast, have a low
diversity, with epidemics usually involving only one subtype
and usually affecting a limited number of domestic species,
though with a high clinical impact. This epidemiological
system thus shows a high stability and a low impact when
there is both a high diversity of hosts and pathogens.
Epidemiological problems arise when diversity in hosts
and pathogens become reduced. When an LPAIV is
introduced into intensive poultry production systems, it goes
through fast selection. Within the high-density, genetically
similar, susceptible host populations of poultry production
systems fast selection can amplify virulent pathogen strains
(Mennerat et al 2010). A new, virulent pathogen can then
escape the leaky confines of the intensive production units to
invade other livestock and wild species, and potentially infect
human populations. It has been shown that HPAIV can be
produced from low pathogenic strains following consecutive
passages through genetically homogenous chickens (Ito et al
2001). Panzootic HPAI H5N1 emerged in China in 1996
(Li et al 2004) following several years of intensification
of chicken and duck production. Closer to Belgium, an
HPAIV H7N7 virus emerged in the Netherlands in 2003 and
spread to Belgium, both countries having very intensified
poultry production systems. Whilst HPAI H5N1 continues to
circulate in several countries in Asia, the 2003 H7N7 epidemic
was quickly controlled in Belgium and the Netherlands.
Nonetheless, the example highlights the fact that the risk
of emergence of novel HPAIV subtypes is far from being
limited to Asian contexts. Whilst the specific roles of
intensive production systems in the emergence of novel
strains of pathogen are not well understood and would need
further investigation, CAST (2005) concluded that intensified
livestock production systems, characterized by a low diversity
of hosts, created ideal conditions for rapid selection and
amplification of highly pathogenic strains of disease agents.
Ecosystem approaches have been particularly important
in identifying the risks of spread of HPAI in Europe.
Kilpatrick et al (2006) found that identification of H5N1
in 20 of 23 European countries was most likely attributable
to migratory birds. Waterfowl, particularly ducks, have been
identified as major carriers, owing to their tendency to
congregate in large multi-species flocks on water bodies or
wetland where the virus can circulate, and the fact that
many species are resistant to HPAI infection, providing
opportunities for genetic recombination and widespread
dispersal (e.g. Rapport 2006, Kim et al 2009). The presence
of the virus in wildfowl also creates a risk of spread to other
wildlife species, with reports from Sweden and Germany
of infection in mink and pine marten following predation
of waterfowl (ECDC/Eurosurveillance, 2006a, 2006b). This
has led to intensified biosecurity concerns about interactions
between wild species and domestic poultry and livestock,
and in extreme cases there have been calls for large scale
culling of wildfowl. Conservation organizations, UNEP,
FAO and WHO have urged caution in restraint in this
regard (International Task Force on Avian Influenza 2006),
and it has been suggested that adopting the ecosystem
approach at the landscape level—preventing and reversing
degradation of habitats enhancing measures to segregate
wildfowl from domestic animals, and greater co-operation
between human health, veterinary and ecological agencies
in disease surveillance and land management, are key to
minimizing significant health and economic risks from the
disease (Rapport 2006). Such approaches may have particular
relevance in Belgium, owing to the particular structure of
the Belgian poultry sector, and the location of the country
on migratory pathways for large numbers of wildfowl
(Vandendriessche et al 2009). This raises additional concerns
about the spatial and ecological relationships between natural
and artificial water bodies (including lakes and ponds in public
parks), agricultural lands and human settlements., further
highlighting the need for ecosystem based approaches to
disease risk.
2.2. Urban green space and health
Access to green space can yield diverse benefits for public
health. For example, Van Herzele and de Vries (2012)
compared two neighbourhoods in the city of Ghent, and they
registered greater happiness and satisfaction in the greener
neighbourhood. Yet many urban residents may not be able
to realize such benefits. Van Herzele et al (2004) showed
that in six major Flemish city centres, more than one third
of the inhabitants did not have easy access to green spaces
(i.e. within 800 m distance). Access is partly limited due
to infrastructural barriers, such as highways. Access is also
unequally distributed amongst social classes; low income
groups have less access. The study also concluded that
9Environ. Res. Lett. 8 (2013) 025015 H Keune et al
although attention to the need for urban green space has
increased, existing urban green space is under pressure from
land conversion or decrease in natural quality. Accordingly,
initiatives have recently been taken to support urban planning
that enables and maintains contact with nature. Two of them
will be briefly outlined here.
In January 2011 the Flemish Agency for Nature and
Forest (ANB) started a strategic project, Green in the City,
manifesting the Flemish ambition to become a green and
dynamic urban region by 2020. The project hopes to instigate
knowledge-based networking, inspiring a diversity of actors
to establish more green space and other aspects of nature
in urban areas. A central part of the project is sharing the
knowledge on parks and green space management which has
been built up over the years, bundled in technical management
tutorials on a variety of topics, including but not limited
to trees, grassland, herbs, water, and paths and pavements.
Moreover, ANB has a history of promoting participatory
approaches to green space management (Van Herzele et al
2005). In the Green in the City project, ANB addresses
voluntary engagement and stimulates local authorities to adapt
their planning and management traditions and arrangements
regarding environmental and biodiversity issues in cities.
Every year ANB issues a call for projects that involve
experimental and innovative actions for a specific theme. Such
efforts support interested city authorities in designing greener
cities and also involve local inhabitants; however, to date
they do not have much experience in providing information
on any specific health related aspects. The ambition of
ANB to mainstream knowledge on the advantages of urban
green space and greenery is positive and may inspire local
institutions and actors, but this will not necessarily strengthen
the link between biodiversity, human health and well-being,
nor turn general concepts into effective measures and models
for healthy town development. Nevertheless, basic data and
knowledge regarding green space and health are being
developed for Belgian cities (Van Herzele et al 2004, Van
Herzele and de Vries 2012), in keeping with the development
of general knowledge regarding contact with nature and health
(Hartig et al 2011). It seems, however, that the Green in
the city strategic project has yet to take advantage of this
knowledge, and integrated programmes to ameliorate public
health problems through intelligent application of green space
and biodiversity remain to be developed.
The second example here involves a series of urban
sustainability initiatives started several years ago by
the Brussels Capital Region, in collaboration with local
organizations (appendix B). In addition to the role of urban
biodiversity as being a natural corridor of biodiversity
between neighbour regions, the importance of urban green
space and biodiversity for physical and mental health is
emphasized in these initiatives, as are other links between
ecosystem health, biodiversity, food security, human health
and the impact of citizen behaviour on environmental, social
and economic issues elsewhere in the world. Most of these
regional initiatives benefit from funding from the Capital
Region. However, the funds are too limited to fully address
the growing demand of citizens to participate in such projects.
As a result, these activities are largely based on the goodwill
of some motivated citizens, and they often lack scientific
and technical support and expertise (e.g. regarding potential
effects on emergent diseases). These initiatives nonetheless
contribute to urban social health through new collaborations
between different urban districts, the exchange of experience
among inhabitants, and renewed appreciation of traditional
knowledge.
2.3. Lessons and challenges
The example of foxes in Flanders shows that an increasingly
urbanized wild animal may bring with it the potential risk
of infectious diseases as well as the potential to reduce the
risk of other infectious diseases. The example also shows
that developments in neighbouring countries need not occur
the same way; local circumstances may differ substantially.
This means that detailed, location-specific knowledge needs
to be carefully monitored to help avoid outbreaks of diseases.
Moreover, the complexity of the ecological associations
between parasite, definitive host (canids and certain wild
mammals), secondary hosts (rodents) and ‘accidental’ hosts
(humans and domestic animals), and the interplay with land
use planning and environmental health issues, illustrates the
importance of integrated approaches.
The case of the mosquitoes and the avian flu also show
that biodiversity can play different roles in public health.
While an increase in diversity of mosquitoes also increases
the range of diseases potentially transmitted in Belgium, the
lack of diversity in commercial poultry production contributes
to the emergence of dangerous pathogens. Whilst associations
between European wild biodiversity and disease risk in West
Nile virus are largely unknown, it is clear that risks of highly
pathogenic avian influenza are closely associated with the
movements of migratory species, the status of ecosystems
they depend upon and their proximity to human settlement.
Linard et al (2007) illustrate that in order to understand the
spatial variation in disease risk of vector-borne and zoonotic
diseases in Belgium, both environmental and socio-economic
factors need to be taken into account, thus requiring an
integrated interdisciplinary approach.
The urban green space examples illustrate renewed
attention to the benefits of nature in the urban context,
complementing the sanitary–environmental and the technoeconomic models that have been dominant in shaping
urban public health over the last decades (Rayner and
Lang 2012). The changing role of the authorities becomes
apparent; giving incentives and providing examples of good
practice seem to be the favourite strategy, while imposing or
working according to a prescribed and comprehensive plan
receives less attention. Time will tell if efforts to inspire a
diversity of actors—not only by sharing information but also
by sharing responsibility through new, more collaborative,
governance arrangements—will yield durable improvements
in biodiversity and human health. Here also the need for
integrated approaches is evident, for among other things
taking both ecosystem services and potential disservices into
account.
10Environ. Res. Lett. 8 (2013) 025015 H Keune et al
The different examples together show the need for
integrated approaches to landscape planning that respect the
links among urban and periurban areas. The overarching
challenge is to plan public and private green spaces in densely
populated regions in such a way that they are sufficiently
diverse and accessible to humans and yet do not create
conditions that will lead to the proliferation of hosts or vectors
of diseases. This requires more background knowledge and
access to information than is currently available to city
planners. The fact that private green spaces also play a
role points to the need of better informing the public
and structurally supporting public–private collaborative
arrangements.
3. The emerging biodiversity–public health
community of practice in Belgium
The foregoing examples have shown that an integrated
approach is needed both to address each of the issues
separately but particularly when developing green space in
urban areas so as to ensure increase of ecosystem services
without creating or increasing potential health risks. An
analysis of the current research landscape (appendix C)
quickly revealed that there is little research on biodiversity
and public health in Belgium so far. Moreover different
policy communities who do not usually come together in their
work (health and planning) need to be brought together—by
increasing the evidence base on health-biodiversity linkages
in Belgium, by building communication networks across
disciplines, and by devising frameworks for on-going
collaboration and practical action.
Against this background and to raise awareness in
Belgium on the importance of the linkages between
biodiversity and public health, on 30 November 2011 the
Belgian Biodiversity Platform organized the first Belgian
Biodiversity and Public Health Conference 2011 (see www.
biodiversity.be/health). This conference, its outputs and
subsequent developments stand as constructive examples
of efforts to address issues at the biodiversity–public
health–urbanization interface.
3.1. The initial gathering: bringing different communities
together
The Belgian Biodiversity Platform encourages interdisciplinary co-operation among scientists and serves as an
interface between researchers and policy makers. The conference it organized in 2011 consisted of introductory keynote
speeches and five thematic workshops. The conference
brought together eighty one Belgian experts. Roughly 68%
of them were scientists (universities and governmental
scientific institutes; health-, ecological- and social-science),
16% represented policy interests (Federal, regions, provinces,
cities; health-, environmental-, nature- and land-planning
policy), and 16% came from consultancies (policy advice,
eco-therapy, education), NGOs (nature protection, landscape
development, ecological life and gardening, health insurance),
or media.
Discussions during the conference focused on scientific
priorities and policy challenges and resulted in the
identification of several issues of interest. The Infectious
Diseases Workshop identified the following priority issues:
(1) The need for biodiversity-related research on, for example,
the distribution and abundance of reservoir and host species,
the influence of host diversity on disease transmission, the
diversity of pathogens and their geographical distribution
patterns, and how the diversity of resources (e.g. food)
influences epidemiological cycles. (2) The need for more
collaboration amongst Belgian research teams and between
different policy fields, such as landscape management
authorities and public health agencies. (3) Disease Early
Warning Systems. (4) Eradication of invasive species.
The Food Workshop listed research priorities such
as genetic diversity, health related diversification of diet,
multifunctional agriculture, the ‘real’ price of food (including
social, environmental and other costs), and ways to
incorporate this knowledge into policy instruments. Raising
awareness among consumers and catering chains, the
relationship between social diversity and use of biodiversity,
and the potential of urban biodiversity (allotments, gardens)
for local food production were addressed as important
social/policy challenges.
The Nature Experience Workshop underlined the importance of involving different policy domains (agriculture,
nature, public health, education, spatial planning, and
mobility) to bring scientific insight closer to practice. In this
respect the challenge of fine tuning the generic policy level
to context specific needs was specifically underlined. For
example, generic policy (and the research which supports such
policy) addresses broad environmental categories (notably
natural and urban), and so does not provide adequate support
for the kind of specific design interventions that can reconcile
increasing urban population density with the values of contact
with nature (Van den Berg et al 2007).
The Spatial Tools Workshop highlighted data-related
issues such as open data access and data integration. The
importance and difficulty of scale coordination was addressed
(e.g. reconciling factors at different policy, geographic and
temporal scales). Also, the importance of communication
and collaboration among a diversity of experts from science,
policy and society was underlined. It was stressed that the
links between biodiversity and health in the landscape context
are often vague or uncertain and in need of further research,
and that spatial planning tools such as ecosystem service
mapping can be important in this regard.
The Ecosystem Services Workshop generally considered
the ecosystem services concept an opportunity to strengthen
linkages between public health and biodiversity. To take
this forward, preliminary steps were suggested, including (1)
development of a catalogue of linkages between biodiversity
and public health; (2) development of an overview of
existing data and indicators; and (3) reinforcement of
communication and collaboration among thematic experts and
policy representatives.
11Environ. Res. Lett. 8 (2013) 025015 H Keune et al
3.2. Next steps: movement towards a Belgian community of
practice on biodiversity and public health
One generic outcome of the conference was recognition of
the need for further capacity and network building. On the
one hand this implies a focus on generating further scientific
understanding in order to be able to provide policy makers
with robust knowledge. According to some participants this is
the prime challenge:
This obviously was a first attempt at bringing together
science and policy making. Much more effort will be
needed to achieve long term results. At this stage focus
should be on getting scientists to agree on the link
between biodiversity and public health. This was still
very unclear at this stage, and it may have confused
decision makers (Keune et al 2012a).
Others stressed that this was not only a scientific
challenge, but also a practical challenge, or as one participant
put it:
Involve more people from a diversity of contexts to
give presentations, not only scientists. Otherwise you
risk inward looking in academic circles, when the
outside world (reality) is not always in accordance with
scientific findings. The biodiverse system of humans
and nature is more than the sum of the parts, but
instead is an interactive interplay of many actors, not
only scientific research. My main message is: invite
more people from many contexts who are dedicated to
biodiversity, it is only then you can reach an integrated
full picture. A challenging opportunity (Keune et al
2012a).
Shortly after the conference, a policy brief was issued
in which science, policy, and other experts called for
support for the establishment of a Belgian Community of
Practice on Biodiversity and Public Health (Bauler et al
2012). A Community of Practice (CoP) is a network
made up of individuals and organizations that share an
interest and practice, who come together to address a
specific challenge, and who further each other’s goals and
objectives in the specific topic area (Wenger and Snyder 2000,
Meessen et al 2011). Inspiring international examples are the
Canadian Community of Practice in Ecosystem Approaches
to Health (COPEH) and the European Community of
Practice in Farming for Health (Dessein 2008). These
examples of Communities of Practice show how different
expert communities can connect by networking and capacity
building and hence contribute to more integrated approaches.
3.3. Further development: creating an inventory of research
needs
In 2012 the emerging Belgian Community of Practice on
Biodiversity and Public Health decided to organize an
inventory of research needs and ideas in order to get a
clearer view of relevant research topics and the potential for
collaboration (Keune et al 2012b).
The policy-driven research needs, articulated by diverse
policy representatives (both national and regional), cover a
wide range of topics and policy-relevant issues. There is a
general interest in integrated data assessment that couples
ecological and public health developments, as well as a
general interest in the relations among green space/nature, the
living environment, and public health. Some specific research
topics involve health risks or health benefits, or both. More
specific thematic focuses include links between biodiversity
and dietary health, medicines and medical research, and
emerging disease threats. Regarding the connections between
green space and public health, specific topics include
the social, mental and physical health benefits of green
space and other contact with nature, their accessibility for
residents, and the relation between ecosystem services and
non-communicable disease such as cancer and diabetes.
Research input has come from members of national,
Wallonian and Flemish research institutions representing
a wide range of expertise. Some of the research gaps
identified included a need for further work on vector-borne
diseases, including patterns and mechanisms of emerging
infectious diseases in domestic animals, further development
of surveillance and monitoring systems, the influence of
habitat and ecosystem change on pathogen ecology, the role
of land use management in vector control, and expanding
knowledge of the virome (the genomes within a viral
population existing in a given organism, a given population
or a given ecosystem) and its link with biodiversity and public
health. Several proposals draw attention to ecosystem health
services, for example in relation to a diversity of habitats,
landscape and species, urban greening and the demand for
ecosystem services and biodiversity.
The diversity of the proposals and of the scientific and
policy backgrounds and institutions involved illustrate an
emerging community of expertise and practice with both
the potential and the will to join forces and build capacity.
As one policy representative put it: ‘We found this exercise
of gathering ideas very interesting for the community of
stakeholders and it was a good opportunity for ourselves to
lay bridges between dossiers inside our own service’.
4. Conclusions
The challenges for research and policy on the issues of
biodiversity and human health in the context of urbanization
are substantial. The first Belgian Biodiversity and Public
Health conference discussed many of the barriers to
mainstreaming ecosystem approaches to human health, and
identified some key areas for action. Firstly the evidence
base on links between biodiversity and health in the context
of urbanization must be further developed so that areas
of overlap between various fields of research, policy and
practice can be better identified. More research is needed
to facilitate a better understanding of the connections,
and to support informed decision making and long term
assessment and monitoring. Secondly, bridges must be built
between different professional communities working within
the biodiversity-health-urban planning sphere, and at all
12Environ. Res. Lett. 8 (2013) 025015 H Keune et al
levels of policy, research and practice. At the Belgian
conference there was some notable friction between different
scientific and policy perspectives of the role of biodiversity
and ecosystems, to public health and more widely. The
ecosystem services community mainly highlighted the benefits
of biodiversity to human health, whereas the infectious
disease community to a large extent focused on the public
health risks of human contact with nature. Both communities
in a sense focus on the same human–nature interactions, but
from different perspectives based on different methodologies,
different realms of knowledge, widely divergent scales of
operation and different practical objectives. To some extent,
the problem is perhaps one of semantics (‘nature’ and
‘biodiversity’ do not necessarily equate), compounded by a
lack of clearly established definitions of core concepts (for
example, a negative outcome of human interaction with nature
may be attributable to certain aspects of ‘wildlife’ but may
not necessarily be a factor of ‘biological diversity’) and a
lack of understanding on each side of one another’s key
drivers (both in the policy and practical sense). Some of
this difficulty may perhaps be resolved by a more coherent
working definition for this kind of forum of what is meant by
biodiversity and ecosystem services, and by development of
a working conceptual model for Belgium that will facilitate
interdisciplinary and ultimately transdisciplinary approaches.
Such models may also benefit from a broader definition of
health, incorporating ‘the ability to adapt’ and recognizing
the value of health as an indicator of sustainability, which
promotes overlap with many aspects of the ecological sciences
and can serve to highlight areas of mutual concern. In
addition, it is important to look beyond ecology and public
health disciplines to ensure that the many other disciplines
affected by these issues are also closely involved, including
forestry, agriculture, fisheries management, economic and
social development, and so on. Thirdly, there is a need
for a practical framework for on-going communication and
collaboration, to enable exchange of ideas and experience and
to support capacity building. And finally there is the need for
better communication of the science of biodiversity and health
linkages to policy makers, and to the general public.
The Belgian Community of Practice on Biodiversity and
Public Health recognizes these challenges and is currently
working to support further collaboration and capacity building
to tackle these important sustainability challenges. In this
way the Belgian community also hopes to contribute to the
international body of knowledge and practice, such as the
IPBES and other relevant processes.
Acknowledgments
We sincerely thank the Belgian Federal Science Policy
department for their financial and logistical support that
made both the 2011 Belgian conference Biodiversity–Public
Health and this publication possible. We also sincerely thank
both anonymous reviewers for their thoughtful and inspiring
comments.
Appendix A. Belgian governmental policy landscape
The Belgian governmental policy landscape is quite
complicated due to its specific federal structure, in which the
federal level, the regional level and the community level play
a role regarding biodiversity (Belgium’s National Biodiversity
Strategy 2006–2016) and public health issues (National
Environmental Action Plan). In Belgium the three regions
(Flanders, Wallonia and Brussels) are responsible for all
territorial matters, including most biodiversity-related matters
and land use planning. The regions are also responsible
for the larger part of health policies, including health
prevention. At the federal level health policies mainly deal
with animal health and food safety. The three communities
(French, Flemish and German) deal with cultural matters
including culture and media, education, use of languages,
some aspects of health policy, youth protection and sport.
Certain collaborative and coordinating institutional structures
exist, in which representatives of the different federal, regional
and community policy level meet, in order to streamline the
Belgian position regarding international forums and policies
and to vice versa establish a coordinated implementation
by Belgium of the decisions and recommendations made in
international forums, such as e.g. European Union policies,
the National Environmental Action Plan initiative of the
World Health Organization, the Convention on Biological
Diversity or the recently established Intergovernmental
Platform on Biodiversity and Ecosystem Services. Still, apart
from the challenge of interfacing different policy fields such
as biodiversity and public health, also the federal structure of
Belgium imposes quite a challenge on fine tuning. To further
explain the historical roots of this fragmented governmental
landscape is beyond the aim of this letter, but it is a
complicating reality to be taken into account when dealing
with a combined focus on biodiversity, public health and
urbanization.
Appendix B. City green spaces initiatives in Brussels
For several years, the Brussels Capital Region has run a series
of initiatives, in collaboration with several local organizations
(Centre d’ Ecologie Urbaine, le Debut des Haricots, Apis ´
Bruoc Sella, Tournesol, Etopia, GASAP and others), exploring various aspects of urban sustainability. Several of these
projects seek to promote sustainable development through
educational and collaborative local projects for greening
public spaces (www.villedurable.be/thema/ville-verte), create
urban collective vegetable gardens (including on green
roofs of large buildings) (www.potagersurbains.be) and
orchards (www.gasap.be/des-vergers-collectifs-a-bruxelles),
placing beehives in the city (www.apisbruocsella.be), promoting sustainable food (www.rabad.be), developing Sustainable
Districts (‘Quartiers durables’) where local motivated citizens
organize activities to increase awareness within their neighbourhood on issues linked to sustainability, and to encourage
local projects to enhance urban spaces by tackling litter
and improving biodiversity (www.bruxellesenvironnement.
be/templates/particuliers/niveau2aspx?id=3204).
13Environ. Res. Lett. 8 (2013) 025015 H Keune et al
Some of these projects, like ‘Maillage vert’ (Green
Network), emphasize the potential obstacles which urban
spaces present to the passage of biodiversity and the
movement or flow of ecosystem services through the wider
landscape, and aim to develop a green infrastructure that
addresses this concept and provides wider benefits. Targeted
local actions include removing or avoiding exotic and
potentially invasive species or varieties of flora in favour of
indigenous plants, and encouraging use of native tree species
in urban planting. In all these projects, the value of urban
green space and biodiversity for physical and mental health
is also underlined, as well as the links between biodiversity
and ecosystem health, food production and nutrition security
etc (e.g. the Apis Bruoc Sella project shows pollinators as
indicators of ecosystem health and as examples of important
ecosystem benefits which urban greenspace can provide) as
well as highlighting the positive or negative potential impacts
which local citizen behaviours may have on environmental,
social and economic issues elsewhere in the world. For
example, the development of urban community vegetable
gardens is seen as a means of reducing the impacts of
community choices on ecosystems in other areas, encouraging
a degree of self-sufficiency and promoting healthy and diverse
food production whilst also promoting outdoor recreation,
social interaction and community cohesion.
Importantly, most of these regional initiatives benefit
from some funds of the Region, but that are still rather
limited for the growing demand of the citizens to participate
in such projects. As a result, these activities are largely based
on the good will of some motivated citizens, but they also
often suffer from lack of expert scientific and technical data
and support. Several of these urban projects are examples of
‘learning by doing’, experimenting and adjusting management
practice based on experience and knowledge gained along the
way. Whereas this could somehow be considered as risky,
it is also fostering a new kind of collaboration between
distant urban districts inhabitants exchanging experience and
revisiting traditional knowledge, improving by this way the
urban social health.
Appendix C. Project database screening
Research projects focusing on the link between biodiversity/ecosystems, human/public health and urbanization are
fairly rare in Belgium. To illustrate this, we screened five
databases collectively holding project information from the
Federal Authorities, Flemish Community and Francophone
Community for the past 12 years. When classifying each
of the 45 public health related research projects according
to their major research focus, the large majority seems
to target the effects of environmental hazards (such as
water and air pollution) on human health, exemplifying the
sanity–environmental approach (Rayner and Lang 2012) in
Belgian research policy. Projects studying the link between
biodiversity/ecosystem related issues and public health, on
the other hand, are clearly less common and of these, only
a very small number (5) also target urban issues. They are all
funded by federal funding sources, and three of these started
in 2009 illustrating increasing interest in this topic from 2006
onwards. Studies focusing on biodiversity/ecological aspects
of human/public health in Belgian urbanized areas are still in
their infancy; in the Walloon region, they are even completely
absent.
We screened five databases collectively holding project
information from the Federal Authorities, Flemish Community and French Community with focus on the past 12 years.
These include the INVENT database (from the Belgian
Science Policy office), the Flemish Research Information
Space (FRIS), the database from the Research Foundation
Flanders (FWO-Flanders), Vision on Technology (VITO), and
Table C.1. Number of public-funded research projects in Belgium on the link between biodiversity/ecosystems, human/public health and
urbanization (1998–2011).
FL FR FE 1998a 2000 2001
2002–
2005 2006 2007 2008 2009 2010 2011 Total
Biodiversity and
public health
1 4 1 1 3 5
Biodiversity and
public health and
urbanization
1 4 1 1 3 5
Environmental
hazards and public
health
15 3 19 1 1 1 6 7 6 10 5 37
Environmental
hazards and public
health and
urbanization
7 2 11 1 1 4 5 4 4 1 20
Urbanization and
public health
7 3 17 1 1 5 7 4 8 1 27
Biodiversity and
environmental
hazards and public
health
1 4 1 2 2 5
a Year a project started.
14Environ. Res. Lett. 8 (2013) 025015 H Keune et al
Agency for Nature and Forest (ANB). In order to select
from these a list of research projects focusing on public
health in Belgium, we used several keywords (biodiversity,
ecosystem, urban, city, environment, health) and several
combinations thereof. Abstracts were carefully screened to
exclude studies on ecosystem or animal health (if no link
with public health), and studies targeting regions outside
Belgium were also excluded. This resulted in a unique list
of 45 public health related research projects (table C.1), the
majority of which were funded by the Federal Authority
(FE: 24 projects); projects funded by the Flemish (NL)
and French (FR) community were less common (17 and 4,
respectively). The projects were subsequently classified into
six groups according to their major research focus. Some
of the categories had a broader focus than others, and as
a consequence projects often classified in more than one
group. Within each category, the start date of each project
was indicated to decipher trends in timing of funding. Project
databases from the Walloon region were not accessible,
but given that the screening of Flemish databases outside
INVENT revealed only three additional projects, we are
confident that the recovered trends are representative for the
post-2000 period.
References
Alcamo J, Ash N J, Butler C D, Callicot J B, Capistrano D and
Carpenter S R 2003 Ecosystems and Human Well-Being.
A Framework for Assessment (Washington, DC: Island)
Allen H K, Donato J, Huimi Wang H, Cloud-Hansen K A,
Davies J and Handelsman J 2010 Call of the wild: antibiotic
resistance genes in natural environmentsNature Rev.
Microbiol. 8 251–9
Arinaminpathy N, McLean A R and Godfray H C J 2009 Future UK
land use policy and the risk of infectious disease in humans,
livestock and wild animals Land Use Policy 26 S124–33
Armitage D, Berkes F and Doubleday N (ed) 2007 Adaptive
Co-Management: Collaboration, Learning, and Multi-Level
Governance (Vancouver: UBC Press)
Armitage D, Marschke M and Plummer R 2008 Adaptive
co-management and the paradox of learning Global Environ.
Change 18 86–98
Barlow A M, Gottstein B and Mueller N 2011 Echinococcus
multilocularis in an imported captive European beaver (Castor
fiber) in Great Britain Vet. Rec. 169 339
Barton H 2009 Land use planning and health and well-being Land
Use Policy 26 S115–23
Barton H and Grant M 2006 A health map for the local human
habitat J. R. Soc. Promot. Health 126 252–3
Bateman I J et al 2011 Economic values from ecosystems UK
National Ecosystem Assessment: Understanding Nature’s
Value to Society (Technical Report) (Cambridge: United
Nations Environment Program World Conservation Monitoring
Centre (UNEP-WCMC))
Bauler T et al 2012 Policy brief: the need for a community of
practice on biodiversity—public health in Belgium Belgian
Biodiversity Platform (www.biodiversity.be/health)
Beaglehole R and Bonita R 2000 Reinvigorating public health
Lancet 356 787–8
Belgian Biodiversity Platform www.biodiversity.be/
Belgium’s National Biodiversity Strategy 2006–2016 www.biodiv.
be/implementation/docs/stratactplan/national strategie
biodiversity en.pdf
Bezirtzoglou C, Dekas K and Charvalos E 2011 Climate changes,
environment and infection: facts, scenarios and growing
awareness from the public health community within Europe
Anaerobe 17 337–40
Blacklock B 1921 Notes on a case of indigenous infection with P.
falciparum Ann. Tropical Med. Parasitol. 15 59–72
Bolund P and Hunhammar S 1999 Ecosystem services in urban
areas Ecol. Econ. 29 293–301
Boucher J M, Hanosset R, Augot D, Bart J M, Morand M,
Piarroux R, Pozet-Bouhier F, Losson B and Cliquet F 2005
Detection of Echinococcus multilocularis in wild boars in
France using PCR techniques against larval form Vet.
Parasitol. 129 259–66
Bradley C A and Altizer S 2007 Urbanization and the ecology of
wildlife diseases Trends Ecol. Evol. 22 95–102
Brochier Bet al 2001 Elimination de la rage en Belgique par la
vaccination du renard roux (Vulpes vulpes) Ann. Med. V ´ et. ´
145 293–305
Bullock C, Kretsch C and Candon E 2008 The Social and Economic
Aspects of Biodiversity: Benefits and Costs of Biodiversity in
Ireland (Dublin: Government of Ireland/The Stationary Office)
Burlingame B, Charrondiere R and Mouille B 2009 Food
composition is fundamental to the cross-cutting initiative on
biodiversity for food and nutrition J. Food Compos. Anal.
22 361–5
Burlingame B and Dernini S (ed) 2012 Sustainable diets and
biodiversity—directions and solutions for policy, research and
action Proc. Int. Scientific Symp. Biodiversity and Sustainable
Diets: United Against Hunger (Rome, 3–5 November 2010)
(Rome: FAO)
Campbell-Lendrum D 2005 How much does the health community
care about global environmental change? Global Environ.
Change 15 296–8
Cardinale B J 2011 Biodiversity improves water quality through
niche partitioningNature 472 86–9
Carmichael L, Barton H, Gray S, Lease H and Pilkington P 2012
Integration of health into urban spatial planning through
impact assessment: Identifying governance and policy barriers
and facilitators Environ. Impact Assess. Rev. 32 187–94
CAST 2005 Global Risks of Infectious Animal Diseases (CAST
Issue Paper No. 28) (Ames, IA: Council for Agricultural
Science and Technology)
CBD (Convention on Biological Diversity)COP Decisions
(available via the CBD’s website at: www.cbd.int/decisions/)
CBD 2010 Global Biodiversity Outlook 3 (Montreal: Secretariat of
the Convention on Biological Diversity)
CBD 2012Cities and Biodiversity Outlook (Montreal: Secretariat of
the Convention on Biological Diversity)
Chautan M, Pontier D and Artois M 2000 Role of rabies in recent
demographic changes in Red Fox (Vulpes vulpes) populations
in Europe Mammalia 64 391–410
Chivian E and Bernstein A (ed) 2008a Sustaining Life—How
Human Health Depends on Biodiversity (Oxford: Oxford
University Press)
Chivian E and Bernstein A 2008b Threatened groups of organisms
valuable to medicine Sustaining Life—How Human Health
Depends on Biodiversity ed E Chivian and A Bernstein
(Oxford: Oxford University Press) pp 203–83
COHAB (Co-operation on Health and Biodiversity) www.cohabnet.
org/
COHAB 2010 Position Statement of the COHAB Initiative
Secretariat with regard to the draft text open for discussion in
relation to Item 4.9(a), Paragraph 8—Discussion document
prepared for the 10th Conference of the Parties to the UN
Convention on Biological Diversity, Nagoya, Japan, October
2010 (Galway: COHAB Initiative Secretariat)
(www.cohabnet.org/news/COP10-position-statement-on-COPdecisions-regarding-co-operation-with-the-health-sector.htm)
15Environ. Res. Lett. 8 (2013) 025015 H Keune et al
Colls A, Ash N and Ikkala N 2009 Ecosystem-Based Adaptation: a
Natural Response to Climate Change (Gland: IUCN)
COPEH (Canadian Community of Practice in Ecosystem
Approaches to Health) www.copeh-canada.org/index en.php
Costanza R 1992 Toward an operational definition of ecosystem
health Ecosystem Health: New Goals for Environmental
Management ed R Costanza, B G Norton and B D Haskell
(Washington, DC: Island) pp 239–56
Cox P A 2009 Biodiversity and the search for new medicines
Biodiversity Change and Human Health: From Ecosystem
Services to the Spread of Disease ed O Sala, L Meyerson and
C Parmesan (Washington, DC: Island) pp 269–80
Cutts B B, Darby K J, Boone C G and Brewis A 2009 City
structure, obesity, and environmental justice: an integrated
analysis of physical and social barriers to walkable streets and
park access Soc. Sci. Med. 69 1314–22
de Oliveira J A P, Balaban O, Doll C, Moreno-Penaranda R,
Gasparatos A, Iossifova D and Suwa A 2010Cities,
Biodiversity and Governance: Perspectives and Chellenges of
the Implementation of the Convention on Biological Diversity
at the City Level (UNU-IAS Policy Report) (Yokohama: United
Nations University)
de Plaen R and Kilelu C 2004 From multiple voices to a common
language: ecosystem approaches to human health as an
emerging paradigm EcoHealth 1 (Suppl. 2) 8–15
Dessein J (ed) 2008 Farming for Health, Proc. Community of
Practice Farming for Health (Merelbeke: ILVO)
DIVERSITAS ecoHealth www.diversitas-international.org/
activities/research/ecohealth
Dobson A P and Carper E R 1993 Climate and health: biodiversity
Lancet 342 1096–9
Dreher A, Gaston N and Mertans P 2008 Measuring
Globalisation—Gauging its Consequences (Berlin: Springer)
ECDC (European Centres for Disease Control) and
Eurosurveillance Influenza Team 2006a H5N1 infections in
cats—public health implications Euro Surveill 11 E060413.4
(available from: www.eurosurveillance.org/ew/2006/060413.
asp#4)
ECDC and Eurosurveillance Influenza Team 2006b Highly
pathogenic avian influenza A/H5N1—update and overview of
2006 Euro Surveill. 11 pii=3098 (available from: www.
eurosurveillance.org/ViewArticle.aspx?ArticleId=3098)
EcoHealth Alliance www.ecohealthalliance.org
EEA (European Environment Agency) 2009 Ensuring Quality of
Life in Europe’s Cities and Towns. Tackling the Environmental
Challenges Driven by European and Global Change (EEA
Report No. 5/2009) (Copenhagen: EEA)
Ernstson H 2013 The social production of ecosystem services: a
framework for studying environmental justice and ecological
complexity in urbanized landscapes Landsc. Urban Plann.
109 7–17
Ernstson H, Barthel S, Andersson E and Borgstrom S T 2010a ¨
Scale-crossing brokers and network governance of urban
ecosystem services: the case of Stockholm Ecol. Soc. 15 28
Ernstson H, van der Leeuw S E, Redman C L, Meffert D J, Davis G,
Alfsen C and Elmqvist T 2010b Urban transitions: on urban
resilience and human-dominated ecosystems AMBIO
39 531–45
Ezenwa V, Godsey M, King R J and Guptill S C 2006 Avian
diversity and West Nile virus: testing associations between
biodiversity and infectious disease risk Proc. R. Soc.B
273 109–17
Feest A, Aldred T D and Jedamzik K 2010 Biodiversity quality: a
paradigm for biodiversity Ecol. Indic. 10 1077–82
Frison E A, Smith I F, Johns T, Cherfas J and Eyzaguirre P B 2006
Agricultural biodiversity, nutrition, and health: making a
difference to hunger and nutrition in the developing world
Food & Nutr. Bull. 27 167–79
Gamfeldt L et al 2013 Higher levels of multiple ecosystem services
are found in forests with more tree speciesNature Commun.
4 1340
Grant G 2012 Ecosystem Services Come to Town: Greening Cities
by Working with Nature (Chichester: John Wiley & Sons)
Hales S, Butler C, Woodward A and Corvalan C 2004 Health
aspects of the millennium ecosystem assessment EcoHealth
1 124–8
Hales S and Corvalan C 2006 Public health emergency on planet
earth: insights from the millennium ecosystem assessment
EcoHealth 3 130–5
Hanski I et al 2012 Environmental biodiversity, human microbiota,
and allergy are interrelated Proc. Natl Acad. Sci. 109 8334–9
Hartig T et al 2011 Health benefits of nature experience:
psychological, social and cultural processes Forests, Trees, and
Human Health ed K Nilsson et al (Dordrecht: Springer)
pp 127–68
Harvey Al 2008 Natural products in drug discovery Drug Discov.
Today 13 894–901
Hegglin D and Deplazes P 2013 Control of echinococcus
multilocularis: strategies, feasibility and cost—benefit analyses
Int. J. Parasitol 43 327–37
Hendrickx G and Lancelot R 2010 A perspective on emerging
mosquito and phlebotomine-borne diseases in Europe Euro
Surveill. 15 pii=19503 (available online: www.
eurosurveillance.org/ViewArticle.aspx?ArticleId=19503)
Hillel D and Rosenzweig C 2008 Biodiversity and food production
Sustaining Life—How Human Health Depends on Biodiversity
ed E Chivian and A Bernstein (Oxford: Oxford University
Press) pp 325–81
Huber M et al 2011 How should we define health? Br. Med. J.
343 235–7
International Task Force on Avian Influenza 2006 Avian Influenza
and Wild Birds—What is their Actual Role in the Spread of the
Virus? (Bonn: UNEP/CMS Secretariat)
IPBES Intergovernmental Platform on Biodiversity and Ecosystem
Services: http://ipbes.net/
Ito T et al 2001 Generation of a highly pathogenic avian influenza A
virus from an avirulent field isolate by passaging in chickens
J. Virol. 75 4439–43 2001
Janko C, Linke S, Romig T, Thoma D, Schroder W and K ¨ onig A ¨
2011 Infection pressure of human alveolar echinococcosis due
to village and small town foxes (Vulpes vulpes) living in close
proximity to residents Eur. J. Wildl. Res. 57 1033–42
Jasanoff S 1990 The Fifth Branch. Science Advisers as Policymakers
(Cambridge, MA: Harvard University Press)
Johns T 2003 Plant biodiversity and malnutrition: simple solutions
to complex problems Afr. J. Food, Agric. Nutr. Dev. 3 45–52
Johnson P T J, Preston D L, Hoverman J T and Richgels K L D
2013 Biodiversity decreases disease through predictable
changes in host community competenceNature 494 230–3
Jones K E, Patel N G, Levy M A, Storeygard A, Balk D,
Gittleman J L and Daszak P 2008 Global trends in emerging
infectious diseasesNature 451 990–3
Kaplan R and Kaplan S 1989 The Experience of Nature: A
Psychological Perspective (Cambridge: Cambridge University
Press)
Keesing F et al 2010 Impacts of biodiversity on the emergence and
transmission of infectious diseasesNature 468 647–52
Kellert S R 2008 Biodiversity, quality of life, and evolutionary
psychology Biodiversity Change and Human Health: From
Ecosystem Services to Spread of Disease ed O Sala,
L Meyerson and C Parmesan (Washington, DC: Island)
pp 99–127
Keune H et al 2012a Report of the 2011 Belgian Biodiversity—
Public Health Conference, Belgian Biodiversity Platform
(www.biodiversity.be/files/1/4/3/1433.pdf)
16Environ. Res. Lett. 8 (2013) 025015 H Keune et al
Keune H et al 2012b Overview results of the inventory of scientific
research needs and ideas biodiversity—public health Belgian
Community of Practice Biodiversity—Public Health, Belgian
Biodiversity Platform (www.biodiversity.be/1996)
Kilpatrick A M, Chmura A A, Gibbons D W, Fleischer R C,
Marra P P and Daszak P 2006 Predicting the global spread of
H5N1 avian influenza Proc. Natl Acad. Sci. 103 19368–73
Kilpatrick A M and Randolph S E 2012 Drivers, dynamics and
control of emerging vector-borne zoonotic infections Lancet
380 1946–55
Kim J-K, Negovetich N J, Forrest H and Webster R G 2009 Ducks:
the ‘Trojan Horses’ of H5N1 influenza Influenza Other Respi.
Viruses 3 121–8
Kruger A, Rech A, Su X and Tannich E 2001 Two cases of ¨
autochthonous Plasmodium falciparum malaria in Germany
with evidence for local transmission by indigenous Anopheles
plumbeus Trop. Med. Int. Health 6 983–5
Lancet 2009 What is health? The ability to adapt Lancet 373 78
Lang D L, Wiek A, Bergmann M, Stauffacher M, Martens P,
Moll P, Swilling M and Thomas C J 2012 Transdisciplinary
research in sustainability science: practice, principles, and
challenges Sustain. Sci. 7 (Suppl. 1) 25–43
Langlois E, Campbell K, Prieur-Richard A-H, Karesh W and
Daszak P 2012 Towards a better integration of global health
and biodiversity in the new sustainable development goals
beyond RioC20 EcoHealth 9 381–5
Lebel J 2003 Health: An Ecosystem Approach (In Focus) (Ottawa:
International Development Research Centre)
Levi T, Kilpatrick A M, Mangel M and Wilmers C C 2012 Deer,
predators and the emergence of Lyme disease Proc. Natl Acad.
Sci. 109 10942–7
Li K S et al 2004 Genesis of a highly pathogenic and potentially
pandemic H5N1 influenza virus in eastern AsiaNature
430 209–13
Li J W-H and Vederas J C 2009 Drug discovery and natural
products: end of an era or an endless frontier? Science
325 161–5
Linard C, Lamarque P, Heyman P, Ducoffre G, Luyasu V,
Tersago K, Vanwambeke S O and Lambin E F 2007
Determinants of the geographic distribution of Puumala virus
and Lyme borreliosis infections in Belgium Int. J. Health
Geogr. 6 15
Lindgren E, Andersson Y, Suk J E, Sudre B and Semenza J C 2012
Monitoring EU emerging infectious disease risk due to climate
change Science 336 418–9
Lines J 2007 Chikungunya in Italy Br. Med. J. 335 576
Long N 2001 Development Sociology: Actor Perspectives
(New York: Routledge)
Lyytimaki J J and Sipila M 2009 Hopping on one leg—the
challenge of ecosystem disservices for urban green
management Urban For. Urban Green. 8 309–15
MA (Millennium Ecosystem Assessment) Full reports of the
Millennium Ecosystem Assessment, including synthesis
reports and related press materials (see www.maweb.org/en/
index.aspx)
MA 2005 Ecosystems and Human Well-Being: Synthesis
(Washington, DC: Island)
Marsh Inc. 2008 The Economic and Social Impact of Emerging
Infectious Disease (New York: Marsh Inc.)
Martens P 2002 Health transitions in a globalising world: towards
more disease or sustained health? Futures 34 635–48
McMichael A J 1993 Global environmental change and human
population health: a conceptual and scientific challenge for
epidemiology Int. J. Epidemiol. 22 1–8
McMichael A J 2002 Population, environment, disease, and
survival: past patterns, uncertain futures Lancet 359 1145–8
McMichael A J 2006 Population health as the ‘bottom line’ of
sustainability: a contemporary challenge for public health
researchers Eur. J. Public Health 16 579–82
McMichael A J 2009 Human population health: sentinel criterion of
environmental sustainabilityCurr. Opin. Environ. Sustain.
1 101–6
Meessen B, Kouanda S, Musango L, Richard F, Ridde V and
Soucat A 2011 Communities of practice: the missing link for
knowledge management on implementation issues in
low-income countries? Trop. Med. Int. Health 16 1007–14
Melillo J and Sala O 2008 Ecosystem services Sustaining
Life—How Human Health Depends on Biodiversity
ed E Chivian and A Bernstein (Oxford: Oxford University
Press) pp 75–115
Mennerat A, Nilsen F, Ebert D and Skorping A 2010 Intensive
farming: evolutionary implications for parasites and pathogens
Evol. Biol. 37 59–67
MODIRISK www.modirisk.be
Molyneux D H et al 2008 Ecosystem disturbance, biodiversity loss,
and human infectious disease Sustaining Life—How Human
Health Depends on Biodiversity ed E Chivian and
A Bernstein (Oxford: Oxford University Press) pp 287–323
National Environmental Action Plan 2013 Operational Report
2003–2008 (www.health.belgium.be/eportal/Aboutus/
relatedinstitutions/NEHAP/index.htm) (in Dutch)
Newman D J, Kilama J, Bernstein A and Chivian E 2008 Medicines
from nature Sustaining Life—How Human Health Depends on
Biodiversity ed E Chivian and A Bernstein (Oxford: Oxford
University Press) pp 117–61
Niemela J, Breuste J H, Guntenspergen G, McIntyre N E, ¨
Elmqvist T and James P (ed) 2011 Urban Ecology: Patterns,
Processes, and Applications (Oxford: Oxford University Press)
Ostroumov S A 2002 Polyfunctional role of biodiversity in
processes leading to water purification: current
conceptualizations and concluding remarks Hydrobiologia
469 203–4
Papa A et al 2010 Ongoing outbreak of West Nile virus infections in
humans in Greece, July–August 2010 Euro Surveill.
15 pii=19644 (available online: www.eurosurveillance.org/
ViewArticle.aspx?ArticleId=19644)
Parmesan C and Martens P 2009 Climate change, wildlife, and
human health Biodiversity Change and Human Health: From
Ecosystem Services to Spread of Disease ed O Sala,
L Meyerson and C Parmesan (Washington, DC: Island)
pp 245–66
Peixoto I and Abramson G 2006 The effect of biodiversity on the
hantavirus epizootic Ecology 87 873–9
Pongsiri M et al 2009 Biodiversity loss affects global disease
ecology Bioscience 59 945–54
Pruss- ¨ Ust ¨ un A and Corval ¨ an C 2006 ´ Preventing Disease through
Healthy Environments. Towards an Estimate of the
Environmental Burden of Disease (Geneva: WHO)
Pysek P et al 2010 Disentangling the role of environmental and
human pressures on biological invasions across Europe Proc.
Natl Acad. Sci. USA 107 12157–62
Rabinowitz P M and Gordon Z 2004 Outfoxing a rash: clinical
example of human–wildlife interaction EcoHealth 1 404–40
Radimersky T, Frolkova P, Janoszowska D, Dolejska M, Svec P,
Roubalova E, Cikova P, Cizek A and Literak I 2010 Antibiotic
resistance in faecal bacteria (Escherichia coli, Enterococcus
spp.) in feral pigeons J. Appl. Microbiol. 109 1687–95
Randolph S E and Dobson A D 2012 Pangloss revisited: a critique
of the dilution effect and the biodiversity-buffers-disease
paradigm Parasitology 139 847–63
Rapport D 2006 Avian influenza and the environment: an ecohealth
perspective Report Submitted to the UN Environment
Programme (available at: www.k4health.org/sites/default/files/
AvianFluEcoHealth.pdf)
Rapport D J, Costanza R and McMichael A J 1998 Assessing
ecosystem health Trends Ecol. Evol. 13 397–402
Rayner G and Lang T 2012 Ecological Public Health: Reshaping
the Conditions for Good Health (London: Routledge)
17Environ. Res. Lett. 8 (2013) 025015 H Keune et al
Rees W 1997 Urban ecosystems: the human dimension Urban
Ecosyst. 1 63–75
Rees W and Wackernagel M 2008 Urban ecological footprints: why
cities cannot be sustainable—and why they are key to
sustainability Environ. Impact. Assess. Rev. 16 223–45
Rook G 2010 Darwinian medicine and the ‘hygiene’ or ‘old friends’
hypothesisClin. Exp. Immunol. 160 70–9
Rohr J R, Dobson A P, Johnson P T J, Kilpatrick A M, Paull S H,
Raffel T R, Ruiz-Moreno D and Thomas M B 2011 Frontiers in
climate change—disease research Trends Ecol. Evol. 26 270–7
Rockstrom J, Gordon L, Folke C, Falkenmark M and Engwall M ¨
1999 Linkages among water vapor flows, food production, and
terrestrial ecosystem servicesConserv. Ecol. 3 5
Santa-Olalla Peralta P et al 2010 First autochthonous malaria case
due to Plasmodium vivax since eradication, Spain, October
2010 Euro Surveill. 15 pii=19684 (available online: www.
eurosurveillance.org/ViewArticle.aspx?ArticleId=19684)
Sarkki S, Niemela J, Tinch R and the SPIRAL team 2012 Criteria ¨
for science–policy interfaces and their linkages to instruments
and mechanisms for encouraging behaviour that reduces
negative human impacts on biodiversity Science–Policy
Interfaces for Biodiversity: Research, Action and Learning
(SPIRAL; FP7 EU research project) (www.spiral-project.eu/
sites/default/files/SPIRAL 3-1.pdf)
Sempik J, Hine R and Wilcox D (ed) 2010 Green Care: A
Conceptual Framework (A Report of the Working Group on the
Health Benefits of Green Care, COST Action 866, Green Care
in Agriculture) (Loughborough: Centre for Child and Family
Research, Loughborough University)
Seto K C, Guneralp B and Hutyra L R 2012 Global forecasts of ¨
urban expansion to 2030 and direct impacts on biodiversity and
carbon pools Proc. Natl Acad. Sci. USA 109 16083–8
Shute P G 1954 Indigenous P. vivax malaria in London believed to
have been transmitted by An. plumbeus Monthly Bull. Minist.
Health Public Health Lab. Serv. 13 48–51
Sirbu A, Ceianu C S, Panculescu-Gatej R I, Vazquez A, Tenorio A, ´
Rebreanu R, Niedrig M, Nicolescu G and Pistol A 2011
Outbreak of West Nile virus infection in humans, Romania,
July to October 2010 Euro Surveill. 16 pii=19762 (available
online: www.eurosurveillance.org/ViewArticle.aspx?
ArticleId=19762)
Skevington S M 2009 Quality of life, biodiversity and health:
observations and applications Biodiversity Change and Human
Health: From Ecosystem Services to Spread of Disease
ed O Sala, L Meyerson and C Parmesan (Washington, DC:
Island) pp 129–42
Soskolne C L and Bertollini R 2002 Global ecological integrity,
global change and public healthConservation Medicine:
Ecological Health in Practice ed A A Aguirre, R S Ostfeld,
G M Tabor, C House and M C Pearl (New York: Oxford
University Press) pp 372–82
Stephens C 2012 Biodiversity and global health—hubris, humility
and the unknown Environ. Res. Lett. 7 011008
Sudmeier-Rieux K, Masundire H, Rizvi I and Rietbergen S 2006
Ecosystems, Livelihoods and Disasters: An Integrated
Approach to Disaster Risk Management (Gland: IUCN)
Swingland I 2001 Biodiversity, Definition of Encyclopedia of
Biodiversity vol 1 (London: Academic) pp 377–91
Tabor G M and Aguirre A A 2004 Ecosystem health and sentinel
species: adding an ecological element to the proverbial Canary
in the mineshaft EcoHealth 1 226–8
Tatem A J, Hay S I and Rogers D J 2006 Global traffic and disease
vector dispersal Proc. Natl Acad. Sci. USA 103 6242–7
TEEB (The Economics of Ecosystems and Biodiversity) 2011 The
Economics of Ecosystems and Biodiversity in National Policy
and Decision Making (London: Routledge)
ten Brink P, Badua T, Bassi S, Gantioler S and Kettunen M 2011
Estimating the Overall Economic Value of the Benefits
Provided by the Natura 2000 Network (Brussels: Institute for
European Environmental Policy)
Thomas M B, Lafferty K D and Friedman C S 2009 Biodiversity
and disease Biodiversity Change and Human Health: From
Ecosystem Services to Spread of Disease ed O Sala,
L Meyerson and C Parmesan (Washington, DC: Island)
pp 229–44
Ticker G, Kuttinen M, McConville A, Cottee-Jones E, Ebert S,
Hulea O, Lucius I, Moroz S, Strobel D and Todorova M 2010
Valuing and Conserving Ecosystem Services: a Scoping Case
Study in the Danube Basin (Brussels: Institute For European
Environmental Policy)
Toledo A and Burlingame B 2006 Biodiversity and nutrition: a
common path toward global food security and sustainable
development J. Food Compos. Anal. 19 477–83
Turnhout E, Bloomfield B, Hulme M and Wynne B 2012
Conservation policy: listen to the voices of experienceNature
488 454–5
Tzoulas K, Korpela K, Venn S, Yli-Pelkonen V, Kazmierczak A, ´
Niemela J and James P 2007 Promoting ecosystem and human ¨
health in urban areas using Green Infrastructure: a literature
review Landsc. Urban Plann. 81 167–78
UN (United Nations) 1992 Report of the United Nations Conference
on Environment and Development (Rio de Janeiro, 3–14 June
1992) (New York: UN) UN General Assembly Document Ref:
A/CONF.151/26 (I)
United Nations Population Division 2010 World Population
Prospects: The 2010 Revision (New York: United Nations)
(available at: http://esa.un.org/wpp/)
Van Den Berge K 1995 De Vos Vulpes vulpes in Vlaanderen:
inventarisatie en synthese van de belangrijkste knelpunten
Mededelingen van het Instituut voor Bosbouw en Wildbeheer
1995/1 pp 71–100 (with English summary)
Van Den Berge K and De Pauw W 2003 Vos Vulpes vulpes
(Linnaeus, 1758) Zoogdieren in Vlaanderen. Ecologie en
verspreiding van 1987 tot 2002. Natuurpunt Studie en
JNM-Zoogdierenwerkgroep, Mechelen & Gent, Belgie¨
ed S Verkem, J De Maeseneer, B Vandendriessche,
G Verbeylen and S Yskout (with English summary)
Van den Berg A E, Hartig T and Staats H 2007 Preference for nature
in urbanized societies: stress, restoration and the pursuit of
sustainability J. Soc. Issues 63 79–96
Vandendriessche Y, Gellynck X, Saatkamp H and Viaene J 2009
Strategies to control high pathogenic avian influenza (HPAI) in
the Belgian poultry sector Biotechnol. Anim. Husb. 25 373–85
Van den Hove S 2007 A rationale for science–policy interfaces
Futures 39 807–26
Van Gucht S and Le Roux I 2008 Rabies control in Belgium: from
eradication in foxes to import of a contaminated dog Vlaams
Diergen. Tijds. 77 376–84
Van Gucht S, Van Den Berge K, Quataert P, Verschelde P and
Le Roux I 2010 No emergence of echinococcus multilocularis
in foxes in flanders and Brussels Anno 2007–2008 Zoonoses
Public Health 57 65–70
Van Herzele A, Collins K and Heyens V 2005 Interacting with
Greenspace: Public Participating with Professionals in the
Planning and Management of Parks and Woodlands (Brussels:
ANB)
Van Herzele A, De Clercq E M, Wiedemann T, De Bruyn L and
Degans H 2004 Stedelijk milieu MIRA-T 2004, Milieu-en
Natuurrapport Vlaanderen ed M Van Steertegem (Leuven:
Garant) pp 355–65
Van Herzele A and de Vries S 2012 Linking green space to health: a
comparative study of two urban neighbourhoods in Ghent,
Belgium Popul. Environ. 34 171–93
Versteirt V, De Clercq E, Dekoninck W, Damiens D, Ayrinhac A,
Jacobs F and Van Bortel W 2009 Mosquito vectors of disease:
spatial biodiversity, drivers of change, and risk MODIRISK
18Environ. Res. Lett. 8 (2013) 025015 H Keune et al
Final Report (Research Programme Science for a Sustainable
Development) (Brussels: Belgian Science Policy) p 152
Versteirt V et al 2012 Nationwide inventory of mosquito
biodiversity (Diptera: Culicidae) in Belgium, Europe Bull.
Entomol. Res. 103/2 1475–2670
von Hertzen L et al 2011 Natural immunity: biodiversity loss and
inflammatory diseases are two global megatrends that might be
related EMBO Rep. 12 1089–93
von Schirnding Y 2002 Health and sustainable development: can we
rise to the challenge? Lancet 360 632–7
Walker Bet al 2009 Looming global-scale failures and missing
institutions Science 325 1345–6
Wenger E and Snyder W M 2000Communities of Practice: The
Organizational Frontier (Boston, MA: Harvard Business
Review) pp 139–45
Whitehead M 2005 Tackling inequalities: a review of policy
initiatives Tackling Inequalities in Health: An Agenda for
Action ed M Benzeval, K Judge and M Whitehead (London:
Kings Fund)
WHO (World Health Organisation) 2004 The Vector-Borne Human
Infections of Europe—their Distribution and Burden on Public
Health (Geneva: WHO Regional Office for Europe)
WHO 2005 Ecosystems and Human Well-Being: Health Synthesis.
A Report of the Millennium Ecosystem Assessment (Geneva:
WHO)
WHO 2011 Our Planet, Our Health, Our Future: Human health
and the Rio Conventions (Geneva: WHO)
Wilby A et al 2009 Biodiversity, Food Provision, and Human Health
Biodiversity Change and Human Health: From Ecosystem
Services to Spread of Disease ed O Sala, L Meyerson and
C Parmesan (Washington, DC: Island) pp 13–40
Wildlife Conservation Society One World, One HealthTM (see www.
wcs.org/conservation-challenges/wildlife-health/
wildlife-humans-and-livestock/one-world-one-health.aspx;
also www.oneworldonehealth.org/)
Wittmer H, Berghofer A, Keune H, Martens P, F ¨ orster J and ¨
Almack K 2012 The value of nature for local development The
Economics of Ecosystems and Biodiversity in Local and
Regional Policy and Management ed H Wittmer and
H Gundimeda (New York: Routledge) pp 7–32
Zielinski-Gutierrez E C and Hayden M H 2006 A model for
defining West Nile virus risk perception based on ecology and
proximity EcoHealth 3 28–34
19
**
**
Evidence of merit of the cited paper in Hydrobiologia. Citation. Other examples of citation of this publications of this series:
Citation of: Polyfunctional role of biodiversity...
http://5bio5.blogspot.com/2013/06/one-of-best-cited-scientific.html
**