In the days before Christmas

In the days before Christmas, 1952, adverse weather conditions and the burning of sulphurous coal led to the death of almost 12 000 people in London. Despite improvements in pollution prevention since the “Great Smog”, London continues to experience toxic air pollution linked to thousands of premature deaths every year. In 2017, however, the main cause of pollution is nitrogen dioxide emitted by diesel vehicles and not the widespread burning of coal. And this time it is invisible. According to European Union regulations, nitrogen dioxide levels ought to only surpass 200 μg/m of air during a 1 h period 18 times in a whole year, but by the beginning of January, London had already breached its annual air pollution limits. 15 other areas in the UK also breached legal limits for air pollution. Air pollution is linked to 40 000 deaths in UK each year, 9000 of which occur in London, costing the country almost £27·5 billion Most premature deaths from air pollution are caused by cardiovascular, cerebrovascular, and respiratory disease; however it has broader effects on health. The effects of air pollution can be very severe on children because of their developing organs and immune systems. And living near congested, dirty roads increases the risk of heart and lung disease in both adults and children, as well as development of dementia in older people. A recent collaboration between and Greenpeace showed that 3000 schools and nurseries across England and Wales are within 150 m of roads with high levels of nitrogen dioxide, putting hundreds of thousands of children at risk.
Awareness of the need for integrated approaches to health has grown with increasing realisation that human, animal, plant, and farnesoid x receptor health are intertwined and ultimately affect the livelihood and wellbeing of human beings, as well as planetary sustainability and resilience. The origins of many diseases are rooted in how we produce and use food, water, energy, and other natural resources for a growing population, but also the way our living environments and social and economic interactions evolve. Historically, this evolution was primarily driven by societies\' desire to increase allocative efficiency and generate better welfare for human beings. In the past 3 decades, although millions of people have been lifted out of poverty, many poor sub-populations worldwide are mired in craters of inequality without opportunities. At the same time, many millions of people produce and consume far more than they need, and this overconsumption has been at enormous environmental and health cost. We are living in an unprecedented situation in which we are changing ecological dynamics and evolutionary processes more rapidly than ever, because of the number of human beings inhabiting the planet and the efficiency of our technological means. Harnessing opportunities to the benefit of humans without further undermining the ecosystem, other species, and our own health is a key element of the UN Sustainable Development Goals. Although these goals set important targets in several dimensions of society, ecology, and economy, they also raise clearly conflicting agendas. As an example, continued economic growth remains elusive without environmental change and consumption of dwindling resources. This approach undermines the benefits people obtain from healthy ecosystems, potentially exacerbating conflict for the affected populations. The global community struggles to capture and manage risks of our own doing, because they occur in a complex and dynamic system of many dimensions. With 23% of global deaths in 2012 attributed to unhealthy environments—plus morbidity and mortality from zoonotic disease, antimicrobial resistance from injudicious medical and agricultural use, and toxicity of pesticides and other chemicals—disease prevention through enhanced environmental resilience is clearly warranted. Shifting from the current paradigm of ever growing resource-intensive responses will require deep, structural change far beyond the clinical dimension. The One Health, Ecohealth, Planetary Health, and related approaches support systems based and integrative efforts of multiple disciplines working to attain optimal health for people, animals, and the environment. They can also be instrumental in collating concerns and real risks from multiple stakeholders in the living and inert world, and above all, emphasise upstream prevention opportunities such as equitable trade, welfare oriented animal husbandry and sustainable land use that promote public health. The regional One Health Inter-ministerial meetings WHO recently held in collaboration with the Food and Agricultural Organisation (FAO) and the UN Environmental Program (UNEP) are a strong step forward. These programmes are further strengthened by the Operational Framework for Good Governance by WHO and the World Organisation for Animal Health (OIE) at the human-animal interface, which supports countries to bridge WHO and OIE toolkits for the assessment of national capacities. However, funding mechanisms and incentives remain limited to support operationalising One Health. For example, although the Contingency Fund for Emergencies provides crucial response resources for public health emergencies, the future Director-General of WHO should also advocate for long-term capacity and infrastructure investments across the UN that ultimately provide incentive for intersectorial collaboration and promote disease prevention.