Environmental Issues Are Health Issues [original]

Special Issue: Psychology and the Environmental Crisis

Original Articles and Reviews

Environmental Issues Are Health

Issues

Making a Case and Setting an Agenda for Environmental

Health Psychology

Jennifer Inauen

, Nadja Contzen

2,3

, Vivan Frick

, Philipp Kadel

, Jan Keller

Josianne Kollmann

, Jutta Mata

5,8

, and Anne M. van Valkengoed

Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Switzerland

Eawag: Swiss Federal Institute of Aquatic Science & Technology, Duebendorf, Switzerland

Faculty of Behavioural and Social Sciences, University of Groningen, The Netherlands

Institute for Ecological Economy Research (IÖW), Center for Technology and Society, TU Berlin, Germany

School of Social Sciences, Chair of Health Psychology, University of Mannheim, Germany

Department of Education and Psychology, Freie Universität Berlin, Germany

Department of Psychology, University of Konstanz, Germany

Mannheim Center for Data Science, University of Mannheim, Germany

Abstract: Increasing demands on ecosystems, decreasing biodiversity, and climate change are among the most pressing environmental

issues of our time. As changing weather conditions are leading to increased vector-borne diseases and heat- and flood-related deaths, it is

entering collective consciousness: environmental issues are human health issues. In public health, the field addressing these issues is known

as environmental health. This field addresses both the effects people have on their environment as well as the effects of the environment on

people. Psychology, as a discipline concerned with explaining, predicting, and changing behavior has much to contribute to these issues

because human behavior is key in promoting environmental health. To date, however, an integrative view of environmental health in psychology

is lacking, hampering urgently needed progress. In this paper, we review how the environment and human health are intertwined, and that

much can be gained through a systemic view of environmental health in psychology. Based on a review of the literature, we suggest that

psychologists unite efforts to promote an integrative science and practice of environmental health psychology, and jointly address

environmental-health related behavior. The research agenda for this field will include integrating behavior change theory and intervention

approaches. Thereby, psychology can potentially make an important contribution to sustained environmental health for generations to come.

Keywords: environmental health, science of behavior change, health psychology, environmental psychology, intervention

Temperatures are rising, extreme weather is increasing,

and water and other natural resources are declining amidst

increasing demand by the human population (IPCC, 2014).

These and further environmental issues are threatening

human life on the planet (Steffen et al., 2015). The magni-

tude of these environmental issues is now markedly enter-

ing the collective consciousness as the voices reminding us

of the impact of today’s decisions on future generations

grow louder (e.g., Thunberg, 2019). Individuals and house-

holds contribute significantly to environmental issues

(Clayton et al., 2015). For example, 26% of the total energy

consumed in the European Union in 2018 were directly

consumed by households, for example, for heating or cook-

ing, and half of that energy originated from fossil fuels,

especially gas (eurostat, 2020). In turn, environmental

issues affect human health and well-being (G. W. Evans,

2019), which can in part be reduced by people’s adaptation

to environmental issues (van Valkengoed & Steg, 2019).

Psychology, a discipline concerned with explaining, predict-

ing, and changing behavior, therefore, has much to offer to

the mitigation of environmental issues and the promotion

of environmental health (Clayton et al., 2015; Otto et al.,

2014; Stern, 2011; sometimes also described as planetary

health; Swinburn et al., 2019).

Environmental health, “[i]n its broadest sense, ... is the

segment of public health that is concerned with assessing,

understanding, and controlling the impacts of people on

their environment and the impacts of the environment on

them”(Moeller, 2011,p.3). It includes environmental

issues such as air pollution, climate change, water, and

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sanitation. Whereas environmental health is an established

segment of public health, psychological research on this

topic is scattered, hampering urgently needed progress.

In particular, two sub-disciplines of psychology are each

partially concerned with environmental health: environ-

mental psychology and health psychology. Contributing to

the understanding of people’s impact on their environment,

in the past decades, environmental psychologists have

researched the drivers and barriers of pro-environmental

behavior and developed effective interventions to promote

behavior change, for example, for energy conservation

(Abrahamse et al., 2005;Andor&Fels,2018), travel mode

choice (Lind et al., 2015), and recycling (Varotto &

Spagnolli, 2017). Environmental psychology is further

concerned with the impact of the environment on people,

especially on their well-being (e.g., favorable impacts of

green spaces; Houlden et al., 2018). However, the impact

of environmental issues on people’s physical health has

received comparatively less attention from psychologists

and has only recently emerged as a topic of interest in

our field (van Valkengoed & Steg, 2019). This, even though

it has been highlighted that environmental issues are ulti-

mately health issues as both are inherently interconnected

(EASAC, 2019;Raworth,2017;Swinburnetal.,2019).

Health psychology, a sub-discipline of psychology dedi-

cated to preventing disease and promoting health and

well-being (Matarazzo, 1980) may offer key insights to

understanding and promoting environmental health,

thereby complementing environmental psychology. How-

ever, health psychology has arguably paid less attention to

environmental factors, traditionally focusing on the individ-

ual’s role in health (Matarazzo, 1980), that is, self-regulation

to prevent chronic disease (e.g., Schwarzer et al., 2011).

Researchers have previously suggested synergies between

environmental and health psychology (e.g., Bernard,

2019). Nisbet and Gick (2008), for example, convincingly

argued that health psychology may enhance our under-

standing of pro-environmental behavior. Yet, although some

applications of health behavior change models to explain

pro-environmental behavior exist (Bamberg, 2013), cross-

pollination between health and environmental psychology

is still rare.

In this paper, we aim to show that much can be gained

from an integrated view of environmental health in psycho-

logical science and practice. Environmental and health

psychology each contribute unique theoretical and method-

ological approaches and insights to understanding and pro-

moting environmental health. Health psychology can add to

our understanding and promotion of behaviors that can

mitigate people’s impact on the environment (Bernard,

2019), which have traditionally been the focus of environ-

mental psychology. We will henceforth refer to these as

“mitigation behaviors”(Bernard, 2019) to avoid precluding

the motives that drive these behaviors (e.g., pro-

environmental or health motives). Further, integration of

environmental and health psychology will expand our

understanding of behaviors that aim to prevent the adverse

impact of environmental issues on human health (hence-

forth referred to as “adaptation behaviors”;Bernard,

2019). Adaptation behaviors may be conceptualized as

health behaviors, but they may also relate back to the envi-

ronment (e.g., by fostering pro-environmental motives). In

summary, our paper makes the case that conceptualizing

and addressing environmental health in an integrated man-

ner in psychology (i.e., as environmental health psychology)

should significantly enhance understanding and promotion

of environmental health. Environmental health psychology

will address both mitigation and adaptation behaviors

related to environmental health (see Figure 1). The aim is

that this integration will enable efficient progress in this

field, which is urgently needed considering the pressing

nature of environmental issues.

Environmental Health and the Role

of Human Behavior

Major planetary processes such as climate and biodiversity

are key to keeping the earth in a Holocene-like state con-

ducive to human life (Raworth, 2017). However, human

activities, such as agriculture, industry, and mineral extrac-

tion, are altering these processes at a large scale (IPCC,

2018), putting the planet at increased risk of destabilization

(Raworth, 2017; Steffen et al., 2015). Already, environmen-

tal issues are causing adverse effects on human health. The

pollution of drinking water, for example, caused by insuffi-

cient sanitation, can lead to the outbreak of waterborne dis-

eases such as typhoid fever and cholera (Schwarzenbach

et al., 2010). Chemical pollution of water and soil (e.g.,

by pesticides) has multiple health effects that are likely

Figure 1. Environmental health psychology: Addressing mitigation and

adaptation behaviors related to environmental health.

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220 J. Inauen et al., Environmental Health Psychology

underestimated (Landrigan et al., 2018). Further, burning

fossil fuels leads to widespread air pollution, causing dis-

eases such as asthma and bronchitis (Künzli et al., 2000),

and relates to 4.2million premature deaths annually

(WHO, 2019). Importantly, burning fossil fuels is the main

source of CO

emissions, a greenhouse gas that contributes

to climate change (Watts et al., 2015).

Climate change is a key environmental issue that poses

several direct and indirect health risks (Watts et al., 2015)

that will likely be of increasing importance as climate

change accelerates. The direct effects of climate change

include increases in the frequency and severity of hydro-

meteorological hazards, such as wildfires, droughts, and

flooding (Sauerborn & Ebi, 2012), which can lead to physi-

cal injury and death. Moreover, experiencing such hazards

can cause psychological illness such as post-traumatic stress

disorder and anxiety (Clayton et al., 2017;Goldmann&

Galea, 2014). Indirectly, climate change adversely affects

human health by enabling the spread of vector-borne dis-

eases (e.g., malaria, dengue fever) through fostering favor-

able conditions for vectors (Campbell-Lendrum et al.,

2015). Other examples include food insecurity (climate

change increases crop failure, loss of livestock, and agricul-

tural plagues; FAO, 2008), and the possibility of increased

armed conflict (Adams et al., 2018;Machetal.,2019). In

addition, psychological consequences are expected, such

as psychological distress (G. W. Evans, 2019), and “eco-

anxiety”(Clayton et al., 2017).

People’s behavior is key to promoting environmental

health. On the one hand, people can mitigate their adverse

impact on the environment by changing their behaviors.

Mitigation behaviors thus aim to alleviate the human

impact on the environment. On the other hand, people

can avoid or reduce adverse health effects of the environ-

ment by adapting to environmental issues. We discuss the

two environmental-health related behavioral domains

(mitigation and adaptation behaviors) in more detail in

the following.

Mitigating Adverse Impact of Humans on

the Environment: Mitigation Behaviors

Through lifestyle changes, individuals and households can

mitigate adverse human impact on the environment (IPCC,

2018). For example, people can walk instead of taking the

car. They can engage in recycling, or using safe sanitation.

They can avoid behaviors such as air travel, consuming

meat, using pesticides, and they can adopt sustainable inno-

vations, such as new technologies (e.g., solar power) or new

products (e.g., insect-based foods).

Mitigation behaviors have been traditionally addressed in

environmental psychology, for example, in the context of

pursuing pro-environmental goals (Kaiser & Wilson,

2004). However, mitigation behaviors can also be relevant

from a health perspective when they have co-benefits (Bain

et al., 2016). Co-beneficial behaviors reduce people’s

impact on the environment and simultaneously and directly

promote personal health as well. Hence, integrating envi-

ronmental and health psychology perspectives when

addressing mitigation behaviors could valuably extend pre-

vious research in this field.

Mitigation behaviors with co-benefits include, for exam-

ple, meat-reduced diets and active mobility. Compared to

other foods, meat production accounts for a substantial

amount of greenhouse gas emissions, land use, use of nat-

ural resources (e.g., water), and pollution (Clark et al.,

2019). Lowering meat consumption or switching to a vege-

tarian diet could reduce up to 50% of greenhouse gas emis-

sions and land demand of the current diet (Hallström et al.,

2015) while also reducing the risk of coronary heart disease,

cancer, type 2diabetes, and overall mortality (Godfray

et al., 2018). Similarly, commuting to work by bicycle or

walking instead of taking the car may lower greenhouse

gas emissions and fossil fuel consumption, while at the

same time increasing air quality, and levels of physical

activity (Barnett et al., 2019). This, in turn, will promote

better health and well-being (Kelley et al., 2018;Lee

et al., 2012;Mataetal.,2012). In addition, mitigation

behaviors with co-benefits for well-being and the environ-

ment have also been identified. For example, engaging in

environmental activism has been shown to relate to greater

well-being and health (Klar & Kasser, 2009).

Reducing Adverse Impacts of the

Environment on Human Health:

Adaptation Behaviors

People can take multiple actions to prevent or reduce envi-

ronmental impacts on human health and well-being (van

Valkengoed & Steg, 2019). These behaviors may or may

not be motivated by health concerns, wherefore we advo-

cate an integrated view of psychological science on these

behaviors. Adaptation behaviors can be categorized as

information seeking, preparative actions, and protective

actions (van Valkengoed & Steg, 2019). Information seek-

ing means acquiring information about a person’sriskof

an environmental hazard and potential behavioral

responses to certain hazards, for example, checking govern-

ment brochures and monitoring air pollution (e.g., Lewis &

Edwards, 2016). Preparative actions are structural mea-

sures that are taken before the onset of an environmental

hazard, aimed at reducing the probability of being affected.

Examples include flood proofing the home, or buying

facemask respirators to protect against air pollution (e.g.,

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J. Inauen et al., Environmental Health Psychology 221

Hansstein & Echegaray, 2018). Protective actions are

behaviors taken in response to an ongoing hazard, aimed

at reducing the impacts of that hazard, for instance, taking

prophylactic medicine for vector-borne diseases, or wearing

a face mask respirator in an air-polluted area (e.g., Zhou

et al., 2016).

Adaptation behaviors affect human health at different

timescales. There are behaviors with immediate health

effects, such as avoiding overexertion during heatwaves

(Akompab et al., 2013). Behaviors could also have interme-

diate-term effects, such as taking structural measures to

ensure indoor temperatures are regulated during a heat-

wave (Murtagh et al., 2019). There are also behaviors with

long-term health effects such as migrating away from

affected areas (Zander et al., 2019). Furthermore, most

people are facing multiple environmental hazards simulta-

neously. A broad repertoire of adaptation behaviors will

therefore be required in the future, wherefore this is an

important emerging field in psychology.

Understanding and Promoting

Environmental Health: The Role of

Psychology

As elaborated above, human behavior plays a pivotal role in

environmental health, even though psychologists have

rarely systemically tackled this. A key contribution of psy-

chology as a discipline, and environmental and health psy-

chology, in particular, is the development of theories about

the determinants of behavior change, and the development

of behavior change interventions based on these theories.

In the following, we provide a brief integrative review of

the determinants of mitigation and adaptation behaviors

from both environmental and health psychology.

Determinants of Mitigation and

Adaptation Behaviors

Both environmental and health psychology are concerned

with explaining mitigation and adaptation behaviors, and

their theories show large overlap. Risk perception, a con-

struct from protection motivation theory (Rogers, 1975),

for example, plays a role in explaining health behaviors,

such as vaccination uptake (Brewer et al., 2007), but can

also be used to explain pro-environmental behaviors

(Brügger et al., 2015). In addition, people are assumed more

likely to engage in behavior change if they expect positive

outcomes of the behavior (outcome expectations). While

health behaviors are usually motivated by positive personal

outcomes, such as promoting personal health, pro-

environmental behaviors are usually encouraged by positive

collective outcomes, such as improved environmental quality

or public health. Accordingly, self-transcendence values

(i.e. biospheric and altruistic values) that elicit a moral

obligation (personal norm) to act have been identified as

key motivators of pro-environmental behaviors (Stern

et al., 1999). Further, perceiving oneself as capable of per-

forming a behavior (self-efficacy; Bandura, 1997), as well as

social norms, have been theorized as key correlates of

behavior change (Ajzen, 1991). Most theories assume that

a key step to behavior change is forming a behavioral inten-

tion, (Ajzen, 1991;Schwarzer,2008).

Despite good intentions, many people fail to translate their

intentions into action (intention-behavior gap; Orbell &

Sheeran, 1998). Behavior change frameworks such as the

health action process approach (HAPA; Schwarzer, 2008;

Zhang et al., 2019) focus on volitional behavioral determi-

nants beyond people’s intentions. Volitional strategies such

as action planning (a detailed plan, where, when, and how

to perform a behavior; Leventhal et al., 1965) and action con-

trol (Sniehotta et al., 2005; e.g., monitor whether one is wear-

ing facemask respirators in air polluted areas; Zhou et al.,

2016) can be further important behavioral determinants.

These are often studied in health psychology. Further, auto-

matic processes, such as habits (cue-behavior associations

with a history of repetition; Fleetwood, 2019) are gaining

renewed attention as predictors of behavior. Finally, contex-

tual factors, referring to environmental and structural

aspects that might enable or hinder behavior can be impor-

tant (Steg & Vlek, 2009). For example, simply the availability

of public transport, recycling facilities, and environmental

alternatives in the supermarket are necessary for relevant

behaviors to take place (Steg & Vlek, 2009).

Overall, behavior change theories in environmental and

health psychology share many overlaps in the key determi-

nants of behavior change as they play a role in both mitiga-

tion and adaptation behaviors. Surprisingly, the exchange

between the two sub-disciplines has been limited, despite

the strong links between environmental and health issues

highlighted previously (Bernard, 2019;Nisbet&Gick,

2008).

Interventions to Promote Behavior Change

Based on behavior change theory, interventions can be

derived to promote mitigation and adaptation behaviors.

An important achievement of psychologists in this field to

date has been to make this process systematic. We now

have a taxonomy of behavior change techniques (BCTs),

that is, the smallest units of interventions that can bring

about change, which makes intervention reporting more

transparent (Michie et al., 2013). The latest work has also

linked BCTs with behavioral determinants, facilitating the

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222 J. Inauen et al., Environmental Health Psychology

selection of behavior change techniques for specific behav-

ioral determinants (Carey et al., 2019; Connell et al., 2019).

While this work has recently strongly been driven by

health psychology, these procedures and tools are readily

applicable to the broader environmental health context.

Yet, this has rarely been done.

Different theories suggest different ways for promoting

behavior change. According to stage models (Bamberg,

2013; Schwarzer, 2008), interventions can be tailored to

two general mindsets. For individuals not yet motivated

to change (i.e., non-intenders), motivational intervention

techniques can aim to create behavioral intentions (“Iwant

to cycle to work, instead of using the car”). For individuals

motivated to change, but not performing the behavior (i.e.,

intenders), volitional intervention techniques could target

behavioral adoption and long-term maintenance.

To motivate non-intenders to adopt environmental-

health behaviors, research has focused on behavioral

determinants such as social norms (e.g., Schultz et al.,

2016), perceived costs and benefits, or self-efficacy (Steg

&Vlek,2009). These interventions may address collective

goals (e.g., improve quality of nature or public health) or

individual goals (e.g., improve the personal financial situa-

tion or improve personal health; De Dominicis et al.,

2017), and should be matched to recipients’values (van

den Broek et al., 2017). For example, pro-environmental

framing has been shown to motivate some persons,

whereas others are better motivated by monetary framing

(Steinhorst et al., 2015), health framing (Carfora et al.,

2019), or social justice (Kals, 1996). Herein also lies the

potential of promoting behaviors that have co-benefits for

health and the environment. The psychological distance

ofadverseeffectsofclimatechangehasbeenfoundtobe

a barrier to mitigation behaviors (Jones et al., 2017). Health

behavioral consequences, in turn, might be perceived as

more proximal. Depending on the mindset of the target

population, interventions may thus either emphasize the

health benefits of, for example, active mobility or meat-

reduced diets, or their benefits for the environment (Bain

et al., 2016). Emphasizing the more proximal health conse-

quences could be promising to motivate those for whom the

environmental consequences seem distal. For others (e.g.,

younger age groups), the health consequences of their

behaviors might seem distal, whereas their concern about

climate change can be higher than in older age groups

(Corner et al., 2015). Research on this promising pathway

to promoting mitigation behaviors should take into consid-

eration spillover effects (i.e., beneficial effects on non-

targeted mitigation behaviors) as some self-interest motives

(e.g., monetary) have been shown to limit spillover

(L. Evans et al., 2013).

People who are motivated, but do not act accordingly

exhibit the intention-behavior gap (i.e., monitoring goal

progress and investing self-regulatory effort in goal pur-

suit ; Sniehotta et al., 2005;Bamberg,2013;Inauenetal.,

2016; Orbell & Sheeran, 1998). These persons benefit from

volitional interventions, including planning, action control,

or habit formation (Hagger & Luszczynska, 2014;

Verplanken et al., 2018). For instance, individuals can form

individual plans on when, where, and how to perform envi-

ronmental health-related behaviors (Bamberg, 2002),

which can be followed up by means of action control (i.e.,

self-monitoring goal progress and exerting self-regulatory

effort in goal pursuit; Sniehotta et al., 2005).

Accelerating Progress: An Agenda

for Environmental Health

Psychology

As shown in this paper, there is a substantial need and

scope for psychology to contribute to promoting environ-

mental health as behavior change is a key factor. In line

with a systemic view of environmental health (Swinburn

et al., 2019), and given the considerable overlap and poten-

tial synergies between environmental and health psychol-

ogy, it seems fruitful that both sub-disciplines join forces

as environmental health psychology, dedicated to accelerat-

ing psychological research and practice related to environ-

mental health. Further psychology sub-disciplines may

also contribute, such as clinical psychology (environmental

issues also have important effects on mental health;

Clayton et al., 2017), or positive psychology (mitigation

behaviors can promote well-being; Hunecke, 2013). Below,

we outline a research agenda for environmental health psy-

chology, delineating theoretical and applied research ques-

tions that should be addressed by psychologists aiming to

tackle environmental health.

Toward an Integrative Understanding of

Environmental Health in Psychology

As shown, environmental and health psychology offer syn-

ergistic perspectives to enhance our understanding of envi-

ronmental health. By tackling both the impacts of humans

on the environment as well as environmental impacts on

human health, environmental health psychology has the

potential to lead to a holistic understanding of human

behavior related to environmental health. Environmental

psychology has already made great progress in understand-

ing mitigation behaviors that help preserve the environ-

ment. This line of research may be further enhanced by

systematically integrating insights from health psychology,

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J. Inauen et al., Environmental Health Psychology 223

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