Women's health in the anthropocene

The destruction of the Roman cities of Pompeii and Herculaneum during the eruption of Mount Vesuvius in 79 AD serves as a well-documented example of the first humanitarian disaster linked to an environmental event. Most of the buildings of the two cities and many of its inhabitants were buried under the volcanic ashes within 48 hours and the rest by further eruptions. Both cities remained hidden until their accidental rediscovery in the 18th century. While dramatic and devastating, events like volcanic eruptions, earthquakes, and tsunamis are naturally occurring and there is no evidence that during the last two millennium even the largest volcanic eruptions affected global climate.1 In contrast, the Anthropocene era describes the period when human activities have been the dominant influence on global climate and ecosystems (www.nationalgeographic.org). Climate change sceptics point to the fact that urbanisation, industrialisation and associated environmental destruction are not new: for example, the construction of Ancient Rome caused widespread deforestation and soil erosion around the Mediterranean which may have contributed to the fall of the Roman Empire (www.smithsonianmag.com). However, like volcanic eruptions or other natural disasters, these events tended to be local and temporary. By stark contrast, global industrialisation over the last century and in particular deforestation for agriculture and the burning of fossil fuels for energy, have led to a rapid increase in carbon dioxide (CO2) in the atmosphere and a rise in world temperatures.2 In 2022, UN data showed that 40% of all land is now classified as degraded by deforestation and intense farming3 limiting not only the ability to feed the world's population, but also the recycling of CO2. The burning of fossils fuel is accompanied by emissions of air pollutants such as nitrogen oxides (NOx), sulphur dioxide (SO2), ozone (O3) and particulate matter (PM). Over the last three decades, mounting epidemiologic evidence have linked outdoor air pollution to increases in respiratory diseases including lung cancer, cardiovascular disease, cognitive decline and dementia (www.gov.uk/government/publications/air-pollution).4 Long-term exposure to ambient air pollutants may be associated with lower cancer survival4 and has led to worse Covid-19 outcomes during the pandemic.5 A recent study has also indicated that air pollution is associated with rising antibiotic resistance across every country and continent.6 Overall, human mortality attributable to ambient PM increased from 3.5 million in 1990 to 4.2 million in 2015 and ambient PM was the fifth-ranking mortality risk factor in the world.7 In 2020, in the European Union (EU), 96% of the urban population was exposed to levels of PM above the health-based guideline level set by the World Health Organization (WHO) resulting in 238 000 premature deaths (www.eea.europa.eu/publications/air-quality-in-europe-2020-report). Modern industrialisation has also given rise to the chemical industry. Globally there are currently over 350 000 chemicals and mixtures of chemicals registered for production and use in manufacturing, agriculture, food packaging, cosmetic and pharmaceutical processes, amongst others.8 While some of these products have contributed these to human development, many by-products of these chemicals have had a negative impact. Pollutants that do not break down in the environment (“forever chemicals”), along with heavy metal contaminants from mining (such as lead and arsenic), can infiltrate the soil, aquifers, and rivers. These ultimately reach the sea with devastating effects on an ecosystem covering 70% of our planet (www.oceanprotect.org/resources). Of particular concern are those chemicals which are used worldwide such as inorganic fertilizer, pesticides, insecticides, herbicides, hormones, painkillers, antibiotics, disinfectants and nano- and micro-plastic that contaminate drinking water (taps and wells) and food products. The latest quarterly report (23 March 2023) of the Department for Environment, Food & Rural Affairs and Health and Safety Executive has found that half of all bread sold in the UK contains at least two different pesticides (www.gov.uk/government/collections/pesticide-residues-in-food-results-of-monitoring-programme). In 2021, the Pesticide Action Network UK (PAN) found that 30% of vegetables and 69% of fruit contain residues of more than one pesticide (www.pan-uk.org). Unlike ambient air pollution, where a relatively small number of pollutants need tracking, the large range of water pollutants complicates epidemiological studies making it difficult to establish clear associations. Drinking water contaminants like nitrates (NO3) and nitrites (NO2), which are by-products of inorganic fertilizer and preservatives used in processed food, have been associated with thyroid disease and an increased risk of gastric, colorectal, breast and bladder cancer.9, 10 There is also mounting evidence that transgenerational inheritance - through epigenetic mechanisms – link prenatal environmental exposures to later life risks, including chronic diseases, cancer and infertility. In the present theme issue, we have gathered the expertise of researchers on the negative impact of the Anthropocene era on women's health. The profound effects associated with climate change and pollution threaten all ecosystems and thus human health and survival (Figure 1). Of course, this works both ways: energy use, waste generation, and CO2 production of modern health care have effects on the environment, too. These insights highlight the urgency of developing comprehensive national and international research programs focused on women's and reproductive health and the environment, and the difference we could make ourselves. All authors contributed to the conception and writing up of this editorial. We are grateful to all the authors and reviewers who have contributed to the BJOG Themed Issue: Women's and Reproductive Health and the Environment. None. None declared. Completed disclosure of interest forms are available to view online as supporting information. None. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.