Healthy Ecosystems as Public-Health Infrastructure: A Framework for Integrating Ecosystem Services into Public Health

Study in one sentence

This study proposes a conceptual framework that positions healthy ecosystems as a form of public health infrastructure, systematically linking ecosystem services to health outcomes and advocating for their integration into public health policy and planning.

Publication and date

The paper was published in the peer-reviewed journal Ecosystem Services in 2018. The authors are Wood, S.L.R., Jones, S.K., Johnson, J.A., Brauman, K.A., Chaplin-Kramer, R., Fremier, A., Girvetz, E., Gordon, L.J., Kappel, C.V., Mandle, L., Mulligan, M., O’Farrell, P., Smith, W.K., Willemen, L., Zhang, W., and DeClerck, F.A.

Research question

The study set out to answer: How can ecosystem services be systematically integrated into public health frameworks, and what are the pathways through which healthy ecosystems function as public health infrastructure?

Method

This is a conceptual framework paper. The authors conducted a synthesis of existing literature on ecosystem services and public health, drawing on the Millennium Ecosystem Assessment classification and the World Health Organization’s definition of health. They developed a logic model that maps ecosystem services (provisioning, regulating, cultural, and supporting) to health determinants and health outcomes. The framework was refined through expert consultation and iterative discussion among the interdisciplinary author team, which included ecologists, public health researchers, and policy experts. No primary data collection or quantitative analysis was performed.

Main findings

The paper presents a framework that categorizes the contributions of healthy ecosystems to public health into four main pathways:

• Provisioning services – supply of food, fresh water, and medicinal resources, which directly affect nutrition and physical health.
• Regulating services – control of infectious diseases, air quality regulation, water purification, and climate regulation, which reduce exposure to harmful agents and mitigate health risks.
• Cultural services – recreational opportunities, spiritual enrichment, and aesthetic benefits that support mental and social well-being.
• Supporting services – soil formation, nutrient cycling, and primary production that underpin all other services and long-term health resilience.

The framework emphasizes that these services collectively function as a form of infrastructure, analogous to built infrastructure like hospitals and water treatment plants, but often unrecognized in public health budgets and planning. The authors argue that maintaining and restoring ecosystems can be a cost-effective public health investment.

What the findings do not prove

This study does not provide empirical evidence of specific health improvements from ecosystem interventions, nor does it quantify the magnitude of health benefits. It does not establish causal relationships between particular ecosystem changes and health outcomes. The framework is a conceptual tool and does not prove that treating ecosystems as infrastructure will lead to better health outcomes in all contexts. It also does not address the economic valuation of health benefits or compare the cost-effectiveness of ecosystem-based approaches to traditional public health interventions.

Limitations

As a conceptual paper, the study does not include empirical validation or case studies. The framework is broad and may oversimplify complex ecological and social interactions. The pathways from ecosystem services to health outcomes are often indirect and influenced by many confounding factors (e.g., socioeconomic status, access to healthcare), which the framework acknowledges but does not fully model. The paper is based on existing literature and expert opinion, which may introduce bias. The framework’s applicability may vary across different geographic and cultural contexts, and it does not provide specific implementation guidelines.

How it compares with previous research

The study builds on earlier work linking ecosystems and human health, such as the Millennium Ecosystem Assessment (2005) and the World Health Organization’s reports on environmental health. It extends the concept of “ecological public health” by explicitly framing ecosystems as infrastructure, a term more familiar to policy-makers and planners. Unlike many previous studies that focus on single ecosystem services or health outcomes, this framework provides a comprehensive, multi-pathway model. It aligns with the growing literature on nature-based solutions and planetary health but is distinct in its emphasis on integrating ecosystem services into public health systems rather than treating them as separate environmental interventions.

Why it matters

This framework offers a practical tool for public health officials, urban planners, and conservationists to recognize and incorporate the health benefits of ecosystems into policy and investment decisions. By framing ecosystems as infrastructure, it encourages cross-sectoral collaboration and funding mechanisms that have traditionally been siloed. The study highlights that protecting and restoring ecosystems can be a proactive public health strategy, potentially reducing disease burdens and healthcare costs while also addressing environmental degradation. It provides a foundation for future empirical research and for integrating ecosystem health indicators into public health surveillance systems.

Link to the primary paper

Wood, S. L. R., Jones, S. K., Johnson, J. A., Brauman, K. A., Chaplin-Kramer, R., Fremier, A., Girvetz, E., Gordon, L. J., Kappel, C. V., Mandle, L., Mulligan, M., O’Farrell, P., Smith, W. K., Willemen, L., Zhang, W., & DeClerck, F. A. (2018). Healthy ecosystems as public health infrastructure: A framework for integrating ecosystem services into public health. Ecosystem Services, 29, 70-82. https://doi.org/10.1016/j.ecoser.2017.12.003