Reply to De Coster et al.: Exploring the complexity of ecosystem–human health relationships

We agree with De Coster et al. (1) that researchers should assess both positive and negative impacts of changes in the structure, composition, and function of natural systems on human health. In fact, one of the key points of our report (2) is that ecosystem changes can lead to either positive or negative health consequences, or even both at the same time along different dimensions of human health. For example, the loss of a wetland may diminish water-filtration or wave-attenuation services, increasing risk of water-borne disease or flooding, yet simultaneously reduce habitat for Anopheline mosquitoes and associated risk of malaria. In other cases, positive health impacts may be experienced by one population while negative impacts are experienced disproportionately by a different group or by future generations. This mix of positive and negative impacts is why our paper emphasizes that “a particular ecosystem alteration may provide health benefits for one segment of a population while incurring health costs for another” (2). Relationships of human health to ecosystem change are complex, reinforcing the importance of considering whose health is in question, as well as the multiple dimensions of health and the possible trade-offs between both positive and negative impacts.