Species Extinction,Biodiversity,Human Health,and Inevitable Role of Lifestyle Medicine: A Narrative Review

The Dilution Effect and Disease Ecology

According to the Convention on Biological Diversity (2005), ¹⁸ biodiversity is defined as:

the variability among living organisms from all sources including, inter alia, terrestrial, marine and other aquatic ecosystems and the ecological complexes of which they are part; this includes diversity within species, between species and of ecosystems. ¹⁸

A central pathway linking biodiversity loss and human health is the alteration of infectious disease dynamics. More than 60% of emerging infectious diseases are zoonotic in origin, and over 70% of these originate in wildlife.^5,6,19 Traditional narratives viewed high-biodiversity regions as dangerous pathogen reservoirs. However, accumulating evidence from ecology and epidemiology reveals a more nuanced picture: in many systems, biodiversity appears protective, reducing disease risk through the ‘dilution effect’. ⁵

The dilution effect posits that higher species richness can reduce pathogen transmission by ‘diluting’ encounters between pathogens and highly competent reservoir hosts, increasing the proportion of hosts that are poor at transmitting infection. ⁵ Empirical studies across Lyme disease, West Nile virus, hantavirus, and other systems suggest that when ecosystems lose species, generalist, fast-living species with high reproduction and rapid turnover tend to persist; these species, including certain rodents and passerine birds, are often the most competent reservoirs for zoonotic pathogens. Conversely, larger-bodied, slower-breeding species that may serve as poor hosts disappear first under hunting pressure, habitat loss, and fragmentation.^5,19-24

Several mechanistic pathways underpin this effect. First, species differ in their host competence ability to maintain and transmit a pathogen and in their contact rates with vectors and humans. Second, diverse communities often include predators and competitors that reduce densities of competent hosts and vectors. Third, intact ecosystems maintain balanced predator-prey and host-parasite dynamics, whereas defaunation, fragmentation, and climate change can destabilize these relationships, leading to unexpected amplifications of disease.^5,25,26

A 2020 synthesis concluded that biodiversity loss underlies the dilution effect in many, though not all, disease systems, with the strongest evidence where host competence is highly skewed among species and where human disturbance preferentially removes low-competence hosts. Importantly, the dilution effect is not universal; in some systems, increased diversity may introduce more competent hosts (an amplification effect). Nevertheless, the preponderance of evidence suggests that rapid biodiversity loss, combined with expanding human encroachment into wildlife habitats, has increased the risk of zoonotic spillover and epidemic emergence.^{5,19,20,22,27-32}

Deforestation, Fragmentation, and Spillover Interfaces

Land-use change and deforestation are consistently identified as dominant drivers of disease emergence. Tropical forests hotspots of biodiversity and carbon storage are converted to croplands, pasture, and settlements, creating fragmented landscapes characterized by forest edges, roads, and human settlements that bring people, livestock, vectors, and wildlife into closer contact.^5,28,31

A seminal study of Mycobacterium Ulcerans, the causative agent of Buruli ulcer, in West Africa illustrates the complex effects of partial ecosystem disruption.^30,33 Moderate levels of deforestation and land-use change produced maximal pathogen abundance because food webs collapsed in ways that removed predators but retained generalist hosts and vectors. This non-linear relationship implies that transition zones not pristine nor fully urbanized landscapes may pose the greatest spillover risk^5,30,33,

Similar patterns have been observed in forest-fragmented landscapes in Africa, where clearing for agriculture and logging has been linked to Ebola outbreaks and other haemorrhagic fevers. Bats, primates, and rodents adapt to fragmented habitats and often forage in agroforestry systems, increasing human exposure through hunting, consumption, and contamination of food or water.^30,33 Habitat fragmentation also concentrates wildlife into smaller areas, increasing intra-species and inter-species pathogen transmission and facilitating viral adaptation to novel hosts.^5,34,35

Land reversion and restoration also carry risk if not carefully managed. Recent analysis suggests that poorly planned reforestation that increases edge habitat or introduces high-risk species could theoretically increase spillover in some contexts, underscoring the need for One Health-informed restoration. Collectively, these findings emphasize that species extinction and ecosystem simplification are intertwined with the spatial reconfiguration of habitats, which in turn shapes disease risk landscapes.^1,34,35

Agricultural Intensification, Animal Agriculture, and AMR

Industrial animal agriculture exemplifies the convergence of biodiversity loss, zoonotic risk, and antimicrobial resistance (AMR). Expansion of livestock production drives deforestation, grassland conversion, and waterway pollution, contributing substantially to biodiversity decline.^2,11,36, High-density confinement systems create crowded, stressful conditions that favour pathogen transmission and necessitate prophylactic and metaphylactic use of antimicrobials. This practice accelerates the evolution and dissemination of resistant organisms.^2,37-40

Low- and middle-income countries (LMICs), where regulatory systems may be weaker and antibiotics more readily available without prescription, face particular challenges in managing AMR from animal agriculture, though high-income countries contribute significantly to the overall burden.^37-39 Resistant organisms and genes move between animals, humans, and the environment through direct contact, food consumption, manure application, water contamination, and wildlife movement. Wildlife including migratory birds and bats can act as flying bridges, transporting resistant bacteria across continents.^37-41

AMR complicates the treatment of both human and animal infections, undermining the efficacy of modern medicine and increasing morbidity, mortality, and health care costs. A Lancet commissioned study calculated that 4.95 million deaths could be attributed to AMR in 2019. ³⁹

As biodiversity declines and habitats are converted to monocultures and intensive livestock operations, ecological checks and balances on pathogen dynamics are eroded, and selective pressures for resistance intensify. Lifestyle medicine’s promotion of dietary shifts away from industrial animal products, therefore, has implications not only for cardiometabolic health and greenhouse gas emissions but also for AMR and biodiversity conservation.^2,11,37-39

Pollination, Food Security, and Nutrition

Pollinators, bees, butterflies, birds, bats, and other animals, play a critical role in the reproduction of three-quarters of global food crops, particularly fruits, vegetables, nuts, and seeds that supply essential vitamins, minerals, and phytonutrients. ⁴² Agricultural intensification, pesticide use, habitat loss, parasite spread, and climate change have collectively contributed to alarming declines in pollinator abundance and diversity.^42-44

The Lancet commissioned modelling found that pollinator deficits, food consumption, and health outcomes, estimated that insufficient pollination currently reduces global production of fruits, vegetables, and nuts by 3-5%, translating into approximately 427,000 excess deaths annually from heart disease, stroke, diabetes, and certain cancers due to reduced intake of these protective foods. ⁴⁵ Mortality impacts are particularly pronounced in middle and high-income countries with higher NCD burdens and diets already low in fruits and vegetables, while low-income countries experience disproportionate agricultural production and income losses that threaten food security. ⁴⁵

Beyond macronutrient supply, pollinator decline jeopardizes micronutrient security. Many pollinator-dependent crops are key sources of vitamin A, folate, calcium, and other micronutrients critical for immune function, growth, and development. ⁴⁶ Modelling has revealed that a 50% loss of pollinators would be associated with 700,000 additional annual deaths and 13.2 million DALYs. ⁴⁶ The Lancet Planetary Health Commission ⁴⁷ has emphasized that healthy diets rich in fruits, vegetables, legumes, and nuts depend on intact pollination systems, making biodiversity conservation a prerequisite for sustainable nutrition. ⁴⁷

Lifestyle medicine’s emphasis on whole-food, plant-predominant diets hinges on sustained access to diverse plant foods. Without pollinators and functional agroecosystems, dietary recommendations become aspirational rather than attainable, particularly for vulnerable populations facing the global syndemic (a synergy of epidemics) of over and under nutrition.^48,49

The global syndemic conceptual framework brings together three health-related challenges that traditionally have been addressed separately: obesity (including high BMI and associated diet-related non-communicable diseases); undernutrition (including stunting, wasting, underweight, and micronutrient deficiencies) and climate change (due to its sweeping effects on human and planetary health). These three pandemics exacerbate one another and stem from the same fundamental causes, primarily within the food and transport systems and overconsumption.^48,49

The drivers for the syndemic include upstream determinants that are part of the Lifestyle Medicine discourse and they include:

- Powerful commercial interests of multinational food corporations (often called ‘Big Food’ and ‘Big Soda’) that promote ultra-processed foods.

Lifestyle medicine has a responsibility to advocate for both upstream and drivers to transform food systems and at the clinical and community interface to educate, counsel and change behaviours that will contribute to health of the individual and the planet.

Medicinal Biodiversity and Pharmaceutical Discovery

Biodiversity provides the molecular library that underpins much of modern pharmacology. Estimates suggest that 50-80% of modern drugs are derived from or inspired by natural products, with 74% of plant-derived drugs discovered through investigations of species used in traditional medicine. Classic examples include paclitaxel from Pacific yew trees for cancer treatment, artemisinin from Artemisia annua for malaria, and ACE inhibitors derived from Brazilian pit viper venom.^50,51

As habitats are cleared and species disappear, the opportunities for discovering novel bioactive compounds diminish irreversibly. ⁵² Many tropical species have never been taxonomically described, let alone screened for pharmacological potential. Extinction thus closes off entire evolutionary lineages and biochemical pathways before their potential benefits can be explored.^50,52,53

Beyond drug discovery, medicinal biodiversity supports local and Indigenous health systems. An estimated 80% of the global population relies at least partly on traditional medicine, often based on wild or cultivated plants and fungi. ⁵³ Overharvesting, habitat loss, and climate change threaten these resources, with disproportionate impacts on communities that contribute least to global environmental degradation. Opportunities exist to align conservation with ethical and equitable benefit sharing, recognizing Indigenous knowledge holders as co-stewards and co-innovators.^53-57

From a lifestyle medicine perspective, the erosion of medicinal biodiversity carries two implications. First, it reduces the future storehouse available to treat diseases that lifestyle interventions cannot fully prevent or reverse (e.g. certain cancers, complex infections). Second, it destabilizes traditional health systems and cultural practices that can complement lifestyle medicine, particularly when integrated respectfully in Indigenous and local contexts.

Climate Regulation, Carbon Sequestration, and Extreme Events

Biodiverse ecosystems, especially intact forests, wetlands, mangroves, seagrass meadows, and peatlands serve as critical carbon sinks, absorbing and storing large amounts of atmospheric CO₂. Forests alone sequester an estimated 2.6 billion tonnes of CO₂ annually, moderating climate change and buffering communities against extreme weather. ⁵⁸ The loss of these ecosystems both reduces sequestration capacity and releases stored carbon through burning or decay, creating powerful positive feedback loops that accelerate global warming.^2,3,58-60

A detailed analysis of forests in the western United States identified irrecoverable carbon, carbon that, if lost, could not be recovered by mid-century that is disproportionately stored in older, biodiverse forests with high structural complexity and intact ecological processes. ⁵⁹ Protecting these forests could sequester 1485 Tt (Tera tonne = 10¹⁸ grams) of carbon by 2099, equivalent to several years of regional fossil fuel emissions, while simultaneously preserving habitat for numerous threatened and endangered species. Similar co-benefits have been demonstrated for forest-based climate mitigation projects globally, where well-designed interventions deliver health benefits via reduced air pollution, improved livelihoods, and enhanced ecosystem services.^59,60

Climate change itself has cascading health impacts, including heat-related illness, vector-borne and water-borne disease expansion, food and water insecurity, mental health complications, and displacement.^61,62 As temperatures rise and extreme events increase in frequency and intensity, health systems are strained, and lifestyle interventions become harder to implement, for example, outdoor physical activity becomes unsafe during heatwaves or wildfire smoke events.

Species extinction and ecosystem degradation thus operate both upstream and downstream of climate change, reinforcing the need to address biodiversity, climate, and health together rather than as isolated domains. Lifestyle medicine can align its clinical goals with climate and biodiversity objectives by continuing to promote high-impact behaviours such as plant-predominant diets, active transport, and reduced overconsumption.

Environmental Microbiomes, the Human Microbiome, and Immune Regulation

Emerging research indicates that biodiversity loss extends into the microscopic realm, with consequences for immune development and chronic disease. The ‘Old Friends’ or ‘biodiversity’ hypothesis proposes that reduced exposure to diverse environmental microbes through urban living, reduced contact with soil and animals, and highly sanitized environments disrupts human microbiome development and contributes to immune dysregulation, allergic disease, and inflammatory conditions. ⁶³

Comparative studies between urban and rural children, and between those exposed to natural environments vs more sterile settings, have shown that greater environmental biodiversity correlates with more diverse and functionally robust skin and gut microbiomes, more favourable cytokine profiles, and lower prevalence of atopic disease. ⁶⁴ A notable intervention study that increased biodiversity in daycare yards by adding forest floor, sod, and planters found that children exposed to these enriched environments developed more diverse skin and gut microbiota, increased regulatory

T-cells, and higher levels of anti-inflammatory cytokines within 1 month compared with controls. ⁶⁵

Environmental microbiome diversity and stability also appear to confer resilience to pathogenic invasion. Degraded ecosystems, including intensively managed urban green spaces or monoculture agricultural systems, harbour less diverse microbial communities that may be less capable of buffering against pathogen establishment and spread.^65,66

Lifestyle medicine, particularly in its preventive orientation during pregnancy, infancy, and early childhood, can incorporate environmental microbiome considerations by encouraging nature play, contact with soil and non-urban green spaces, reduced overuse of broad-spectrum antibiotics, and consumption of fibre-rich, minimally processed foods that nourish a diverse gut microbiota.

Mental Health, Eco-Anxiety, and Nature Deficit

Mental health represents another critical domain where species extinction and environmental degradation exert growing influence. Environmental decline climate change, deforestation, biodiversity loss, pollution has been associated with increased anxiety, depression, trauma. ⁶⁷ Complex emotions specifically linked to environmental decline are emerging as new areas for concern such as ecological grief and solastalgia.^68-70

Conversely, contact with natural environments, particularly biodiverse green and blue spaces, is associated with lower stress, better mood, improved cognitive function, and reduced incidence of depression and anxiety.^67,69 Neighbourhood green space has been linked with healthier diurnal cortisol patterns and reduced perceived stress, especially in socioeconomically deprived communities. ⁷¹ A scoping review of greenspace interventions found consistent reductions in cortisol, perceived stress, and negative affect, with some evidence of improved cardiovascular and metabolic markers.^71-77

The emerging practice of nature prescribing in which clinicians formally recommend time in natural environments as part of treatment plans leverages these benefits.^78,79 Green Social Prescribing programs in the United Kingdom and elsewhere connect patients to guided nature walks, community gardening, conservation volunteering, and outdoor group activities, reporting improvements in mental health, social connectedness, and physical activity. These programs highlight how biodiversity and ecosystem access function as therapeutic infrastructure. Environmental changes that eliminate or degrade natural spaces such as urban sprawl, deforestation, and species extinction, therefore, remove not only ecosystem services but also critical mental health resources.

For Indigenous peoples, whose cultural identity, spirituality, and knowledge systems are deeply entwined with specific species and landscapes, biodiversity loss can be experienced as cultural and spiritual injury, compounding the mental health burden of colonization and dispossession.^1,53,56,57

Lifestyle medicine’s stress management and social connection pillars can explicitly incorporate nature-based practices, eco-therapeutic approaches, and community green initiatives, acknowledging that mental health is co-produced by social and ecological environments ⁸⁰

Whole-Food, Plant-Predominant Nutrition as an Ecological Intervention

The global food system is the single largest driver of biodiversity loss, responsible for roughly 70-85% of terrestrial biodiversity threats through land-use change, pesticide use, water extraction, and nutrient pollution. Ruminant livestock and animal feed production account for a disproportionate share of agricultural land, greenhouse gas emissions, and habitat conversion.^{7,11,45,46,48}

The EAT-Lancet Commission’s planetary health diet outlines a dietary pattern that can sustain 10 billion people within planetary boundaries while reducing diet-related NCDs. ⁷ This pattern emphasizes whole grains, legumes, fruits, vegetables, nuts, and unsaturated oils; includes modest amounts of dairy, poultry, and fish; and minimizes red meat, processed meat, and added sugars. Modelling suggests that widespread adoption could prevent 11-15 million deaths annually and reduce diet-related greenhouse gas emissions by up to 70% by 2050, while freeing large areas of land for conservation and restoration.^7,11

Estimates indicate that transitioning from a typical Western diet to a vegan diet could reduce global agricultural land use by up to 75%, largely by eliminating pasture and reducing cropland devoted to animal feed.^7,11 In addition, it has been shown that GHG emissions in meat-eaters are approximately twice as high as those in vegans. It is likely that reductions in meat consumption would lead to reductions in dietary GHG emissions as well. ⁸¹

Even partial shifts such as reducing red meat consumption by 50%, yield substantial reductions in land use, water use, and emissions.^11,31,81,82 These reductions directly translate into lower pressure on forests, grasslands, and freshwater systems, creating space for biodiversity recovery.^7,11,82

Lifestyle medicine practitioners routinely counsel patients on plant-predominant diets to prevent and manage NCDs. Integrating biodiversity and climate considerations into these consultations can strengthen motivation by highlighting health co-benefits and ethical dimensions. For example, framing a transition to a plant-predominant diet to treat both coronary artery disease and planetary degradation could resonate with patients' values, particularly when accompanied by specific, culturally appropriate strategies.^14,15,80

At the same time, clinicians must be attentive to equity and the syndemic of malnutrition, in which undernutrition, micronutrient deficiencies, and obesity coexist in the same populations or individuals. ⁴⁸

Recommendations should be adapted to local contexts, considering affordability, accessibility, cultural foodways, and Indigenous food sovereignty. Collaboration and co-design with public health and policy actors is necessary to align dietary guidance with structural reforms in agricultural subsidies, food environments, and marketing regulations.^7,10,11,48

Physical Activity, Active Transport, and Urban Design

Physical inactivity is a leading risk factor for cardiovascular disease, diabetes, certain cancers, and premature mortality. ⁸³ Simultaneously, transport is a major contributor to greenhouse gas emissions and urban air pollution, with road traffic also degrading biodiversity through habitat fragmentation, roadkill, and noise pollution.^1,8,10,18

Lifestyle medicine encourages regular moderate-to-vigorous physical activity, which can be synergistically achieved through active transport, walking, cycling, wheelchair use, and public transport. ⁸ WHO Europe highlights that increasing active mobility not only reduces physical inactivity but also lowers air pollution, noise, greenhouse gas emissions, and traffic injury risk. A shift toward active transport has been described as a no-regrets strategy because it delivers benefits under virtually all plausible futures.^83,84

Sustainable physical activity programs that promote walking and cycling, particularly when integrated into daily routines (e.g. commuting, school travel), have been shown to reduce carbon footprints per participant while improving cardiometabolic health. ⁸³ However, the feasibility of outdoor activity is threatened by extreme heat, wildfires, and poor air quality, ⁸⁵ especially in disadvantaged neighbourhoods with limited tree cover and green infrastructure. ⁸⁶

Lifestyle medicine must therefore move beyond individual-level exercise prescriptions to advocate for urban designs that create safe, accessible, biodiverse environments for physical activity. This includes protected bike lanes, walkable neighbourhoods, green corridors, and urban tree canopies that reduce urban heat islands and provide habitat as suggested by WHO guidelines. ⁸³ Such environments support both human and non-human species, aligning physical activity promotion with habitat connectivity and biodiversity goals.^77,84

Stress Management, Nature Exposure, and Microbiome-Supporting Practices

Stress management is a core pillar of lifestyle medicine, with chronic stress recognized as a driver of cardiometabolic disease, mental health disorders, and immune dysfunction.^87,88 Nature-based interventions including forest bathing, green exercise, gardening, and conservation volunteering offer evidence-based tools for stress reduction, with additional benefits for microbiome diversity, physical activity, and social connection.^{71-74,78-80,84}

The concept of ‘nature as medicine’ has been advanced as a potential seventh pillar of lifestyle medicine. ⁸⁰ Mechanisms for its benefits include modulation of the hypothalamic–pituitary–adrenal axis and cortisol patterns, increases in parasympathetic activity, exposure to phytoncides and other bioactive plant compounds, enhancement of gut and skin microbiome diversity, and provision of restorative environments that reduce cognitive load.^71,74,75,80

Practically, clinicians can prescribe specific doses of nature exposure (e.g. 120 minutes per week, with at least 20-30 minutes per session) in parks, forests, waterways, or community gardens. These prescriptions can be embedded within management plans for hypertension, depression, anxiety, pain, and sleep disorders, among others. Collaboration with local governments, parks agencies, and community organizations can facilitate structured programs and reduce barriers, particularly for people in nature-poor environments. From a biodiversity perspective, the evidence suggests that nature prescriptions are most effective when they involve biodiverse environments rather than low-diversity lawns or heavily manicured spaces.

This reinforces the need for urban biodiversity planning and conservation of peri-urban and rural natural areas. It also underscores that environmental degradation is a direct threat to an emerging category of low-cost, high-impact non-pharmacological therapies.^77,86

Sleep, Environmental Quality, and Circadian Health

Sleep health is a pillar of lifestyle medicine, with inadequate sleep linked to obesity, diabetes, cardiovascular disease, and mental health disorders.^87,89 Environmental conditions, including air pollution, noise, light pollution, and ambient temperature, profoundly affect sleep onset, duration, and quality.

Sleep disturbance serves as a potent activator of systemic inflammation, with substantial implications for chronic disease pathogenesis. A landmark systematic review and meta-analysis examining nearly 35,000 participants for C-reactive protein (CRP) and over 3000 participants for interleukin-6 (IL-6) demonstrated consistent associations between sleep disturbance and elevated inflammatory biomarkers. ⁹⁰ Sleep disturbance was associated with higher CRP levels (effect size 0.12, 95% CI 0.05-0.19) and elevated IL-6 across diverse populations. Importantly, both short sleep duration (typically <6 hours) and long sleep duration (typically >9 hours) exhibited associations with inflammation markers. ⁹⁰

Systematic reviews indicate that chronic exposure to fine particulate matter (PM^2.5), NO₂, and O₃ is associated with shorter sleep duration, reduced sleep efficiency, sleep-disordered breathing, and increased insomnia symptoms.^91-93 Mechanisms may involve airway inflammation and obstruction, central nervous system effects, altered melatonin secretion, and cardiovascular strain. Heatwaves further disrupt sleep, especially in urban areas with limited vegetation.^91-93

As noted previously, biodiverse green spaces mitigate some of these stressors by filtering air pollutants, reducing noise, moderating urban temperatures, and providing darker nighttime environments. Therefore, environmental restoration and biodiversity-friendly urban design support sleep health, while lifestyle medicine can incorporate environmental assessments into sleep counselling, including discussions on air quality, bedroom environment, and timing of outdoor activity.

Social Connection, Community Resilience, and Environmental Stewardship

Social connection is another pillar of lifestyle medicine as it is a significant determinant of health. Social connection can also be a facilitator of collective environmental action. Communities with strong social capital-dense networks, trust, shared norms, are more resilient to climate-related and ecological shocks, including floods, heatwaves, wildfires, and pandemics. Socially cohesive communities have been shown to better coordinate emergency responses, distribute resources, and advocate for protective policies.^94-98

Lifestyle medicine increasingly recognizes loneliness and social isolation as risk factors comparable to traditional cardiometabolic risk factors.^99,100 Loneliness and social stress have been shown to be associated with activation of the hypothalamic-pituitary-adrenocortical axis and the sympathetic nervous system. There is evidence to suggest that chronic social stress leads to glucocorticoid resistance, enhanced myelopoiesis, upregulated proinflammatory gene expression, and oxidative stress. ⁹⁹ The mechanisms in the development of loneliness-associated CVD remains unclear.

Interventions such as group-based programs, shared medical appointments, and community-based lifestyle interventions not only improve health behaviours but also build social networks.^79,101

When these interventions are nature-based, for example, group walks in parks, community gardening, or conservation volunteering, they simultaneously promote environmental stewardship and biodiversity awareness.^79,94,96,97

Green social prescribing schemes in the UK and elsewhere demonstrate that connecting individuals with nature-based group activities can reduce loneliness, improve mental health, increase physical activity, and strengthen community resilience.^102,103 These programs align naturally with lifestyle medicine's social connection pillar and represent a model for integrating healthcare, public health, and environmental agencies in a One Health framework.

Avoidance of Risky Substances and Environmental Toxins

Lifestyle medicine’s avoidance pillar traditionally focuses on tobacco, alcohol, and other addictive substances, as well as ultra-processed foods. Expanding this pillar to encompass environmental toxins including pesticides, endocrine-disrupting chemicals, heavy metals, and air pollutants, reflects a broader understanding of risky substances that undermine both human and ecological health.^1,10,47

Environmental toxins can elicit oxidative stress, a condition characterized by an imbalance between the production of reactive oxygen species (ROS) and the body’s ability to detoxify and repair the resulting damage. Oxidative stress triggers a cascade of events, including inflammation, endothelial dysfunction, lipid peroxidation, and vascular remodelling, which can contribute to the development of atherosclerosis, hypertension, and other cardiovascular and related pathologies for example.^104,105

As previously reported above, pesticide use reduces biodiversity including pollinators, soil biota, and aquatic life, and has also been associated with increased risks of cancer, neurological disease, developmental disorders, and endocrine disruption in humans. Air pollutants contribute to NCDs while also harming vegetation and wildlife. Lifestyle medicine practitioners can collaborate with patients about reducing personal exposure (e.g. smoking cessation, indoor air quality, avoiding some household chemicals) while advocating for upstream regulatory and policy changes that protect both people and ecosystems.