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Billions of people living in poverty are at risk of environmentally mediated infectious diseases-that is, pathogens with environmental reservoirs that affect disease persistence and control and where environmental control of pathogens can reduce human risk. The complex ecology of these diseases creates a global health problem not easily solved with medical treatment alone.We quantified the current global disease burden caused by environmentally mediated infectious diseases and used a structural equation model to explore environmental and socioeconomic factors associated with the human burden of environmentally mediated pathogens across all countries.We found that around 80% (455 of 560) of WHO-tracked pathogen species known to infect humans are environmentally mediated, causing about 40% (129 488 of 359 341 disability-adjusted life years) of contemporary infectious disease burden (global loss of 130 million years of healthy life annually). The majority of this environmentally mediated disease burden occurs in tropical countries, and the poorest countries carry the highest burdens across all latitudes. We found weak associations between disease burden and biodiversity or agricultural land use at the global scale. In contrast, the proportion of people with rural poor livelihoods in a country was a strong proximate indicator of environmentally mediated infectious disease burden. Political stability and wealth were associated with improved sanitation, better health care, and lower proportions of rural poverty, indirectly resulting in lower burdens of environmentally mediated infections. Rarely, environmentally mediated pathogens can evolve into global pandemics (eg, HIV, COVID-19) affecting even the wealthiest communities.The high and uneven burden of environmentally mediated infections highlights the need for innovative social and ecological interventions to complement biomedical advances in the pursuit of global health and sustainability goals.Billamp; Melinda Gates Foundation, National Institutes of Health, National Science Foundation, Alfred P. Sloan Foundation, National Institute for Mathematical and Biological Synthesis, Stanford University, and the US Defense Advanced Research Projects Agency.

International audience; As sustainable development practitioners have worked to "ensure healthy lives and promote well-being for all" and "conserve life on land and below water", what progress has been made with win-win interventions that reduce human infectious disease burdens while advancing conservation goals? Using a systematic literature review, we identified 46 proposed solutions, which we then investigated individually using targeted literature reviews. The proposed solutions addressed diverse conservation threats and human infectious diseases, and thus, the proposed interventions varied in scale, costs, and impacts. Some potential solutions had medium-quality to high-quality evidence for previous success in achieving proposed impacts in one or both sectors. However, there were notable evidence gaps within and among solutions, highlighting opportunities for further research and adaptive implementation. Stakeholders seeking win-win interventions can explore this Review and an online database to find and tailor a relevant solution or brainstorm new solutions.

The transmission of vector-borne diseases is sensitive to environmental conditions, including temperature, humidity, rainfall, and land use/habitat quality. Understanding these causal relationships is especially important as increasing anthropogenic changes drive shifts in vector-borne disease dynamics. In this chapter, we first briefly describe the biology of vectors and pathogens that underlies environmental influences on transmission of vector-borne diseases. Next, we review the impacts of each of the major environmental drivers (as previously mentioned), synthesizing and comparing mechanisms across different vector-borne disease systems. Then, we discuss key challenges and standard approaches to research in the discipline. Finally, we highlight areas where research is advancing in promising new directions and suggest areas where new approaches are needed.

The original paper was published without unique DOIs for GBIF occurrence downloads. These have now been inserted as references 70-76, and the error has been corrected in the PDF and HTML versions of the article.

Background: Every day, billions of people - especially those living in poverty - are exposed to infectious pathogens in the environment and are at risk of contracting 'environmentally mediated' infections: those with environmental reservoirs that affect disease persistence and control. The complex ecology of environmental pathogens creates a global health problem not easily solved with medical treatment alone. Methods: Here, we quantified the global disease burden caused by environmentally mediated infections and used a structural equation modeling approach to explore correlated factors at the global scale. Findings: We found that 80% of pathogen species known to infect humans are environmentally mediated, causing about 40% of today's burden of infectious disease (global loss of 130 million years of healthy life annually). More than 91% of environmentally mediated burden occurs in tropical countries, and the poorest countries carry the highest burdens across all latitudes. We found weak or absent effects of biodiversity or agricultural land use at the global scale. In contrast, the strongest proximate indicator of environmentally mediated infectious disease burden is rural poor livelihoods. Political stability and wealth are associated with improved sanitation, better health care, and lower proportions of rural poor people, indirectly resulting in lower burdens of environmentally mediated infections. Interpretation: The high and uneven burden of environmentally mediated infections highlights the need for innovative social and ecological interventions to complement biomedical advances in the pursuit of global health and sustainability goals. Funding Statement: SHS, IJJ, and GADL received support from the Stanford Institute for Innovation in Developing Economies Global Development and Poverty Initiative. SHS and GADL also received support from the Bill & Melinda Gates Foundation (OPP1114050), National Institutes of Health (NIH) grant #1R01TW010286, National Science Foundation Coupled Natural and Human Systems grant #1414102, and the National Institute for Mathematical and Biological Synthesis through the Working Group "Optimal Control of Neglected Tropical Diseases.” IJJ was also funded by National Science Foundation Graduate Research Fellowship #1656518. SHS, SRH, CLW, KDL, MBonds, and GADL were supported by a grant from the National Center for Ecological Analysis and Synthesis through the Science for Nature and People Partnership program. AJL was supported by the Davis Family E-IPER Fellowship at Stanford and the Stanford Interdisciplinary Graduate Fellowship from the Stanford Vice Provost for Graduate Education. NN was supported by the Stanford Bing Fellowship in Honor of Paul Ehrlich. CLW was supported by a Sloan Research Fellowship from the Alfred P. Sloan Foundation and by the Michigan Society of Fellows at the University of Michigan. AJP was supported by a Queensland Government Accelerate Postdoctoral Research Fellowship and the DARPA PREEMPT program Cooperative Agreement # D18AC00031. Declaration of Interests: The authors declare no competing interests.

A foundational paradigm in biological and Earth sciences is that our planet is divided into distinct ecoregions and biomes demarking unique assemblages of species. This notion has profoundly influenced scientific research and environmental policy. Given recent advances in technology and data availability, however, we are now poised to ask whether ecoregions meaningfully delimit biological communities. Using over 200 million observations of plants, animals and fungi we show compelling evidence that ecoregions delineate terrestrial biodiversity patterns. We achieve this by testing two competing hypotheses: the sharp-transition hypothesis, positing that ecoregion borders divide differentiated biotic communities; and the gradual-transition hypothesis, proposing instead that species turnover is continuous and largely independent of ecoregion borders. We find strong support for the sharp-transition hypothesis across all taxa, although adherence to ecoregion boundaries varies across taxa. Although plant and vertebrate species are tightly linked to sharp ecoregion boundaries, arthropods and fungi show weaker affiliations to this set of ecoregion borders. Our results highlight the essential value of ecological data for setting conservation priorities and reinforce the importance of protecting habitats across as many ecoregions as possible. Specifically, we conclude that ecoregion-based conservation planning can guide investments that simultaneously protect species-, community- and ecosystem-level biodiversity, key for securing Earth’s life support systems into the future.