We are seemingly locked into a downward spiral of ecological degradation, biodiversity loss, and a climate emergency. Ecological restoration aims to improve the ecological trajectory of degraded ecosystems. Ecosystem declines threaten human health (Romanelli et al. 2015, Whitmee et al. 2015). Dramatic changes in human behavior and government policy are essential, but will only occur through a profound paradigm shift explicitly linking human and ecological health. We outline the case for ecological restoration as a ‘public health intervention’, and provide an action plan that enables the required paradigm shift.

Health systems, world-wide, are struggling to cope with the burgeoning global burden of disease. There is a growing awareness of the environmental determinants or co-determinants of many diseases (Bhatnagar 2017, Burbank et al. 2017, Prüss-Ustün et al. 2017), including allergies, immune dysfunction, infectious diseases and emerging zoonoses, and mental health disorders (Romanelli et al. 2015, Whitmee et al. 2015).
The United Nations (UN) Decade on Ecosystem Restoration (https://www.decadeonrestoration.org/) and the Land Degradation Neutrality programme of the UN Convention on Combatting Desertification (https://www.unccd.int/actions/achieving-land-degradation-neutrality) encourage signatory nations to recognize the central importance of ecological restoration.

There is growing understanding of the causal links between human health and ecological health, including the role of soil health and biodiversity both above and below ground (Liddicoat et al. 2020). However, while the links between environmental quality and human health are becoming better understood, the potential of ecosystem restoration as a public health intervention remains inadequately explored.

Ecological restoration improves ecological health through the reversal of ecosystem degradation, the repair of damaged ecosystems, and the reconnection of society with nature. While there have been attempts to understand and conceptualize the nexus between ecological restoration and human health, a unifying framework and resolution of the mechanisms is yet to be defined.

Two principal knowledge gaps currently limit our ability to fully realize the benefits of linking ecological restoration with public health:

1.Quantification of individual health benefit, resulting from directly participating in restoration activities (e.g., the achievement of restoring an area can reduce the anxiety and depression common among the environmentally aware); and,
2.Population health benefits resulting from the outcomes of ecological restoration (e.g., restored ecosystems providing cleaner downstream water, reducing a number of disease risks).