IDEA Position on ECOHEALTH (Using an Ecosystem Approach to Human Health)

The earth's ecological system, or ecosystem, is an interactive community consisting of both living and non-living entities. It is based on the mutual dependence of all life processes on one another. The relationships among the members of an ecological community are non-linear and involve multiple feedback loops. Nothing works in isolation - devoid of context. Its fundamental principle of interdependence describes how the behaviour of every living member of the ecosystem depends on the behaviour of many others. Humanity is one of the members embedded in an ecosystem but its activity is fundamentally disturbing the web of life, which provides the conditions that sustain life in its many forms on our planet.
Human impact is instrumental in disrupting the ecosystem's water, nitrogen and carbon cycles, as well as the earth's physical topography, resulting in myriad implications that we are only beginning to appreciate. The serious climatic disruption triggered by the atmospheric release of greenhouse gasses is estimated to contribute to the development and proliferation of parasites, bacteria, and viruses with the spread of both vector borne and infectious diseases between the southern and northern hemispheres.
According to the World Health Organization the global incidence of chronic diseases, especially cancers, are increasing alarmingly. The WHO also found that 150,000 deaths were directly attributed to the climate change in the year 2000. This reflected increases in both malaria and diarrhoea and the consequent dehydration. Droughts can increase malarial infection when flowing streams dry into small stagnant pools of water where the disease carrying mosquitoes can breed more easily. They also affect the quality of traditional sources of drinking water, which become muddier before drying up. This forces people to take their water from polluted sources. At a three-day meeting of international experts at the World Health Organization's Geneva headquarters in 2004, it was announced that the ecological changes caused by human activity represent "by far" the most important factor in the emergence of diseases that jump from animals to humans. The meeting was held with the purpose of finding ways to prevent and improve responses to such diseases.
The degradation of ecosystems also impacts strongly on the human cost from natural disasters. When mountains are deforested, coral reefs are destroyed, coastal mangrove forests are eradicated, we are removing the front line of defence against flooding and landslides due to torrential rains as well as the devastation from powerful tsunamis.
In 1987, the World Commission on Environment and Development reported that six times as many people died, from natural disasters annually in the 1970's, as they did in the 1960's. This trend has continued through the last decades.

The concept of ecohealth was precipitated by the question:
Can people remain healthy on a planet that is sick and getter sicker?
(Both ecologically and socially)

It is now recognized that both pollution and imbalances in the ecosystem have an enormous effect on human health. Toxic substances transmitted through the soil, air, water, the food chain as well as through placenta in pregnancy and breast milk during lactation are undermining the collective health and well-being of humanity.
An assessment of air quality by the European Commission last year revealed that, air pollution is killing 310,000 Europeans annually and costing EU countries 80 billion euro a year in sick leave (Irish Times 23 Feb. 2005 Environment Editor) In the same article, air pollution is now considered to be responsible for reducing the life expectancy of Europeans by an average of almost nine months. For every working European, the toll of illness caused by air pollution is at least a half-day of sick leave each year.
On another level, the values underpinning the current quest for economic globalisation is creating societies with rapidly rising levels of stress, depression & suicide, substance abuse and violence. Another obvious symptom of the human's holistic health is the increasing problem of Stress with its overwhelming health implications. Research has revealed that in terms of mortality, stress is a more serious risk factor than tobacco. In this time of the new millennium, our environment, social systems and individual human health globally, are all predominately stressed. In the UK, it is estimated that between fifty to seventy-five percent of doctors' appointments are primarily concerned with stress related problems. In the United States, eight out of ten of the most commonly used medications are used for stress related disorders. These include antidepressants, medications for high blood pressure, heartburn, ulcers as well as anti-anxiety drugs. It is estimated that approximately two million people in Britain take antidepressants each year. In the last ten years antidepressant medication consumption in most advanced Western countries has doubled.
The situation in our hospitals' Accident and Emergency wards in Ireland, also attest to how dramatically these problems can impact on human health.

Scientific reductionism has escalated our possibilities to problem-solve. However it is now clear that this methodology is most effective when dealing with the mechanical, predictable aspects of life (found in non-living systems). When used on living systems, due to the interdependent and unpredictable relationships inherent in living systems, it can create enormous problems. The use of a Systems or holistic approach which always keeps the whole system in mind while dealing with its parts, is essential in order to understand living systems which are dynamic and can behave unpredictably. This Systems approach complements modern Science's reductionist approach to expand our understanding of life and human health in giving us the larger picture of our world that is made up of both living and non-living systems.
It is apparent that our conventional medical/health education, which has divided human health from its environment, needs to be urgently addressed. Ecohealth education reflects the reality of Nature's integrated essence. It necessarily calls for a trans-disciplinary and holistic approach within education to address our flailing planetary health, for it is not an exaggeration, to say that human health is ultimately dependent on the health of the planet and its ecosystems. With this information, we must expand the focus of healthcare from simply "fixing our patients' illness" toward anticipating and preventing health disasters and epidemics. This necessarily broadens the scope to include the social, financial and political forces that influence humanity's actions. It necessitates social justice, which will address the issues of poverty, equity and security. The trans-disciplinary approach allows information and knowledge from the different disciplines to be shared and put towards developing more appropriate and effective interventions and policies.

Inspired by an international conference on the increasing global health and environmental problems hosted by Canada in 2002, the magazine ECOHEALTH: Conservation Medicine, Human Health, Ecosystem Sustainability was launched in 2005. It is based in the John Burns School of Medicine, University of Hawaii. The editorial board of the magazine is made up of an international group of medical and health professionals and academics from universities across the USA, Canada, Germany, Sweden, Australia, New Zealand and various countries in South America, Africa and Asia. The magazine, in affiliation with the University of Western Ontario's Faculty of Medicine and Dentistry produced a supplement on introducing ecosystem health into medical, public health and veterinary curricula, while providing examples of established and planned ecosystem health programs in various universities. (1)

Dr. John Howard who is on the board, has been instrumental in introducing Ecohealth into the Medical faculty of University of Western Ontario, explained:

The environment is a key determinant of health for humans. A deteriorating environment is leading to new human diseases. To best deal with these emerging diseases, future physicians must have a good understanding of the issues affecting the global ecosystem. To meet this challenge, a comprehensive undergraduate medical program in Ecosystem Health has been developed and implemented in a Canadian medical school. This Ecosystem Health program represents the first comprehensive ecosystem health program in a medical school.

IDEA was represented at the international EcohealthONE conference at University of Wisconsin, Madison. The conference focused on how Medical, Public Health, Dentistry and Veterinary education internationally, is being expanded to incorporate Ecohealth.
In Ireland, Ecohealth is now being introduced to first and second year students in the department of Epidemiology and Public Health at University College Cork.

More information on Ecohealth can be found on www.ecohealth.net or on the International Development Research Centre (IDRC) website.

Juliet Duff, March 2007

Notes
(1) This supplement of the magazine can be accessed through the publisher at www.springerlink.com (Ecosystem Health in Professional Curricula; ECOHEALTH: Conservation Medicine, Human Health, Ecosystem Sustainability, volume 1, supplement 1, 2004).

ECOHEALTH: Using an Ecosystem Approach to Human Health