Building Health and Wellbeing on Ecological Principles

George Morris

20th February 2013

• Any modern definition of health and the goals of public health must extend to wellbeing

• Health and wellbeing invariably flow from societies to individuals, not the other way round

• Creating the conditions for health wellbeing is a project for all society

What can we reasonably assert?

• the state of the environment, and how it will change in the future, is intimately connected to our health and wellbeing

• climate change, biodiversity loss, pollution, water issues and food security are already undermining health and wellbeing nationally and globally

• in terms of "re-thinking" things as a society, we can no longer consider health, wellbeing and health services without thinking about the environment

For too long we have looked at these issues in our discipline and community silos (whether scientific, policy, professional or stakeholder). The result has

been destruction of the environment, our health and our wellbeing, short and long term – the way forward

has to be the ecological perspective

Making the case for an Ecological Perspective on Wellbeing

The Principle of Transition

“A core notion within public health – however defined - is the notion of change ……and the actions of those seeking to improve public health

and wellbeing will vary as circumstances and conditions dictate”

Rayner & Lang (2012)

In joint interaction, Transitions

- are the Drivers which create and continuously alter the ground on which population health and wellbeing must be built- are the Context which so often translates population level threats into risks for individuals and communities - determine the style of Intervention and the chances of success

Nutritional

Urban

Demographic

Energy

Economic

Disease

Cultural

Environmental

Nutritional

UrbanDemographic

Energy

Econom

ic

Cultural

Environmental

Epidemiological

Many Transitions are Key for Health and Wellbeing

Nutritional

Urban

Demographic

Energy

Economic

Disease

Cultural

Environmental

Nutritional

UrbanDemographic

Energy

Econom

ic

Cultural Environmental

Disease

Making the Case for an Ecological Perspective on Wellbeing

The Environment in Health and Wellbeing

Policy and action on environment could be much more effectively exploited for better more equal health and wellbeing but only if we developed:

• an enhanced capacity to navigate in complexity

• a recognition in policy of the capacity of good environment to generate good health and wellbeing

• A way to embrace a psychosocial dimension in the relationship between people and their surroundings

Good Places Better HealthPrototype Phase 2008 -2011(Children’s Health and Environment)Strongly supported by the RERAD–Funded EDPHiS Project,GPBH has produced useful learning around navigating in complexity notably around:

• Evidence• The Science Policy Interface• Stakeholder Engagement

http://www.scotland.gov.uk/Topics/Health/Healthy-Living/Good-Places-Better-Health

http://www.scotland.gov.uk/Topics/Health/Healthy-Living/Good-Places-Better-Health/Approach/Methodology

http://www.edphis.org/

It has been especially valuable in showing thethe value of Conceptual Models in complex situations as:

1. ‘Tools to think with’

2. ‘Tools to Unify’

3. ‘Tools to Communicate and Engage’

Supporting

ExperienceExperience

Experience

POLICY and

ACTION

Drivers

Pressures

State of the Environment

Exposure or Experience

Human Health And Wellbeing

Social, economic & environmental etc. context

MODIFIED DPSEEA(Morris et al, 2006)

Making the Case for an Ecological Perspective on Wellbeing

Planetary Crisis

A Safe Operating Space for Humanity: Planetary Boundaries

Rockstrom et al (2009)

Applying an Ecological Perspective in Practice

Developing Ecological Public Health

HUMAN HEALTH

ECOSYSTEMS HEALTH

“THE DYNAMICS OF ECOLOGICAL PUBLIC HEALTH”

Rayner and Lang (2012)

Why is Ecological Public Health Different?

• EPH posits that human (social) ecology is inextricable linked to natural ecology and in dynamic interaction with it

• Unlike previous expressions of the environmental contribution to health and wellbeing, environment is no longer an “out there”

• EPH is a unifying concept on many levels

Adapted from Rayner and Lang (2012)

Why is Ecological Public Health Different?

• EHP reminds those who might think we can plunder, destroy and ignore environment that ecological forces underpin all life.

• It does not retreat from complexity … there are no pump handles in this story!

• EPH demands an integration of Environmental Impact Assessment and Health Impact Assessment

Adapted from Rayner and Lang (2012)

Applying and Ecological Perspective in Practice

Ecosystem Services and Human Wellbeing

SUPPORTINGNutrient CyclingSoil FormationPrimary Production

PROVISIONINGFoodFreshwaterFuelWoodFibre etc.

REGULATINGClimate Reg.Flood Reg.Water Purif.

CULTURALAestheticSpiritualEducationalCultural

HUMAN SECURITYPersonal SafetySecure Resources etc.Security from Disasters etc

MATERIAL MINIMAAdequate LivelihoodsShelter etc. Fuel, Food, Fibre etc.SOCIAL RELATIONSSocial CohesionMutual Respect Ability to Help others

FREEDOM OF CHOICEOpportunity to achieve what an individual values doing and being

HEALTHStrengthFeeling WellAccess to Clean Air, Water, etc.

Ecosystem Services Link to Wellbeing Through:

Applying and Ecological Perspective in Practice

Tools To Think With

POLICY and

ACTION

Human Health and Wellbeing

Through our impact on the

proximal environment

DRIVERS

Though our influenceon ecosystems

TWO PATHWAYS

Supporting

ExperienceExperience

Experience

POLICY and

ACTION

Drivers

Pressures

State of the Environment

Exposure or Experience

Human Health And Wellbeing

Social, economic & environmental etc. context

DRIVERS TO HEALTH EFFECT VIA THE PROXIMAL ROUTE

MODIFIED DPSEEA(Morris et al, 2006)

DRIVERS TO HEALTH EFFECT VIA AN ECOSYSTEM SERVICES ROUTE

Pressures

Ecosystem ServicesRegulating

Provisioning

CulturalSupporting

Experience

Determinants of health and wellbeing

Supporting

Drivers

POLICY and

ACTION

Human Health And Wellbeing

Freedom of Choice

Social Relations

Security

Material Minima

Experience

Social, economic & environmental etc. context

ECOSYSTEMS ENRICHED DPSEEA

(Reis, S. Morris, G et al, 2013 in press)

Applying and Ecological Perspective in Practice

5 Pillars of Ecological Public Health

A Suggested Goal: A Society in which health, wellbeing, inclusiveness, equity etc. are pursued in a way which respects planetary boundaries and creates and protects a safe an operating space for humanity and

the species with which we share the planet

5 PILLARS OF ECOLOGICAL PUBLIC HEALTH

AdoptHolistic Issue

Framing

Synthesise a Mixed

Economy of Evidence

Develop an Appropriate

Ethical Framework

Carefully ConsiderInfrastructure

Work to Optimise

Governance

Complexity

Planetary Boundaries

Ecosystem Services

Interconnectivity

etc

Sustainability

Equity

EnvironmentalJustice

Social Justice

etc.

Institutional

Educational

Physical

Transparency

Stakeholder Engagement

Accountability

etc

Qualitative

Quantitative

Experimental

Non-Experimental,

Multiple Sources

DARWIN’S ENTANGLED BANK

The Entangled Bank