George Morris, NHS Health Scotland, United Kingdom
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1) Public health realities are increasingly complex due to socio-ecological factors like nutrition, urbanization, demographics, energy, economics, disease, and culture interacting with the environment. 2) The document discusses how the environment is intimately connected to human health and wellbeing, and climate change, pollution and other environmental issues are undermining health. 3) It proposes that public health must consider the environment and that human and ecosystem health are interlinked, in that human activities impact ecosystems and the services they provide that determine wellbeing.
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George Morris, NHS Health Scotland, United Kingdom
- 1. 8GHPC HELSINKI Europe Day 13.6.2013 Revisiting Health in All Policies in Times of Environmental Crisis: Building Public Health on Ecological Principles George Morris
- 2. Four public health realities 1. So-called socio-ecological complexity has defined the public health challenge in the developed world, arguably since the 1970s, and is here to stay 2. The aspiration for Health in All Policies has its roots in this realisation 3. A core notion within public health, however defined, is the notion of change 4. The art and the science of public health is about building population health on shifting foundations
- 3. Nutritional Urban Demographic Energy Economic Disease Cultural Environmental In Joint Interaction, Transitions Define and Redefine the Public Health Challenge and How it Can be Addressed Developed from Rayner and Lang (2012)
- 4. Supporting Experience Experience Experience State of the Environment Exposure Diminished Human Health The “Classical” Environment: Health Interface in Public Health
- 5. Supporting Experience Experience Experience Environmental Hazard or Environmental “Good” Exposure or Experience Modified Health and Wellbeing A more realistic representation?
- 6. Supporting Experience Experience Experience Environmental Hazard or Environmental “Good” Exposure or Experience Modified Health and Wellbeing Social, economic & environmental etc. context More realistic still!
- 7. Supporting Experience Experience Experience State of the Environment Exposure or Experience Human Health And Wellbeing Social, economic & environmental etc. context State of the Environment
- 8. Supporting Experience Experience 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) More Realistic and Policy Relevant
- 9. • 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 The New Environmental Public Health Imperative
- 10. A Safe Operating Space for Humanity: Planetary Boundaries Rockstrom et al (2009)
- 11. 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. • 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” Adapted from Rayner and Lang (2012)
- 12. HUMAN HEALTH ECOSYSTEMS HEALTH “THE DYNAMICS OF ECOLOGICAL PUBLIC HEALTH” Rayner and Lang (2012)
- 13. SUPPORTING Nutrient Cycling Soil Formation Primary Production PROVISIONING Food Freshwater Fuel Wood Fibre etc. REGULATING Climate Reg. Flood Reg. Water Purif. CULTURAL Aesthetic Spiritual Educational Cultural HUMAN SECURITY Personal Safety Secure Resources etc. Security from Disasters etc MATERIAL MINIMA Adequate Livelihoods Shelter etc. Fuel, Food, Fibre etc. SOCIAL RELATIONS Social Cohesion Mutual Respect Ability to Help others FREEDOM OF CHOICE Opportunity to achieve what an individual values doing and being HEALTH Strength Feeling Well Access to Clean Air, Water, etc. Ecosystem Services Link to Wellbeing Through:
- 14. POLICY and ACTION Human Health and Wellbeing Through our impact on the proximal environment DRIVERS Though our influence on ecosystems TWO PATHWAYS
- 15. Supporting Experience Experience 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) Morris et al ( 2006)
- 16. DRIVERS TO HEALTH EFFECT VIA AN ECOSYSTEM SERVICES ROUTE Pressures Ecosystem Services Regulating Provisioning Cultural Supporting 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)
- 17. 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 Adopt Holistic Issue Framing Synthesise a Mixed Economy of Evidence Develop an Appropriate Ethical Framework Carefully Consider Infrastructure Work to Optimise Governance Complexity Planetary Boundaries Ecosystem Services Interconnectivity etc Sustainability Equity Environmental Justice Social Justice etc. Institutional Educational Physical Transparency Stakeholder Engagement Accountability etc Qualitative Quantitative Experimental Non- Experimental, Multiple Sources
- 18. DARWIN’S ENTANGLED BANK The Entangled Bank
Editor's Notes
- As we speak, Ecosystem Services is not part of the lingua franca of public health. It has power and utility for public health