Planetary Health and Health promotion: is there a role for ... · Manuela Boyle MHSC BHSC FIO SIO...

Planetary Health and Health promotion: is there a role for

health care practitioners?Manuela Boyle MHSC BHSC FIO SIO IFM AIMA WHIS

CMA International Conference 2019, Sydney - Manuela Boyle WHIS

Planetary health is an attitude towards life and a philosophy for living.


Objectives

• Human health and health of the natural environment are related.• Human health as part of planetary health.• The role of holistic health care practices in planetary health


Planetary Health


Planetary Health

• It broadens health research to include the external systems that sustain or threaten health.

• It includes the economy, industry and energy production; processes and systems that we, as a civilisation, depend upon (Watts, Amann & Ayeb-Karlsson 2018)

• It offers an exciting opportunity to find alternative solutions for a better and more resilient future.

• It aims not only to investigate the effects of environmental change on human health, but also to study the political, economic, and social systems that govern those effects (Laverack and Mohammadi, 2011)


A new system of health care

Planetary health challenges the traditional boundaries between medical and other disciplines.It focuses on a holistic model of health care that encourages people to consider planetary health in their everyday lives (Brousselle and Butzbach 2018)


Planetary health is an

attitude towards life

To safeguard human health we need to maintain the health of the planet on which we all depend from (Horton, Beaglehole, Bonita, Raeburn, McKee & Wall 2014)


Planetary Health and Human Health

Human activity is rapidly transforming Earth’s natural systems. Accelerating climatic disruption, land degradation, water scarcity, fisheries degradation, biodiversity loss, and pollution threaten global health gains (Wright and Nyberg 2015)


Planetary Health and Human Health

• By altering the composition of the atmosphere, • degrading arable lands faster than they can be replenished, • overfishing• polluting• changing the chemistry and temperature of our oceans• withdrawing ground water faster than it can be recharged, • and dramatically reducing the number and population sizes of species who

co-inhabit the planet with us, • we are putting the poor, the indigenous populations and future

generations in danger.


Humanity ecological footprint

• The Anthropocene defines Earth's most recent geologic time period as being human-influenced, or anthropogenic, based on overwhelming global evidence that atmospheric, geologic, hydrologic, biospheric and other earth system processes are now altered by humans (Whitmee, Haines, Beyrer, Boltz, Capon, de Souza Dias et al., 2015)


The highest standard of health

• Planetary health is the achievement of the highest attainable standard of health, wellbeing, and equity worldwide (Myers, 2018)

• Through judicious attention to the human systems – political, economic, and social – planetary health shapes the future of humanity and the Earth’s natural systems (The Rockefeller Foundation-Lancet Commission on Planetary Health, 2016)


Global citizens

• As the global health burdens shifted from infectious to non-communicable diseases, greater emphasis is placed on the health-mediating role of lifestyle and the total lived environment, including the health implications of human-manufactured threats to life within the biosphere (Giles-Corti, Lowe, Arundel 2019)


A holistic model of planetary care

• Planetary health requires changes for long-term benefits of entire communities. As such, it requires a paradigm shift from a model of health care that encourages an emphasis on the value of the short term and quick wins of treatment over the longer-term investment needed for prevention (e.g. climate change mitigation; pollution prevention) (Watts, et al. 2018)


Planetary health and holistic medicine

• Holistic medicine is uniquely positioned to educate and advocate on behalf of patients and communities to safeguard the health of persons, place and planet and to reduce unprecedented environmental degradation, social stress and injustices, which are all contributing to the non-communicable disease crisis.

• Mainstream planetary health discourse will be strengthened by inter-professional healthcare perspectives (Prescott and Logan, 2019)


What are the health risks?

• About 70% of the 9 million excess deaths caused annually by pollution are due to non-communicable diseases, including cardiac disease, stroke, chronic obstructive pulmonary disease, and lung cancer.

• Air pollution (both outdoor and indoor) alone is responsible for over 7 million deaths annually and has been called the “new tobacco” (Foley Monfreda, Ramankutty & Zaks 2007)



• Warmer temperatures associated with climate change could increase the formation of tropospheric ozone, depending on emissions of ozone precursors. Ozone is a major constituent of smog and a contributor to cardiorespiratory disease, allergic respiratory diseases (such as asthma) by lengthening pollen seasons and increasing pollen production (Requia, Adams, Arain, Papatheodorou, Koutrakis & Mahmoud 2018).



• Degrading land — such as burning forests or draining peatlands to clear land for agriculture or extraction — can expose large populations to smoke from fires and increase their risk of associated cardiorespiratory health impacts (Requia et al, 2018)



• Changing biogeochemical flows can have ramifications for ecosystems in favour of infectious disease vectors and pathogens.

• For example, agricultural contamination of nitrogen and phosphorous can cause eutrophication of water sources, leading to collapse of local fish populations and the growth of toxic algae, ecological changes that have been shown to increase infectious disease exposure (Udeigwe, Eze, Teboh & Stietiya 2011)



• Foods are expected to be less available, due to globally declining pollinator populations and reduced vegetable and legume production as a result of environmental (including climate) change.

• The global decline in pollinator populations makes it harder to grow fruits, vegetables, nuts, and seeds, which can increase the costs of nutritious food and contribute to deficiencies in vitamin A, folate, and other key nutrients (Giannini, Costa, Cordeiro, Imperatriz-Fonseca, Saraiva & Biesmeijer 2017)


What are the health risks ?

• Rising atmospheric carbon dioxide concentrations decrease key nutrients, such as zinc, iron, and protein, in staple crops, expanding and exacerbating nutritional deficiencies worldwide, particularly in low- and middle-income countries. Fisheries are collapsing at the hands of overfishing and ocean ecosystem transformations, with consequences for key micronutrients, such as iron, zinc and omega-3 fatty acids (Fahd, Veitch & Khan 2019).



• Depleted resources, rising temperatures, extreme weather events, drought, and other factors can change natural landscapes, disrupt food and water resources, change agricultural conditions, alter land use, weaken infrastructure, raise financial stress, increase risks of violence and aggression, and displace entire communities.

• Witnessing environmental degradation and experiencing ecological losses can cause hopelessness, despair, and “ecological grief” (Levy and Patz 2015)



• Climate change, natural hazards, water scarcity, land degradation, and resulting crop and livestock failures will make parts of the world that currently support large numbers of people uninhabitable, displacing already resource-poor populations.


Call for action: the role of holistic health care practitioners• Advise patients about important co-benefits• Everyday choices and key changes can simultaneously benefit

individuals and the environment, including:• Transitioning to locally-grown, unprocessed food and healthy diets to reduce

undernutrition and obesity.• Switching to renewable energy sources and away from fossil fuels, such as

coal, could greatly reduce air pollution and greenhouse gas emissions.• Spending more time outside in nature — including in green space in cities —

can have benefits for physical and mental health and increase a sense of stewardship for our natural environment.


Engaging in communities

• Fostering social connectedness through community-building not only results in mental health benefits, but also can help build the social capital necessary for collective action (O'Rourke and Sidani 2017)

• This can be particularly effective when mobilizing around a common goal, such as bringing more green space, bike lanes, composting services, or farmers’ markets to the community.


Holistic clinical practices

• In the context of personalized/precision medicine, where possible holistic health care practitioners promote understanding of human dependence on the natural environment (flora, fauna and the physical world).

• In clinical practices there are opportunities to illustrate and educate patients on how physiology is linked through ecosystems operating from the micro to macro scales (e.g. misuse of antimicrobials, low-grade inflammation and/or the microbiome) (Franco de Sá, Nogueira, De Almeida Guerra 2019)


Holistic practices

• Holistic practitioners intuitively understand that partitioning body from mind and spirit is unnatural and that the separation of human health from the health of communities and the planet is similarly a very limiting concept.


Holistic practices• Holistic integrative

practitioners are therefore ideal educators for patients and colleagues about the steps that can be taken to mitigate ecologic health impacts.


Holistic health care practitioners: a trusted role• Holistic (and ethical) health care practitioners are consistently ranked

as some of the most trusted sources of information for their unique capacity to understand and communicate the shifting landscape of planetary health challenges and the strategies that individuals can take to simultaneously safeguard their health and that of the environment (Montague, Nemis-White, Aylen, Torr, Martin & Gogovor 2019)


The pathway to a thriving and sustainable future: Vitality• The vitality of all biodiverse ecosystems includes the more broadly

defined human-constructed social, political, and economic ecosystems that favour health equity and the opportunity to strive for high-level wellness and further supports businesses focused on sustainable and health-promoting local and global commerce (WHO, 2019)


The pathway to a thriving future: values and purpose• Attitudes, values and behaviours are at the heart of planetary health.• Human wellness depends intimately on planetary vitality that in turn

depends on humankind, on human kindness, empathy, mutualism, responsibility, and reciprocity at the individual, community, societal and global levels.

• Achieving planetary health must be a product of the interconnected systems of life and the approach to living (lifestyle) (WHO, 2019)


The pathway to a thriving and sustainable future: integration and unity• Planetary health is rooted in ancestral concepts of the unity of life; the

complexity of the challenges we face demands integrationist approaches.

• Responsibility for planetary health requires us to relinquish conventional professional, societal, and cultural partitions and to develop contextual coalitions based both on science and broader cultural narratives (WHO, 2019)


The pathway to a thriving and sustainable future: narrative health• Promoting awareness and discourse toward solutions (including those

emerging from science) demands a narrative-based process that includes traditional knowledge and sciences and an understanding of the power of language (WHO, 2019)

• In healthcare, this underscores a role for holistic health care practitioners in engaging patients and the community to underscore the importance of the earth's natural systems and biodiversity to human health and well-being.


The pathway to a thriving and sustainable future: health literacy• Holistic health care practitioners should advocate for greater inclusion

of the planetary health perspective in their clinical work by illustrating the interconnectivity of human life with the Earth's biodiversity and its natural systems (Sorensen, 2012)

• Health literacy helps communities to address the social, economic and environmental determinants of health. Governments and health systems are required to present clear, accurate, appropriate and accessible information for diverse audiences (WHO, 2019)


The pathway to a thriving and sustainable future: personal commitment to shaping new behaviours• We should strive to live by example: in clinical/academic/public

settings and beyond we should endeavour to include the principles and practices of a planetary health lifestyle;

• In daily behaviour, we should aim to be part of the solution, not the problem; remain committed to a planetary peace agenda; encourage mutualism, empathy and community cohesion; and underscore that aggression, conflict and violence are destructive to person, place and planet.


References

• Brousselle, A., Butzbach C. 2018. Redesigning public health for planetary health. Lancet Planet Health 2: e188-e189• Fahd, F., Veitch, B., Khan, F. 2019 Arctic marine fish 'biotransformation toxicity' model for ecological risk assessment.

Marine pollution bulletin 142:408-418. doi: 10.1016/j.marpolbul.2019.03.039.• Franco de Sá, R., Nogueira, J., De Almeida Guerra, V. Traditional and complementary medicine as health promotion

technology in Brazil. Health promotion international 34(Supplement_1):i74-i81. doi: 10.1093/heapro/day087.• Foley, J.A, Monfreda, C., Ramankutty, Zaks D. 2007. Our share of the planetary pie. Proceedings of the national academy

of science USA 104(31):12585-6. doi: 10.1073/pnas.0705190104• Giannini, T.C., Costa, W.F., Cordeiro, G.D., Imperatriz-Fonseca, V.L.,Saraiva, A.M., Biesmeijer J. 2017 Projected climate

change threatens pollinators and crop production in Brazil. PLoS One 12(8):e0182274. doi: 10.1371/journal.pone.0182274. • Giles-Corti, B., Lowe, M., Arundel, J. 2019 Achieving the SDGs: Evaluating indicators to be used to benchmark and

monitor progress towards creating healthy and sustainable cities. Health policy pii: S0168-8510(18)30441-X. doi: 10.1016/j.

• Horton, R., Beaglehole, R., Bonita, R., Raeburn, J., McKee, M., Wall, S. (2014) From public to planetary health: a manifesto. Lancet. 383(9920):847. doi: 10.1016/S0140-6736(14)60409-8.

• Laverack, G. & Mohammadi, N. K. 2011. What remains for the future: Strengthening community actions to become an integral part of health promotion practice. Health promotion international, 26. doi:10.1093/heapro/dar068

• Levy, B.S., Patz, J.A., 2015 Climate Change, Human Rights, and Social Justice. Annals of global health 81(3):310-22. doi: 10.1016/j.aogh.2015.08.008.


• Myers, S.S. (2018) Planetary health: protecting human health on a rapidly changing planet. Lancet. 23;390(10114):2860-2868. doi: 10.1016/S0140-6736(17)32846-5.

• Montague, T., Nemis-White, J., Aylen, J., Torr, E., Martin, L., Gogovor, A. 2019 Canada's Evolving Medicare: Patient-Centred Care. Healthcare quarterly 22(2):27-31. doi: 10.12927/hcq.2019.25908.

• O'Rourk,e H.M., Sidani S. 2017 Definition, Determinants, and Outcomes of Social Connectedness for Older Adults: A Scoping Review. Journal of gerentologic nursing 43(7):43-52. doi: 10.3928/00989134-20170223-03.

• Prescott, S.L., Logan, A.C. 2019 Planetary Health: From the Wellspring of Holistic Medicine to Personal and Public Health Imperative. Explore (NY) 15(2):98-106. doi: 10.1016

• Requia, W.J., Adams, M.D., Arain, A., Papatheodorou, S., Koutrakis, P., Mahmoud, M. 2018 Global Association of Air Pollution and Cardiorespiratory Diseases: A Systematic Review, Meta-Analysis, and Investigation of Modifier Variables. American journal of public health 108(S2):S123-S130. doi: 10.2105/AJPH.2017.303839.

• Udeigwe, T.K., Eze, P.N., Teboh, J.M., Stietiya, M.H. 2011 Application, chemistry, and environmental implications of contaminant-immobilization amendments on agricultural soil and water quality. Environnent international 37(1):258-67. doi: 10.1016/j.envint.2010.08.008.

• Sorensen, K. 2012 Health literacy and public health: A systematic review and integration of definitions and models. BMC of public health 12 :80. doi: 10.1186/1471-2458-12-80

• Watts, N., Amann, M., Ayeb-Karlsson, S. 2018. The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health. Lancet. 391: 581-630

• Whitmee, S., Haines, A., Beyrer, C., Boltz, F., Capon. A.G., de Souza Dias. B.F. 2015 Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation-Lancet Commission on planetary health. Lancet. 14;386(10007):1973-2028. doi: 10.1016/S0140-6736(15)60901-1.

• World Health Organisation (2019) WHO: 9th Global Conference on Health Promotion• Wright, C. Nyberg, D. Climate change, capitalism, and corporations. Cambridge University Press, Cambridge; 2015


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