Eastern Lake Ontario Environmental Research Group 2000 (cont'd from eloerg.tripod.com/waupoos)

Ecological public health, the 21st centurys big idea? British MedicalJournal Sept1,2012

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Ecological public health, the 21st centurys big idea? British MedicalJournal Sept1,2012
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Ecological public health: the 21st century’s big idea? (Excerpts from) An essay by Tim Lang and Geof Rayner, British Medical Journal, September 1, 2012


Today, as financial crises continue—banking failures, debt bubbles, slowing economic growth, nervous but contradictory consumerism—there is an opportunity to review what is meant by public health for the 21st century. The connection between health and societal progress has been severely weakened in public policy of late. It is adrift when it ought to help shape a new direction. Public health ought to be articulating what a good society and a good economy are. Improving public health is at the heart of defining what is meant by progress. Indeed, part of the current crisis is that 20th century notions of progress underplayed how economic development distorted the relationship of humans to the planet, despite it being known that human health ultimately depends on the health of ecosystems. With water, biodiversity, soil structures, energy, and biological resilience all becoming problematic in the era of climate change, this connection is once more central. Somehow, modern public health had almost forgotten the primacy of the human-environmental interface, despite this being a component part of the original sanitarian vision. Edwin Chadwick (1800-1880) and others fully recognised, for example, how the health of towns (now a majority human experience in the 21st century) depended on the sustainability of agriculture. The interface of human and ecosystems health now deserves to be central for policy making). …………

Five models of public health…………

Each of these four models has merit but, tellingly, they mostly engage with health in anthropogenic terms. By this we mean that the health of the living, natural, and physical world—ecosystems health—is marginalised. This is one among many reasons we now champion a fifth model: ecological public health. Centrally, ecological public health focuses on interactions, with one strand focusing on the biological world—in concerns about increasing strains on biodiversity or antimicrobial resistance, for example. Another strand centres on material issues such as links between industrial pollution, energy use and toxicity, and the impact on human species and nature. The advantage of ecological thinking is that it theorises complexity, a key feature facing modern conceptions of health.

A strength of the ecological public health model is that it draws upon and integrates parts of the other models). Secondly, it articulates modern thinking about complexity and system dynamics, addressing, for example, questions of non-linearity, variations in scale, feedback, and other emergent qualities of nature, biology, and human behaviour. In the UK, we see some of such thinking in the government chief scientist’s Foresight programme.16 Thirdly, ecological public health seeks to build knowledge as a continual intellectual engagement. This means more than just evidence, and includes the open pursuit of social values, highlighting the role of interest groups, and debate across society not just within restricted scientific circles. Think Darwin and Wallace, Beveridge or Roosevelt: big thinking about the nature of life, good societies, order and change. Fourthly, it incorporates an evolutionary perspective, from matters like nutritional mismatch to questions of biological feedback. Fifthly, this is an overtly interdisciplinary and multi-actor model. It celebrates that public health requires action on multiple fronts and embraces the argument familiar in the 19th century that public health action requires a public health movement.

We argue that 21st century ecological public health must address the inherent complexity of shaping factors across what we call the four dimensions of existence. These are: (a) the material dimension—that is, the physical and energetic infrastructure of existence (matter, energy, water), and the physical building blocks on which life depends; (b) the biological dimension—that is, the biophysiological processes and elements, including all animal and plant species and also micro-organisms; (c) the cultural dimension—that is, how people think and through which mental categories they think, and the spheres of interpersonal relationships, community, and group and family traditions; and (d) the social dimension—that is, institutions created between people and expressed in terms of laws, social arrangements, conventions, and the framework of daily living generally outside individual control. ………………..

Public health success is as much about imagination as evidence: challenging what is accepted as the so called normal, or business as usual. Public health must regain the capacity and will to address complexity and dare to confront power. This demands a new mix of interventions and actions to alter and ameliorate the determinants of health; the better framing of public and private choices to achieve sustainable planetary, economic, societal, and human health; and the active participation of movements to that end. Public health professions today need to think and act ecologically if they are to help reshape the conditions that enable good health to flourish.



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Eastern Lake Ontario Environmental Research Group