Ecological Medicine - October 2002
|I.||Editor's Note - Ecological Medicine||Carolyn Raffensperger|
|II.||The Case For Ecological Medicine||Ted Schettler|
|III.||Ecological Medicine: A Call for Inquiry and Action||February 2002|
|I. Editor's Note - Ecological Medicine||TOP|
|By Carolyn Raffensperger
Its always dangerous to hold staff or board meetings at the Science and Environmental Health Network because someone might ask a question that will launch entire new projects or turn our thinking inside out. On our staff we have a botanist (Mary O'Brien), a writer (Nancy Myers), and a physician (Ted Schettler). Ted has co-authored two books, one on reproductive toxicants and the other on neurotoxicants and learning disabilities. One day we asked, "What would a learning disorder look like in a Florida panther? What would a reproductive disorder look like in a Burr oak tree?"At the same time my husband and I were immersed in the medical world because of his metastatic cancer. How could we make choices that promoted healing and didn't cause further damage in the world? How could we invite our healers into a full ecological analysis?
None of these were easy questions. But then, neither were the questions that had been posed by the Health Care Without Harm Campaign when it began dealing with toxicants like dioxin and mercury in health care. Or the questions asked by the environmental health movement as it sought to implement the precautionary principle in place of policies of measuring and managing risk.
In February of this year SEHN convened a meeting to weave together many questions under the rubric of ecological medicine. We hoped to find some answers. Gathered at Commonweal in California were ecologists, physicians ministering to those in refugee camps, pioneers in the environmental health movement, the managing trustee for the free people's clinic in Bhopal, philosophers and many others. We offer the statement defining ecological medicine and a call to action written by this group.
Preceding the ecological medicine statement is Ted Schettler's analysis of why we need new thinking about health and medicine.
Two ideas might season your thinking on this topic as you read the rest of the , one from Aldo Leopold, the other from Wendell Berry. Aldo Leopold defines health as the internal capacity of the land or the organism for self-renewal. (Sand County Almanac) Wendell Berry says "health is membership" (Another Turn of the Crank).
To your health! To the health of the Earth!
|II. The Case for Ecological Medicine||TOP|
|By Ted Schettler, MD MPH
Medical advances have resulted in substantial decreases in morbidity and mortality in many parts of the world. Some of these advances come at considerable economic as well as environmental costs, and benefits are not equally distributed. Now medicine and public health struggle to address the changing patterns of disease resulting both from a rapidly changing and degraded earth and from the ways people live on it.In 1977, George Engel, professor of psychiatry and medicine at the University of Rochester, wrote a paper published in Science called "The Need for a New Medical Model: A Challenge for Biomedicine."1 Engel contended that medicine was in a crisis that derived from adherence to an outdated model of disease. He developed an argument for a biopsychosocial model of illness and disease, arguing that exclusion of psychosocial factors distorted perspectives and even interfered with patient care. "The boundaries between health and disease, between well and sick, are far from clear and never will be clear, for they are diffused by cultural, social, and psychological considerations."
Engel's arguments were revolutionary at the time, but they have since entered the mainstream. No well-informed physician today can doubt that psychosocial factors impact a patient's health and response to care. It seems, however, that Engel's ideas need to be expanded. Engel encouraged us to consider how the psychosocial environment impacts human health and to incorporate those factors routinely into medical practice. It was a step toward getting us to think about other impacts of the environment on health--beyond social conditions to include the environment writ large.
The Changing World In 1998, Jane Lubchenco, outgoing president of the American Association for the Advancement of Science, urged scientists to rethink their social contract with the public.2 "Part of our collective responsibility to society must include a scientific community-wide periodic reexamination of our goals and alteration of our course, if appropriate," she said. "Despite the plethora of reports examining the future of the scientific enterprise, I see the need for a different perspective on how the sciences can and should advance and also return benefit to society. This different perspective is firmly embedded in the knowledge of specific, identifiable changes occurring in the natural and social worlds around us."
Some of those changes are the following:
Changing Patterns of Illness At the same time patterns of human disease are changing throughout the world. To remain focused on increases in life expectancy and decreasing child mortality in many parts of the world is to miss the "essential newness" of environmental change and associated diseases.3,4
Smoking, sun exposure, and diet explain few of these trends. Genetic factors explain, at most, about half of the population variance for a few of these conditions and far less for the majority of them. Improved understanding of development of the brain, immune, reproductive, respiratory, and cardiovascular systems and of gene-environmental interactions leads to the conclusion that other environmental factors contribute significantly to impairments. In laboratory animals, wildlife, and humans, considerable evidence documents a link between ambient levels of environmental contamination and malignancies, birth defects, reproductive success, and impaired behavior and immune system function.Medicine's Failure But there is more to the story. During the past 25 years, the medical-industrial complex has grown enormously in the US, and it now represents about 12% of the GNP. Its reach into many corners of our social and political institutions is extensive--patient care facilities and all the support services that these complex institutions require; medical device manufacturers; a large government, university, and corporate research enterprise; pharmaceutical sales; insurance companies; government regulatory agencies; public utilities; and so on.
Ironically, during this time of unprecedented global environmental change, the expanding medical industrial complex has itself contributed substantially to environmental damage through the manufacture, use, and disposal of an extensive array of materials, including toxic substances like mercury, cadmium, solvents, dioxin precursors, cleansing agents, and pharmaceuticals. Health care institutions use large amounts of water and are second only to manufacturing in electricity consumption on a square foot basis. The exhaust from vehicles traveling to and from medical facilities adds considerably to resource depletion and air pollution. Some of these environmental threats are unique to the health-care industry. Others are shared by other industrial sectors.
In sum, health care delivery services that are essential for addressing the "essentially new" ecological changes in the world also contribute to environmental degradation and resultant diseases.
Like other enterprises intended to focus on the public good in return for public support, medical and public health practices have attempted to respond to societal needs as they were perceived and articulated in the last century. But even by prevailing standards, the shortcomings of the dominant medical model have become apparent. Some alternative or complementary forms of individual medical care address these deficiencies in substantive ways. A less positive result has been a weakening of the public health system. The public health approach, which emphasizes primary prevention for individuals, families, and communities, has often stood in contrast to and competed unsuccessfully for resources supporting the biomedical model of treating disease. And environmental health is often narrowly imagined as dealing with little more than the impacts of air, water, or food contamination on the wellbeing of people.
The New Context The context for any of these approaches or practices has fundamentally shifted, and a new perspective is needed to guide how medicine advances and returns benefit to society. This perspective must be embedded in knowledge of changes in the natural and social worlds, and the shifting patterns of disease. Indeed, not only must health care providers and institutions reexamine their stance in the world, but all individuals and communities would do well to become aware of how their wellbeing is connected to other people, other species, and the natural world.
The challenge is to integrate an ecological perspective into health care and public health practice in ways that demonstrate understanding of the identifiable changes occurring in the natural and social worlds around us, as we collectively develop the new social contract for medicine.
2. Lubchenco J. Entering the century of the environment: A new social contract for science. Science 279:491-497, 1998.
3. McCally M. Environment and health: an overview. Can Med Assoc J 163(5):533-535, 2000.
4. McMichael A. Global environmental change and human health: new challenges to scientist and policy maker. J Public Health Policy 15(4):407-419, 1994.
|III. Ecological Medicine: A Call for Inquiry and Action||TOP|
Ecological Medicine is a new field of inquiry and action to reconcile the care and health of ecosystems, populations, communities, and individuals.The health of Earth's ecosystem is the foundation of all health. Human impact in the form of population pressure, resource abuse, economic self-interest, and inappropriate technologies is rapidly degrading the environment. This impact, in turn, is creating new patterns of human and ecosystem poverty and disease. The tension among ecosystem health, public health, and individual health is reaching a breaking point at the beginning of the Twenty-First Century.
Public health measures, education, and medical advances have significantly reduced death and disease in many parts of the world, but some advances come at considerable cost, and the benefits are not equally distributed. Public health systems charged with creating healthful conditions for all have suffered in competition with technologically intensive health care aimed at individual consumers. Health care systems struggle to keep up with the changing patterns of disease that result both from a rapidly changing and degraded Earth and from the way people live. New and old diseases spread with increasing speed within and across national borders. Meanwhile, industrially based medicines and technologies that heal also contribute to the growing burden of environmental toxins in people, air, water, fish, animals, and plants. (See "The Case for Ecological Medicine," Article II.)
Healing disciplines and movements of public health, ecology, conventional medicine, complementary and alternative medicines, conservation medicine, conservation biology, and campaigns such as Health Care Without Harm have sought to address this cycle of conflict among individual health, public health, and ecosystem health in different ways. Ecological Medicine honors these contributions and builds upon them. Ecological Medicine invites the biomedical community, ecologists, scientists, activists, and individuals who are concerned for personal health as well as the health of communities and future generations to learn from each other and to embrace a balanced, ecological approach to sustaining health.
Ecological Medicine integrates the following concepts and values:
Ecological Medicine sounds an urgent call to action. Understanding the ominous changes in the biosphere compels us to act, individually and collectively. Whether it is in the way we build clinics and hospitals; make, grow, and use medicines; choose areas for scientific study; communicate across disciplines; conduct public health services globally and in particular communities; or choose the means of maintaining our own health, we must do so with a commitment to enhancing life on this planet.