Ecological Public Health: A 21 st Century Imperative Delivering Health Through the Environment BELFAST Nov 2015 George Morris European Centre for Environment and Human Health
“ While a new environmental conceptualisation of health (Ecological Public Health) might seem a difficult and complex task, that is the 21st century’s unavoidable task” Rayner & Lang (2012)
What I will cover • The Environment in Public Health • Issue Framing and its use in a Scottish policy context • The “ecological transition” and its implications for health and wellbeing • Building population health and wellbeing on ecological principles
The “Classical” Environment-Health Interface Hazardous Environmental Experience State Experience Exposure Experience Diminished Human Health
PRESSURES ON THE CLASSICAL EH MODEL SOCIAL COMPLEXITY A Wellbeing Psychosocial Dimension HAZARD EXPOSURE Physiology of Stress Biology Deprivation DIMINISHED HEALTH Environmental Environmental Health Justice Inequalities Health Nurturing Environments
PRESSURES ON THE CLASSICAL EH MODEL SOCIAL COMPLEXITY A Wellbeing Psychosocial Dimension HAZARD EXPOSURE Physiology of Stress Biology Deprivation DIMINISHED HEALTH Environmental Environmental Health Justice Inequalities Health Nurturing Environments
Would this be an improvement ? Hazardous Environment State Experience or Experience Environmental “Good” Exposure or Experience Experience Modified Health and Wellbeing
A further refinement? Drivers Pressures Experience Experience State of the Environment Exposure or Experience Human Health And Wellbeing
More policy relevant? Drivers Pressures Experience Experience POLICY and State of the Environment ACTION Exposure or Experience Human Health And Wellbeing W HO (2004)
The modified DPSEEA Model (Morris et al, 2006) Drivers Experience Pressures Experience POLICY POLICY and and State of the Environment ACTION ACTION Exposure or Experience Human Health And Wellbeing Social, economic & environmental etc. context
“Essentially, all models are wrong, but some are useful" George Edward Pelham Box FRS (1919 – 2013)
“Good Places Better Health”, the Scottish Government’s strategic policy initiative on Environment and Human Health was built on issue framing using mDPSEEA Good Places Better Health
Some reflections on GPBH thus far • It is useful to view socio-ecological complexity in public health through the prism of the environment • Conceptual models are tools to think with, to assemble evidence to engage and to communicate • Environment is highlighted as inequalities issue • The approach allows actions delivering co-benefits to emerge • We have distilled clear recommendations to government
Reflections on GPBH thus Far • It is useful to view socio-ecological complexity in public health through the prism of the environment • Conceptual models are tools to think with, to assemble evidence to engage and to communicate • Environment was highlighted as inequalities issue • We have distilled clear recommendations to government
A Safe Operating Space for Humanity: Planetary Boundaries Rockstrom et al (2009)
THE IMPLICATIONS ARE SIGNIFICANT • Society can no longer hope to deliver health, wellbeing, health care (and equity in these things) without returning to an “environmental conceptualisation” of public health • From now on, we must build public health and wellbeing on ecological principles • Those of us concerned with the relationship between environment, health and wellbeing must embrace a distal dimension to their work
THE DYNAMICS OF ECOLOGICAL PUBLIC HEALTH: A SIMPLE MODEL HUMAN HEALTH ECOSYSTEM HEALTH Rayner and Lang (2012) http://www.routledge.com/books/details/9781844078325/
A response demands that we: • reconnect Social and Ecological systems • integrate Health Impact Assessment and Environmental Impact Assessment • embrace a Distal Dimension to the relationship between environmental change and human wellbeing
Environmental pathways from human activities to health and wellbeing can be “distal”, usually, for one or more of 3 reasons • They may be “temporally distal“ - because the true extent and gravity of their impacts on health and wellbeing will be felt only with time, • They may be “spatially distal” - because they relate to those environmental impacts which are happening, or predicted to happen, elsewhere. perhaps after decades or even generations. • They may be “extremely complicated” - involving an unfamiliar interplay of societal, economic and physical factors which modifies and amplifies risk. Morris et al (2015)
We Need Tools to Think With!
Conceptually, there are 2 Pathways from human-driven Environmental Change to Human Health and Wellbeing DRIVERS HUMAN HEALTH AND WELLBEING
ECOSYSTEM SERVICES AND THEIR LINKS TO HUMAN WELLBEING CAN HELP TO ILLUMINATE THE DISTAL PATHWAY 4 TYPES • Provisioning services • Regulating services • Cultural services • Supporting services
Ecosystem Services are the Benefits Humans get from their Environment Specifically through.... PROVISIONING Food Freshwater Fuel Wood Fibre etc. REGULATING SUPPORTING Climate Reg. Nutrient Cycling SOCIAL RELATIONS Flood Reg. Soil Formation Water Purif. Primary Production HUMAN FREEDOM OF CHOICE Opportunity to achieve what WELLBEING CULTURAL an individual values doing and being Aesthetic Spiritual Educational HEALTH Cultural Access to Clean Air, Water, etc . Millennium Ecosystem Assessment 2005
Ecosystem Services Specifically through.... PROVISIONING Food HUMAN SECURITY Personal Safety Freshwater Secure Resources etc. Fuel Security from Disasters etc Wood Fibre etc. MATERIAL MINIMA Adequate Livelihoods Shelter etc. Fuel, Food, Fibre etc. REGULATING SUPPORTING SOCIAL RELATIONS Climate Reg. Nutrient Cycling Social Cohesion Flood Reg. Soil Formation Mutual Respect Water Purif. Ability to Help others Primary Production FREEDOM OF CHOICE Opportunity to achieve what CULTURAL an individual values doing and being Aesthetic Spiritual HEALTH Educational Strength Cultural Feeling Well Access to Clean Air, Water, etc . Millennium Ecosystem Assessment 2005
DRIVERS TO HEALTH EFFECT VIA AN ECOSYSTEM SERVICES ROUTE ECOSYSTEMS ENRICHED Drivers DPSEEA (Reis, S. Morris, G et al , 2013 in press) Pressures Cultural POLICY Supporting Supporting Regulating and Ecosystem Services Provisioning ACTION Material Minima Experience Freedom of Choice Experience Social Relations Determinants of health and wellbeing Security Human Health And Wellbeing Social, economic & environmental etc. context
DRIVERS Insufficient investment in urban transport U Lack of transport planning Perceived status & convenience of car ownership R B ACTIONS PRESSURE (EXAMPLES) A • Emission of air pollutants & noise from transport Policies addressing vehicle numbers and N • Extensive, unplanned infrastructure growth emissions (technological & fiscal) • Old, polluting ,poorly maintained public transport Investment in cycle/walking infrastructure and greenspace provision and maintenance T STATE Improved urban & traffic planning • Bicycle & walking unfriendly environment R • Reduced greenspace area and quality and access Traffic-control measures • Ambient air pollution • Elevated background noise levels A Smog-alert measures • Severed dislocated communities • Surface water flooding Subsidies for zero-emission vehicles • Noisy homes N (n.b. Policies and actions to improve health and wellbeing may be targeted to EXPOSURE/EXPERIENCE S different stages on the pathways and/or • Inhalation of air pollutants to the context • Physical inactivity P • Exposure to noise • Dislocated communities • Population exposure to speeding vehicles O • Insecurity • Damaged social relations HEALTH & WELL-BEING • Reduced individual choice R • Mortality, morbidity related to physical CONTEXT inactivity, obesity and traffic accidents, toxic T Social, cultural, effects CVD, cancers, birth outcomes etc. behavioural, • Stress, sleep disturbance economic etc. • Reduced wellbeing
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