Ecosystem Health Restoring the Health in Health Care Healing the Planet - PGS

1. Ecosystem Health Restoring the Health in Health Care Healing the Planet - PGS John Howard MD, FRCPC Professor of Paediatrics and MedicineSchulich School of MedicineUniversity of Western Ontario Chair, Canadian Association of Physicians For the Environment

2. Objectives • To define Ecosystem Health from a health care perspective • To look at some of our societal beliefs from “outside the box” • To look how the health of the environment is being eclipsed by “individual human health” • Describe an Ecosystem Health model for Ontario, and elsewhere

3. What is Ecosystem Health??

4. What does Ecosystem Health mean to me? The UWO Definition How can it form the basis for medical education and for health care?

5. The Evolution of the Doctor-Patient relationship 1) Traditional Medical Model 2) Patient-Centered Model 3) Ecosystem Health Model

6. Traditional Medical ModelWhere we were Patient • What is the disease? • How do I fix it? HEALTH Disease

7. Patient-Centered Modelwhere we are trying to be • What is the disease? • How do I fix it? • What is my patient's unique illness?? • How do I help my patient? Patient HEALTH Illness Disease Context

8. Ecosystem Health • The health of the “context” and the interaction of the “context” with human health - the physical, social, economic and political environment

9. Ecosystem Health ModelWhere we want to go • What is the disease? • How do I fix it? • What is my patient's unique illness?? • How do I help my patient? • Why is this patient here? • What can I do to prevent others from having the same illness? Patient HEALTH Illness Disease Home Community Region World

10. Ecosystem Health - Mission • To train professionals to work with other professions to create a healthier world. • Transdisciplinary thinking

11. Ecosystem Health Model • What is the problem? • How do I fix it? • What are the unique cultural needs? • How do I meet those needs? • Why did this problem occur? • What can I do to prevent similar problems Patient HEALTH Illness Disease Home Community Something we care about Region World

12. So what? Does it make one think any differently? Some thoughts about health, health care and the practice of medicine in Canada

13. What is Health?

14. Spiritual Moral Environmental Social Nutritional Community Health Physical Mental Personal Health Economic Political Societal Health Ecosystem Health

15. Spiritual Health - Aboriginal The Earth is our Mother, the female giver of Life to all her children, some of whom are human beings. Decisions must respect 7 generations of our ancestors and 7 generations of our children to come

16. Moral Health?

17. $150B$/yr for 15 years would provide safe water and effective sanitation to every person in the world - UNEP Bailout US $833B EEC $2,000B

18. Cost of global human need programs Annual cost in billion dollars Percent of current military spending Provide safe clean water 50 6.4 Retire developing nation’s debt 30 3.8 Provide shelter 21 2.7 Eliminate starvation and malnourishment 19 2.4 Provide health care 15 1.9 Stabilize population 10.5 1.3 Eliminate illiteracy 5 0.6 TOTAL 150.5 19.1 Moral Health

19. A Modest Proposal: Alternative Security Security is better achieved by trying to establish equityrather than dominating

21. EH Health Care System? 3-4 kilometers per litreWilderness Capabilities

22. Let’s describe Health in its widest sense: include moral health and spiritual health!! Is our society’s attitude to the environment morally healthy?

23. Revelations • Many/all diseases have a significant Ecosystem Health component • We need to put less money in sickness care • Uncertainty is more important than certainty • Bigger is better! • Things can be done! • Accountability should be replaced by responsibility

24. Revelations • Many/all diseases have an ecosystem health component? • We need to put less money in sickness care • Uncertainty is more important than certainty • Bigger is better! • Things can be done! • Accountability should be replaced by responsibility

25. Crohn’s Disease

27. Immunologic disruptors?? Other Diseases • Rheumatoid Arthritis – 2% of the population • Asthma – 30% of SW Ontario children on puffers at some point in their lives • Diabetes – massive increase in Type II Diabetes Mellitus • 1997 – 5.8% of US population diagnosed Is it the environment??

28. Revelations • Many/all diseases have a significant Ecosystem Health component • We need to put less money in sickness care! • Uncertainty is more important than certainty • Bigger is better! • Things can be done! • Accountability should be replaced by responsibility

30. 37%/5years 7.4%/year

31. Land, Air, Water!! Sickness Health is considered separately

32. 2016 Where are we going? 2010 % of Provincial Budget Year 2044 = 100%

33. Health Care • NOT a determinant of health • “The majority of the health care dollar is spent in the last 6 months of one’s life” - 1993 • Average health expenditures on people who are in their last year of life is between 50 and 100 times more than expenditures on those who are not. - Health Canada-2005

34. Revelations • Many/all diseases have a significant Ecosystem Health component • We need to put less money in sickness care • Uncertainty is more important than certainty • Bigger is better! • Things can be done! • Accountability should be replaced by responsibility

35. Uncertaintynot part of our vocabulary • Obsession with certainty • Double blind trials, critical appraisal • Evidenced based medicine • The present scientific method is about reductionism • Inclusion, exclusion criteria, controls

36. Uncertainty - not part of our vocabulary • EH - Can’t find appropriate controls, system has many interactions, etc. • Don’t study it • Absence of data implies no effect • Complexity ≡ Uncertainty • Complexity ≠ Complicated

37. Which is the More Important Question? • Have pesticides used on land been proven to lead to illness in humans? • Might pesticides cause illness in humans? Or both!

38. Revelations • Many/all diseases have a significant Ecosystem Health component • We need to put less money in sickness care • Uncertainty is more important than certainty • Bigger is better! • Things can be done! • Accountability should be replaced by responsibility

39. Systems ThinkingThe Perspective for the 21st Century

40. Need to study big issues!!

41. Revelations • Many/all diseases have a significant Ecosystem Health component • We need to put less money in sickness care • Uncertainty is more important than certainty • Bigger is better! • Things can be done! • Accountability should be replaced by responsibility

42. Things can be done • Smoking – a once-attractive pastime • Automobile take-back • So much potential • we can be/are opinion leaders

43. EH Health Care Institution? Advocate health 3-4 kilometers per litreWilderness Capabilities

44. Revelations • Many/all diseases have a significant Ecosystem Health component • We need to put less money in sickness care • Uncertainty is more important than certainty • Bigger is better! • Things can be done! • Accountability should be replaced by responsibility

45. Accountability • Meet minimal standards • Health care: • Single use instruments • Insurance issues, legal departments • Much $$ spent on non-medical issues • Limits boundaries • One-way accountability • Focus on practices

46. Responsibility • Striving for excellence • Health Care-responsible for health • Health in its greatest sense • Single use recyclable /Multiple use • Decisions to improve health • Bidirectional • Public has a responsibility – behaviour, resources • Focus on Values

47. The Need The Desire

48. Learning • Knowledge • Skills • Attitudes (perspectives)

49. Learning in University • Knowledge • Skills • Attitudes (perspectives)

50. Global/Ecosystem Health Learning • Knowledge • Skills • Attitudes (perspectives)