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Ecosystem Health Restoring the Health in Health Care Healing the Planet - PGS. John Howard MD, FRCPC Professor of Paediatrics and Medicine Schulich School of Medicine University of Western Ontario Chair, Canadian Association of Physicians For the Environment. Objectives.
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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
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
What does Ecosystem Health mean to me? The UWO Definition How can it form the basis for medical education and for health care?
The Evolution of the Doctor-Patient relationship 1) Traditional Medical Model 2) Patient-Centered Model 3) Ecosystem Health Model
Traditional Medical ModelWhere we were Patient • What is the disease? • How do I fix it? HEALTH Disease
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
Ecosystem Health • The health of the “context” and the interaction of the “context” with human health - the physical, social, economic and political environment
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
Ecosystem Health - Mission • To train professionals to work with other professions to create a healthier world. • Transdisciplinary thinking
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
So what? Does it make one think any differently? Some thoughts about health, health care and the practice of medicine in Canada
Spiritual Moral Environmental Social Nutritional Community Health Physical Mental Personal Health Economic Political Societal Health Ecosystem Health
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
$150B$/yr for 15 years would provide safe water and effective sanitation to every person in the world - UNEP Bailout US $833B EEC $2,000B
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
A Modest Proposal: Alternative Security Security is better achieved by trying to establish equityrather than dominating
EH Health Care System? 3-4 kilometers per litreWilderness Capabilities
Let’s describe Health in its widest sense: include moral health and spiritual health!! Is our society’s attitude to the environment morally healthy?
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
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
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??
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
37%/5years 7.4%/year
Land, Air, Water!! Sickness Health is considered separately
2016 Where are we going? 2010 % of Provincial Budget Year 2044 = 100%
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
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
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
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
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!
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
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
Things can be done • Smoking – a once-attractive pastime • Automobile take-back • So much potential • we can be/are opinion leaders
EH Health Care Institution? Advocate health 3-4 kilometers per litreWilderness Capabilities
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
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
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
The Need The Desire
Learning • Knowledge • Skills • Attitudes (perspectives)
Learning in University • Knowledge • Skills • Attitudes (perspectives)
Global/Ecosystem Health Learning • Knowledge • Skills • Attitudes (perspectives)