Building Health and Wellbeing on Ecological Principles

1. Building Health and Wellbeing on Ecological Principles George Morris 20th February 2013

2. What can we reasonably assert? • Any modern definition of health and the goals of public health must extend to wellbeing • Health and wellbeing invariably flow from societies to individuals, not the other way round • Creating the conditions for health wellbeing isaproject for all society

3. the state of the environment, and how it will change in the future, is intimately connected to our health and wellbeing • climate change, biodiversity loss, pollution, water issues and food security are already undermining health and wellbeing nationally and globally • in terms of "re-thinking" things as a society, we can no longer consider health, wellbeing and health services without thinking about the environment

4. For too long we have looked at these issues in our discipline and community silos (whether scientific, policy, professional or stakeholder). The result has been destruction of the environment, our health and our wellbeing, short and long term – the way forward has to be the ecological perspective

5. Making the case for an Ecological Perspective on WellbeingThe Principle of Transition

6. “A core notion within public health – however defined - is the notion of change ……and the actions of those seeking to improve public health and wellbeing will vary as circumstances and conditions dictate” Rayner & Lang (2012)

7. In joint interaction,Transitions - are the Drivers which create and continuously alter the ground on which population health and wellbeing must be built - are the Context which so often translates population level threats into risks for individuals and communities - determine the style of Intervention and the chances of success

8. Many Transitions are Key for Health and Wellbeing Epidemiological

9. Disease

10. Making the Case for an Ecological Perspective on WellbeingThe Environment in Health and Wellbeing

11. Policy and action on environment could be much more effectively exploited for better more equal health and wellbeing but only if we developed: • an enhanced capacity to navigate in complexity • a recognition in policy of the capacity of good environment to generate good health and wellbeing • A way to embrace a psychosocial dimension in the relationship between people and their surroundings

12. Prototype Phase 2008 -2011 • (Children’s Health and Environment) • Strongly supported by the • RERAD–Funded EDPHiS Project, • GPBH has produced useful learning • around navigating in complexity • notably around: • Evidence • The Science Policy Interface • Stakeholder Engagement Good Places Better Health http://www.scotland.gov.uk/Topics/Health/Healthy-Living/Good-Places-Better-Health/Approach/Methodology http://www.scotland.gov.uk/Topics/Health/Healthy-Living/Good-Places-Better-Health http://www.edphis.org/

13. It has been especially valuable in showing thethevalue of Conceptual Models in complex situations as: ‘Tools to think with’ ‘Tools to Unify’ ‘Tools to Communicate and Engage’

14. MODIFIED DPSEEA Drivers (Morris et al, 2006) Pressures Experience Experience State of the Environment POLICY and ACTION Supporting Exposure or Experience Experience Human Health And Wellbeing Social, economic & environmental etc. context

15. Making the Case for an Ecological Perspective on Wellbeing Planetary Crisis

16. A Safe Operating Space for Humanity: Planetary Boundaries Rockstrom et al (2009)

17. Applying an Ecological Perspective in PracticeDeveloping Ecological Public Health

18. “THE DYNAMICS OF ECOLOGICAL PUBLIC HEALTH” HUMAN HEALTH ECOSYSTEMS HEALTH Rayner and Lang (2012)

19. Why is Ecological Public Health Different? • EPH posits that human (social) ecology is inextricable linked to natural ecology and in dynamic interaction with it • Unlike previous expressions of the environmental contribution to health and wellbeing, environment is no longer an “out there” • EPH is a unifying concept on many levels Adapted from Rayner and Lang (2012)

20. Why is Ecological Public Health Different? • EHP reminds those who might think we can plunder, destroy and ignore environment that ecological forces underpin all life. • It does not retreat from complexity … there are no pump handles in this story! • EPH demands an integration of Environmental Impact Assessment and Health Impact Assessment Adapted from Rayner and Lang (2012)

21. Applying and Ecological Perspective in PracticeEcosystem Services and Human Wellbeing

23. Link to Wellbeing Through: Ecosystem Services HUMAN SECURITY Personal Safety Secure Resources etc. Security from Disasters etc PROVISIONING Food Freshwater Fuel Wood Fibre etc. MATERIAL MINIMA Adequate Livelihoods Shelter etc. Fuel, Food, Fibre etc. REGULATING Climate Reg. Flood Reg. Water Purif. SOCIAL RELATIONS Social Cohesion Mutual Respect Ability to Help others SUPPORTING Nutrient Cycling Soil Formation Primary Production FREEDOM OF CHOICE Opportunity to achieve what an individual values doing and being CULTURAL Aesthetic Spiritual Educational Cultural HEALTH Strength Feeling Well Access to Clean Air, Water, etc.

24. Applying and Ecological Perspective in PracticeTools To Think With

25. TWO PATHWAYS DRIVERS POLICY and ACTION Through our impact on the proximal environment Though our influence on ecosystems Human Health and Wellbeing

26. DRIVERS TO HEALTH EFFECT VIA THE PROXIMAL ROUTE Drivers MODIFIED DPSEEA (Morris et al, 2006) Pressures Experience Experience State of the Environment POLICY and ACTION Supporting Exposure or Experience Experience Human Health And Wellbeing Social, economic & environmental etc. context

27. DRIVERS TO HEALTH EFFECT VIA AN ECOSYSTEM SERVICES ROUTE Drivers ECOSYSTEMS ENRICHED DPSEEA (Reis, S. Morris, G et al, 2013 in press) Pressures POLICY and ACTION Cultural Supporting Supporting Regulating Ecosystem Services Provisioning Experience Material Minima Experience Freedom of Choice Determinants of health and wellbeing Social Relations Security Human Health And Wellbeing Social, economic & environmental etc. context

28. Applying and Ecological Perspective in Practice5 Pillars of Ecological Public Health

29. A Suggested Goal: A Society in which health, wellbeing, inclusiveness, equity etc. are pursued in a way which respects planetary boundaries and creates and protects a safe an operating space for humanity and the species with which we share the planet Synthesise a Mixed Economy of Evidence Carefully Consider Infrastructure Develop an Appropriate Ethical Framework Work to Optimise Governance Adopt Holistic Issue Framing Institutional Educational Physical Complexity Planetary Boundaries Ecosystem Services Interconnectivity etc Transparency Stakeholder Engagement Accountability etc Qualitative Quantitative Experimental Non-Experimental, Multiple Sources Sustainability Equity Environmental Justice Social Justice etc. 5 PILLARS OF ECOLOGICAL PUBLIC HEALTH

30. DARWIN’S ENTANGLED BANK The Entangled Bank