The Environment in Public Health:

1. The Environment in Public Health: Rethinking the Public health project on Ecological Principles George Morris 26th February, 2014

2. “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)

3. THE REALITY OF TRANSITION Environment Epidemiological

4. Unsurprisingly these transitions have profound implications for what how we (society) intervene to secure population health

5. One way of looking at this is to think that at any one time there is usually a shared view (or paradigm) concerning how health is created and destroyed. • The dominant paradigm : • defines the era • informs the analytical approach • shapes public health policy and action It also dictates how we see the role of the environment in public health

6. ERA OF SANITARY STATISTICS (1800 – 1850) ” n.b. An “Environmental Conceptualisation” of Public Health After Susser & Susser (1996)

7. ERA OF INFECTIOUS DISEASE EPIDEMIOLOGY (Initially) affirmed the key role of the environment in public health n.b. An “Environmental Conceptualisation” of Public Health After Susser & Susser(1996)

8. ERA OF CHRONIC DISEASE EPIDEMIOLOGY (1950 – date) Reinforced an Increasingly Narrow, Hazard-Focussed and Compartmentalised view of Environment in Public Health n.b. An “Environmental Conceptualisation” of Public Health

9. This was by no means the only public health narrative going on in the post war era. The other was about an individualisation of health status

10. However, despite the persuasive arguments, in the late 20th Century era of Chronic Disease Epidemiology, there was seemingly… Black Box There was ‘NO PLACE FOR PLACE!’

11. A refreshing challenge to a post WW2 orthodoxy!

12. THE LALONDE FRAMEWORK THE HEALTH FIELDS Human Biology Environment HEALTH Health Care Organisation Lifestyle “A New Perspective on The Health of Canadians” Marc Lalonde, Canadian Minister of Health and Welfare (1974)

13. The paradigm which has defined the public health era for perhaps 30 years now has been: “EVERYTHING MATTERS” Environmental Health found it difficult to gain traction on this agenda.

14. THE PROBLEM? • The discipline was perceived as having become “old fashioned”. In its outlook It was: • Narrow • Hazard Focused • Compartmentalised

15. Environmental health appeared scarcely relevant to many of the key challenges facing public health, e.g. challenges such as • Obesity • Diminished mental health and wellbeing • Early onset non communicable diseases • Inequalities in health

16. However there here have also been some useful and policy relevant developments in Environmental health Scientifically and ConceptuallyScotland has played an important role in each

17. SCIENTIFICALLY?

18. CONCEPTUALLY

19. The “Classical” Environment: Health Interface Hazardous Environmental State Exposure Diminished Human Health

20. A more realistic representation? Hazardous Environment State or Environmental “Good” Exposure or Experience Supporting Modified Health andWellbeing

21. More realistic and policy relevant? Drivers Pressures Supporting State of the Environment Exposure or Experience Human Health and Wellbeing

22. The DPSEEA Model Drivers Pressures POLICY and ACTION State of the Environment Exposure or Experience Human Health and Wellbeing WHO (2004)

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

24. “Essentially, all models are wrong, but some are useful" George Edward Pelham Box FRS (1919 – 2013)

25. However there is a new challenge which means that even the much more sophisticated public health response which is being developed is unequal to the challenge........It is an “ECOLOGICAL TRANSITION” and it presents mankind with its greatest 21st challenge

26. Some Simple Metrics

27. Earth Overshoot Day Earth Overshoot Day, a concept originally developed by Global Footprint Network partner and U.K. think tank, the New Economics Foundation, is the annual marker of when we begin living beyond our means in a given year.

28. In 2013 Earth Overshoot Day - approximate date human resource demands exceed nature's budget—fell on August 20. Two days earlier than last year. In fact, since 2001, Overshoot Day has moved ahead by an average of 3 days per year Source: Global Footprint Network 2013 http://www.footprintnetwork.org/en/index.php/gfn/page/earth_overshoot_day/

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

30. THE NEW PUBLIC HEALTH CHALLENGE IS ONE OF BUILDING HUMAN HEALTH AND WELLBEING ON ECOLOGICAL PRINCIPLES • The current 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 • We must re-think things as a society - we can no longer consider health, wellbeing and health services without thinking about the environment

31. SUPPORT IS GROWING FOR A NEW ENVIRONMENTAL CONCEPTUALISATION OF PUBLIC HEALTH “ECOLOGICAL PUBLIC HEALTH”

32. 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)

33. 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)

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

35. “While a new environmental conceptualisation of public health, what we call….Ecological Public Health, may seem a difficult and complex task, that is now the twenty-first century’s unavoidable task” Rayner and Lang (2012)

36. EXPLOITING ECOSYSTEMS SERVICES TO OPERATIONALISE ECOLOGICAL PUBLIC HEALTH

37. Ecosystem Services in Context The Millennium Ecosystem Assessment (MEA) established 4 types of service: • Provisioning • Regulating • Cultural • Supporting The UK National Ecosystem Services Assessment (UK NEA) took these into account in developing a framework for valuing the changes.

38. 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.

39. TWO PATHWAYS DRIVERS POLICY and ACTION Through our impact on the proximal environment Though human influence on ecosystems Human Health and Wellbeing Morris et al (in press) 2014

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

41. THREE CLOSING THOUGHTS!

42. Message No1 We must never lose our capacity to think of health and disease as characteristics of populations

43. Message No 2 Ecological Public Health is an” Environmental Conceptualisation” of Public Health

44. Message No 3 Understand and Embrace Darwin’s Entangled Bank