Ecological Public Health: A 21 st Century Imperative Delivering - - PowerPoint PPT Presentation

Ecological Public Health: A 21st Century Imperative

George Morris

European Centre for Environment and Human Health

Delivering Health Through the Environment

BELFAST Nov 2015

“While a new environmental conceptualisation

• f 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

Experience Experience Experience

Hazardous Environmental State Exposure Diminished Human Health

The “Classical” Environment-Health Interface

Wellbeing Physiology of Deprivation Environmental Health Inequalities Environmental Justice Stress Biology A Psychosocial Dimension Health Nurturing Environments SOCIAL COMPLEXITY

HAZARD EXPOSURE

DIMINISHED HEALTH

PRESSURES ON THE CLASSICAL EH MODEL

Wellbeing Physiology of Deprivation Environmental Health Inequalities Environmental Justice Stress Biology A Psychosocial Dimension Health Nurturing Environments

SOCIAL COMPLEXITY

HAZARD EXPOSURE

DIMINISHED HEALTH

PRESSURES ON THE CLASSICAL EH MODEL

Experience Experience Experience

Hazardous Environment State

• r

Environmental “Good” Exposure or Experience Modified Health and Wellbeing

Would this be an improvement?

Experience Experience

Drivers Pressures State of the Environment Exposure or Experience Human Health And Wellbeing

A further refinement?

Experience Experience

POLICY and ACTION

Drivers Pressures State of the Environment Exposure or Experience Human Health And Wellbeing

More policy relevant?

W HO (2004)

Experience Experience

POLICY and ACTION

Drivers

POLICY and ACTION

Pressures State of the Environment Exposure or Experience Human Health And Wellbeing

The modified DPSEEA Model

Social, economic & environmental etc. context (Morris et al, 2006)

“Essentially, all models are wrong, but some are useful"

George Edward Pelham Box FRS (1919 – 2013)

Good Places Better Health

“Good Places Better Health”, the Scottish Government’s strategic policy initiative on Environment and Human Health was built on issue framing using mDPSEEA

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

Rayner and Lang (2012)

http://www.routledge.com/books/details/9781844078325/

HUMAN HEALTH ECOSYSTEM HEALTH

THE DYNAMICS OF ECOLOGICAL PUBLIC HEALTH: A SIMPLE MODEL

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

• Provisioning services
• Regulating services
• Cultural services
• Supporting services

4 TYPES

SUPPORTING

Nutrient Cycling Soil Formation Primary Production

PROVISIONING

Food Freshwater Fuel Wood Fibre etc.

REGULATING

Climate Reg. Flood Reg. Water Purif.

CULTURAL

Aesthetic Spiritual Educational Cultural

Ecosystem Services are the Benefits Humans get from their Environment

Millennium Ecosystem Assessment 2005

Specifically through....

SOCIAL RELATIONS FREEDOM OF CHOICE Opportunity to achieve what an individual values doing and being HEALTH Access to Clean Air, Water, etc.

HUMAN WELLBEING

SUPPORTING

Nutrient Cycling Soil Formation Primary Production

PROVISIONING

Food Freshwater Fuel Wood Fibre etc.

REGULATING

Climate Reg. Flood Reg. Water Purif.

CULTURAL

Aesthetic Spiritual Educational Cultural

Ecosystem Services

Millennium Ecosystem Assessment 2005

Specifically through....

HUMAN SECURITY Personal Safety Secure Resources etc. Security from Disasters etc MATERIAL MINIMA Adequate Livelihoods Shelter etc. Fuel, Food, Fibre etc. SOCIAL RELATIONS Social Cohesion Mutual Respect Ability to Help others FREEDOM OF CHOICE Opportunity to achieve what an individual values doing and being HEALTH Strength Feeling Well Access to Clean Air, Water, etc.

DRIVERS TO HEALTH EFFECT VIA AN ECOSYSTEM SERVICES ROUTE

Pressures Ecosystem Services Regulating Provisioning Cultural Supporting Experience

Determinants of health and wellbeing

Supporting Drivers

POLICY and ACTION

Freedom of Choice Social Relations Security Material Minima

Experience

Social, economic & environmental etc. context

ECOSYSTEMS ENRICHED DPSEEA

(Reis, S. Morris, G et al, 2013 in press)

Human Health And Wellbeing

• Emission of air pollutants & noise from transport
• Extensive, unplanned infrastructure growth
• Old, polluting ,poorly maintained public transport

ACTIONS PRESSURE EXPOSURE/EXPERIENCE STATE DRIVERS HEALTH & WELL-BEING

• Bicycle & walking unfriendly environment
• Reduced greenspace area and quality and access
• Ambient air pollution
• Elevated background noise levels
• Severed dislocated communities
• Surface water flooding
• Noisy homes
• Inhalation of air pollutants
• Physical inactivity
• Exposure to noise
• Dislocated communities
• Population exposure to speeding vehicles
• Insecurity
• Damaged social relations
• Reduced individual choice
• Mortality, morbidity related to physical

inactivity, obesity and traffic accidents, toxic effects CVD, cancers, birth outcomes etc.

• Stress, sleep disturbance
• Reduced wellbeing

Insufficient investment in urban transport Lack of transport planning Perceived status & convenience of car ownership

CONTEXT

Social, cultural, behavioural, economic etc.

(EXAMPLES)

Policies addressing vehicle numbers and emissions (technological & fiscal) Investment in cycle/walking infrastructure and greenspace provision and maintenance Improved urban & traffic planning Traffic-control measures Smog-alert measures Subsidies for zero-emission vehicles (n.b. Policies and actions to improve health and wellbeing may be targeted to different stages on the pathways and/or to the context

U R B A N

T R A N S P O R T

ACTIONS PRESSURE EXPOSURE/EXPERIENCE STATE URBAN TRANSPORT DRIVERS HEALTH & WELL-BEING

• Emission of air pollutants & noise from transport
• Extensive, unplanned infrastructure growth
• Old, polluting ,poorly maintained public transport
• Bicycle & walking unfriendly environment
• Reduced greenspace area and quality and access
• Ambient air pollution
• Elevated background noise levels
• Severed dislocated communities
• Surface water flooding
• Noisy homes
• Inhalation of air pollutants
• Physical inactivity
• Exposure to noise
• Dislocated communities
• Population exposure to speeding vehicles
• Insecurity
• Damaged social relations
• Reduced individual choice
• Mortality, morbidity related to physical

inactivity, obesity and traffic accidents, toxic effects CVD, cancers, birth outcomes etc.

• Stress, sleep disturbance
• Reduced wellbeing
• Diminished mental and physical health
• Reduced wellbeing

EXPOSURE/EXPERIENCE PRESSURE STATE

Emission of GHGs and particulates from transport Damaged planetary ecosystems result in climate-related (and other) environmental change impacting on Supporting, Provisioning, Regulatory and Cultural “ecosystem services” for the local population. Local population experience reduced material benefits, damaged social relations, and security Policies addressing vehicle numbers and emissions (technological & fiscal) Investment in cycle/walking infrastructure and greenspace provision and maintenance Improved urban & traffic planning Traffic-control measures Smog-alert measures Subsidies for zero-emission vehicles (n.b. Policies and actions to improve health and wellbeing may be targeted to different stages on the pathways and/or to the context n.b. Global economic social and ecosystem connectivity means the distal pathway can impact on the proximal pathway in health relevant ways and vice versa

Insufficient investment in urban transport Lack of transport planning Perceived status & convenience of car ownership

Social, economic, behavioural etc..

CONTEXT

Social, economic, behavioural etc..

CONTEXT

(EXAMPLES)

GOVERNANCE INFRASTRUCTURE

HOLISTIC ISSUE FRAMING

ETHICS EVIDENCE

Morris, Racioppi, Matic, Martuzzi (in preparation)

HUMAN HEALTH ECOSYSTEM HEALTH

REFLECTIONS/CONCLUSIONS

• We urgently need to pursue health and wellbeing on

ecological principles

• We need to think about both the proximal and distal

pathways

• The models I have exposed you to are not “the truth”

(or the only choice) but they are versatile tools to think with, to engage stakeholders, to communicate.

• Many of our most challenging environmental and

health issues today embody proximal and distal dimensions.

Reis S, Morris G, Fleming LE, et al. Integrating Health & Environmental Impact

• Analysis. Public Health. 2013. doi:10.1016/j.puhe.2013.07.006.

Morris GP, Reis S, Beck S, Fleming LE, Adger WN, Benton TG, Depledge MH Climate Change and Health in the UK: Scoping and communicating and scoping longer term “distal” dimensions (anticipated October 2015) European Environment Agency (2015) A Europe to thrive in – environment, health and well-being Foresighted Reasoning on Environmental Stressors and Health (FRESH) www.eea.europa.eu/ehwb

References/Acknowledgements

Thanks are due to my fellow authors but also to WHO Europe in Bonn and Copenhagen especially Srdan Matic, Francesca Racioppi, Marco Martuzzi, Bettina Menne and Francesca Racioppi whose support and ideas in conversation have been influential in shaping elements of this work. Morris GP, Beck SA, Hanlon P, et al. Getting strategic about the environment and health. Public Health. 2006;120:889–907. Morris GP, (2010) Ecological public health and climate change policy. Perspectives in Public Health.130 No1 34-40