Health as Ecological
written by Elahi Hossain, Sarah Aliko, Araceli Camargo
2022
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We are currently living through a health inequity crisis, driven by factors such as long-term socio-economic inequity, extreme weather events, biodiversity loss, and Covid-19.
If these factors are not addressed, the health crisis will only become more acute. Epidemiologists have for many decades framed and understood health as an ecological phenomena. Meaning health is a complex process involving not only the individual, but also their social interactions, other species and the external environment. It is based on a constant communication between Nature and the body, whereby we integrate in a specific ecosystem and both make use and give back to it.
However, this framing is not implemented into many of our health organisations or policies. For example, a recent National Health Service (NHS) advertisement, shows a Black woman eating a salad as a solution for obesity. This negates the complexity of the disease which is a dysregulation of various biological systems with links to childhood trauma, exposure to air pollution (AP), malnutrition, and even light pollution. Framing obesity only as a set of behavioural choices is not only inaccurate, it prevents people from accessing a comprehensive healing strategy, fuelling further health problems and inequities.
Introduction
A BRIEF HISTORY
There is a need to understand the history behind framing health as individual choices or behaviours to better appreciate why an ecological health approach looks like and its significance in eradicating health inequities.
Early Christianity saw disease and illness as divine punishment, believing it could only be alleviated through repentance and prayer. This belief discouraged the use of Nature, such as medicinal plants for healing (source). This belief set part of the course of individualising disease and disconnecting disease (and healing) from the places we inhabit.
Moving along to the age of the science method, rooted in Greek and Cartersian philosophy of mind and body dualism. Health was severed from its metaphysical and spiritual aspects and instead, focus was placed on bodily biological factors. This came to be known as the ‘biomedical model of health’, which emphasised a ‘bottom-up’ reductionist and mechanistic view of health, where health was seen merely as the absence of disease (Tamm, 1993) (Rocca & Ajum, 2020).
The reductionist approach of the biomedical model of health, whilst having utility in the medical domain, provided a scientific basis for discourse of so-called ‘degeneracy’, the idea that differences in health and societal outcomes across a population could be solely attributed and explained by biologically-based inheritable mechanisms. This spurred obscene solutions of racial and societal cleansing, made popular for example by the Eugenics movement in Britain and the Nazi regime (Nye, 1993).
Today, parts of this framing are still evident, we only have to look at how racialised Black communities were seen as inherently being more vulnerable to Covid-19 due to genetics rather than the consequences of their racialisation (source).
The biomedical model of health failed to adequately account for wider causal psychological, and environmental factors and so there were calls to expand upon the biomedical model of health by acknowledging ‘top-down’ factors that also contribute to health and disease.
This has come to be known as the biopsychosocial model of health, which emphasises an interplay between biological, psychological and socio-cultural factors in determining health and disease. Biological factors themselves are seen as necessary but not sufficient cause of disease, and so ‘top-down’ psychological, behavioural and socio-cultural factors must be be taken into account, where an individual's health is a psychophysical phenomenon that is socially situated (Engel, 1977; Tretter & Löffler-Stastka, 2019).
This conception of health aligns with the WHO’s definition where “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” (World Health Organisation, 2020).
The biopsychosocial model of health was built upon by new ecological models of health, that emphasised the complex relationships between wider ecological factors (e.g. biodiversity, pollutant exposure, socio-economic issues) and the individuals lived experience in contributing to health and disease. Ecological models of health, similar to Indigenous models, situates health as a balanced interplay between Nature and individual with emphasis on human health acting reciprocally with planetary health (source 1, source 2, source 3)
This model of health aligns with Indigenous concepts of health, such as of the Aboriginal and Torres Strait-Islanders, which conceptualise health as not only an individual-level phenomenon but one that extends to the wider community. With this view, a person's health and wellbeing is deeply connected to the community's physical land, and social, emotional, and cultural functioning across the lifetime (source). Dr. Camacho, a Quechua midwife, medical doctor, and scholar says that healing is in the soil, we heal the soil, we heal the people (source). Centric Lab takes a similar ecological approach to health that acknowledges the dynamic interplay between external antecedents and internal biological systems - defined as “the ability for our biological systems to enter stability after experiencing trauma or stress throughout our entire lifetime, to give us all an equal opportunity to realise our full potential.” (Centric Lab, n.d.).
The Biological Mechanics of Ecological Health
Taking an ecological approach to health necessitates the idea that the state of health is the result of a constant negotiation between the human and their environment.
One way this negotiation is embodied is through a process known as ‘allostasis’ (AL) - which refers to a process of “achieving stability through change” (source) to adapt to environmental demands and maintain biological equilibrium. Allostasis encompasses many physiological, cognitive and behavioural regulatory processes in animals and plants (source).
Allostasis is part of the human stress-response which involves regulatory systems such as the neuroendocrine (hypothalamic-pituitary-axis / HPA-Axis), autonomic (sympathetic nervous), metabolic and immune systems. If an individual is constantly exposed to new environmental demands, unable to adapt to a stressor, or adequately respond, they will experience wear and tear of these systems through what is known as ‘allostatic load’. If this continues, allostatic load eventually results in ‘allostatic overload’ manifesting as disease and death (source, source2).
Although our bodies are designed to adapt to and regulate threats, these must be within the parameters of natural origin and natural biological time. For example, we are able to adapt to thermal changes in real-time if the increase is gradual and in time with our biological systems, if not we can suffer heat stroke. Or in the context of evolutionary time, the Inuit, for example, have adapted to extreme cold through generational genetic changes (source). However, genetics is not the only way that we learn to adapt, we also use cognition, in the case of the Inuit, they have also adapted through creating habitat specific housing, clothing, diet, technologies, tools, and culture (source).
In contrast, we are now living in an era where environmental demands are increasingly rising in both concentration and composition and can be attributed predominantly to anthropological industrial causes. Demands such as air pollution have increased globally in both concentration and diversity of particulates that go beyond our biological capacity, preventing effective adaptation by both plants and animals (source1). Similar trajectories have been shown for global temperatures which are doubling in rates since the 1980’s (source), global light pollution has increased between 270 to 400% (source), and noise pollution, which has been shown in a recent report by the European Environment Agency to affect 20% of EU citizens, who are exposed to noise levels that are harmful to health. This number is expected to increase as urbanisation and mobility demands rise (EEA, 2020).
When these ubiquitous changes in the environment are paired with psychological stressors such as the experience of poverty our biological systems can become dysregulated through a process called allostatic overload (source). There is now substantial research that links allostatic overload to various diseases such diabetes, depression, PTSD, and obesity (source).
Microbiome and Biodiversity Dysregulation
It is not only humans that are having difficulty adapting to environmental changes. Pollution, nutrient deficiency in the microbiome soil, temperature changes, drought, flooding, light pollution, radiation, and other contaminants can change the balance between production and scavenging of reactive oxygen species and induce a phenomenon known as oxidative stress, which in turn can damage cells, putting plants at risk for disease and death (source).
In the UK alone, over 15% of species are at threat of extinction due to urbanisation and pollution, even in rural areas (source). Biodiversity of the land is vital for human health. One relationship that exists between the outside world and health is that planetary biodiversity supports diversity of the human gut microbiome/biota, which in turn promotes proper immune functioning (source).
Research shows that up to 11-12% of human gut microbiome diversity depletion can be explained by levels of air pollution (O3 in particular), highlighting how detrimental these chemicals are for our health and of the negative interaction between environmental demands and resources - where higher levels of environmental demands cause a decrease in health-supporting resources (source).
The decrease in healthy species externally, and increases in air pollution, negatively affects the biodiversity and health of our internal gut microbiome, making us more susceptible to disease via increased inflammatory responses. Our bodies are dependent on the mutualistic symbiotic relationship with the gut bacteria, destroying its biodiversity means putting our bodies at further risk and forcing our immune response to be constantly engaged against a threat that it cannot combat. This state of constant inflammation and the energy required to maintain it, leave our bodies more susceptible to disease (both viruses, bacteria and NCD) (source).
Studies on non-communicable diseases and microbiome, have shown that as a direct result of AP exposure, our microbiome diversity and health is destroyed, leading to higher levels of inflammation and increased NCDs such as obesity and diabetes (source). The gut microbiome is particularly malleable during prenatal development and early life, which means reduced ecological support early on can have negative future health consequences (source).
Ethics and Theory of Adaptation
Due to Nature's incredible ability to adapt, there can be an inclination to think that people and biodiversity will continue its adaptation process in the face of pollution and contamination.
For example studies suggesting that anthropogenic changes to environments (eg. air pollution) induce natural selection and drive adaptation of new species (source). Although under the guise of ecological studies, these theories are dangerous in terms of ecology because they imply that humans and other organisms should be able to adapt to toxic environments such as air pollution. However, we have to contemplate two things. Is it ethical for industrial anthropogenic factors to drive the natural world to this level of stress and death (adaptation at this rate would mean even more loss)? Secondly, is this the world that we want to leave for future generations, especially, as we’ve had the privilege of experiencing such an abundant world?
Ecological Health as Health Justice
The ecological framing of health provides an opportunity for a health justice argument. As our health is so intrinsically tied to the places we live, then it should be a human right to live without contamination and pollution. Furthermore, since there is no place on Earth that has not been touched by industrial anthropogenic destruction, should the companies responsible not be held accountable for our poor health outcomes?
We can no longer blame people for their poor health or frame it as “genetic bad luck”, instead the structural and systemic pollution and contamination of our planet needs to be recognised as the core cause of our poor health.
"Water is not only a question of hygiene but it is part of our beingness"
- Amit Singh
Amit is a medical student and climate justice advocate, he is also part of the Punjabi community. All of these factors contribute to how he frames health, healing, and justice. We sat down with him for a long conversation on ecological health, we cover the Indian Farmers protest, the role of love in healing, and the sacred nature of water.