Social and Cultural Perspectives on Ecosystem Health Research Paper

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Introduction: Ecosystem Health

Ecological thinking provides a way to understand the environment and the place of humans and human health within a given environment. The ecosystem approach uses ecological thinking to explore the interconnections between the health of environments and human health with the aim of finding ways of optimizing both. This perspective defines health as a key criterion of human sustainability. An ecosystem health approach also addresses the effects of global change on both ecosystem sustainability and human health. Initially, researchers viewed the health of ecosystems as a precondition of human health. More recently, investigators have focused on how environmental, social, and economic factors interrelate to influence ecosystem and human health.

Historical Perspectives Of Human And Ecosystem Health

The link between public health and the broad environment within which people live is an enduring subject of inquiry. Hippocrates (ca. 400 BC) first examined the relationship between the climate and biophysical features of a region, cultural values, the occupations, and the distinctive health profile of its human inhabitants. He observed:

Whoever wishes to investigate medicine properly, should proceed thus: in the first place to consider the seasons of the year .. . then the winds … the quality of the waters. In the same manner, when one comes into a city to which he is a stranger, he ought to consider its situation, how it lies to the winds and the rising of the sun …

From these things he must proceed to investigate everything else. For if one knows all these things well … he cannot miss knowing … either the diseases peculiar to the place, or the particular nature of common diseases, so that he will be in no doubt as to the treatment of the diseases. (Lloyd, 1978: 148)

Hippocrates also suggested that health examinations consider the cultural mores of the inhabitants of a particular region. We can therefore suggest a second Hippocratic oath: health professionals need to examine the complex relationships between the elements of the total environment of the patient (individual or population) to evaluate health. Health was an important metaconcept in the ancient world and it still has the advantage of being widely used in public discourse to describe the well-being of individuals, families, and communities. Health is therefore a concept that is easily understood in nonscientific circles when extended to systems at different levels, ranging from human organs, to society as a whole, and even the planet Earth itself.

In Europe, the importance of the built environment as a factor affecting human health was made abundantly clear during the Industrial Revolution (1780–1850). The impact of rapid industrialization with its attendant air and water pollution was noted by physicians and social observers as a major challenge to public health. In what has become known as the Sanitation Movement, pioneers in public health policy and practice, such as Edwin Chadwick in 1842, pointed out the direct relationship between poverty, the degradation of urban environments, and the decline in public health. Chadwick’s solution was to enable people to once again access fresh air, clean water, and sunlight. In addition, a task of the Sanitation Movement was to clean up the urban environment and return organic ‘matter,’ such as sewage, back to the countryside to contribute to ‘nature’s balance.’

Even before there was a clear understanding of the existence of disease-causing microorganisms such as bacteria and viruses, mid-nineteenth-century physicians like John Snow considered water polluted by human sewage to be a primary cause of cholera and other infectious diseases. Occupational health and medicine, as a discipline, emerged from the early recognition that some workplaces are implicated in worker sickness and death associated with toxic substances used in agricultural or industrial processes. The famous example of ‘phossy jaw,’ painful inflammation of the face and jaw caused by excessive exposure to white phosphorous by workers in match factories, dramatically highlighted the connections between the work environment and human health. (White phosphorous-based bombs continue to be used in modern warfare affecting thousands of noncombatants).

Evolution And Ecology As Revolutionary Ways Of Knowing

The culturally acquired tendency to see the environment as something ‘out there’ and human culture as comfortably isolated from ecological reality is a manifestation of fundamentally dualist thought identified and analyzed by Western philosophers. Western ideas about the environment also have their origins in religious beliefs that see humans as somehow special and separate from the rest of creation. This hubris has been supported by scientism and technocentrism promoting the idea that humans do not need ecology to be sustainable and that human ingenuity and invention can always substitute for the ‘services’ provided by ecosystems. For example, while humans can produce potable water from seawater at great expense in capital and energy, no substitute for the hydrological cycle has yet been forthcoming from science.

The application of ecological thinking revolutionizes the way Western societies and Western science conceptualize humans and the environment. Under the twin influence of the sciences of evolution (the longitudinal study of change in life forms by way of the process of natural selection) and ecology (the study of the spatial interconnections between living and nonliving components of the biosphere), other forms of scientific knowledge have engaged with the ancient but foundational understanding that ‘all things are interconnected’; an understanding that underpins the worldviews of many indigenous peoples. The older Newtonian mechanistic paradigm of simple cause and effect leading to predictable outcomes in all areas of science, including biomedical science, was challenged by eco-evolutionary approaches to the understanding of issues connected to life and living systems. The shift from a mechanistic to an organic process philosophy has been facilitated by the global reach of human impact on the biosphere and the emergence of diseases (e.g., mad cow disease) that defy analysis in terms of traditional, reductionist science. The influence of culture – particularly a globalized, industrial, and technological one – on ecosystems and, in turn, human health, is now a prominent area of inquiry in the health and social sciences. The incorporation of culture and ecology promotes new biomedical understandings of personal and public health that are multilayered, dynamic, and complex.

The New Environmental Health

Aldo Leopold, the twentieth-century American environmental philosopher, was one of the first to see the importance of the health of ecosystems to the health of humans. In the posthumously published A Sand County Almanac (1949), he drew attention to the problem of ‘land sickness’ and how such sickness can contribute to economic and cultural collapse of human agricultural systems. Leopold even spoke of the need for a new science of land health, lamenting that in the American West there was ‘‘as yet, no sense of shame in the proprietorship of a sick landscape’’ (Leopold, 1949: 158).

It was not until the early 1960s, with publications from environmental health pioneers such as Rachael Carson’s Silent Spring (1962) and Murray Bookchin’s Our Synthetic Environment (1962) that clear connections were made between the threat posed by toxic chemicals, ecosystem health, and human health. Carson’s work fostered a sense of shame about the possibility that humans could, with toxic pesticides such as DDT, literally render a spring without birds. Carson argued that full knowledge of the cumulative impacts of organic pollutants was needed if humans were to fulfill their ‘obligation to endure’ on this planet. This statement marks one of the earliest observations about what is now referred to as sustainability. With knowledge of the cumulative impacts of persistent pollutants and the idea of bioaccumulation through food chains or pyramids, new ideas about the relationship between ecosystem health and human health began to emerge. Carson argued that ecological relationships do not only operate outside of the human body. The ‘ecology of the world’ also operates within the body where ‘minute causes produce mighty effects.’ In many non-Western worldviews, this interdependency of macrocosm (the whole of existence) and microcosm (the human body) is a well-developed system of thought.

Carson’s new environmental health had to deal with the fact that hazards new to life and evolutionary processes, such as synthetic pesticides, had been introduced by human agency. Critically, the full effects of these pesticides might not be known until sometime in the future. The impact of the bioaccumulation of toxins through the food chain has proven to be even more pervasive than Carson ever envisaged. The indigenous people of Greenland and the Inuit of northern Canada have the highest concentrations of the toxic element mercury in their bodies, yet they are the humans most distant from the industrial sources of this element. The bodies of beluga and killer whales, also at the top of the food chain in the Arctic and sub-Arctic regions of the Northern Hemisphere, have such high levels of persistent pollutants that their dead bodies are declared toxic waste under the U.S. Environmental Protection Agency (EPA) standards.

Carson’s pioneering work established three important concepts for examining the relationship between ecosystem and human health:

Minute causes can produce mighty effects;
Immediate causes can produce effects in the future;
Immediate causes can produce spatially distant effects

(Carson, 1962).

Support for the ecological study of interconnections also emerged from complexity theory in the late twentieth and early twenty-first centuries. One of the foundations of complexity theory lies in the laws of thermodynamics. The first law states that the energy of the universe is constant, and the second law states that any system (open or closed) left to itself will tend spontaneously to a state of maximum possible disorder (entropy) – that is, the state of thermal equilibrium. The operation of both laws makes it seem highly improbable that anything as interesting as life and living systems could ever have emerged.

However, although complexity theory has given some emphasis to the chaotic, unpredictable elements of life, it promotes the idea that patterns of order can flow from seemingly chaotic or random events (perturbations). The idea, that as complex systems dissipate energy they spontaneously create order and complexity, has been used to help explain emergent complexity domains as diverse as life, ecosystems, the weather, and stock market fluctuations. A fundamental insight is that new forms of complexity are achieved and maintained over time through the spontaneous self-organization of dynamic systems. Some of the key features of complex systems and complexity are:

Order arises from fluctuations or perturbations within a system.
The interaction of local and global levels of complex systems determines their properties.
Local interaction can produce global order, and global order can affect local behavior.
Interactive causal relationships exist within and between entities and are at their richest at the tipping point between order and disorder.
Complex adaptive systems can form patterns and follow predictable paths of development.
The identification of attractors or states to which a system finally settles, is one clue as to why certain patterns (order) and not others are created.
Complex systems can self-organize and evolve toward states of increased complexity. They are able to do this only if there is a pathway to a suitable sink for the waste (entropy) produced to be dissipated (Higginbotham et al., 2001).

Complexity theory suggests a resolution of the apparent contradiction of the laws of thermodynamics and life. Building the complexity and diversity of life challenges entropy at the local level; however, entropy will always increase globally while a gradient for material flows is available for waste assimilation. The availability of waste sinks is crucial for the health of systems from local to global levels. The old saying, ‘Don’t foul your own nest’ is based on this thermodynamic insight at a local level. Relatively new concerns about the limits of the atmosphere as a waste sink for the carbon dioxide produced by burning fossil fuels express it at a global level. It is worth noting that Barry Commoner’s (1971) famous second (‘Everything must go somewhere’) and fourth (‘There is no such thing as a free lunch’) laws of ecology simply restate the first and second laws of thermodynamics. Recognition that there are limits to growth at micro and macro levels of the continuum of life requires that we have detailed understanding of complex systems and the way they operate as either healthy or unhealthy dissipative structures. The laws of thermodynamics and ecology act in such a way that the ‘ecology of the world,’ as Carson expressed it, is reflected and reproduced in all other ecologies whether large or small scale.

‘Transdisciplinarity’

Understanding the interrelationships explained by ecology and complexity makes it possible to go beyond traditional discipline-based insight to understand emergent issues such as public health problems. New transdisciplinary frameworks that can create novel conceptualizations are needed to provide a systemic account of how the world actually works at all levels from the micro to the macro. As an antidote to reductionism (the study of a phenomenon by reducing it to its constituent parts), transdisciplinary thinking acknowledges the interrelated complexity of the real world, thereby producing novel integrative sciences such as ecosystem health. Indeed, it can be argued that the commitment to transdisciplinary ways of thinking about health issues is the distinctive mark of an ecosystem approach to health.

The need for transdisciplinary insight is no better illustrated than with the issue of global warming. The increase of greenhouse gases in the atmosphere is not simply a technological problem; it is connected to social and cultural values such as the belief that quality of life is tied to increasing levels of material affluence. Moreover, as climate changes, so too does the potential for disease and health. To fully understand global warming, or climate change, a full range of disciplines, including the biophysical, biomedical, sociological, psychological, and the political need to be engaged.

The influence of widespread industrialization on the sustainability of ecosystem health and, in turn, human health, is now a major concern of the ecosystem health approach to understanding human–nature relationships. Human health, as a manifestation of social justice and equity, can also be seen as a major indicator of social sustainability. The humanities and social sciences play a key role in the full transdisciplinary understanding of the complexity of human health. While human subjectivity is deliberately minimized in the traditional scientific method, it is a vital component of transdisciplinary methods applied to the resolution of human problems tied to ecosystem health. Human subjectivity, cultural knowledge, and participation in the various explanations of issues, and direct involvement in actions to remedy health problems, are an integral part of acknowledging the full complexity of health issues.

Inquiry that explores the social determinants of health helps overcome the limitations of the dominant biomedical and biophysical approaches to the study of environment and health. In addition, the convergence of the biophysical, eco-environmental, and social sciences into new transdisciplinary sciences becomes possible because the focus of research is on common public health issues and problems. Public health is the outcome of a broad arrangement of forces operating at multiple levels. Gunderson and Holling (2002) see life as a transformative process or ‘panarchy,’ whereby nested systems are linked together in adaptive cycles of growth, accumulation, restructuring, and renewal. Public health practitioners can apply these understandings of complex adaptive systems to strengthen the resilience and hence sustainability of the system as a whole.

Ecosystem Health And Eco-Health Approaches

As is befitting a trans disciplinary, evolutionary, and ecosystem approach to health, there are many niches where different theoretical emphases emerge. Hippocrates suggested such niches can range from specific biophysical influences on health to the totality of human cultural influences on those very biophysical systems. Many levels of analysis are open to ecological investigations of human health: from eco-psychology to critical anthropology and political ecology. The various schools of ecosystem health and eco-health differ in the choice and level of their commitment to transdisciplinarity as outlined in the approaches discussed in the following sections.

Ecosystem Health As Biophysical Health

A biophysical approach applies metrics of human health to develop ecological assessments, monitoring, audits, and indicators of the health of specific ecosystems such as rivers and their catchments. An ‘objective’ report card style of assessment is followed using the pressurestate-response model of state-of-the-environment reporting. Despite this model stressing the overwhelming impact of human pressure acting as an ecosystem stress agent, there is a tendency to isolate and separately measure that which is easy to measure in the ecosystem (water quality, erosion rates, biodiversity loss). Thus the biophysical approach minimizes or overlooks the active role of human agency, in particular, the causal pressures of modernization and industrial development. The implication of such an approach is that if the biophysical parameters of a healthy ecosystem are in place, then the health of human beings in the ecosystem should be optimally supported.

In other areas where the interaction between biophysical parameters and human health has highlighted important health outcomes, new transdisciplinary fields of inquiry have emerged. Medical geology, for example, examines the public health impacts of geologic materials and geologic processes with an aim to prevent diseases linked to toxic and harmful elements and compounds (Bunnell, 2004). However, even here, medical geology must examine the full circumstances whereby humans come into contact with toxic substances; these may include mining and other economic activities, as well as government and nongovernment organization policies implicated in the exposure. Foreign aid to build thousands of tube wells in Bangladesh, for example, has been the indirect cause of thousands of people being exposed to naturally occurring arsenic in the groundwater through drinking water taken from those wells.

Ecosystem Health As Healthy Ecosystems

Early approaches in ecosystem health focused on the health of ecosystems as a foundation or precondition for human health. Indicators of biophysical health were then developed to help diagnose health and ill health in ecosystems, much as if ecosystems were living bodies or patients being examined by a physician. In many respects, ‘health’ was being used as a metaphor that was easily understood by people from different academic disciplines and laypeople. Following Aldo Leopold and his concept of land sickness, pioneer researchers such as David Rapport developed concepts such as ‘ecosystem distress syndrome’ (Rapport and Whitford, 1999) as a diagnostic tool. Ecosystem distress syndrome implies that human disturbance of ecosystems creates situations in which ecosystems do not ‘bounce back’ to former (healthy) configurations, even when factors that stress the system are removed. Such systems are stressed to the point where they lack resilience and they then reconfigure to less productive and simpler states (a different ecosystem).

A key theme of the ecosystem health approach is that upstream intervention in degrading processes requires that the human activities and values that are the primary cause of degradation be directly addressed. In other words, a humans-in-the-ecosystem approach sees human activity as the primary cause of ecosystem distress syndrome. To prevent situations of irreparable damage, humans need to regulate their own activity and values so that they complement ecosystem integrity, rather than try heroic, expensive, and often futile efforts to repair unhealthy ecosystems. Hence, the healthy ecosystem approach emphasizes the human agents in the ecosystem.

The systematic application of a ‘humans in’ approach to ecosystem health challenges traditional medical approaches to disease. Rather than focusing on a cure that might involve heroic intervention at open-ended expense, the ecosystem health approach is anticipatory and preventive. John Howard (2005) has highlighted the different approaches to human health care and disease:

Traditional doctor–patient model. In this model, the patient visits doctor, doctor diagnoses the disease, and treats the disease. The disease is understood as something that affects many different people, for which there is standard treatment. For example, patient complains of shortness of breath, doctor diagnoses asthma and prescribes medications to ease symptoms.
Patient-centered model. This model builds on the traditional one: doctor also considers the patient’s individual experience of a particular disease ‘illness’ and the illness or experience of disease will depend on the context of the patient such as family and community. For example, patient diagnosed with asthma, extra role for doctor to determine the unique illness experience of that patient (e.g., bricklayer, smoker, 60-years-old, wealthy or poor).
Ecosystem health model. This model considers, in addition, intersection of the patient with the environment (physical, economic, social, and political). For example, patient complains of shortness of breath, health-care provider needs to also consider why so many people now require asthma therapy, what the health-care system can do about it. (Key questions: What caused the patient to have this problem? What can the physician or society do to prevent the problem developing in other people?)

The ecosystem health model looks at health from as ‘‘broad a perspective as possible’’ (Howard, 2005: 11). Health and disease are understood to result from complex interactions and involve not only traditional aspects of physical, mental, occupational, and nutritional health, but also social, political, economic, and physical environments, because they all influence the health of the patient. Under an ecosystem health paradigm, healthy ecosystems must display the complete integration of biophysical and cultural dimensions.

Global Influences On Ecosystem Health

The study of health takes on a global perspective as the emphasis shifts from the analysis of change in distinct regional ecosystems, to consideration of the worldwide interconnection of cultural, environmental, and technological elements. Global-scale change and its impacts on human health are vibrant new research themes. Conservation medicine, for example, is one of the integrative transdisciplinary sciences that address interactions among human-induced changes in the total environment and the emergence of pathogens within human, animal, and plant communities. Emergent diseases that are ‘‘zoonotic’’ or ‘‘are suspected of having originated relatively recently as pathogens in wild populations inhabiting natural ecosystems (e.g., influenza, HIV/AIDS, severe respiratory syndrome)’’ are an expression of development pressures and require an ‘‘integrated biomedical and bioecological research agenda’’ (Wilcox, 2005: 130). Such transdisciplinarity is achieved through the integration of ideas from ecology, biology, epidemiology, veterinary medicine, human medicine, and public health. Humans are seen as central elements of the global system and its subsystems, nested hierarchically within the larger biosphere.

Ecosystem Health As Eco-Health

The term eco-health has been used to highlight the social dimensions of the transdisciplinary arrangement of elements that promote or diminish health. Such highlighting was thought necessary because of the perceived biophysical origins of early accounts of ecosystem health. As such, there is an emphasis on the potential of policy and management to improve the health of human populations and also to address the complex interactions between environmental, sociocultural, and economic factors. An eco-health approach to human health

builds on the ecosystem health model by recognising that human health and well-being are intimately tied not only to the health of ecosystems that sustain human life, but also to complex interactions between environmentalsociocultural and economic factors. (De Plaen and Kilelu, 2004: 9)

By emphasizing the social and cultural end of the transdisciplinary spectrum, those who use the term eco-health engage the social sciences’ attention to justice and equity issues. Involving people themselves in action to achieve better health is fundamental to the eco-health approach.

Ecosystem Health As Human Ecology And Ecological Anthropology

The humans-in-the-system approach to ecosystem health has prompted debate about the role that human factors (ethics, culture, politics, policy, economies) play in determining the foundations of system health. As global connectedness, human population numbers, urbanization, and industrialization increase, the role of humans in the total ecosystem becomes critically important. It might even be argued that as humans increasingly live within environments of their own design and construction, the ecology that must be studied is a human one. Proponents of ‘human ecology’ argue for the incorporation of sociological and anthropological insights to highlight the direct and indirect effects on health of ‘‘unhealthy trajectories of development, anthropogenic ecosystem change, and related social inequities’’ (Parkes et al., 2003: 671). In a similar vein, ecological anthropology investigates social inequality and demonstrates how smalland large-scale political economies shape environmental outcomes and interpretations (Kottak, 1999).

Health Psychology And Conservation Psychology

A new transdisciplinary synthesis of health psychology and conservation psychology has emerged to foster people’s engagement in the construction and maintenance of ecosystem health. This new field in psychology explores self–place relationships, environmental perception, experiential issues, and caring, nurturing, and environmentally sensitive behaviors (see Saunders and Myers, 2006). It is important when examining complex adaptive systems, and the adaptive management techniques needed to achieve sustainability, that attention is paid to understanding the meanings that emerge from people’s experience of their localities (Bott et al., 2003). Sense of place and place attachment (Horwitz et al., 2001) are powerful concepts that connect human and environmental health. For example, ‘solastalgia’ (Albrecht, 2005) describes the melancholia or lack of solace in one’s home environment caused by the effects of negative environmental change such as mining and drought. Human action and reaction to environmental change cannot be understood without consideration of concepts derived from the psychological end of the transdisciplinary ecosystem health spectrum.

Ecosystem Health And Critical Realism

Arguably, the study of ecosystem health must integrate analysis of the health of a constructed and managed ecosystem with public health approaches. However, as Hippocrates, the Sanitation Movement pioneers, and Rachael Carson observed, it is precisely the disconnection between foundational ecosystem services (clean air, potable water, arable soil, symbiotic relationships with biodiversity, nature’s surplus) that creates health problems in human-constructed environments in the first place. The eco-health approach is guided by the philosophy of critical realism. Critical realism asserts that total system health is based on the reciprocity principle: Ecosystems influence human health, humans influence ecosystem health. Sustainability is achieved through reciprocal relationships, whereby complexity and resilience in the human element is not achieved at the expense of complexity and resilience in the ecosystem element. By embracing the concept of ‘‘non-deterministic coevolution’’ (Carolan, 2005: 5), critical realism avoids both environmental and cultural determinism.

Ecosystem Health And Participatory Public Health

A community-based and participatory model of investigation is required to evaluate the role of human actors in the construction (or destruction) of their own ecosystems and their eco-health. A participatory model of public health defines humans as agents who participate in their own health outcomes as well as actively participating in the restoration of damaged (unhealthy) ecosystems. This includes those who research eco-health problems as well as those who are being researched. The political inequalities that may obstruct the outcomes of participatory models of action also need to be considered and addressed by practitioners, policy makers, and researchers.

Conclusions

Humans are initiating global-scale changes that profoundly affect the biosphere, including climate change and ozone depletion. This trend has been accompanied by the emergence of transdisciplinary accounts of these challenges to total systems of health. The foundations of an ecosystem approach to health lie in the biophysical sciences and ecology. However, increasingly, the social sciences and humanities are required to explain how the disintegration or maintenance of interconnections between humans and the environment is fundamental to explaining public health problems. We have highlighted the diversity of approaches to ecosystem health, including biophysical, healthy ecosystem, conservation medicine, eco-health, human ecology and ecological anthropology, health psychology, and conservation psychology. We also have discussed key concepts and methods of the ecosystem approach including complex systems, critical realism, transdisciplinarity, and participatory methods. While by no means fully united, ecosystem health (eco-health) represents an emergent sustainability framework that can integrate many aspects of public health research and practice in the twenty-first century.

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