Towards an ecological understanding of health
Western medicine is heavily focused on treating the biology and symptoms of diseases. The underlying assumption of this model is that by curing more diseases, we will move towards a healthier society. Indeed, both pharmaceutical companies and national research labs are constantly seeking to develop new drugs and treatments: immunotherapies to cure cancer; novel antidepressants with fewer side effects; oral medications for patients with Type-2 Diabetes.
Developing better treatments is certainly a noble and extremely important endeavour. This pharmaceutical-based approach, however, seems to have diverted our attention away from preventive solutions that would target the root cause of many diseases in favour of treating the symptoms.
In Canada and many other developed countries, non-communicable disorders such as vascular disease, diabetes, and dementia are among the top causes of mortality. In an overwhelming number of cases, these health disorders are related to lifestyle factors: for instance, lack of physical exercise, an unbalanced diet or even loneliness.
In many regards, the North American way of life doesn’t make it easy for us to develop healthy habits. While we are told that regular physical activity is essential for good health, schools and work environments are designed in such a way that people remain sitting for most of the day. Furthermore, our society’s definition of success places a huge emphasis on productivity and high achievement, whether academically or professionally. Although this mindset does promote productivity, it can easily slip into overworking and burnout. If work and achievement are given top priority, it becomes difficult to make time for self-care, whether this means cooking a nutritious meal, spending time with friends or simply getting enough sleep. The consequence of the North American work ethic is often a chronic lack of time; therefore, when it comes to our wellbeing, we have placed convenience and speed on a pedestal. This mindset contributes to the pervasiveness of fast-food restaurants and the popularity of drive-through services in North America, and why our first reaction to a headache is to gulp down a pill rather than resting and taking a nap.
An unhealthy lifestyle increases the prevalence of many chronic health conditions, and our healthcare system deals with the downstream consequences by treating the symptoms of these conditions. However, as Sir Michael Marmot, who teaches Epidemiology and Public Health at University College London, famously pointed out: “Why treat people and send them back to the conditions that made them sick in the first place?”
One major issue with a primarily pharmaceutical approach to medicine is its perception of patients as siloed individuals who are entirely responsible for, and in control of, their own health. A perhaps kinder and more accurate alternative would be to adopt an ecological understanding of health, inspired by the ecological view of nature. This way of thinking was popularized by Rachel Carson, who pioneered the environmental justice movement in the 1960s. In her book, Silent Spring, Carson calls attention to the delicate interconnectedness between natural species: each species crucially contributes to the overall balance of an ecosystem. Using this analogy, we can think of ourselves not as isolated individuals, but as part of an ecosystem embodied by our community and society—its infrastructures, people, culture, and resources. These factors all have an influence on our well-being and are known as social determinants of health (SDHs).
The World Health Organization defines SDHs as “conditions in which people are born, grow, live, work and age [which are] shaped by the distribution of money, power and resources at global, national and local levels.” Common examples of SDHs include health literacy, social connectedness and food security. In fact, according to the Canadian Medical Association, 50 percent of factors that make Canadians sick are related to SDHs, while only 15 percent are related to our biology! Therefore, we need to adopt a more holistic understanding of health that goes beyond individual circumstances and takes into account factors at the community and systemic levels. By viewing people as interconnected nodes in a network or web, we can shift our efforts towards strengthening the web as a whole rather than rescuing individuals one at a time.
This ecological mindset would encourage communities to take action and transform their environment into one that enables a healthier lifestyle—for instance, by building more pedestrian- and biker-friendly roads to encourage physical activity, or by fostering social connectedness. At the same time, we need broader systemic changes across multiple sectors to improve access to healthcare, food security, housing affordability, and many other SDHs. We might even need to expand our understanding of “community” in order to include the natural environment. The term “planetary health,” which has only recently emerged, captures the relationship between human health and the health of natural systems. This field of study offers a unique opportunity to couple environmental protection with efforts to build healthier communities.
This shift towards understanding health from an ecological perspective is perceivable also in universities: students are increasingly speaking up to advocate for affordable education, environmental protection measures and accessible mental health resources. Moreover, some departments at the University of Toronto now offer community-engaged learning courses, which give students an opportunity to interact with marginalized populations and make an impact through volunteer work.
It is true that SDHs can be very difficult to change, because they are often embedded in the fabric of our Western capitalist society. However, the conversation around SDHs is currently gaining momentum in Canada and many other countries. Moving forward, we need to redirect our healthcare resources towards building more equitable and resilient communities, and we need to collectively re-imagine a society that prioritizes balance and self-care.
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