Making the Case for Health and Reciprocal Care

The Call to Action

Craig Stephen

The guiding premise of this book is that health is the product of our relationships with each other and the world around us. This is not new. Hippocrates wrote over 2,000 years ago about the web of social and environmental connections that influence health and well-being. Long-held aboriginal perspectives of health and wellness are founded on the interdependence of the land, culture, self, and community (Hill, 2009). Aldo Leopold, one of the most widely read Western environmentalists of the 1900s, saw the health of the land connected to the health of human and non-human communities. The unprecedented rate and global reach of social and ecological changes occurring today are reinvigorating a worldview of connectedness wherein health is the outcome of the interplay of animals, environments, and societies.

We are living in the Anthropocene which is the name for the current geological age when people have the dominant influence on climate and the environment. The Anthropocene is characterized by the Great Acceleration which refers to the rapid and sometimes exponential growth of human impacts, starting in the 1950s characterized by increased carbon pollution, consumption, human population growth, habitat loss, species extinction, and more. The exponential growth of the human population along with ever-increasing global movements of people, goods, and biota are creating landscapes that generate new and sometimes unforeseen health risks shared by people, animals, and environments. In 2017, the United Nations Department of Economic and Social Affairs projected a human population of 8.6 billion in 2030, 9.8 billion in 2050, and 11.2 billion in 2100 (UN, 2017). This anticipated rate of population growth, along with a growing middle class, will put extraordinary strains on the ecological services provided by our biotic and abiotic environments, which in turn will diminish the resources needed for healthy and sustainable biodiversity. The authors of the 2014 5th Intergovernmental Panel on Climate Change assessment report were very confident that global warming will lead to very high risks of severe, widespread, and irreversible impacts on individuals, ecosystems, and communities by the end of the 21st century. The United Nations Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services concluded in 2018 that we were losing species 1,000 times faster than the natural rate of extinction. The 2016 Living Planet Index linked these losses to human-induced factors: habitat degradation, invasive species, climate change, pollution, unsustainable freshwater use, and species overexploitation. Accelerating environmental and human behavioural changes have been creating new ecological niches that drive microbial evolution and epidemiological shifts that have fostered the emergence of new infectious diseases, like the COVID-19 pandemic of 2020. Persistent poverty, food insecurity, and urbanization remain major challenges to achieving sustainable development. Many international initiatives are rising to address these shared challenges through multisectoral action plans and strategies (Table 1.1). Success in these plans will require people capable of working across boundaries and able to inspire collaborative actions in the animal, environment, social, and health sectors.

This book asks: What actions can we take at the animal-society interface to foster reciprocal care of the health of ourselves our communities and the life with which we share Earth? The socio-ecological model of health is instrumental in answering this question. The origins of the socio-ecological model can be found in the Lalonde report (1974), “A New Perspective on the Health of Canadians,” which concluded that lifestyle and the environment contributed to our health as much or more than health care and biology. It was followed in 1986 by the Ottawa Charter for Health Promotion which repositioned health as a positive aspiration to pursue rather than the result of negative consequences avoided. It extended the reach of health management beyond the health care system to the upstream social and ecological factors that provide the opportunities and capacities to live a healthy life. The prevailing public health perspective for understanding what makes a population healthy or not is based on the interactions and contributions of abiotic, biotic, and social elements that determine health outcomes. The population health perspective focuses on the state and interactions among the many contributing factors that influence health rather than measuring health as a physiological state. A similar conception of health began appearing in the animal health literature in the 2010s (e.g. Wittrock et al., 2019; Hanisch et ah, 2012) (Figure 1.1).

Population welfare, whether human or otherwise, is coherence between a species’ adapted capacities and expectations and the realities of its current social and biophysical environments (Stephen and Wade, 2018). Health management is being reframed as a collaborative enterprise that continually creates and improves physical and social environments that provide the raw material for people and non-human communities to mutually support each other’s health.

The socio-ecological model of health sees health as a series of interconnected, co-dependent, and interacting factors - in other words, as a system (Diez Roux, 2011). This creates challenges to those wishing to study health. The fact that ecosystems are ever-changing and human systems undergo

TABLE 1.1

Examples of International Agreements Dependent on Co-Management, Cooperation, and Reciprocal Care of Social, Animal, and Environmental Health

Agreement

Purpose

Focus

Global Health Security Agenda (2014)

Help create a world safe and secure from infectious disease threats

Multisectoral "action packages” to build capacity to prevent, detect, and respond to infectious diseases and thereby contain threats at their source

Convention on Biological Diversity. Strategic Plan for Biodiversity (2011-2020)

Conserve and sustain the fair and equitable use of biological diversity

Strategies to promote living in harmony with nature by (i) initiating action to address the underlying causes of biodiversity loss; (ii) ensuring that biodiversity concerns are mainstreamed throughout government and society; (iii) acting to decrease the direct pressures on biodiversity; (iv) protecting access to ecosystem services, especially for the poor who most directly depend on them

United Nations Sustainable Development Goals (2015)

Peace and prosperity for people and the planet, now and into the future

End poverty and other deprivations by working together with strategies to improve health and education, reduce inequality, and spur economic growth - all while tackling climate change and working to preserve oceans and forests

United Nations Framework Convention on Climate Change - 2016 Paris Agreement

Preventing dangerous anthropogenic interference with the Earth's climate system by strengthening the global response in the context of sustainable development and poverty reduction

Peaking and reducing greenhouse gas emissions, protecting carbon sinks found in biodiversity, strengthening resilience, and reducing vulnerability to climate change, with a view to contributing to sustainable development

United Nations Conference on Environment and Development - Agenda 21 (1992)

Rethink economic development and find ways to halt the destruction of irreplaceable natural resources and pollution of the planet

Rights and responsibilities of nations in environmental protection and sustainable development. Balancing natural resource use with preserving the environment and ensuring natural resources for future generations

Illustrative determinants of health model for fish and wildlife

FIGURE 1.1 Illustrative determinants of health model for fish and wildlife. Categories of determinants are in the circles, with illustrative contributing determinants within each circle. The size, shape, interaction, and contributions of each determinant will vary w'ith species, ecosystem, and social context. (Adapted from Wittrock et al., 2019.)

ongoing transformations makes socio-ecological systems inherently unknowable, unpredictable, and not well suited to research seeking a mechanistic truth in a reductionist fashion. Health gains made in the 19th and 20th centuries came largely from advances in knowledge on individual drivers of death and diseases. Discrete disciplines emerged and grew' to further our understanding of health and diseases by analysing their distinct components. Humanity can be proud of the increases in longevity and quality of life experienced by an ever-increasing proportion of people; of advances in animal health, welfare, and productivity that increase access to safe and nutritious food; and in reductions in poverty and suffering that has come with improving living standards. Improvements in human well-being have unfortunately and too often come at the expense of wild and domesticated biodiversity and environments. The Millennium Ecosystem

Assessment (2005) showed how human changes to ecosystems have resulted in a substantial and largely irreversible loss in the diversity of life on Earth, which in turn is diminishing the essential ecological services upon which we depend. Biodiversity and ecosystems have responded in kind. New emerging infections, lost income opportunities due to pests and invasive species, and the climate’s responses to carbon pollution are examples of how nature has reacted by inadvertently producing new threats to humanity, biodiversity, and living systems. Our responses to these emerging threats are too often too late. The focus on clinical care in human health and on eliminating hazards from animals and environments after they emerge put us in a constant state of reaction and recovery rather than investing in the protection of the assets we need to stay healthy. It is increasingly being recognized that focusing health care services on reducing diseases and prolonging life through clinically oriented services is insufficient to protect well-being and ensure health of subsequent generations and all species.

The good news is that there is a way forward. The solutions to modern health problems require us to embrace health as a product of interacting and interdependent animal, human, and environmental systems. Governments, businesses, and communities are recognizing the advantages of integrated, proactive approaches that focus on protecting the social and environmental services that lay at the heart of healthy people, animals, and systems. Several new forms of collaboration emerged towards the end of the 20th century and began nudging researchers and practitioners back towards seeing health as a positive socio-ecological phenomenon that should be viewed as a whole and not reduced to its parts. Whether termed EcoHealth, One Health, Planetary Health, or something else, the last two decades saw a rapid expansion in the number of people and programs dedicated to promoting health equity across populations, species, and generations.

 
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