Core Concepts

Working Together for WHOLE Systems: Approaching Well-Being and Health While Oriented to Living Systems and Equity

Margot W. Parkes

INTRODUCTION

Drawing on precedents and convergence across disciplines, sectors, and cultures, this chapter identifies, examines, and profiles key characteristics of an integrative shift in how health is protected, promoted, and planned for. A preoccupation with specialization is starting to be balanced with a re-emphasis on integrative approaches that include and are informed by Indigenous knowledges that have fostered this awareness for many thousands of years (Durie, 2004; McGregor, 2004; Parkes, 2011; Redvers, 2018). This chapter examines the value of addressing the WHOLE (Well-being and Health Oriented to Living Systems and Equity) as a foundation for a healthy, equitable, and ecologically sustainable future. Whether the focus is on individuals, or groups, of humans, animals, or other species, any approach to protecting, promoting, and planning for health and w'ell-being will fall short if it is not oriented to equity as well as ecosystems (living systems) within our planetary home. A WHOLE perspective recognizes that without the living systems we depend on, health, equity, and life itself are simply not possible. A living systems view also demands attention to equity, across cultures, generations, species, and society and across scales from the local to the global (see Capra and Luisi, 2014; Wahl, 2016; Horwitz and Parkes, 2019).

In a time when our health systems are being confronted by what can seem to be competing and converging imperatives ranging from climate change to the COVID-19 pandemic, WHOLE approaches are more necessary than ever. An emphasis on WHOLE systems resonates with other efforts paying attention to transformative, creative, collective, and integrative approaches to health in social and ecological context, especially those that foster regenerative rather than degenerative processes (Waltner-Toews, 2004; Brown, 2007; Poland and Dooris, 2010; Fullerton, 2015; Bartlett et al., 2015; Benne and Mang, 2015; Wahl, 2016; Gislason et al., 2018; Ratima et al., 2019; Redvers, 2018; White, 2019). Orientation to WHOLE systems demands that we work together in new ways and focus our attention to both knowledge(s) and action(s). A WHOLE approach draws on many efforts to appraise health in relation to both ecological and social contexts, spanning, for example: ecosocial approaches; socio-ecological health; social-ecological systems and health; ecohealth; planetary health; and One Health1 (Zinsstag et al., 2011; Hallstrom et al., 2015; Hancock et al., 2017; Buse et al., 2018; Harrison et al., 2019; Parkes et al., 2020). Attention to the WHOLE brings to the fore interrelationships between knowledge, participation, and action from the outset of our efforts. This requires awareness of what we hold in mind as we enter into a WHOLE-systems approach, and the questions we ask as we progress.

A primary point of reference and starting point, therefore, is the need for attention to both content and process, where what we know is directly in relation to how we know it and will inform how responses are designed (Parkes et al., 2012; Cole et al., 2018). An integrative turn, in relation to concepts, content and knowledge, has increased potential for impact if it is combined and “matched” with an overtly collaborative turn, in relation to processes, practices, and actions. A combined integrative and collaborative turn leads to an emphasis on asking different kinds of questions (see, for example, Brown, 2010; Wahl. 2016). Along these lines, the WHOLE acronym can also stand for "Who and How are we Open to Listen, and Engage/exchange?” This question extends attention beyond the act of integrating knowledge(s) about a specific content or topic area, towards the processes of interaction, exchange, and potential collaboration among knowledge holders (Parkes et al., 2012). This combined content and process emphasis underscores an active, dynamic, and oftentimes complex relationship between issues being observed (the objects and subjects under consideration) and the interactions of the observer(s) of the issue, including those who may be working together to do the observing, and how this will influence what is addressed. Awareness of interrelationships between observations and observer(s), between knowledge and action, and the nuances of integration, participation, and collaboration are important considerations when seeking to address complex health, ecological, and equity concerns (see Brown, 2010; Parkes et al.. 2012; Parkes, 2015; Brown et al., 2019).

An implication of the WHOLE view is the respect for, and relevance of, crossing boundaries between worldviews and cultures, between knowledge and action, between research and policy, and between theory and practice. A focus on application and implementation (and learning about both) should be familiar to many working in human health care and veterinary practice. It is also increasingly important when health and well-being are considered beyond individuals or single species, and across the range of personal, public, population, and planetary health.

The WHOLE approach asks us to shift from describing and analyzing “problems” and “solutions” (e.g. how can I describe this problem to select the “right” solution?) towards strength-based orientations that privilege contextually nuanced, regenerative, restorative, and emergent principles and perspectives (e.g. what do we need to know and understand about this system in order to enhance conditions for thriving?). A WHOLE view also highlights axes of equity that need more attention, specifically in relation to future generations and those who have less or no voice within our existing knowledge generation and decision-making processes, including other species beyond humans (see de Groot, 1998; Masuda et al., 2008; Poland and Dooris, 2010; Masuda et al., 2014; and Chapter 3 for more on healthy equity in One Health). A WHOLE perspective prompts the question: Who or what is this work serving? and drives a need to respond in ways that identify, create, and promote co-benefits for the health of humans, animals, and other species.

This chapter presents ideas and processes that can enhance and operationalize a WHOLE approach through strength-based and appreciative processes. The chapter begins by considering the role of the “specialist generalist” in undertaking or engaging with this kind of work, with attention to learning cycles (described in Brown, 2005,2010) relevant to creating healthy WHOLE systems change. The rest of the chapter is structured around the four questions within Brown’s collective learning cycle, where each learning stage poses the questions: "What should be?” “What is?” "What could be?” and “What can be?” (Brown, 2010). The chapter concludes by revisiting the role of the “specialized generalist” in understanding and responding to contemporary health and well-being challenges while oriented to living systems and equity for the benefits of both people and other species.

 
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