Ecological Health: Society, Ecology and Health: Volume 15

A crucial contemporary public health issue is the construction and contestation of the relevance of the natural world to human health.

Taking a critical approach, this chapter examines how the natural environment as a health determinant is positioned in relation to the ‘social’ within social theory generally and social epidemiological studies of health, illness and disease specifically.

– This study shows how current constructions of social and natural environmental health drivers contour social approaches to the study of health and proposes an integrated social-ecological approach for generating new contributions of social epidemiology to research on environmentally driven health injuries.

– The research breaks ground for further social scientific studies of health and the environment and in particular substantiates the call for an extended notion of the ‘environment’ using ecological principles. Methodologically, the interdisciplinary reach of this research draws attention to the tensions that arise when working across the medical, natural and social sciences.

Ecosystem-based approaches to human health, also known as Ecohealth approaches, fall in an emerging field of study that focuses on understanding how social, political and economic factors shape people–environment interactions and consequently influence human health. The approach integrates scientific and local perspectives to develop interventions aimed at improving human health through sustainable ecosystem management.

Three principles are central to traditional ecohealth approaches: (1) transdisciplinarity which integrates the expertise of professionals from the natural, health and social sciences with those of other stakeholders; (2) community participation; and (3) social equity and gender relations.

However, the extent to which these concepts benefit from rigorous theoretical analysis is still very limited. As an emerging field of study, the use of poststructuralist, feminist, postcolonial, and political ecology perspectives is still limited. This chapter illustrates the application of critical theory to the conceptual and methodological tools used in ecohealth research and practice.

Critical theory is used to examine people–environment interactions, transdisciplinarity, community participation, and social equity and gender relations. The discussion is informed by an ecohealth project conducted in the Upper West region of Ghana.

As an emerging field of study, ecohealth is yet to benefit from rigorous critical theoretical frameworks that are used to examine health and environment issues in other subdisciplines. This chapter illustrates the application of these perspectives to ecohealth.

This is the first chapter that outlines a critically informed approach to ecohealth research and practice.

Aboriginal people across Australia have diverse practices, beliefs and knowledges based on thousands of generations of managing and protecting their lands (Country). The intimate relationship Aboriginal people have with their Country is explored in this chapter because such knowledge is important for building insight into the relationship between social and ecological systems. Often in research Aboriginal views have been marginalised from discussions focused on their lands to the detriment of ecosystems and human health. This chapter aims to understand if such marginalisation is evident in Western human–nature relationship discourses.

This chapter provides a critical literature review which examines whether Aboriginal people’s diverse understanding of their ecosystems have been incorporated into human–nature theories using the biophilia hypothesis as a starting point. Other concepts explored include solastalgia, topophilia and place.

Critiques of these terminologies in the context of Aboriginal people’s connection to Country are limited but such incorporation is viewed in the chapter as a possible mechanism for better understanding human’s connection to nature. The review identified that Aboriginal people’s relationship to Country seems to be underrepresented in the human–nature theory literature.

This chapter emphasises that the integration of Aboriginal perspectives into research, ecological management and policy can provide better insight into the interrelationships between social and ecological systems.

This chapter explores the protest self-immolations since 2009 of over 100 Tibetans in China. It investigates whether these events have ecological as well as social causes and may thus be relevant to the emerging discipline of ‘EcoHealth’.

Targeted literature review and reflective analysis, presented as a narrative.

Chinese citizens identifying as Tibetan have experienced substantial ethnically based discrimination for over 60 years, manifest as attempted cultural destruction, pervasive disrespect and linguistic suppression. Tibetans, now a minority in much of their former territory, have witnessed and at times been forced to participate in ecological destruction, much of it led by Chinese settlers, endorsed by occupying authorities. Tibetans have for decades protested against the Chinese they regard as invaders and occupiers, but Tibetan acts of protest self-immolation are a recent response. Academic analysis has been scarce, particularly by Chinese scholars. Until now, EcoHealth practitioners have also denied any relevance, as if in a waltz led by the Chinese government.

Attempts to identify rational causes for Tibetan self-immolation conflict with themes of liberation and fairness central to Communist Chinese ideology. Most Chinese analysis of Tibetan self-immolation is superficial, nationalistic and unsympathetic. Also disturbing is the reaction to these issues shown by the International Association of Ecology and Health. It is suggested that this illustrates a failure to translate rhetoric of ‘speaking truth to power’ to reality, a retreat from idealism common to many social movements.

Increasing human demand on a limited biosphere necessitates a deepened understanding of eco-social factors. Practitioners concerned with sustaining our civilisation are encouraged to explore the integrated dimensions revealed by this case study.

The goal of this chapter is to cultivate interest in the societal dynamic of ability expectations and ableism, a dynamic first thematized by the disabled people rights movement but which is also broadly applicable to the study of the relationship between humans, animals, and environments. Another aim of this chapter is to think about disabled people within ecosystem approaches to health through the ableism framework and to show that insights gained from disability studies are applicable to a broader study of health within contexts of environmental degradation. Building from this approach, the reader is invited to consider the utility of the conceptual framework of eco-ability “expectations” and eco-ableism as a way to understand health within coupled social-ecological systems.

This chapter uses an ability expectation and ableism lens and a disability studies and ability studies approach to analyze the relationship between humans, animals, and environments.

Certain ability expectations and ableism are responsible for (a) the invisibility of disabled people in ecological health discourses; (b) the standoff between anthropocentric and biocentric/ecocentric approaches to health; and (c) the application of scientific and technological advancements to address problems arising out of current relationships between humans, animals, and environments.

The reader is introduced to the concepts of ableism and eco-ableism, which have not yet been used in EcoHealth discourses and flags the need for further engagement with disability issues within the field.

This chapter proposes a way to deepen our understanding of the health impacts of climate change. It explores how and why individuals and communities may experience the climate change-human health interface in different ways.

We suggest that the concepts of structural vulnerability and narrative inquiry can provide a thick (ethnographic) description of how and why individuals and communities experience and give meaning to the health impacts of climate change. We begin by defining the two concepts before bringing them together to explore the relationship between climate change and health.

The combination of these two concepts offers the potential to advance our knowledge in two key ways. Firstly, they facilitate a critical and interpretive approach to both the notion of agency and the public health paradigm of the ‘rational-actor’. Secondly, they reveal how vulnerability to climate change is embodied at the level of the mundane and everyday.

These concepts, when applied to the climate change–human health interface, can help demonstrate how vulnerability is often a social construction, and, with sufficient political will, may be ameliorated. We see the combination of the concepts discussed here as an opportunity for research to address inequality and justice.

This paper takes two innovative and established concepts in medical anthropology (structural vulnerability) and social science (narrative inquiry) and invites their application to our understanding of climate change and human health. Research analysed via these concepts will provide a clearer understanding of the impacts of climate change and experiences of vulnerability.

This chapter examines the historical development of different conceptions of health among environmental activists in the postwar United States.

The historical analysis combines archival research with oral history interviews.

This study argues that applications of “health” to describe the environment are more diverse than generally acknowledged, and that environmental activists were at the forefront of connecting the two terms within broader public discourse.

This study provides a historical context for understanding the contemporary diversity of perspectives on the links between ecology and health. It illustrates the cross-fertilization between scientists, philosophers, and environmental activists in the 1970s that led to this contemporary diversity.

By bringing together aspects of sustainable forest management, population health, and local livelihoods, the purpose of this study was to characterize how household dependence on forest resources changes through three phases: the period before HIV became a problem in the household, the period during HIV-related morbidity, and after AIDS-related mortality.

Sixty semi-structured interviews were conducted with members of unaffected and HIV/AIDS-affected households in four case study districts in Malawi.

This study demonstrates that the relationship between HIV/AIDS and dependence on specific forest resources appears to correspond closely with the stage of the disease. Firewood and water were consistently ranked as being one of the three most important resources, regardless of HIV-affectedness. During the morbidity phase, respondents reported their need for medicinal plants increased substantially, along with other resources. The importance of timber increased significantly after HIV-related mortality.

Interview respondents themselves suggested key interventions that would assist households in the HIV/AIDS-mortality phase, in particular, to obtain the forest resources they require. These interventions could address the impacts of HIV/AIDS on the sustainability of important resources, compensate for a decreased availability of household labor, and foster greater access to these resources for vulnerable households in the four study sites.

In spite of the fact that forest resources can play a crucial role in enabling a household to control and adapt to the disease, research on the environmental dimensions of HIV/AIDS remains limited. This chapter helps to address this knowledge gap, suggests practical, innovative interventions that could alleviate some of the disease burden on rural Malawian households, and offers insight into potential areas of further inquiry in this research domain.

This chapter studies the link between urban planning and health. Access to safe drinking water is already a very serious issue for large urban populations in fast-growing economies such as India. Water availability is further being impacted by climate change, leading to the drastically increased spread of water-related diseases.

Leh Town, which is located in an ecologically vulnerable semi-arid region of the Himalayas in Ladakh, has been considered for this study because it is undergoing large-scale transformation due to rapid growth in its tourism industry. In 2012–2013 our interdisciplinary group comprising researchers from Germany and India conducted field surveys, including geographic information system-based (GIS) mapping of point sources of water pollution, questionnaire surveys of 200 households and 70 hotels and guesthouses and semi-structured interviews. We also reviewed secondary medical data.

We found that diarrhoeal incidence has increased in the local population in Leh in the past decade, which may be linked to water pollution: Further, we found that rapidly increasing water consumption coupled with a lack of adequate water and sanitation infrastructure is causing serious water pollution.

Further, data is needed for causal connections between water pollution and health impacts to be conclusively drawn.

This study discusses the use of GIS to support a call for the need for more integrated urban planning and decision-making that holistically addresses water and health challenges in Leh and advocates the development of a decentralized or hybrid sanitation system to support water resources conservation as a central dimension of an integrated health management approach.

GIS is also a very useful platform for supporting participatory urban planning in Leh.

With such an integrated urban planning approach, Leh would be a lighthouse example for other towns in the region.

Millions of people die of chronic diseases within inpatient settings annually in the United States, despite patient preferences for dying at home. This medicalization of dying has received social and economic critiques for decades. This chapter offers a further analysis to these critiques by examining the ecological impacts of inpatient end-of-life care on the natural environment and occupational and public health.

We compare the ecological health outcomes of medical care in three inpatient units (conventional cancer unit, palliative care ward, and hospice facility) using ethnographic observations, semi-structured interviews, and institutional records on medical supply use, waste generation, and pharmaceutical administration and disposal.

Care provided on all three medical units had significant socioecological impacts. Cumulative impacts were greatest on the conventional unit, followed by palliative care, and lowest on the hospice unit. Variations in impacts mirrored differences in dependence on material interventions, which arose from variations in patient needs, institutional policies, and nursing cultures between the three units.

Social and economic concerns have been major drivers in reforming end-of-life medical care, and our analysis shows that ecological concerns must also be considered. Transitioning terminal patients to less materially intensive modes of care when appropriate could mitigate ecological health impacts while honoring patient preferences.

This chapter describes how the medicalization of dying has converged with institutional policies, practices, and actors to increase the negative consequences of medical care, and recognizes that the far-reaching impacts of clinical decisions make the provision of medical care a socioecological act.

The purpose of this chapter is to offer reflections on conventional theories concerning causes and determinants of diseases. It also intends to examine both theoretical and empirical bases for adopting an Integrated Social-Ecological Systems (ISES) lens as a tool for understanding complexities related to drivers, determinants and causes of diseases.

We assessed the theoretical underpinnings of a range of historical and contemporary lenses for viewing infectious disease drivers and the implications of their use when used to explain both personal (i.e. individual) and population health. We examined these issues within the empirical context of the City of Dhaka (Bangladesh) by adopting an ISES lens. Within this study an emphasis has been placed on illustrating how feedback loops and non-linearity functions in systems have a direct bearing upon various aspects of infectious disease occurrences.

A brief triumph over microbes during the last century stemmed in part from our improved understanding of disease causation which was built using disciplinary-specific, monocausal approaches to the study of disease emergence. Subsequently, empirical inquiries into the multi-factorial aetiology and the ‘web of causation’ of disease emergence have extended frameworks beyond simplistic, individualistic descriptions of disease causation. Nonetheless, much work is yet to be done to understand the roles of complex, intertwined, multi-level, social-ecological factors in affecting disease occurrence. We argue, a transdisciplinary-oriented, ISES lens is needed to explain the complexities of disease occurrence at various and interacting levels. More theoretical and empirical formulations, with evidence derived from various parts of the world, is also required to further the debate.

Our study advances the theoretical as well as empirical basis for considering an integrated human-nature systems approach to explaining disease occurrence at all levels so that factors at the individual, household/neighbourhood, local, regional and global levels are not treated in isolation.

Since the beginning of the 20th century environmental health researchers have known about the association between toxicant exposure and disease. However, that knoweldge has not been well integrated into mainstream medicine. Shedding light on why is the focus of this chapter.

To shed light on this issue I analyze the 2011 American Academy of Pediatrics’ clinical practice guidelines for Attention Deficit/Hyperactivity Disorder (ADHD), focusing specifically on the omission of environmental health research pertaining to ADHD symptoms and exposures, such as lead and mercury.

I found that while environmental researchers have been documenting the link between lead and ADHD for over forty years, the American Academy of Pediatrics has completely omitted this research from its 2012 clinical practice guidelines. Moreover, I argue this omission can be traced to competitive pressures to protect medical jurisdiction, and a reductionist worldview that emphasizes treatment over prevention.

This is the first attempt to analyze the way clinical practice guidelines help reinforce and perpetuate dominant medical perspectives. Moreover, to shed explanatory light, this chapter offers a synthetic explanation that combines materialist and ideological factors.

Beyond the specific case of ADHD, this chapter has implications for understanding how and why environmental health research is omitted from other materials produced by mainstream medicine, such as materials found in the medical school curriculum, continuing medical education, medical journals, and on the medical association web sites.

This chapter presents an organizational learning approach to understanding the objectives and challenges of an National Health Service (NHS) Sustainable Development agenda, which involves the integration of social, ecological and economic concerns into organizational functioning, for example the construction and management of buildings, design and delivery of services, and employment of staff.

The approach is used to frame an empirical analysis of 11 Projects conducted by NHS organizations aiming to advance this agenda during a particularly active phase in the mid to late 2000s. The approach helps identify the assumptions of organizational purpose, strategy and practice inherent in proposals for Sustainable Development and expose the challenges these are likely to pose. This framing helps articulate a vision and identify the actor groups, and their guiding assumptions, which need to be engaged if progress is to be made.

The vision of Sustainable Development being promoted was predominantly one of an NHS contributing to the economic and social determinants of health through its procurement, service development and employment activities. Contributions to environmental determinants only took place where financial gains to the NHS organizations themselves made activities, such as investment in renewable energy, viable in the short-term. Within most Projects strategic tools able to predict and measure benefits had to be developed on-the-job and most received help from external agencies to do this work.

Rather than expecting individual NHS organizations to progress this agenda alone, others involved in the shaping of collective assumptions of the NHS' purpose and strategies for growth must be engaged in what can be viewed as a social process of learning.

Risk governance is being successfully inserted into scientific and political agendas as a way to understand and address complex problems, such as health problems that have both social and ecological dimensions. However, to date, the debate on risk governance has remained rather conceptual. This chapter addresses these lacunae through describing research that was conducted on the Flemish environmental health governance arrangement and draws on this empirical case study to suggest ways that risk governance can be put into practice.

The case study analysis was conducted through a mixed methods study that combined document analysis and data gathered through 22 in-depth interviews with environmental and health scientists as well as policymakers.

This research shows that the Flemish environmental health risk governance arrangement has succeeded in increasing the exchange of information between: (1) governments at a variety of levels; (2) scientists, policymakers and the general public and (3) environmental and public health civil servants. The analysis also provides insights into some shortcomings and makes recommendations for ameliorating this arrangement: (1) the integration of environmental health objectives into all relevant policy domains, (2) the need for additional research into environmental health indicators and (3) the facilitation of the co-production of knowledge and multi-actor governance.

Empirical contributions and analysis about risk governance and policy formation processes are not often conducted. The added value of this Flemish case study is that it presents an example of good practice from which lessons for future risk governance arrangements can be drawn.

This chapter examines the characteristics, challenges and prospects of environmental governance and participation in issues pertaining to human health and the ocean in the CARICOM Caribbean region.

Utilising the fisheries sector – one of the principal economic, social and environmental drivers relating to the marine environment in the Caribbean region – we discuss the concepts of hierarchical governance in contradistinction to heterarchical governance. This is done through a socio-legal analysis of the predominant top-down model of governance, a discussion of the successes and shortcomings of bottom-up governance and a proposal for more inclusive participation methodologies in the region.

While the paradigm of new collaborative environmental governance was birthed in the aftermath of the 1985 Brundtland Commission Report, and moreso since the 1992 Rio Conference, this analysis will show that governance of the marine resource, and consequently how the individual is juxtaposed within this matrix, has not shifted from a position of hierarchy to one of heterarchy, as prescribed by the governance literature. Indeed, the structures for governance remain largely top-down in nature and while many states have begun to embrace more inclusive and participatory methodologies many of these interventions will need to be bolstered if the governance of the region’s marine resources is to progress from traditional top-down to more inclusive and representative typologies.

These concepts, when applied to the subject of environmental governance, will demonstrate that there needs to be an improvement in participatory environmental governance in the CARICOM region if the integrity of human health and the ocean is to be maintained. Importantly, while these methodologies strive for the formulation prescribed in Principle 10 of the 1992 Rio Declaration, and most famously exemplified in the 1998 Aarhus Convention, issues of environmental advocacy, transparency, inequality and justice need to be reconceptualised, if the region is to see prudent governance of the interface between humans and the ocean.

This research takes established concepts on the issue of locus standi in the common law legal tradition and juxtaposes it within the emerging paradigm of ecohealth and environmental governance. This conceptual framework has identified both the prospects and problems of environmental governance in the Caribbean region and may provide the basis for further research as well as more inclusive and sustainable environmental governance.