Towards Integration of Ecosystem and Human Health: A Novel Conceptual Framework for the Operationalisation of Ecological Public Health

References: Adger WN, Eakin H, Winkels A. Nested and teleconnected vulnerabilities to environmental change. Front Ecol Environ 2009; 7(3):150–157, doi:10.1890/070148.Morris GP, Beck SA, Hanlon P, et al. Getting strategic about the environment and health. Public Health 2006;120:889–907Rayner G and Lang T. Ecological Public Health: Reshaping the Conditions for Good Health. Routledge Publishers 2012.

Stefan Reis1,2, Lora Fleming2, Sheila Beck3, George Morris2, Michael Depledge2, Timothy Taylor2, Mathew White2,Rognvald Smith1, Jan Dick1, Melanie Austen4

1NERC Centre for Ecology & Hydrology, 2University of Exeter Medical School/ECEHH, 3NHS Health Scotland, 4Plymouth Marine LaboratoryContact: srei@ceh.ac.uk

1 Shaping a new Approach for Public HealthPublic health has been uniquely challenged over recent decades to translateemerging socio-ecological thinking on health and its determinants into effectivepolicy and action. Various conceptual models have been developed to portraythe complex interaction of social, behavioural, environmental and geneticfactors in creating and destroying health. The modified Drivers-Pressures-States- Exposure-Effect-Action [DPSEEA] (mDPSEEA) model (Morris 2006)(Figure 1) reflected such perspectives in environment and health policy, and hasbeen exploited in Scotland for issue framing, to support stakeholderengagement, and to underpin more holistic and crosscutting approaches inenvironmental health.

3 Ecological Public Health

Concerns over sustainability and the breach of planetary boundaries for humanexistence make evident that humans are not distinct from natural ecosystems, butrather, actually integral to them. Humans interact dynamically with other parts ofthose ecosystems. Human activity, including economic activity, is a direct andindirect driver of changes in ecosystems on which they rely for many servicescritical tor health and wellbeing. Recognising that public health must embrace andoperationalize this integration of social relationships with the ecology of thenatural world, Rayner and Lang (2012) have called for a new “Ecological PublicHealth” built on the core idea that “human health depends on the coexistence ofthe natural world and social relationships.”

2 Ecosystem Services

The concept of Ecosystem services has its origins in the desire of environmentalscience to integrate the natural and the physical with social economic and otheranthropocentric concerns. Ecosystems underpin all human life and activities, and“Ecosystem Services” are benefits which people obtain from them. The followingcategories of ecosystem services, each important for human life, have beenidentified:1. Provisioning Services are products obtained from the ecosystem (e.g. fresh

water, food, timber, fibres, fuels, genetic resources, natural medicines,pharmaceuticals);

2. Regulating Services govern issues such as air quality, climate, rainfall,pollination, the spread of disease, the purification of water, the filtration andbreakdown of organic waste;

3. Cultural Services encompass non-material ways in which people benefit fromecosystems, ranging from benefits such as Cultural Diversity (significantlyinfluenced by the diversity of ecosystems) to inspiration (e.g. for art orarchitecture to the opportunity for Recreation or Eco-Tourism);

4. Supporting Services underpin the production of all other ecosystem services(e.g. soil Formation, photosynthesis, nutrient cycling, etc).

4 Ecological Public Health & Ecosystem Services

We identify significant convergence between Ecological Public Health, with itscalls for the acknowledgement in policy and action of the integration of social andnatural ecology, and the concept of Ecosystem Services, particularly to expressthe connectivity of planetary ecosystems and human health/wellbeing.

Experience in using mDPSEEA to integrate socio-ecological perspectives inenvironmental health policy - to frame complex issues in a policy relevant wayand, especially to support stakeholder engagement, implies a new conceptualmodel which can also help communicate and operationalize Ecological PublicHealth. We believe integration of the process simplifications represented byFigure 1 (mDPSEEA) can provide the basis for such a model. In Figure 2(Ecosystems Enriched DPSEEA or “eDPSEEA”), we offer a prototype, which hasbeen applied to public health and environmental discourse over a range of topics,including in workshops on seafood and mineral fertiliser application and is beingexpanded in the context of proximal and distal effects of climate change.

Figure 2 “The ecosystem-enriched DPSEEA” (eDPSEEA) Model”

For a more detailed introduction of the eDPSEEA model and the concept of proximal and distal pathways, please refer to the following publications: Morris GP, Reis S, Beck S, Fleming LE, Adger WN, Benton TG, Depledge MH (2014) Climate Change and Health in the UK: Scoping and Communicating the Distal Dimension. Position paper to the Living With Environmental Change

(LWEC) Health Conference, 08/10/2013, London/UK (under review)Reis S, Morris G, Fleming LE, Beck S, Taylor T, White M, Depledge MH, Steinle S, Sabel CE, Cowie H, Hurley F, Dick JMcP, Smith RI, Austen M (2013) Integrating Health & Environmental Impact Analysis. Public Health.

http://dx.doi.org/10.1016/j.puhe.2013.07.006 (in press, corrected proof)

P2-477

Figure 1 mDPSEEA maps from high level cultural, political etc. Drivers to the Pressures which modify the environment to produce an environmental State with defined characteristics with human Exposure and on to health Effect, all enclosed by Context to reflect the influence of demographic, social, cultural, etc. factors on both exposure and health effect. The model allows Actions to be directed to any point on the chain or context.

Figure 3 Pathways from Climate-Related Environmental Change to Human Health and Wellbeing in any Locality

5 Proximal and distal pathways

Figure 3 illustrates how individuals and socio-economic groups in localenvironments can be affected by a combination of proximal and distal effects.There may be immediate effects, but also others which are subsequentlytranslated to individuals and communities by economic, biophysical and resourceflow mechanisms. These mechanisms linking vulnerabilities across space and timehave been elaborated by Adger et al. (2009). The process and the product ofpopulating simple conceptual models can make more explicit some of theconceptually difficult distal pathways through which e.g. climate change canimpact on our health.