4.1. Challenges for the Ecology and Health Nexus
An enmeshed and complex, interconnected world, that benefits from units of analysis that are ecologically coherent, provides a counter view to mechanical and reductionistic interpretations of nature’s component parts and functions, where a divide exists between nature and culture. The counter view allows recognition of a ‘living system’ of which humans are a part. As noted, this orientation resonates with Indigenous peoples’ knowledge systems [7
]. An example is the way that spiritual entities create and continue to exist in landforms and lifeforms: where relationships and interdependence are prominent in socio-cultural structures [56
], and are equivalent to, and inform, the systems’ principles inherent in ecological thought. A first, fundamental challenge for the health community is to genuinely engage with the ecological in this ‘living system’ sense [16
A living system is more than the literal, mechanistic recognition that ecosystems have living components. For example, soils can be described as ‘living’ because they have a significant biological assemblage—from a plethora of microbes (bacteria and fungi in particular) to microinvertebrates, to the roots of plants and macroinvertebrates, where complex symbiotic relationships enhance function (e.g., [58
]). This recognition is important, but not yet the fullness of the concept. A soil (system) is ‘living’ where there is no easy distinction between the biological components (including humans) and the mineral, physical and chemical components with which they are constantly interacting. These components all contribute to the processes and functions of what the soil is doing, or capable of doing. Soils respond to, and modify, their surroundings and conditions, in this way they are self-organised, and have emergent properties. Soils grow, they have states—and can be healthy and unhealthy accordingly. The essential properties of soil as a living system are the properties of the whole soil, which none of the component parts have, requiring us to shift our focus from objects to relationships (see [57
An engagement in the ecological in a living systems sense means a commitment to boundary-crossing in a number of ways: engaging with flows, processes and dynamics that extend beyond (often equally arbitrary) governance boundaries or the conglomerates of human populations. This demands explicit attention to the way systems are nested. All systems are components of smaller systems and make up larger systems. Therefore, the ‘living system’ scales up: from local, landscape, regional through to the planetary. A particular challenge for health researchers is the need for attention to the contextual meso-scale of living systems: the landscapes where the benefits from ecosystems manifest, where the ecological footprints of our cities and countries stamp, and where ecosystems do much of their work of creating the foundation for life (and health).
A second, related challenge is a need to move beyond dichotomies that have tended to characterise our health orientations, achieved by a simple but powerful shift from either/or thinking, to both/and thinking [59
]. Separating the biotic (living) and abiotic (non-living) in a system, instead of seeing the whole ‘living system’ as outlined above, is an example of a dichotomy that structures the way we think about our relationships in the world. Another two familiar, but outdated, and false, dichotomies highlighted by the recent convergence of knowledge, are those between urban and non-urban, and between ecological and social determinants of health.
Exclusive attention to urban contexts, and urbanization, without attention to non-urban, will fail to offer an adequate understanding of reciprocal, interrelated upstream determinants of health. The point here is not to dispute the merits of the urban health agenda or its ongoing effort to engage with the ecological context of a growing proportion of humans on the planet [52
]. Rather, a key concern is that a primary emphasis on the urban can have a domineering and ‘othering’ effect that tends to diminish the meaningful mutual relationships with the non-urban, creating an entrenched and misleading dichotomy that has long-term political, governance, ecological and societal consequences for our shared future [61
]. In addition, a dichotomizing of the urban and non-urban simply fails to reflect the ecological principles of how living systems interact. For example, the mass production of food and water means that rural systems can be understood in terms of where regional demand arises, and the regional populations receiving these provisioning services must be aware of how that production occurs. While the demand may indeed be understood, the latter is at a critical low point, exacerbated by declining food (ecosocial) literacies. Despite some effort labelling foods, fewer and fewer people know where their food comes from, how it is produced and perhaps more importantly, what the ecosocial consequences are of those means of production and distribution.
Likewise, the time has come to celebrate the benefits of a focus on social determinants of health, while also making a path correction to overcome the exclusion of and blindness to the ecological [1
]. Put simply, these dichotomies construct a reality that diminishes the ecological in the living systems sense. Similarly, the benefits of understanding the social determinants of health cannot be divorced from understanding the ecological and vice versa. Both are culturally value-ladened and socially constructed. A river contributes differently to public health depending on which of multiple perspectives is considered: a clean or polluted domestic water resource, a recreational asset, an aesthetic landscape feature and a source of awe and wonder, a way of removing wastes or delivering nutrients to the floodplain, a transport route or impediment, or providing real estate. The social and ecological are both mediated and moderated by market forces that enable the trading of these values. Measuring the benefits provided by ecosystems, that underpin, compound, and enable socio-economic factors determining our well-being, is an explicit attempt to intervene in the market’s exclusion of the things we value yet take for granted from nature. The next generation of systems-oriented work will enable an increased focus on interdependence and relationships among urban and non-urban, the ecological and social, in our collective future.
A third, obvious, but critical challenge, informed by the convergence described above, is to engage actively in the moving across scales and boundaries to operate in complex and uncertain worlds. For the ecological determinants of health, a sectoral paradox exists. Response and intervention themes are often common across different sectors, yet many of the possible response options for human health and ecosystem change lie outside the direct control of the sectors responsible for each [63
]. Options exist as embedded attitudes, decisions and activities in areas, such as sanitation and water supply, education, agriculture, energy, trade, tourism, transport, development, employment and housing. Cross-sectoral activity is nothing new to those engaged with systems thinking, but the failure to do so remains a potent blind spot for many contemporary institutions, processes and prioritization, especially in health. This boundary crossing is particularly important when moving between and among scales and levels within global, through regional to local systems [64
]. The deep governance and policy implications of this add to already recognized challenges of efforts toward Health in All Policies and Intersectoral Action for Health [67
Overlapping sectoral mandates and organizational complexity mean that context-specific ecologically informed solutions are uncertain, a situation best addressed by action followed by reflection, in the adaptive management [71
] of cyclical learning and policy adjustment and implementation. When we overcome the boundaries created by dichotomous thinking, it allows us to pursue a focus on relationships, reciprocity, and interdependence [72
4.2. The Demand for a Critical Re-Interpretation
Discernible in this commentary and related challenges is a critical interpretation by those involved in these intertwined strands, whether they be poet, painter, ecologist or planetary health practitioner. First, we are dealing with living systems, the mesh continually and perpetually reweaving itself, the mesh of which we are a part. Second, the environmental crisis is caused by a cultural tradition that rationalizes the separation of culture from nature, including an elevation of the former to moral predominance, and a failure to recognise or benefit from longer standing traditions that have held, fostered and honoured human capacity that emphasise reciprocity and interrelatedness. Third, the reflexive features (poisoning our home) demand application of, and to, concepts of health, directly, indirectly and metaphorically. Fourth, there is a commitment to effecting change. By its very character, this is a political enterprise.
Accordingly, elements of the romantic period, remain: an emotional wonderment of nature, the aesthetic of the beauty of nature, and a subversion of the mechanistic and even the rational. In their article on the human dimensions of the environmental crisis, Bergthaller et al. [73
] point to the need for a slow methodology that involves “shuttling back and forth between the whole and its parts, between the past, the present, and the future, and … between the environment and culture”. As we continue to relearn the relationships between ecology and health, Bergthaller et al. challenge that “The skills of narration and of careful reading demand that we pay attention to texts and contexts until we can reveal their deeper implications, ambiguities, and blind spots”.
These challenges and the (re)learning and convergences involved represent a fascinating juncture in our understanding of expanding health imperatives. This presents the additional challenge (not always the strong suit of emergent fields) of being engaged, reflective, inclusive and respectful of history, precedents and near-neighbours. Indigenous knowledges and perspectives serve as a particular, and often overlooked, exemplar. Moving beyond pervasive and erosive deficit-oriented approaches to Indigenous health, are rapid and ongoing developments in Indigenous leadership and governance around the ecological in relation to the cultural, social, historical and political [3
], which carry notable imperatives and provide potential fuel for the efforts to re-couple the ecological with social dynamics that serve as the context for health.
The challenges noted here emerge as relatively consistent themes across the diverse, and somewhat ‘crowded’ understanding of the ecosocial and health dynamics of our planet and regions. We are challenged to harness this range of overlapping knowledge in constructive ways. As we do so, we should also anticipate the fertile tensions of living systems—continuing to learn about convergences, overlaps, cycles, redundancies and resilience across our understanding and our responses to expanding health imperatives.