Converging Paradigms for Environmental Health Theory and Practice. (Research Commentary)
Parkes, Margot, Panelli, Ruth, Weinstein, Philip, Environmental Health Perspectives
Converging themes from the fields of environmental health, ecology and health, and human ecology highlight opportunities for innovation and advancement in environmental health theory and practice. In this commentary we outline the role of research and applied programs that integrate biophysical and social sciences with environmental health practice in order to address deficiencies in each field when taken on its own. New opportunities for environmental health protection and promotion are outlined based on the three converging themes: integrated approaches to research and policy, methodological acknowledgment of the synergies between the social and biophysical environments, and incorporation of core ecosystem principles into research and practice. These converging themes are discussed in relation to their implications for new types of intervention to achieve health gains across different spatial and temporal scales at the interface between biophysical and social environments. Key words: determinants of health, ecology and health, environmental health, human ecology, multistakeholder processes, participation, socio-ecological systems. Environ Health Perspect 111:669-675 (2003). doi:10.1289/ehp.5332 available via http://dx.oi.org/ [Online 23 January 2003]
Over the past century a range of disciplines have provided diverse resources and a rich heritage of knowledge relevant to environmental health theory and practice. In this commentary we briefly review the core themes and generic concepts emerging from environmental heath, ecology and health, and human ecology. Through these fields, we can trace various approaches to identifying health differences and strategies for health promotion and protection that can generate health "benefits"--generally measured as decreased morbidity and/or mortality. Environmental health, ecology and health, and human ecology each provides constructs applicable to public health interventions at different scales of temporal, spatial, and conceptual complexity. These constructs are not mutually exclusive, because approaches attuned to deal with complex issues can also provide useful new insights to address more basic problems. The three fields should be seen as complementary approaches to addressing overlapping problem fields in health, environment, and development.
Our commentary highlights the increasingly complementary and converging work of the last two decades and argues for a further conceptual and methodological integration of knowledge and action to ensure comprehensive and sustainable environmental health gains. Our contention is that research and applied programs that integrate biophysical and social sciences with public health practice can go some way toward addressing the deficiencies in each approach when taken on its own. We also propose that reconsideration of more integrated conceptual frameworks as well as methodological choices can enable more comprehensive understandings of the complex ecosystem and social dimensions of multiscaled health problems and potential interventions.
A broad definition of environmental health encompasses "the theory and practice of assessing and controlling factors in the environment that can potentially affect adversely the health of present and future generations" [World Health Organization (WHO) 1993, p. 18]. As a science, environmental health has traditionally been grounded in medicine, epidemiology, toxicology, chemistry, ecology, and physics, with an associated focus on protection through regulation and standards (Institute of Medicine 2001). Consequently, practitioners of environmental health generally concern themselves with the more direct, biophysical effects of the environment on human health.
The "germ theory" origins of environmental health are well illustrated by the cause-and-effect approach adopted by early practitioners such as John Snow, who was able to abort the 19th century cholera epidemic in London by removing the handle from the Broad Street pump--the major source of contaminating water. …