Ecosystem Health: Prescribing a New Vision for the Future of Medicine
Howard, John, Alternatives Journal
MEDICAL CARE IS IN CRISIS throughout North America. In the United States, health care is excellent for those who can afford it, or for those who are fortunate enough to have comprehensive medical coverage. But there are millions of Americans with no medical coverage of any sort. Canada, on the other hand, may be famed for its social health care system, but it is plagued by a critical mismatch between demand and supply. Waiting lists for surgery are getting longer. Elective surgeries must often be cancelled due to bed shortages, and effective medications are sometimes denied due to their increasing costs. The skyrocketing costs of health care are alarming. In Ontario, the percentage of the provincial budget devoted to health care has risen from 34 percent in 1995, to 38 percent in 2000, and to 41 percent in 2004. These increases must come from other sectors of public spending such as education and social support, and yet, do not seem enough to meet the demand.
The solution lies not in increased health care spending, but in more strategic spending. The concept of ecosystem health provides a model that could change the way health care is provided and money is allocated, by changing the way we look at health altogether. Ecosystem health is most simply understood as a systematic approach to health care that attempts to address the relationships between ecosystems and human activities--between the health of people, and the health of the environment.
But perhaps ecosystem health is best understood by looking at the history of the doctor-patient relationship. Traditionally, the patient visits the doctor, presenting symptoms of disease. The job for the doctor is then two-fold--first, to diagnose the disease and second, to treat the disease. The disease is understood to be something that affects many different people, and for which there is usually a standard treatment. For example, a patient may complain of shortness of breath. The doctor diagnoses asthma, and prescribes suitable medications to ease the patient's symptoms.
The patient-centered model builds on the traditional medical model. In this doctor-patient relationship, the doctor also considers the illness (which is the individual patient's unique experience of a particular disease) and the context in which the patient lives. The illness (or experience of the disease) will depend on the context of the patient--the family, the community and so on.
There are two added roles for the physician in this model: to determine the unique illness experience of the patient, and to try to meet the unique needs of that specific patient. In the example of the patient with the diagnosis of asthma, the illness will be very different from patient to patient--whether the patient is a brick-layer or an opera singer, whether he is five years old or 95, whether she smokes or doesn't smoke, whether he is wealthy or not. The treatment of the disease will therefore differ significantly depending upon the experience of the illness and upon the context of the patient.
The ecosystem health model incorporates the first two models but also considers the important interaction of the patient with the environment--not just the physical environment, but also the economic, social and political environments. In the shortness of breath example above, the health care provider needs to consider why so many people now require asthma therapy and more so, what the health care system can do about it. This model forces the health care provider to consider two very important questions that are for the most part overlooked in conventional medical approaches: What caused the patient to have this problem? What can the physician or society do to prevent the problem from developing in other people?
The ecosystem health model looks at health from as broad a perspective as possible. Health and disease are understood to result from an infinite number of interactions. …