Planetary Health: A Paradigm Shift into Interdependence

 by Elisabeth Osgood-Campbell 

Introduction

When Copernicus radically proposed that the Earth was not the center of the universe, he challenged the geocentric view of the planets with a heliocentric view in which the Earth and other celestial bodies are understood to revolve around the sun (Crotty, 1998). On a smaller scale, within the scope of life on our beautiful, blue planet, an emerging paradigm shift to planetary health asserts that humans are not isolated at the top of an evolutionary pyramid, in control of all life forms “beneath” them. Instead, the framework of planetary health views humans, and their health, as embedded in interdependent relationships with animals and other elements in our ecosystems. Some schools of nursing like the University of Minnesota, Massachusetts General Hospital Institute of Health Professions, and Yale University, have created planetary health initiatives to advocate for ‘better health for all people…and the planet.’

Figure 1

 

Health Paradigms

A paradigm is comprised of a set of beliefs and ideas, or a model, for understanding a topic (Crotty, 1998). For centuries in Western cultures, the dominant health paradigm has viewed wellness as an individual phenomenon, defined by the proper functioning of physiological systems (Arah, 2009). If the various processes such as breathing, circulation, digestion, and immunity proceed as usual, a person has generally been deemed to be healthy. Clinical medicine has focused on diagnosing and treating dysfunctions of particular systems like lung disease, heart disease, and irritable bowel syndrome, to name a few. However, at various points in history, many cultures have also incorporated an understanding of public or population health by acknowledging external influences on the well-being of communities of people including lifestyle (e.g., nutrition) and immediate environment (e.g., sanitation). (Tulchinsky & Varavikova, 2014). In fact, in 1859, Florence Nightingale’s Environmental Theory defined nursing as “the act of utilizing the patient’s environment to assist him in his recovery” (Lilienfeld et al., 2018, p.487). Key elements to support patient health in her theory included fresh air, pure water, efficient drainage, cleanliness, and sunlight.

While population health has historically focused on community health within a particular region or country, the concept of international health that emerged in the late 19th century addressed medical issues that spanned national borders, i.e., epidemics like the Spanish flu. Next, with the creation of the World Health Organization in 1948, the paradigm of global health emerged (Brown et al., 2006). This framework similarly considers the health needs of people in a very large geographic area rather than specific nations, but it also focuses on medical issues that have global impact or need to be addressed through global solutions (Chen et al., 2020).

 

Crises Spur Paradigm Shifts

According to philosopher Thomas Kuhn, a paradigm shift occurs when current findings are not adequately explained by the dominant paradigm (Crotty, 1998). In the past two decades, environmental crises have forced a revision of conventional approaches to individual, population, and global health. The detrimental effects of toxins in our water, soil, and air, from the contamination of the public water supply in Flint, Michigan, to the derailment of a train carrying toxic chemicals in Ohio this past February, are becoming increasingly clear to both the general public and medical professionals. In fact, in the emerging field of geomedicine, geographic information systems (GIS) can inform healthcare workers about environmental hazards such as asbestos or contaminated water in the region of a person’s home or school (Setia et al., 2017). Medical issues associated with climate change events such as more frequent wildfires, floods, and hurricanes have also become more obvious in recent years. Increasingly, human health is viewed in the context of ecological phenomena that are associated with global warming (Figure 2). Some nursing programs have noticed this trend and have spearheaded a new paradigm in Western medicine that reframes human health as interdependent on the health of the planet (Rosa & Upvall, 2018).

 

Figure 2

 

The Planetary Health Paradigm

The planetary health paradigm approaches health not as a solely human-based phenomenon, but rather as an interconnected web of relationships among animal, human, and ecosystem well-being (Rosa & Upvall, 2018). It also asserts that climate crises are the greatest threat to human health worldwide (Lilienfeld et al., 2018). Additionally, the framework of planetary health comprises more than an awareness of the humanitarian crisis that our changing climate presents. Sadly, but not surprisingly, resource-rich countries (e.g., the U.S.)  contribute most to climate change, but those living in resource-poor countries are often the most vulnerable, suffering more direct adverse effects (ibid). Thus, climate change also presents an urgent social justice challenge. Accordingly, the paradigm of planetary health calls for massive collaboration across disciplinary and national boundaries to address health inequities that will be further exacerbated by global warming.

The paradigm shift to planetary health may be “new” in the context of contemporary Western medicine, but the idea that humans are embedded in the web of life and that the health of individuals depends on the health of communities and ecosystems has existed in indigenous cultures across the globe for millennia.  Below, Figure 3 depicts an indigenous perspective on health that emphasizes interdependence between multiple aspects of individual and community wellness, including the natural environment (Gallagher, 2019).

 

Figure 3

 

The Role of Nursing in this Paradigm Shift

As nurses care for people individually and in communities, they are in a unique position to advocate for planetary health and mitigate the negative effects of climate crises in multiple ways (Kurth, 2017). For example, nurses can educate patients about the personal and collective benefits of decreasing greenhouse gasses by eating more plant-based foods and walking rather than driving. Nurses can also encourage a reduction of their workplace carbon footprints through more economical use of resources such as electricity and water as well as paper and plastic products. In addition, nursing schools can integrate planetary health curricula into their programs. Furthermore, nurses can broaden their traditional roles beyond providing healthcare services and advocate for policy changes on local, state and federal levels to minimize the impact of climate crises on the immediate and more distant future. This paradigm shift will also shape nursing research science in the years to come. Here are a few of the countless questions that could be investigated through a planetary health lens:

• What effect does climate change anxiety have on stress levels and immune function?
• What impact does climate change activism have on stress levels and immune function?
• What effect does time spent outdoors in the natural environment have on stress levels and immune function?

 

Conclusion

              Driven by an increasing awareness of the impact of climate crises on human well-being, the paradigm shift from individual, public, and global health to planetary health seems inevitable. Reflecting ancient indigenous views of the interrelatedness of human and ecological health, this framework has the potential to alter current nursing practices, roles, and research. However, widespread adoption of this perspective will require extensive education, collaboration, and financial resources. Hopefully, healthcare professions will be able to respond effectively to the complex challenges and opportunities that this new paradigm presents. The health of the planet depends on it.

 

 

Resources 

https://nursing.umn.edu/about/planetary-health

https://www.mghihp.edu/nursing/centers-initiatives/center-climate-change-climate-justice-and-health

https://nursing.yale.edu/global-affairs-planetary-health/planetary-health-initiatives

https://www.britannica.com/event/Flint-water-crisis

https://www.nytimes.com/article/ohio-train-derailment-timeline.html

https://www.planetaryhealthalliance.org/planetary-health

 

 

References

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Chen, X., Li, H., Lucero-Prisno, D. E., 3rd, Abdullah, A. S., Huang, J., Laurence, C., Liang, X., Ma, Z., Mao, Z., Ren, R., Wu, S., Wang, N., Wang, P., Wang, T., Yan, H., & Zou, Y. (2020). What is global health? Key concepts and clarification of misperceptions: Report of the 2019 GHRP editorial meeting. Global health research and policy, 5, 14. https://doi.org/10.1186/s41256-020-00142-7

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Gallagher J. (2019). Indigenous approaches to health and wellness leadership: A BC First Nations perspective. Healthcare management forum, 32(1), 5–10. https://doi.org/10.1177/0840470418788090

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Rosa, & Upvall, M. J. (2019). The case for a paradigm shift: from global to planetary nursing. Nursing Forum (Hillsdale), 54(2), 165–170. https://doi.org/10.1111/nuf.12310

Setia, S., Singh, S., Mathur, A., Makkar, D. K., & Pal, V. (2017). Health care and geomedicine: a review. World Journal of Environmental Biosciences, 6(1), 1-3.

Tulchinsky, T. H., & Varavikova, E. A. (2014). A History of Public Health. The New Public Health, 1–42. https://doi.org/10.1016/B978-0-12-415766-8.00001-X