Ecosystem HealthBalancing Climate Change

with Health Care

John Howard MD, FRCPC

Professor of Paediatrics and MedicineSchulich School of Medicine

University of Western Ontario

Chair, Canadian Association of PhysiciansFor the Environment

Objectives

• To emphasize that health is not the same as health care

• To suggest that there are other important issues other than health care

What is Ecosystem Health??

The Evolution of the Doctor-Patient relationship

1) Traditional Medical Model

2) Patient-Centered Model

3) Ecosystem Health Model

Traditional Medical ModelWhere we were

PatientDisease

1. What is the disease?

2. How do I fix it?HEALTH

Patient-Centered Model

PatientDisease

Illness

Context

1. What is the disease?

2. How do I fix it?

3. What is my patient's unique illness??

4. How do I help my patient?

HEALTH

Ecosystem Health

• The health of the “context” and the interaction of the “context” with human health

- the physical, social, economic and political environment

Ecosystem Health Model

PatientDisease

Illness

HomeCommunity

RegionWorld

1. What is the disease?

2. How do I fix it?

3. What is my patient's unique illness??

4. How do I help my patient?

5. Why is this patient here?

6. What can I do to prevent others from having the same illness?

HEALTH

What is Health?

HealthPhysical Mental

Nutritional Community

Personal Health

Environmental Social

PoliticalEconomic

Spiritual Moral

Societal Health

Ecosystem Health

Spiritual Health - Aboriginal

The Earth is our Mother, the female giver of Life to all her children, some of whom are human beings.

We are related to the animals, the plants, the birds, the insects, and they are related to us. Our lives depend on them.

Moral Health

6.450Provide safe clean water

19.1150.5TOTAL

0.65Eliminate illiteracy

1.310.5Stabilize population

1.915Provide health care

2.419Eliminate starvation and malnourishment

2.721Provide shelter

3.830Retire developing nation’s debt

Percent of current military spending

Annual cost in billion dollars

Cost of global human need programs

Is society’s attitude to climate change morally healthy?

Revelations• Many/all diseases have a significant Ecosystem

Health component

• We need to put less money in sickness care!

• Uncertainty is more important than certainty• Bigger is better!• Things can be done!• Accountability should be replaced by responsibility

37%/5years7.4%/year

2008 Ontario Expenditures

Health46%

Social Support11%

Education18%

Other25%

Environment0%

SicknessHealth

Where are we going?

2010

2016

2044 = 100%Year

% o

f P

rovi

ncia

l Bud

get

Health Care

• NOT a determinant of health

• “The majority of the health care dollar is spent in the last 6 months of one’s life” - 1993

• Average health expenditures on people who are in their last year of life is between 50 and 100 times more than expenditures on those who are not. - Health Canada -2005

Is there a crisis?If so what is the crisis?

CAPE is a group of physicians, allied health care practitioners and citizens committed to a healthy and sustainable environment.

www.cape.ca