Healthy People Healthy Planet:
Holistic Integrative Health as a Global Solution
IHS New York City
February 2020
Mimi Guarneri MD FACC ABOIM
Pres. Academy Integrative Health and Medicine
www.aihm.org
STRENGTH OF CONVENTIONAL WESTERN HEALTHCARE
Trauma Care
Surgery
AntibioticsDiagnostics
Acute Care
Cardiovascular diseases: leading causes of death in the world
Around 3 in 10 deaths globally are caused by cardiovascular diseases –At least 80% of premature deaths from cardiovascular diseases could be prevented through a healthy diet, regular physical activity and avoiding the use of tobacco. WHO 2016
Almost 1 in 10 Adults has Diabetes
Almost 10% of the world’s adult population has diabetes, measured by elevated fasting blood glucose (≥126 mg/dl). People with diabetes have increased risk of heart disease and stroke. Deaths due to diabetes have been increasing since the year 2000, reaching 1.5 million deaths in 2012.
WHO 2016
NAFLD on the Rise
If the current rates of obesity and diabetes
continue for another two decades, the prevalence of
NAFLD in the US is
expected to increase by 50% in 2030.
International Liver Congress, 2011 Statement.
“The next generations will be the first in recorded history to die younger and sicker than their parents--a public-health catastrophe”.
Olshansky 2005 NEJM
Industrialized Food SystemGood Intentions:Dangerous Consequences
▪ Limited (no) outdoor access
▪ Closed worker environment
▪ Concentrated fecal waste exposure
▪ Cramped, stressed environment
▪ Results:
▪ Pro Inflammatory
▪ Hormones
▪ Antibiotics Resistance
▪ The average U.S. farm uses 3 kcal of fossil energy in producing 1 kcal of food energy (in feedlot beef production, this ratio is 35:1), and this does not include the energy used to process and transport the food
Government Subsidies
One of the largest beneficiaries of federal agricultural subsidies are the cattle ranchers whose animals graze on federal lands for less than one-third the price they would pay on private land.
Total subsidies in the federal grazing program cost taxpayers at least $500 million a year, notcounting the cost of the environmental degradation caused by overgrazing
Industrial Agriculture
Monocultures are eroding biodiversity among plants and animals.Chemical pesticides and fertilizers are polluting soil, water, and air, harming both the environment and human health.Soil is eroding much faster than it can be replenished--taking with it the land's fertility and nutrients that nourish both plants and those who eat themWater is consumed at unsustainable rates
Animal Based Foods and Chronic Disease
• Pesticide residues enter our bodies through air, water, and food and raise risks for certain cancers as well as reproductive and endocrine system disorders.
• Concentrated, high-speed meat production leads to a greater risk from foodborne pathogens.
• Excessive use of antibiotics in animal agriculture leads to antibiotic resistance
Atrazine, Insulin Resistance and Obesity
“These results suggest that long-term exposure to the herbicide ATZ (atrazine) might contribute to the development of insulin resistance and obesity, particularly where a high-fat diet is prevalent.
ATZ has been extensively used in the USA since the early 1960s, a time frame that corresponds to the beginning of the present obesity epidemic.
ATZ-usage and obesity maps show striking overlaps, suggesting that heavy usage of ATZ may be associated with the risk of obesity.”
Lim S et al. Chronic Exposure to the Herbicide, Atrazine, Causes Mitochondrial Dysfunction and Insulin Resistance. PLoS ONE, April 2009;4(4):e5186.
“Much evidence has emerged showing that environmental toxins, including POPs, affect mitochondrial function and subsequently induce insulin resistance.”
Hayes TB, Khoury V, et al. PNAS USA 2010;107(10):4612-7.
Hayes TB, Collins A, et al. PNAS USA 2002;99(8):5476-80.
Arsenic in Drinking Water
“Elevated mortality rates were observed for both males and females for all diseases of the circulatory system [SMR ≈ 1.13], cerebrovascular diseases [SMR = 1.19], diabetes mellitus [SMR ≈ 1.28], and kidney diseases [SMR ≈ 1.33].
Meliker JR et al. Environ Health 2007.
American Medical Association
More attention also needs to be paid to the economic and regulatory policies that encourage the production of unhealthy, non-sustainable food at low immediate financial cost to consumers, at the expense of poorer health outcomes that cost far more to treat with medications and procedures than investments in healthy food
Hypercholest-
erolemia
Statin
Gastroesophageal
Reflux Disease
H2 blocker
Depression
SSRI
HypertensionACE
inhibitorMigraines Triptan
Osteoarthritis
NSAID
Irritable Bowel
Syndrome
Dicyclomine
Each individual
diagnosis becomes a
distinct entity unto itself.
Poly-pills for poly-ills?
Pharmaceutical Industry and GDP
The Price of Disease Care
“Climate change is the largest health threat in the 21st
century” – The Lancet
The World’s Poorest Suffer the Most
Food security
Drought
Clean water
Diarrhea diseases
Extreme heat
Balbus, J., A. Crimmins, J.L. Gamble, D.R. Easterling, K.E. Kunkel, S. Saha, and M.C. Sarofim, 2016: A Scientific Assessment. U.S. Global Change Research Program, Washington, DC, 25–42
The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to comeNick Watts, MA Markus Amann, PhD Prof Nigel Arnell, PhD Sonja Ayeb-Karlsson, PhDKristineBelesova, PhDProf Helen Berry, PhD
Healthcare
Climate Refugees
Bangladesh Bhola Island
Maldives
Venice
Louisiana
Floating Schools of Bangladesh
School BoatsIn Bangladesh, climate-induced flooding is swallowing up much of the countrys land. The nonprofit organization Shidhulai SwanirvarSangstha, which means self-reliance, is building schools on boats. The group has built more than 40 school-boats, complete with computers and libraries. Solar lamps allow students to study at night after working all day.
Tuvalu
The island nation of Tuvalu has struck an agreement with New Zealand to accept its 11,600 citizens in the event that rising sea levels overtake the country. Tuvalu is made up of eight tiny coral atolls, with a total land area of just 26 square kilometers (10 square miles).
The Passport That protected 450,000 Refugees
We can see signs that things are now reaching a breaking point, due to the rapid pace of change and degradation; these are evident in large‐scale natural disasters as well as social and even financial crises, for the world’s problems cannot be analyzed or explained in isolation.
We are faced not with two separate crises, one environmental and the other social, but rather with one complex crisis which is both social and environmental.
The same mindset which stands in the way of making radical decisions to reverse the trend of global warming also stands in the way of achieving the goal of eliminating poverty.
Physiology /
Biochemistry
Genetics
Environment
Lifestyle
What Really
Determines
Health or
Disease?
Understanding The Origin Of Chronic Disease
Poor Diet
Trauma
Drugs, Alcohol
Stress, Negative Emotions
Smoking
Lack of
Exercise
Oxidative Stress
Immune Imbalance
Decreased Energy Production
Poor Detoxification
Hormone Imbalance Emotional Stress
GI Problems
Structural Stresses
Body
Cells
RadiationToxic
Chemical Exposure
Expression of Inflammationand Preclinical SymptomsInflammation
Chronic Disease
GenomicInstability
Sullivan VK. J Amer Diet Assoc May 2006;106(5):668-671.
Our genes haven’t changed, but our environment has…
“According to the thrifty genotype theory, few if any changes in genes or gene sequences have occurred over the past 10,000 years.”
American Medical Association
More attention also needs to be paid to the economic and regulatory policies that encourage the production of unhealthy, nonsustainablefood at low immediate financial cost to consumers, at the expense of poorer health outcomes that cost far more to treat with medications and procedures than investments in healthy food
We Are at a Tipping Point.
Sustainable Development Goals
End Poverty
Zero Hunger
Good Health and Well-Being
Quality Education
Gender Equality
Clean Water Sanitation
Affordable clean energy
Decent work
Industry Innovation
Reduced inequalities
Sustainable cities
Climate action
Life below water
Life on land
Peace Justice
Partnership
WELLNESS ROUTE MAP
Old Road New HighwayHealth care as an
institution-led service
Health and social care
as part of a community
Curative and fixing
medical care
Early intervention and preventative
care
Meaningful scorecard information and
in real time
Integrated and in partnership
Single indicators and
out-of-date measurements
Isolated and segregated
Sickness Health and wellbeing
Source: Adapted from England’s National Health Service (NHS) Route Map for Sustainable Health3
Old Road New Highway
Sustainability as an add-onIntegration in culture,
practice and training
A balanced use of resources where
waste becomes a resource
Caring Community
Waste and overuse
of resources
Nobody’s business
Buildings Healing environments
Source: Adapted from England’s National Health Service (NHS) Route Map for Sustainable Health3
Procedure-focused treatmentChronic illness management focused on
a return to health
WELLNESS ROUTE MAP
WHO Traditional Integrative Medicine Strategy
The strategy aims to support Member States in developing proactive policies and implementing action plans that will strengthen the role traditional medicine plays in keeping populations healthy.
We Have to Think DifferentlyWe Are the Change
Biomechanical
Silos
Parts
Hospitals
Hierarchy
Waste
Treating Disease
Quantity
Patriarchy
Holistic
Systems
Whole
Communities
Collaboration
Sustainability
Creating Health
Quality
Matriarchy
Ecological Integrative Health and Medicine
The first goal of medicine is to establish the conditions for health and wholeness, thus preventing disease and illness.• The second goal of medicine is to cure.• The earth is also the clinician’s client• Humans are part of a local ecosystem.• Disturbing an ecosystem can affect the health and well-being of humans.• Medicine, in general, should not add to the illnesses of humans or the earth.• Medical care should not damage other species on the earth or the ecosystem
The doctor of the future will give
no medicine, but will interest her
or his patients in the care of the
human frame, in a proper diet,
and in the cause and prevention of
disease.
Thomas Edison
The best way to predict the future is to create it!
“Turning Off” Cancer-Causing Genes by Intensive Lifestyle Changes(red = turned on; green = turned off)
Ornish D et al. Proceedings of the National Academy of Sciences USA. 2008;105:8369-8374.
Where healthcare is about health and available to all;Where prevention is our foundation and mechanical fixes are embraced when we need them;Where all healthcare providers work collaboratively to heal body, mind and spirit;Where sustainability is integrated into our culture, practice and training;We are the solution.Working together to establish a new paradigm of health care for humanity and the planet
A holistic approach to health, health care means more than a prescription: it means empowering communities to become whole.
Internationally Inter-professional education and community dedicated to the transformation of health care
The New EconomyNuka System of Care
https://www.southcentralfoundation.com/nuka-system-of-care/
South Central Alaska, moved from a centrally organized bureaucratic system to customer ownership and control of the health care system...
ACP Recommendation
The health care sector, within the United States and globally, must implement environmentally sustainable and energy-efficient practices and prepare for the impacts of climate change to ensure continued operations during periods of elevated patient demand.
“Green” Environments
Transportation
Energy operations
Energy in the built environment
Waste
Food Service
(Source: Health Care without Harm)
Image
Case Study: University of Washington Healthy Food Initiative
Increased purchasing of sustainable, local, organic (SLO) food: 20% produce, 67% dairy, 47% is locally sourced Meatless Mondays, more vegetarian/non-meat protein options, decreasing meat portion sizes has reduced amount of meat servedUW estimates that efforts have cut overall GHG emissions by 11.8%, the emissions equivalent of 211 cars
ACP 2017
Case Study: Seattle Children’s Hospital
Hospital Comprehensive Transportation Plan
Reduce vehicle traffic by shuttle links to transit hubs, parking changes, encourage carpooling, free transit for employees, vanpool service
Make area more walk-, cycling-friendly through capital investments that link hospital and surrounding community to larger walking/biking networks, free bikes to employees who pledge to bike to work, cash for those who don’t drive to work, on-site bike maintenance, discounts on gear from in-house bike shop.
Seattle Children’s Hospital is already more than halfway to its goal of getting from 50 percent car commuting to 30 percent.
Drive-alone commuting trips by employees down from 73% in 1995 to 38% in 2015
Case Study: Boston Green Ribbon Commission Health Care Working Group
Image
• Nearly all major Boston-area hospitals participate. Commission’s goal is 25% drop in GHG emissions by 2020, 100% by 2050
• Member hospitals achieved cuts in electricity, natural gas use, GHG reductions for all fuels.
• Sector energy use dropped by 9.4% from 2011-2015, “avoiding greenhouse gas (GHG) emissions equivalent to 126 million miles traveled by an average passenger vehicle.”
• 100% of Partners HealthCare energy is from zero emission sources. Boston Medical Center expects to be 92-100% carbon neutral by 2018.
• Cost savings conservatively estimated at $15 million, enough to pay for healthcare for 1,357 Massachusetts Medicare enrollees.
IPES and Global Alliance for the Future of Food 2017
"Truly healthy food systems will be built on a more integrated, multi-faceted, and holistic approach including nutrition, health, happiness, and social and cultural indicators interpreted together and in relation to each other within the context of healthy and well-functioning food and agricultural systems."
www.thefoodcommons.org
A community food system that fosters health, stewardship, equity, and economic development. This system includes farm production, processing, distribution, and retail sales in Fresno and the surrounding San Joaquin Valley.Broad-based community participation is a core value of the Food Commons. Food Commons Fresno assets are utilized for the benefit of the community by the nonprofit Food Commons Fresno Trust.
Building a Community Food System
“One of the most ambitious regional efforts to reimagine the food system from farm to plate"
John Thakara - How to Thrive in the Next Economy
“Marks a radical shift from a narrow focus on the production of food on its own, towards a whole-system approach in which the interests of farm communities and local people, the land, watersheds and biodiversity are all considered together
David Bollier - The Nation
www.thefoodcommons.org
The New EconomySustainable Agriculture
Small, profitable farms
Fewer off-farm inputs
Integrate animal and plant productionMaintain a higher biotic diversityTechnologies that are appropriate to the scale of production
Utilize renewable forms of energy.
Community Supported Agriculture
Farmers markets and community-supported agriculture (CSA). In the CSAmodel, consumers purchase a "share" in a farm and receive a portion of itsharvest. This gives farmers more working capital at the beginning of thegrowing season and a guaranteed market at the end. Consumers develop adirect link to their food supply and have input into production decisions.CSAs have helped keep many small farms in business Meanwhile, farmersmarkets have enjoyed rapid growth in the United States. Between 1994 and 2014, the number of U.S. farmers markets increased by 63%, from 1,755 to 8268
Climate Change MitigationMore efficient use of energy
Expanded use of carbon neutral or low-carbon energy
Reductions in deforestation and increases in reforestation
Lifestyle and behavioral changes (such as energy conservation and reduced energy demand).
Sri Narayani Hospital and Research Centre
Solutions to High Risk Pregnancy
Solution to 5 CV Deaths Daily
Sri Narayani School of Nursing
Sri Puram Agriculture
Sri Puram Food Hall
From Wood Burning to Solar
Reforestation
Zero waste
Turning Trash into Black Gold
Women Empowerment
Vidalaya Children’s School
Vidalaya Children’s School
“The economy should not be a mechanism for accumulating goods, but rather the proper administration of our common home. It is an economy where human beings in harmony with nature, structure the entire system of production and distribution in such a way that the the abilities and needs of each individual find suitable expression in social life”
Pope Francis, July 9,2015
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