Preparing for the future of public health: ecological determinants of health and the call for an eco-social approach to public health education

Abstract

As a collective organized to address the education implications of calls for public health engagement on the ecological determinants of health, we, the Ecological Determinants Group on Education (cpha.ca/EDGE), urge the health community to properly understand and address the importance of the ecological determinants of the public's health, consistent with long-standing calls from many quarters-including Indigenous communities-and as part of an eco-social approach to public health education, research and practice. Educational approaches will determine how well we will be equipped to understand and respond to the rapid changes occurring for the living systems on which all life-including human life-depends. We revisit findings from the Canadian Public Health Association's discussion paper on 'Global Change and Public Health: Addressing the Ecological Determinants of Health', and argue that an intentionally eco-social approach to education is needed to better support the health sector's role in protecting and promoting health, preventing disease and injury, and reducing health inequities. We call for a proactive approach, ensuring that the ecological determinants of health become integral to public health education, practice, policy, and research, as a key part of wider societal shifts required to foster a healthy, just, and ecologically sustainable future.

Education for sustainable healthcare: Leadership to get from here to there

“…A complex systems thinking approach provides a lens that overtly acknowledges the interdependency and interrelationships of all agents in the systems, that 'simple' rules or changes can lead to large effects, and that a change in one part of the system can have unanticipated consequences throughout the system (Till et al 2016;Obolensky 2010). The combined goals of health and sustainability demand that we consider the context of our actions in new ways, including overt attention to both the social and the ecological context for health and healthcare with focused attention to different scales of influence (Buse et al 2019;Parkes et al 2020). ESH recognizes that the health of people and their planet are linked through interdependent living systems from local, bioregional to planetary scales and across generations and cultures, including Indigenous knowledges (Redvers 2018;Horwitz and Parkes 2019;Redvers et al 2020).…”

“…ESH recognizes that the health of people and their planet are linked through interdependent living systems from local, bioregional to planetary scales and across generations and cultures, including Indigenous knowledges (Redvers 2018;Horwitz and Parkes 2019;Redvers et al 2020). Likewise, ESH requires attention to the range of social influences and interactions across the education system(s) (academic, regulatory, accreditation, credentialing), and as part of allied social change efforts (advocacy and leadership, policy, regulation, community engagement) (Woollard and Boelen 2012;Parkes et al 2020). These actions exemplify regenerative leadership (Hutchins and Storm 2019) and global leadership (Javidan and Walker 2012) in systems change implementation.…”

“…The productive interaction of all facets of health professions' education systems can lead to novel approaches to issues related to sustainability and human health situated within a complex system (Plsek and Greenhalgh 2001). This productive interaction has been clearly exemplified by the many existing and evolving tools and resources on environmental sustainability in HPE, including eco-social approaches to health and planetary health, that are available for institutional adaptation (Walpole et al 2019;Barna et al 2020;Huss et al 2020;Parkes et al 2020). In advancing needed organizational change in the health and educational systems, the simultaneous convening of an environmental and social accountability 'partnership pentagram' (Figure 2, Woollard 2006) and using an appreciative inquiry approach (Watkins and Stavros 2009) has proven effective in both high and low resource contexts (Rourke 2006;Green-Thompson et al 2017).…”

Strengthening collaborations at the public health system–academic interface: a call to action

“…For instance, the Council for Education in Public Health (CEPH) has recognized health equity as a foundational public health competency (CEPH 2016). Competency gaps already identified by schools and programs and professionals in public health, and other organizations also include the lack of attention to health, social and racial equity, competencies in Indigenous health, ecological determinants, and leadership (Parkes et al 2020; National Collaborating Centre for Determinants of Health 2012). Overall, the advancements to date do not adequately address the Naylor Report's recommendations for strengthening the funding and capacity of the public health system and for integrated public health system-academic collaborations.…”

Are Health Innovations Techno-economic or Social Values in a period of a Health Crisis? A Reflection on the Field of Public Health through the Examples of Ebola and Covid-19

“…In addition, sustainable innovations that do not damage or affect personal, public, and planetary health are necessary. For that, in a dynamic of proactivity and sustainability, it is relevant to put forward an integrated and eco-social approach to health in which ecological determinants are complementary to the social determinants of health [75]. In this sense, the innovations promoted in public health must take into account their relationships with and consequences for the various elements related to ecologies and ecosystems at local and global scales.…”