Mother Lode River Center urges an ecological approach to health

In the United States, human health has traditionally been viewed in isolation from its ecological context. During my medical training and subsequent career in Emergency Medicine, issues such as climate change, habitat destruction, species extinction, pollution, and the depletion of freshwater supplies were treated primarily as environmental issues that were outside from the medical industry. Equity has been seen as primarily a political, economic and social issue. Sustainability was rarely considered.

I believe that this point of view must be changed and that not only doctors, but all Americans, have a responsibility to effect this change. Achieving health requires that we address all of these elements in an integrated ecological approach. Our goal must be “healthy people, living in equitable and sustainable societies, in balance with the natural world.” Ignoring any of these elements has profound and unacceptable consequences.

Few people have anticipated these consequences better than my Stanford University biology professor, Dr. Paul Ehrlich, considered by many to be the father of American ecology. Winner of the Crafoord Prize, the equivalent of the Nobel Prize for his pioneering work in the field of ecology, Dr. Ehrlich delivered an extraordinary speech that was, in effect, an urgent call for an ecological approach to health. I encourage you to click here to listen to this speech delivered in 1970. I think you will be surprised at how contemporary and compelling it is today, almost forty years later.

I would argue, however, that one of the best examples of implementing some of the elements of an ecological approach to health actually anticipated Dr. Ehrlich’s speech by several decades. As a clerk in the US Army, I traveled to Japan in 1946 with my family to spend three years while my father participated in the effort led by General Douglass MacArthur to implement the Marshall Plan in Japan after World War II. Although most Americans have understood the Marshall Plan as a financial assistance program, it is less well known that its approach was systems-based, comprehensive, and had three distinct components: democratization, decentralization, and demilitarization. To implement the “three D’s”, MacArthur took radical measures that affected all aspects of Japanese society. For example, his approach to decentralization reflected an understanding that the concentration of wealth and power in the giant family industrial monopolies, the Zaibatsu, had played a crucial role in the genesis of Japanese fascism. These monopolies controlled the Japanese economy and, among other things, had eliminated unions. MacArthur dissolved these monopolies and addressed his extreme concentration of wealth by imposing a minimum wage, maximum wage, and redistributing Zaibatsu wealth. He also brought with him universal access to health care. The end result of these measures was the transformation of Japan from a nation with one of the largest gaps between rich and poor and the worst health indices (longevity, infant mortality, etc.) in the world, into the Japan of today. Japan is now the nation with the best health indices and the narrowest gap between rich and poor in the industrialized world.

Given the current challenges we face as Americans, let us consider what happened in the United States during this same period. Although our nation ranked fifth in the world in 1950 in terms of health indices and had a relatively small gap between rich and poor and a growing middle class, these trends have since reversed. Today our comparative health indices do not exceed 21, below all other developed nations, Costa Rica and Cuba. The gap between rich and poor in our country is now the largest in any industrialized nation. During the same period, our health care spending has skyrocketed. The United States now spends more than half of all the money spent on health care in the world, the highest per capita of any nation, while accounting for just 4% of the world’s population. By contrast, Japan spends the lowest per capita amount on health care among the world’s industrialized nations, while achieving the best health indices.

Another very different society that employs important aspects of an ecologically sound approach to health is the nation of Bhutan, located in the Himalayan mountains near Nepal. Although Bhutan admits very few visitors in an effort to preserve its cultural traditions, over the past two winters, Mary and Phil of DeReimer Adventure Kayaking have been granted permission to lead groups of kayakers to explore Bhutan’s rivers. I encourage you to visit his website at http://www.adventurekayaking.com for details of his trips.

The significance of his experience from the perspective of an ecological approach to health is that the Bhutanese, who are materially poor by US standards, are comparatively physically and spiritually healthy. Paraphrasing Mary and Phil, “The definition of happiness in Bhutan is not ‘having and receiving’, rather in their culture wealth has little to do with being happy. On the contrary, they believe that wishing and wanting often causes suffering. This principle is an underlying motivator of behavior with the result that its culture is open, loving, curious and tolerant Its government pursues “gross national happiness” and to promote happiness the government engages in the implementation of educational, social and environmental models that take into account the desire to protect the environment and the country’s cultural traditions.

The distant Kingdom of Bhutan and the concept of “Gross National Happiness” may seem esoteric to many Americans. However, more than 400 respected American economists, including Nobel Laureate Professor Herbert Simon, argue that it would actually be more realistic and useful to replace our use of Gross Domestic Product (the total of all goods and services produced) by measuring of the Genuine Progress Index. , which attempts to measure the quality of our lives. Comparing these measures over the period since the 1970s is revealing. While the conventional GDProduct more than doubled, the Genuine Progress Index decreased by 45% during this period. Measuring GPI would have warned us that, contrary to many assurances to the contrary, the US economy was actually undermining our health during this period. Not only was our prosperity unevenly and unsustainably distributed, it was not performing its most important function. That function is to support improvements in the health of our population.

Clearly, an ecological and scientific approach to health requires that we define what health is, how best to measure it, and then promote the conditions that achieve it. If we do not do these things, it is logical that we will not achieve health. We must recognize that health is more than the absence of disease. Rather, it requires doing things that actively promote it. It is not enough to try to correct the effects of doing things that destroy you.

At Mother Lode, our ongoing commitment is to contribute to this effort, one river-based experience, one charter, one environmentally and socially responsible act at a time. We hope you will bring your ideas and suggestions, and help explore the possibilities. Remember, recreation is just that: “re-creation,” a process by which meaningful and constructive change occurs and a vital part of an integrated, ecological approach to health.

See you on the river!