What will it take for human civilization to forge a common identity and to be bound together by a common purpose? The recent West African Ebola epidemic demonstrated how vulnerable we all are in a truly globalized world to the dangers of rapid, widespread disease dissemination. What’s more, it demonstrated the underprepared state of our global health infrastructure to contain such an outbreak. The Ebola outbreak was a stress test for our global health systems and it was a test that we failed. And yet, despite this disaster—one able to capture the attention of the world—we remain a divided planet. Divided by religion, nationalism, ethnicity and other such artificial barriers to our common humanity. Will it take the oceans rising and displacing tens of millions of people or a disease outbreak that sweeps the world to galvanize a sense common identity? This was the unspoken question that formed the anxious foundation of this year’s Consortium of Universities for Global Health (CUGH) national meeting in San Francisco.
The focus of this year’s meeting was planetary health, a new discipline aimed at addressing the “health of human civilization and the natural ecosystems on which it depends.” In a fundamental way, this health discipline is about the young woman in Uganda who must turn to illegal logging for firewood. It is about the soy farmer in the Brazilian rainforest whose fields press gradually deeper into the forest to accommodate the increasing demand for soy in China. But it is equally about water use practices in California where the water used to irrigate alfalfa alone constitutes more usage than all of the individual human usage in California combined, all so that it can be shipped to the Middle East to provide feed for herd animals. For the past century, the paradigm we have operated under has been to meet the swelling needs of a growing world population at the expense of our ecosystem. As Wendell Berry reflects in The Long-Legged House, “we have lived our lives by the assumption that what was good for us would be good for the world. We have been wrong.” As Jonathan Foley, the executive director and chair of the California Academy of Sciences, noted in his lecture at this year’s conference, “we have affected more changes in the past 50 years than the entire sum of human history combined.” That should be shocking to you and we must harness that shock and treat our current situation as an inflection point. Perhaps not surprisingly, in order to address a problem as complex as one that requires a fundamental reimagining of how we as people interact with our world and interface with our environment, we need an approach that is truly interdisciplinary. We must leverage the human capital, social capital, manufactured capital and otherwise to counteract the dramatic and unprecedented loss of natural capital we have witnessed and been party to for the last century.
The question then becomes, how do we work as an interdisciplinary team to promote health solutions that are both generalizable and wide reaching? One model of how to address issues at the intersection between human health and environmental health has been pioneered by Health in Harmony, an NGO that works in Sukadana in West Kalimantan, Indonesia. Recognizing the need for a more robust approach to human health, the founder of Health in Harmony, Dr. Kinari Webb developed a three pronged model of health care delivery that accounts for individual health, community health, and environmental health. Such a model accounts for the fact that human health does not occur in a vacuum, but rather is a product of both interpersonal relationships as well as our relationship with the natural world.
Dr. Webb’s ASRI clinic in Indonesia should serve as a model of how planetary health can be practiced on a local level that can be replicated and improved upon elsewhere in the world. However, despite the hope provided by success stories like Health in Harmony, many issues remain to be addressed that should demand our attention. One such issues is the global burden of mental health disorders. The 2010 Global Burden of Disease study estimated the aggregated years lost to disability (YLDs) at 22.7%, higher than the burden resulting from any other disease category. Despite this indisputable and empirical evidence that mental health constitutes a huge proportion of the total disease burden of the world, funding and global investment directed at mental health disorders remains stagnant. The single greatest barrier to an expedient resolution to this global mental health burden remains the significant stigma tied to mental illness. This stigma can lead to poor health outcomes in cultures where the disinclination to care for the mentally ill is especially prominent.