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Suggested Citation:"9 Overcoming Existing Barriers to Knowledge Development and Moving to Action." National Academies of Sciences, Engineering, and Medicine. 2023. Integrating Public and Ecosystem Health Systems to Foster Resilience: A Workshop to Identify Research to Bridge the Knowledge-to-Action Gap: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26896.
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9

Overcoming Existing Barriers to Knowledge Development and Moving to Action

NATURE AND HEALTH: DRIVING INNOVATION AND IMPACT

Presented by Gretchen Daily, Stanford University

The Natural Capital Project, said Daily, recognizes the many pathways that link nature and health outcomes and builds on a decade of prior work on easier problems. It is an international partnership involving 100 research institutions and 300 implementing institutions designing the approach to new research problems and informing solutions to those problems through strategic demonstrations in some 80 countries in rural and urban contexts. Underpinning this work is a data and software platform designed to make the science accessible and actionable.

Initially, the project worked with two scaling partners, the Nature Conservancy and World Wildlife Fund. Today, while still connected deeply to those two, the project is working with other scaling partners with what Daily called “tremendous financial influence,” including the Asian Development Bank, the Inter-American Development Bank, and the World Bank, as well as several United Nations agencies and more recently several central banks. The project has also worked with the

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1 This list is the rapporteurs’ summary of the main points made by individual speakers (noted in parentheses), and the statements have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.

Suggested Citation:"9 Overcoming Existing Barriers to Knowledge Development and Moving to Action." National Academies of Sciences, Engineering, and Medicine. 2023. Integrating Public and Ecosystem Health Systems to Foster Resilience: A Workshop to Identify Research to Bridge the Knowledge-to-Action Gap: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26896.
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private sector on major projects in specific places and contexts around the world, but Daily said the project has not made as much headway with the private sector as it has with public investments.

Today, the project is focusing on making the connection between a wide variety of environmental factors and health. For example, the project had been connecting landscape conditions, such as the amount of forest or wetlands, to water quality and water security. Daily said that the goal is to connect those factors to actual health outcomes.

Urban health is an area of focus, particularly urban mental health and its relationship to people spending less time in nature. The approach Daily and her collaborators are taking brings together leaders in a variety of fields, including public health, ecology, other areas of science, and public policy, to map out a way to integrate health-related science into work to inform policy, planning, financial investment, and other activities in key contexts in which health conditions are influenced (Bratman et al., 2019).

Daily and her collaborators acquire data on what people experience regarding different natural features in their urban context; the level of exposure to nature and whether it is direct or indirect, such as through a window or devices; and then the effects on health that result from this exposure. She noted that different groups of people might experience a different effect based on past experiences. If there had been a negative experience in a natural setting, for example, exposure to nature might increase stress or decrease working memory compared to the responses of those who did not have a bad experience. The research team then uses modeling to evaluate the effect of alternative investments in green spaces in cities or increasing the density of tree cover in urban spaces. As an example, Daily pointed to studies that connect attention deficit disorder prescriptions in a population as a function of trees planted along roadways in that community.

In another study, Daily and her colleagues focused on physical activity and health, such as how urban nature influences physical activity through a variety of pathways and then how that influences health (Remme et al., 2021). This study included a literature review to inform the development of models that would support decision makers in cities and in health care. For example, urban planners and urban health care providers might want to know where and how much to invest in improving access to nature to promote physical activity and the health benefits that would result from a boost in physical activity. The model would make different predictions for different types of communities. Daily added that this work included a focus on inequitable access to nature.

Many countries now have experience implementing these different approaches in a variety of contexts with support from the international development banks, Daily pointed out. At the 2021 United Nations Climate Change Conference, the main development banks committed to center the values of nature throughout their operations. So far, said Daily, these implementation efforts have not focused directly on health, though there is an urgent need to do so and to do so in collaboration with the community.

For example, in most parts of the world, water treatment in physical water treatment plants is rare, with the quality of the water that people experience depending on rivers and streams whose source areas are hundreds of kilometers away. Many countries in Latin America are implementing reciprocal watershed agreements that pay people living upstream in source areas to change their land use and management practices. These payments compensate the upstream communities to improve water quality and other outcomes for downstream communities. The question is where in the millions of square kilometers of a watershed would be best for making these investments. To answer that question, Daily and her collaborators have developed software to support decision making in some places in Latin America. The software predicts the portfolio of transformations needed to protect and restore forests and to enrich the understory in areas with high densities of cattle, for example. “One can actually estimate

Suggested Citation:"9 Overcoming Existing Barriers to Knowledge Development and Moving to Action." National Academies of Sciences, Engineering, and Medicine. 2023. Integrating Public and Ecosystem Health Systems to Foster Resilience: A Workshop to Identify Research to Bridge the Knowledge-to-Action Gap: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26896.
×

the improvement in water quality that would result under different budget levels from investment in this sort of portfolio approach,” said Daily.

In fact, said Daily, this approach is now in various stages of implementation and operation across Latin America, funded by a variety of lenders. Countries across Africa and Asia are also using this approach, mostly for water security in rural agricultural settings, though cities are now looking at using this approach in the context of the health effects.

Daily emphasized three important points. First, she is optimistic about making progress to advance engagement in science beyond health sciences researchers (i.e., engaging local communities, practitioners, and decision makers). The second point is that an opportunity exists to make research more accessible and actionable using data science, smartphone apps, wearable devices, and other technological advances. This could be a top priority, said Daily.

Her third point was that there are partnerships for implementation upon which the field can build. She noted that there is so much momentum behind the agenda for creating more inclusive green development pathways to improve community health.

PUBLIC HEALTH PERSPECTIVE ON KNOWLEDGE ACQUISITION AND DEVELOPMENT

Presented by Aaron Bernstein, Harvard University

Bernstein acknowledged that the health sciences have come relatively late to looking at the intersection of human health and nature. Even the One Health movement was largely an initiative of the veterinary and ecosystem health communities. One challenge is that health care providers do not have the right incentives to be active collaborators in this field given that the current incentives focus on sick care. That raises the question of whether the health care community could unequivocally affirm that attending to this connection is critical to what the system incentivizes it to do.

To Bernstein, the cultural history of ideas matters. For example, schools of public health were not established to protect nature but rather to eradicate infectious diseases, which were not seen at the time to be a consequence of human engagement with nature. As a result, public health has models of disease that are very much reductionist in ideology, he said. Similarly, nutrition science and environmental science grew out of occupational health and have not historically been concerned with their connection to nature. “If you look at the faculties in environmental health and schools of public health, [they are] dominated by folks interested in single toxic exposures and the like,” said Bernstein. Cultural history, he added, has created strong silos that are barriers to participating in this field.

At the same time, Bernstein said that the foibles of academia may in some ways be a strength. That every doctoral student around the world needs to have something original to study creates an open opportunity space in the health sector for junior faculty and doctoral students to engage. The fix is relatively straightforward, he said: senior faculty need to be vocal in their institutions to support projects and careers that address this intersection of human health and nature. It helps, he added, when the National Institutes of Health (NIH), the Gordon and Betty Moore Foundation, and the National Science Foundation (NSF) get behind this change. He noted that the longest-standing joint funding mechanism between NIH and NSF is a successful one on the ecology of infectious diseases.

There is an opportunity to do better with metrics, said Bernstein. The metrics in the health sciences today reflect the reductionist approach to science that measures one outcome at a time. In fact, he argued that many challenges that exist today are a consequence of the reductionist approach to problem solving. That approach excludes problems that are inherently interconnected and that require different types of measures to capture the effectiveness of interventions. There are exceptions, such as

Suggested Citation:"9 Overcoming Existing Barriers to Knowledge Development and Moving to Action." National Academies of Sciences, Engineering, and Medicine. 2023. Integrating Public and Ecosystem Health Systems to Foster Resilience: A Workshop to Identify Research to Bridge the Knowledge-to-Action Gap: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26896.
×

research in Borneo where health systems-focused interventions also benefitted forest conservation. He added that in the quest for new metrics, many speakers noted the need to acknowledge that Indigenous knowledge and understanding about how the world operates can be informative for the changes needed in causal inference.

Thought leadership is another barrier to knowledge acquisition, and embedded theories of change may need scrutiny. If a change in how to think about the value of outcomes or optimizing systems and how to understand causal thinking is in order, the question becomes one of how to make that transformation and who would lead it. Bernstein suggested learning from anthropologists, whose work involves learning how society changes. He said that the opportunity for cultural transformation is not just about the idea but rather about where the idea is positioned within society to get to where society needs to go.

Q&A DISCUSSION

Moderated by Albert Ko, Yale University, and Katie Arkema, Pacific Northwest National Laboratory

Ko asked Daily for her “wish list” of actions that the health sector or public health sector could take that would quickly maximize the impact of the Natural Capital Project. She replied that the health sector could illuminate the vital importance of nature to everyone’s health. “It is such a visceral connection that once people get it, they tend to hang on to it,” she said. Having more affluent people, particularly in urban settings, see that their own health is at stake might drive more rapid transformation at scale.

In terms of prioritizing needed actions, Daily said the first item on her list would be to illuminate the connections between ecosystem and human health in a more sophisticated way and acknowledge how current models for informing decision making are linear and simplistic. Her second item would be to have more research activity involving practitioners. The goal would be to create a tight and productive cycle between implementation and research innovation. Getting metrics that matter at different levels of scale would be the third item on her list.

Arkema relayed a question from Liz Willetts, from the International Institute for Sustainable Development, on whether the Natural Capital Project has used metrics related to non-economic health impacts that would inform conversations.2 Daily replied that one metric involves quantifying how many people are at risk or are already experiencing poor health outcomes resulting from degradation of or lack of access to nature.

The China Ecosystem Assessment, for example, monetized none of the results and looked across all of mainland China at the importance of different places that provided key benefits or prevention of key harms to health (Ouyang et al., 2016). Simply quantifying the number of people at risk and their distribution across the country was enough to convince the government to make massive investments to regenerate nature. Currently, said Daily, 51 percent of mainland China is zoned for ecosystem regeneration, and the government is paying some 200 million people to drive that regeneration and achieve a suite of high-level benefits to the natural environment and biodiversity. “I feel that if we could now add in more specific health-related consequences of ecosystem decline, we would see much greater uptake of these approaches,” she said.

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2 The original question raised by Willetts framed this around the discussion on loss and damage under the United Nations Framework Convention on Climate Change.

Suggested Citation:"9 Overcoming Existing Barriers to Knowledge Development and Moving to Action." National Academies of Sciences, Engineering, and Medicine. 2023. Integrating Public and Ecosystem Health Systems to Foster Resilience: A Workshop to Identify Research to Bridge the Knowledge-to-Action Gap: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26896.
×

Arkema asked Bernstein to comment on priority areas at the nexus of nature and public health, and whether those should be included in a future research agenda. Bernstein answered with an example from the Six Cities study, which was one of the first to show that air pollution kills people (Dockery et al., 1993). When the results were published in the New England Journal of Medicine, one of the lead authors expressed hope that the paper would get a great deal of attention because hundreds of thousands of people were likely dying from air pollution. While the study was not ignored, it had little societal impact. However, when the team published a follow-up study looking at how air pollution was causing heart attacks in White men ages 40 to 60, it prompted a national crisis.

The lesson here, said Bernstein, is that researchers can think about the right question, but if they do not understand the social and cultural context of the knowledge, even the most important discovery will not have much of an impact. “If we really want to have an actual research agenda, we absolutely need to understand the cultural context in which it operates,” said Bernstein.

Joshua Rosenthal, from the NIH Fogarty International Center, asked Daily what a holistic systems-level valuation of the impacts look like for one of the Natural Capital Project’s activities in the Columbia River Basin. Daily replied that the research team found that people do not want a whole system because it is too easy to become overwhelmed. In fact, several governments adopted a system to account for ecosystem services, but little policy change followed. Often, she said, it can be powerful to pick measures that would be transformative in an arc of driving change toward a goal, and even if there is only one point made in each case, the effect can be broader and lead to momentum building and capacity building that would enable a more holistic approach. She added that a new metric called “gross ecosystem product” is being tested and applied around the world to be reported alongside gross domestic product to reflect the goods and services from ecosystems multiplied by their quantity and sometimes by an economic lower-boundary measure of their value.

Daily noted that the Global Environment Facility has asked the Natural Capital Project to bring a more holistic approach to between 60 and 80 countries over the next four years. Even there, however, the project will be strategic and choose part of the system on a country-by-country basis that seems ready for some change rather than bringing a totally holistic approach. “I think we have to work at both ends of the problem of generating new knowledge with partners [who are] ready to inform decisions but at the other end, really understanding better how to inform those decisions and what dose of knowledge would lead to a better outcome,” said Daily.

Arkema described work she did in close collaboration with the government of Belize on designing an integrated coastal zone management plan. The government wanted measures of the benefit to fisheries that mangroves, coral reefs, and sea grass provide. Another measure it wanted was how those same ecosystems reduced the risk of flooding and erosion along the coast and how they benefited tourism in regard to local livelihoods in the region.

What was powerful about this project, said Arkema, is that the research team did not try to measure all the values that mangroves, coral reefs, and sea grasses provide; rather, through collaboration with their partners, they selected three categories of benefit and had several metrics, both economic and biophysical, for each category. The next step, she said, would be to have health metrics associated with each of those. One interesting aspect of this study was that the government did not want a sum of all parts and did not look at the total economic value of alternative development scenarios because it knew that each category would be meaningful to different people. Arkema added that there is a tendency for scientists to want to synthesize everything, when many times the intermediate analyses are the most powerful.

Suggested Citation:"9 Overcoming Existing Barriers to Knowledge Development and Moving to Action." National Academies of Sciences, Engineering, and Medicine. 2023. Integrating Public and Ecosystem Health Systems to Foster Resilience: A Workshop to Identify Research to Bridge the Knowledge-to-Action Gap: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26896.
×

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Suggested Citation:"9 Overcoming Existing Barriers to Knowledge Development and Moving to Action." National Academies of Sciences, Engineering, and Medicine. 2023. Integrating Public and Ecosystem Health Systems to Foster Resilience: A Workshop to Identify Research to Bridge the Knowledge-to-Action Gap: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26896.
×
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Suggested Citation:"9 Overcoming Existing Barriers to Knowledge Development and Moving to Action." National Academies of Sciences, Engineering, and Medicine. 2023. Integrating Public and Ecosystem Health Systems to Foster Resilience: A Workshop to Identify Research to Bridge the Knowledge-to-Action Gap: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26896.
×
Page 62
Suggested Citation:"9 Overcoming Existing Barriers to Knowledge Development and Moving to Action." National Academies of Sciences, Engineering, and Medicine. 2023. Integrating Public and Ecosystem Health Systems to Foster Resilience: A Workshop to Identify Research to Bridge the Knowledge-to-Action Gap: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26896.
×
Page 63
Suggested Citation:"9 Overcoming Existing Barriers to Knowledge Development and Moving to Action." National Academies of Sciences, Engineering, and Medicine. 2023. Integrating Public and Ecosystem Health Systems to Foster Resilience: A Workshop to Identify Research to Bridge the Knowledge-to-Action Gap: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26896.
×
Page 64
Suggested Citation:"9 Overcoming Existing Barriers to Knowledge Development and Moving to Action." National Academies of Sciences, Engineering, and Medicine. 2023. Integrating Public and Ecosystem Health Systems to Foster Resilience: A Workshop to Identify Research to Bridge the Knowledge-to-Action Gap: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26896.
×
Page 65
Suggested Citation:"9 Overcoming Existing Barriers to Knowledge Development and Moving to Action." National Academies of Sciences, Engineering, and Medicine. 2023. Integrating Public and Ecosystem Health Systems to Foster Resilience: A Workshop to Identify Research to Bridge the Knowledge-to-Action Gap: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26896.
×
Page 66
Next: 10 Approaches to Developing Solutions to Improve Integration of Public Health and Nature and Inform Policy and Practice »
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Ecosystems form the foundation upon which society can survive and thrive, providing food, water, air, materials, and recreation. These connections between people and their environments are under stress from human-driven climate change, pollution, resource exploitation, and other actions that may have implications for public health. The integral connection between nature and human health is recognized and has been explored through different bodies of work; however, because of the breadth of this issue, many implications regarding public health are not well characterized. This has created a gap in understanding the interconnections between public health and ecosystem health systems and how ecosystem resiliency may affect public health.

To inform the development of a research agenda aimed at bridging the knowledge-to-action gap related to integrating public and ecological health to foster resilience, the National Academies of Sciences, Engineering, and Medicine held a workshop across three days that brought together interdisciplinary researchers and practitioners from the public health, natural resource management, and environmental protection communities to exchange knowledge, discuss critical gaps in understanding and practice, and identify promising research that could support the development of domestic and international policy and practice. Day 1 of the workshop, held on September 19, 2022, addressed the following question: What has been learned about how to integrate public health and nature into research, policy, and practice to foster resilience? Days 2 and 3, held on September 29 and 30, 2022, explored advancement opportunities in transdisciplinary and community-engaged scholarship to improve integration of public health and nature and inform policy and practice and opportunities to bridge the knowledge-to-action gap with strategies to translate knowledge into policy and practice. This publication summarizes the presentation and discussion of the workshop.

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