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Suggested Citation:"11 Looking to the Future." 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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11

Looking to the Future

INTRODUCTION

Presented by Jonathan Sleeman, U.S. Geological Survey National Wildlife Health Center

Sleeman began the workshop’s final session with a summary of the preceding discussions:

  • Humans are dealing with multiple, high-level crises including climate change, land use change, and social injustice.
  • The approach taken in the past to address problems may not be fit for purpose for today’s issues. New system-level approaches may be needed to address key questions and move knowledge into action.
  • There is a great deal of existing knowledge, particularly among Indigenous and local communities, for how to move from the egocentric approach to an ecocentric approach. The research community could focus on breaking down barriers to accessing this information and listening intentionally to other voices that have largely been discounted in the past.
  • There is desire among many participants for more information, data, and evidence-based approaches to link public health and ecosystem health.
  • There may be a need to better engage the public health community, though taking a nature-based approach to public health competes with other public health priorities.
  • Current training programs may not give students the right skills to address today’s issues effectively.
  • Co-creation of solutions can help to build better, more effective, and more robust partnerships.
  • Understanding and tailoring interventions to accommodate societal and community values, as well as the social context in which programs will operate, would likely be beneficial. At the same time, there is the challenge of changing societal values such that conservation of biodiversity becomes a core value.
  • Better and more diverse metrics could be useful in determining how success is measured.
  • While the problems facing ecosystem and human health may seem overwhelming, there are success stories to build on incrementally. Taking a “lily pad” approach may be more effective than following a “moonshot” model at moving forward on solutions.
Suggested Citation:"11 Looking to the Future." 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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A WHOLE-OF-GOVERNMENT APPROACH TO EMBEDDING THE VALUE OF NATURE INTO DECISION MAKING

Presented by Eli Fenichel, White House Office of Science and Technology Policy

Fenichel noted that the Biden-Harris Administration has a robust program for elevating and better including other knowledge systems, particularly Indigenous knowledge systems, in policy making. He suggested that researchers go to the Office of Science and Technology Policy website to learn about possibilities to engage with Indigenous knowledge.1

On Earth Day 2022, the federal government announced an initiative to include natural capital accounts and environmental economic statistics as part of the National Economic Accounting Program. Fenichel said this initiative brings the natural environment into a whole-of-government approach to thinking about embedding nature and the value of nature into economic and policy decision making. On August 18, 2022, the administration issued a draft nation strategy for developing these natural capital accounts and environmental economic statistics,2 with public comment ending in October.

Addressing why this initiative is so important for combining public health and the natural environment, Fenichel said that the current national economics statistics system was not designed to track the strong connections among health, the environment, the economy, and well-being and hence does not do it well. One goal of this new initiative is to provide complementary metrics to current measures such as the gross domestic product (GDP); developing these new metrics will involve some 20 federal agencies.

An important part of this effort will develop accounting boundaries beyond the current ones focused on market transactions. In addition, the draft plan calls for developing a “defensive expenditures” boundary that will define how health is included in national accounts and economic statistics. Using a rough analogy, Fenichel said that selling cigarettes increases the GDP and so does treating lung cancer. This could be considered a case of double counting because the nation is spending money to cause a problem and spending money to clean it up. Addressing the defensive expenditures boundary, he explained, is one way to think about health benefits as economic outcomes.

Fenichel said that another area where there might be some connection to health is a boundary related to household-produced services. As an example, he noted that the expense of sending a child to daycare shows up in national economic accounts, but caring for a child at home does not, even though that is producing something good. “We think there are many things related to nature and health that also fall into these household-produced services and where they might be intertwined,” said Fenichel. The mental health benefits of exposure to nature might fall into this category, he said.

The national strategy, said Fenichel, is a 15-year plan to go from what he said is the “current agency-based, disorganized effort in the federal government” to an integrated, all-of-government effort to develop core statistical products that are produced regularly and are approved by the U.S. statistical system for analysis. “I know the problem is urgent and I know we want things faster,” said Fenichel, “but we also want things to be robust, to stand the test of time, and to both solve the problem and change the system.” As an analogy, he likened this to both changing the rules of a board game and changing the board itself.

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1 See https://www.whitehouse.gov/ostp/ostps-teams/climate-and-environment/indigenous-knowledge/ (accessed November 25, 2022).

2 The draft is available at https://www.whitehouse.gov/wp-content/uploads/2022/08/Natural-Capital-Accounting-Strategy.pdf (accessed November 25, 2022). The final national strategy was published in January 2023: https://www.whitehouse.gov/wp-content/uploads/2023/01/Natural-Capital-Accounting-Strategy-final.pdf (accessed March 20, 2023).

Suggested Citation:"11 Looking to the Future." 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.
×

People have asked Fenichel about what will change, and he shared the vision that implementation of this national strategy will not change just one or two specific issues but rather provide a paradigm shift in the framing of research related to ecosystem and human health. “The reality is, it is the culmination of our research that changes things. It is the ability to change the conversation,” he said. He drew a parallel to how the creation of the GDP statistic in the 1930s changed economic conversations.

Fenichel said he was energized by the workshop discussions, and he encouraged the attendees to pay attention to requests for information and comment. He added that comments do not have the same level of rigor as a peer review of a paper, but having comments on the record from experts in the field is helpful.

When asked how the administration anticipates that future administrations will continue this initiative over the next 15 years, Fenichel replied that the administration does not view this as a national policy initiative but rather something “bubbling up” across many federal agencies that is needed to keep up with something the international community is doing. To prevent a future administration from reversing direction, the initiative will build as much as possible on science and economics. He noted that the current U.S. statistical system has stayed primarily apolitical since its inception in the 1930s, and he hopes that will continue.

Sleeman asked Fenichel if the National Nature Assessment plan and process could break down public health and ecosystem health silos to support communities and practitioners. Fenichel said the National Nature Assessment was announced at the same time as the National Strategy for Natural Capital Accounting with the idea that the two would complement one another. He noted that as with the National Climate Assessment, topical teams will author the assessment, and the acting director of the assessment is interested in making sure that these teams are not siloed in the traditional university department approach to organizing science.

MODERATED DISCUSSION WITH CONVERSATIONALISTS

Presented by Sam Myers, Harvard University, and Benis Egoh, University of California, Irvine; Moderated by Jonathan Sleeman

Myers began his comments by emphasizing the scale and urgency of the current moment. “I feel pretty strongly that the work we are talking about cannot be purely an academic pursuit and cannot be centered on curiosity-driven research. I think that as a community, we are watching humanity sleep walking toward a cliff, and it is our job collectively to wake people up and to try to move global society onto a different trajectory,” said Myers. “I would argue that we are a field forged in urgency and that we carry a critical message that we can no longer effectively safeguard human health and well-being in a world where our natural life support systems are actually crumbling under the weight of our collective ecological footprint.” Myers observed that the workshop discussions fundamentally recognized that the current Earth crisis has reached a scale where it now represents a global health, humanitarian, and social justice crisis.

While he agreed with the inclination toward transdisciplinary research and considering the policy implications of that research from the beginning of a project, Myers said shifts in how the field conducts research are necessary but not sufficient to make change at the right scale and pace. Today’s crisis, he said, requires deep, rapid structural change in how people live to reduce humanity’s collective ecological footprint and safeguard a livable future.

Suggested Citation:"11 Looking to the Future." 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.
×

As for the steps beyond being more creative in the way research is conducted, Myers noted the benefits of coming together in new ways to build a global community of practice with a shared narrative about the current moment. That has been a focus of the Planetary Health Alliance and its more than 300 organizations from 60 countries.

Also important, said Myers, is a reimagining of how institutions fund research so as to break down silos and find mechanisms that encourage scientists to conduct the research needed to address this planetary crisis. He suggested bringing the Planetary Health, One Health, and ecohealth communities together and bringing in other sectors—policy makers, the private sector, Indigenous voices, the social justice movement, and youth leaders, among others—to create a communal group with a shared narrative and vision. While the workshop discussed creating new knowledge, that new knowledge could be mainstreamed in new conceptual models, policies, decision making, and action. Communication will be an important aspect of that mainstreaming, and Myers noted one example of the Science Communication Lab in Munich receiving a five-year grant to engage in planetary health science communication.

Myers said that this work needs to be regionalized to reflect how environmental change affects human health differently in different regions and among different communities. He described this moment as an opportunity to establish regional hubs that bring together civil society, academia, government, and the private sector to address regional problems.

In a recent trip to Europe, Myers observed several trends that provide some optimism and show that the United States is behind other parts of the world in thinking about the questions this workshop addressed. In Stockholm, he attended the Swedish Medical Society’s annual meeting, which was dedicated to planetary health. He learned that the Swedish medical community is actively engaged around planetary health, developing new courses for medical and public health schools, creating new games to teach about planetary health, and working on how to communicate to the public about this subject.

In Paris, the L’Alliance Santé Planétaire has convened clinicians and students from around France to work on this issue, and it has been teaching planetary health in France’s medical schools. The policy community there is thinking about how to advise European Union policy makers about the core issues of Earth’s crisis that are becoming a humanitarian crisis. In Amsterdam, Myers attended the first convening of the Planetary Health European Hub which brought together more than 72 organizations from 12 countries to think about how to create a new secretariat for this hub. What is driving these efforts, said Myers, is that the European Union funding agencies have signaled that planetary health is central to both the Health and Environment Research Agenda and the New Horizons Agenda. In addition, the European Environment Sustainable Development Advisory Councils Network has adopted a planetary health frame for its activities this year and beyond.

“We have the policy makers, advisors to government, a funding situation, and this enormous amount of activity coming up from universities—new degree programs, new institutes—all around these central themes,” said Myers. “There is an opportunity to bring all of that community together and move this whole agenda forward at the societal level, which is really what I think we need to do.”

Myers noted that as clinicians and public health practitioners convey the critical nature of this problem, they bring moral authority to address the climate crisis in a way that has not happened yet. He noted that disciplines, sectors, countries, and every other dimension of human activity could come together to address the climate crisis as a humanitarian crisis and try to stabilize and regenerate Earth’s natural systems as a critical dimension of safeguarding a livable future for the planet’s children.

Next, Egoh spoke about the topics she heard during the workshop that changed her thought process. She noted that the voices of children have to be heard. She thought about power dynamics and

Suggested Citation:"11 Looking to the Future." 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.
×

how they shape whether her research is accepted and proposals approved based on her qualifications or whether she needs to have collaborators with more name recognition. It also made her think about how to prioritize the issues in a way that will lead to action.

The second way her thinking changed is that she acknowledges the silos that exist and the need to create spaces to bring together people from different disciplines to highlight research and discuss how to link it with public health. She also is more cognizant of the need to train the next generation of students to do research that is impactful, not just publishable. As for impactful research, Egoh said it is important to engage communities and policy makers to establish a broad spectrum of action that can go from policy to action on the ground.

Sleeman asked Myers what the future desired state looks like and how to know when it has been achieved. From his perspective as a physician, Myers said that the size of humanity’s collective ecological footprint is disrupting all natural systems on the planet at the fastest pace in the history of the human species and at a scale that exceeds Earth’s capacity to absorb humanity’s way of life and sustainably provide the resources humans need. The changes triggered by human activity are interacting with one another in complex and varied ways that affect the fundamental conditions for human health and well-being.

Myers said the treatment is to drastically and quickly shrink humanity’s ecological footprint, which is why he believes that humanity needs to make rapid and deep structural changes to the way it lives. Those changes may need to occur across energy systems, food production systems, urban design, manufacturing, and resource use, and they highlight the importance of creating a circular economy rather than the current linear economy. He called this massive and rapid shift “the Great Transition.”

Another important topic raised by workshop participants was the need to define the end goal and what success will look like 100 years from now. There is no reason, he said, that the children and grandchildren of the future could not be living in a world in which the human population has stabilized, where the energy economy has been decarbonized, where food and manufactured goods are produced with smaller ecological inputs, and where every passing decade is leaving more room for the rest of the biosphere. “I think we need to paint that aspirational picture of a bright future so that we can steer toward it,” said Myers.

In fact, he said, there is no reason humanity cannot achieve that aspirational goal. There are solutions in every domain he mentioned, but the question is whether the political and social will exists to move in that direction. In his view, it is the job of this community to catalyze that will with science and with activism.

Egoh reiterated the importance of identifying a problem after talking to vulnerable communities, assessing their resilience to a set of changes, and looking for nature-based solutions. Instead of rescuing communities after disasters, she wants to see investments in restoration work and nature-based solutions that help communities become more resilient to a host of insults, such as air pollution, infectious diseases, flooding, and fires. Egoh wondered how much of the ecosystem humans need for recreation and food production. She also questioned how much humanity can take from nature before it collapses and stops functioning. “I think we need to think about those things and see how we can bring solutions rather than responding to disasters,” she said.

For her, a sign of progress is the development of indicators in natural accounting systems that assign a monetary value to the services nature provides. As an African, she has noticed that negotiating power seems to depend on a country’s GDP, even though many countries with large GDPs have markedly lower levels of happiness and even nutrition, while there are countries with small GDPs that have maintained their lifestyles because of the nature to which they have access.

Suggested Citation:"11 Looking to the Future." 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.
×

Egoh said that communities have a right to know when they are in high-risk areas and that this is where effective communication is paramount. Effective communication, she said, is based on understanding where to communicate, the audience for communication, and the appropriate language for a given community.

The final session ended with a discussion among the conversationalists, the moderator, and several workshop participants about integrating human health and ecosystem health. Discussants noted the importance of building an integrated community of practice that includes a coalition of actors with a wide range of viewpoints, knowledge, and interests that can break down silos. At the same time, the discussion also acknowledged that connecting people, building an infrastructure for collaboration, and breaking down silos is difficult work that deserves recognition and value.

Suggested Citation:"11 Looking to the Future." 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 75
Suggested Citation:"11 Looking to the Future." 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 76
Suggested Citation:"11 Looking to the Future." 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 77
Suggested Citation:"11 Looking to the Future." 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 78
Suggested Citation:"11 Looking to the Future." 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 79
Suggested Citation:"11 Looking to the Future." 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 80
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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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