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Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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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5

Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge to Action

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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:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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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INTRODUCTION

Presented by Rodolfo Dirzo, Stanford University, and Jonathan Sleeman, U.S. Geological Survey National Wildlife Health Center

Dirzo remarked that two central issues underlie the lack of appreciation for the inextricable link between the health of Earth’s natural ecosystems and global human health. The first is the inability to detect the challenges and gaps that represent barriers to move from knowledge to action. The second is what Dirzo called a “pathological lack of integration” that is palpable across disciplines, institutions, societal groups, practical approaches, and research approaches.

For example, there is still a lack of appreciation for the fact that global change includes not only climate change but also land use change, overexploitation of Earth’s resources, and pollution that work together in complex synergies. Similarly, there is a lack of appreciation for the overlap of two complex adaptive systems—human culture and the biosphere—and the effects that each has on the other. In addition, said Dirzo, “We tend to neglect the fact that the human enterprise is driven by our insatiable emphasis on growth [and] that the collective action of our cultural silos and lack of integration foments the threat to our life supporting systems, and leads to a terrible social inequity whereby the sectors of society that contribute the least to the manifestations of the Anthropocene are the most impacted by global change.”

Sleeman added that the diseases the National Wildlife Health Center studies are increasingly affecting human health, livestock health, agricultural economies, and environmental integrity. He and his colleagues thus have had to work across sectors to find mutually beneficial outcomes for the actions and interventions they take to manage these diseases.

HEALING THE PLANET

Presented by Kinari Webb, Health in Harmony

“We are in a situation of facing civilization collapse on our planet,” said Webb, due to the climate crisis, the planet’s sixth great extinction, the justice crisis, and other factors all interwoven with one another. She noted that while melting ice and thawing of the tundra are top concerns, so too are the world’s rainforests, which if rainfall diminishes sufficiently would turn into savanna. “That would be game over for our planet,” said Webb.

While the world’s rainforests are important for storing carbon, they also contain half of the world’s biodiversity and create what Webb called “flying rivers” that transport moisture around the planet. The drought affecting California, she said, resulted in part from forest loss in the Amazon, Congo Basin, and Indonesia.

During her time studying orangutans in Borneo, she came to appreciate that the people logging the forests are doing so to pay for access to health care since there may be no other way to earn that much money. These communities, she realized, understand the complex interrelationship between the forest and their own well-being, including the increase in malaria and diarrhea, and that local climate would change if the forest were gone. At the same time, she said, they are in a terrible position of having to choose between their future and short-term well-being.

Webb’s response was to create Health in Harmony, a nonprofit organization that works in Indonesia, Madagascar, and Brazil. Using a process she calls radical listening, she and her colleagues collaborate with rainforest communities to determine what benefits these communities would like to

Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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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exchange for being stewards of the forest and then find external resources to fulfill those wishes. These community-designed solutions often include a health care component, a livelihood component, and an education component. To create affordable health care, for example, Webb’s team in the Amazon worked out barter options that suited the local community based on the community’s input. In Madagascar, the communities had heard of workable solutions to address issues in their agricultural systems but did not know how to implement them. There, Webb’s organization worked with communities to share specific knowledge and information to design agricultural systems that better protect the local forests.

At the organization’s first site in Indonesia, the primary forest surrounding the community has stabilized after 10 years, which compared to other Indonesian national parks averted some $65 million worth of carbon loss. In addition, approximately 52,000 acres of rainforest regrew thanks to the local community’s efforts that cut illegal logging by 90 percent, and there has been a 67 percent reduction in infant mortality (Jones et al., 2020).

INTEGRATING INDIGENOUS PUBLIC HEALTH WITHIN NATURE

Presented by Angela Fernandez, University of Wisconsin–Madison School of Nursing

Fernandez shared a personal experience from her father from their home in the Menominee Reservation in northeastern Wisconsin. For Fernandez, this story illustrated the relationship between Indigenous health within nature. Her father told her that he ‘went into the woods’ to stay away from drugs and alcohol. When he was a child, he saw his uncle—a boarding school survivor—turn to hard liquor. His uncle later quit drinking when he took up traditional ways of hunting, trapping, fishing, taking long walks in the woods, and appreciating the blessing provided by the Creator. Her father learned and practiced these traditions from his uncle as a child, and said, “I saw too many of my friends living short lives, and always wished they could go back to those old traditional ways before alcohol was introduced to our people by the Europeans.”

The story of her family and her community is not unique, said Fernandez. Across the United States, American Indians and Alaska Natives have shorter life expectancies and are more likely to die from chronic disease and alcohol- and mental health–related causes compared to all other populations.2 Along with the trauma Indigenous communities face, Fernandez emphasized that they have extraordinary resilience. “We are still here, and our people are doing good work to heal our relationships with our lands and bodies,” said Fernandez.

Growing evidence, she said, shows multiple health benefits from nature contact—the interface between humans and other biotics, such as plants and animals, and abiotics such as water and sunlight (Frumkin et al., 2017). However, many nature contact studies do not include Indigenous Peoples or account for the relational connections that Indigenous Peoples have with nature that portray nature as kin. Fernandez explained that Indigenous cultural practices such as dancing, storytelling, as well as activism or practices that involve human interconnectedness within nature—gathering wild rice or fishing, for example—are the basis for common interventions for risk prevention and health promotion across a variety of health outcomes.

Understanding the trauma Indigenous Peoples experience requires understanding how separation from the land has negative effects on health, said Fernandez. She noted that the term environmental dispossession describes the processes that reduce Indigenous People’s access to the resources of their

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2 See https://www.ihs.gov/newsroom/factsheets/disparities/ (accessed March 20, 2023).

Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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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traditional environments (Richmond and Ross, 2009). Since 1492, settler colonialism included policies and practices that dispossessed Indigenous Peoples from their lands, foods, shelter, language, culture, and identity. Examples include the Trail of Tears or militarized boarding schools designed to “kill the Indian and save the man.”

In addition to the historical traumas that involved sustained and multigenerational cultural and psychological annihilation, Indigenous Peoples continue to face attempts at environmental dispossession today. One well-known example is the battle that the Standing Rock water protectors continues to fight to protect their access to clean drinking water from the Dakota Access Pipeline.3

Fernandez presented an Indigenous theoretical framework showing how relationships with trauma and resilience can occur simultaneously and how to prevent negative health outcomes (Figure 5-1) (Walters et al., 2002). She noted that Indigenous scholars are conducting research demonstrating the health benefits of cultural practices and interconnectedness with nature. Her research has explored culture-centered and place-based interventions designed to prevent chronic and co-occurring diseases in both rural and urban settings. Connectedness to place—the interrelated welfare of the individual, one’s family, one’s community, and the natural environment—is foundational to Indigenous health, she said (Mohatt et al., 2011).

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FIGURE 5-1 An Indigenous theoretical framework showing the relationship between trauma and resilience.
NOTE: Fernandez note that this theoretical framework can also be used to identify health benefits, strengths, and knowledge from the cultural buffers.
SOURCE: Fernandez presentation, adapted from Walters et al. (2002).

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3 The water protectors at Standing Rock are demonstrators who protested against the construction of the Dakota Access Pipeline between 2016 and 2017. See https://www.pbs.org/newshour/nation/military-force-criticized-dakota-access-pipeline-protests (accessed March 13, 2023).

Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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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Much of Fernandez’s work uses a community-based participatory research approach that prioritizes building close partnerships with the community from the design stage to when she returns results to the community and its leaders. This approach, she said, is essential for building trust and long-term relationships with tribal communities. Her research, she added, centers Indigenous traditional health knowledges in partnership with mainstream theories and methodologies that are culturally congruent.

Her current work looks at how the relationship among place, culture, and nature might affect sleep health and chronic disease. Her research team has developed questions that the ongoing American Indian Chronic Disease Risk and Sleep Health Study4 will incorporate into its Patient Reported Outcome Measure. The questions came from interviewees’ descriptions of various cultural practices that involve a relationship within nature, such as praying with different plants (i.e., sage, cedar, sweetgrass, tobacco), picking berries, gardening, walking to the creek, protecting the land for future generations, and dreaming about these things, and how these may affect their mental wellness or their sleep. “We hope that this research will help us better understand how tribal communities are preventing and treating mental wellness, sleep problems, and chronic disease,” said Fernandez.

In another study, Fernandez’s team is using the same set of questions to focus on substance misuse prevention among Indigenous youth. She is also planning a study to use an intergenerational environmental health intervention aimed at reducing substance misuse and suicide among Indigenous youth.

Fernandez feels that it is her responsibility as an Indigenous researcher to help tell the stories of her people’s strengths and the knowledge grounded in relationships with the land and other aspects of nature that are viewed as kin to humans. It is important to tell this story not only to inform efforts to prevent illness and disease, she said, but also to show why it is critical to “protect and preserve our lands, our waters, and other more than human relatives for our own health as well as that of future generations.”

CONCEPTUAL AND PRACTICAL BARRIERS TO INTEGRATING CONCERNS FOR HUMAN HEALTH AND NATURE

Presented by Steve Luby, Stanford University

Reductionism—the notion that complex phenomena are best understood by breaking them down into simpler, isolated parts and then analyzing those parts—is a conceptual barrier to integrating concerns for human health and nature, said Luby. The reductionist scientific approach has succeeded in advancing many fields but may not be fit for purpose for integrating concerns about nature and humans. The reason, he explained, is because natural systems have emergent properties in that they self-organize, adapt, and interact dynamically with human systems. However, the reductionist framing affects how problems are framed, how projects are funded, and how life scientists are promoted. “This often-unconscious frame of mind is the wrong frame of mind when we are thinking about nature and humans,” said Luby.

As an example, he cited a project involving an old-world fruit bat known as the Indian flying fox. From the flying fox’s perspective, the forest is a source of fruit and nectar, its primary foods. However, these animals do not just take from the forest; they also disperse seeds and pollen over long distances, which plays an important role in regenerating cleared tropical forest. Another consideration is

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4 Additional information is available at https://app.dimensions.ai/details/grant/grant.8474387 (accessed March 30, 2023).

Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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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that these animals are social and share biological excrements through roosting and grooming together. Their excrement, Luby explained, contains a microbiome and virome with trillions of organisms that have coevolved a complex interacting ecology.

One virus that coevolved with these bats is the Nipah virus, which does not cause illness in the bat but can cross over to humans and cause illness. Approximately 75 percent of people infected by the virus will die, and some patients can transmit the virus to other people.5 Fortunately, person-to-person transmission is not efficient, so outbreaks tend to end on their own. However, Luby pointed out that every time Nipah virus infects a human, it creates the opportunity for the virus to mutate to become more transmissible, as the SARS-CoV-2 virus has since it first appeared in humans. If that were to happen with Nipah virus, the result could be a devastating global pandemic.

An important question, said Luby, is how Nipah virus gets into humans, and epidemiologic studies identified an association between human Nipah infection and drinking fresh date palm sap. Anthropologists on his team determined that from late November through March, local populations in Bangladesh collect sap from date palms and sell it fresh as a local delicacy or use it to make molasses. However, bats shed the virus in their saliva and urine, which can contaminate the sap when they lick the sap stream flowing from the tree into the sap collecting device.

To stop transmission, Luby and his team had the local communities make four types of bamboo nets that could function as skirts around the sap collecting devices and keep bats away from them. A trial that compared bat visits to trees with and without the nets showed that bats fed often from the unprotected trees but showed no interest in the trees with any of the bamboo nets (Nahar et al., 2017). A subsequent trial showed that date palm sap collectors would use the skirt, and people willingly purchased the skirt-protected sap.

While this seems like a success story, Luby noted it was only partially successful. It was a scientific success because he and his collaborators identified the pathway for virus transmission, a way to protect humans from the virus that was accepted by the community, and a way to protect the bats from humans cutting down their roosting trees. However, though some sap collectors are using the nets, Bangladesh’s Ministry of Health has chosen not to encourage using the nets. Like many governments, said Luby, Bangladesh’s is reluctant to use harm reduction in public health, believing that any sap drinking is a risky behavior.

Luby noted that the largest practical barrier to integrating a concern for nature with human health is the practice of paying people for activities that destroy nature even though people understand that clearcutting forests or strip mining, for example, are bad for the planet. “We are stuck in a dominant model of an extracting, linear economy that ignores harms,” he said. Economists call these harms externalities to nature and human health.

To Luby, this means that the research community needs to consider the incentives that drive the system and not focus solely on the natural science. “We need to not only understand what is happening between humans and the environment but why it is happening,” he said, and that requires an investment in the social sciences. His project on promoting sap-protecting nets in Bangladesh involves anthropologists, for example.

To move forward to integrate nature and human health, Luby suggested taking three steps. First, Luby suggested developing a deeper appreciation that the health of human communities depends on a healthy biosphere in ways that go beyond climate change and include land misuse, ocean acidification, polluted waterways, and other harms to the planet.

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5 According to the World Health Organization, the case fatality rate for Nipah virus infection in humans is 40-75 percent and human-to-human transmission can occur. See https://www.who.int/news-room/fact-sheets/detail/nipah-virus (accessed January 19, 2023).

Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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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His second suggetion is to embrace systems thinking and understand the interactions and feedback among ecosystems, humans, and community health at all levels, from the biochemical and microbiological to the human health level, the ecological level, the Earth systems level, and the economic and political levels. This is not meant to replace productive, reductionist science but to complement it by embracing systems thinking. “We should do this in our workplace conversations, in our writing, and in the influence we have on what work gets funded,” said Luby.

Suggestion three involves encouraging long-term considerations when making decisions that play out over time. Individuals, said Luby, have a difficult time making decisions in the long-term interests of their health—skipping a donut to go for a run, for example—and this problem is even more difficult for societies. Still, suggestion three is a cornerstone to achieving a healthy future over the long-term.

Through his work, Luby learned that leading with an emphasis on dystopia may not be the best approach because it does not inspire people. “We need to envision a thriving future, and we need to show a pathway toward a future that encourages making the decisions and sacrifices today,” said Luby. In summary, he said, it is possible to integrate concerns about nature and human health and bridge the knowledge-to-action gap by considering the incentives of actors, the whole system, and the long-term.

Q&A DISCUSSION

Dirzo asked Webb if she had any suggestions for priority research needs. She replied that it is important to stop the colonial paradigm6 used to evaluate community well-being and instead have Indigenous evaluators ask the community how it feels that it is doing. For example, she said a pastoral community would know things are going well if “the young boys were singing to the cows, which would mean the boys were healthy and happy; the cows were healthy and happy; and the ecosystem was healthy and happy.”

Webb and her colleagues are also working on using satellite imagery to analyze the effects of environmental change on human health. The challenge is that many organizations in the southern hemisphere lack access to the resources and researchers they need to study impact. She is working with scientists at the Woodwell Climate Research Center to look at various techniques that might show how much forest communities are protecting and how mechanisms of reciprocity are having an impact.

Dirzo asked Fernandez to elaborate on the concept of traditional health knowledge. Fernandez responded by saying that traditional ecological knowledge, traditional health knowledge, and cultural practices that involve human interconnectedness with nature are all terms in English. However, those English terms cannot describe how Indigenous Peoples speak about these concepts in their own languages. Fernandez explained that in traditional ecological knowledge, health is a concept of the interconnectedness of everything and the infusion of human health with the health of other non-human relatives.

Sleeman asked Luby for his thoughts on how to improve the relationship between science and scientific information to inform government officials and how to better translate science into interventions and actions. Luby replied that this is a long-term effort that requires building relationships and credibility. When his team first identified the link between date palm sap and Nipah virus, the Bangladesh government did not want to issue any warning. It took a concerted effort of working with the government and identifying that this was an ongoing and recurring problem to get the government to

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6 In this instance, “colonial” refers to the intellectual values and paradigms typically associated with Western science, or the scientific methods derived from the European Renaissance.

Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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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talk to people about this risk. One challenge is that there tends to be a great deal of turnover in the government, making it difficult to continue discussions.

Reflections on the Presentations

Presented by Anne Guerry, Stanford University; Catherine Machalaba, EcoHealth Alliance; and Liz Willetts, International Institute for Sustainable Development

Guerry began by commenting on Luby’s discussion of reductionism and moving up the scale in complexity. To Guerry, it is easy to focus on individual health, but it is important to continue to scale and think about the alternative framing that focuses on the social determinants of health and how they determine people’s well-being. In the environmental community, it is easy to focus on human impacts, but the alternative non-reductionist framing views people and nature as inseparable parts of a system that includes negative effects as well as human stewardship of natural systems and how nature sustains and fulfills human life. “If we focus on those reciprocal relationships and we make clear those intimate connections between people and healthy functioning ecosystems and healthy functioning communities, economies, and countries, then it becomes increasingly clear that caring for ecosystems is caring for ourselves,” said Guerry.

In her work with the Natural Capital Project, the theory of change is that integrating the diverse values of nature into decision making will enable determining how to motivate greater, more targeted investments in conservation and restoration of Earth’s life support system and ultimately improve the well-being of both people and nature. Science, she said, can determine which activities are best to do and where the project might generate the best return on investment, and software can make that science more accessible. However, partnerships are likely critical for asking the right questions, involving the right people, and determining what is socially acceptable in different communities.

To Machalaba, the three presentations showed there are different major aspects of the interaction of ecology and public health that require economics and social sciences to ensure that research is reaching and working with all stakeholders. One area that would likely benefit from investment is the establishment of “environmental health systems,” including a workforce with the necessary skills to deal with growing challenges. This workforce could include wildlife managers, biodiversity managers, and people working on climate science and climate change mitigation and adaptation. Investment may also be needed to enable implementation of action plans and national biodiversity strategies given that the world is failing to meet the ambitious global climate and biodiversity targets needed to safeguard our planet and our health.

While there are examples of progress and of species recovery, they are few, said Machalaba. The reason there are not more positive results across the system, she said, is a lack of investment in the work that needs to be done and the people who can do the work. In her view, there are some solutions already in hand, and it is often a matter of adapting and implementing them and investing in the necessary capacity at the global, national, and community levels. A One Health approach that works with government partners, communities, and other relevant stakeholders would likely help to capitalize on promising opportunities, create incentives and awareness, and avoid unintended consequences.

Willetts noted that the environment is so severely affected that this is a global problem, making it necessary to connect local efforts to global actions and launch a multidimensional approach to achieve progress. Example solutions, based on her recent work, include adopting a common problem, having a common language, and setting common agendas to converge in the same meeting spaces at all scales.

Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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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Environmental health is a global problem, but it rarely is looked at that way, presented in that way, or costed out that way. The language used across health and environmental domains, she said, is not consistent or cohesive, nor does it reflect the terminology that different Indigenous groups use.

Studies of the environmental determinants of health are increasing, Willetts continued, but the health field rarely or comprehensively considers them or includes them in research. Still, it is a concept that might “move the dial” in terms of convergence and integrated policy making, she said. As for a common agenda, she said there is a need to align global health and global environmental policies. Currently, global environmental policies are segregated from the global health agenda. This lack of integration trickles down into national implementation—for example, few national biodiversity plans she has reviewed reference nutrition, and very few health plans talk about ecosystems. Willetts also noted that health ministers (or the U.S. equivalent) are not participating in policy discussions and negotiations regarding the environment. This means that efforts to design and strengthen resilience to global environmental changes do not always occur under the authority of the health sector. For example, the heat action plans in India are under the jurisdiction of the Ministry of Housing, not the Ministry of Health or Ministry of Environment.

In terms of the increasing health risks of environmental change, Willetts said a goal is to be “shock prepared and shock responsive” by building a foundation of interdisciplinary knowledge and implementers to address the chronic, cumulative, complex cascading problems, such as the loss of pollinators, as well as the sudden episodic risks from natural hazards, such as a pandemic or major storm. A positive approach to achieve that goal could be to examine the evidence, how it is framed, the domain language it is in, the policy agenda related to it, and how that evidence is making its way into decision making. She noted that stakeholders from different sectors need to be in the same rooms not only for building evidence and sharing research, but also to converge to make decisions together.

Discussion with the Plenary Speakers and Panelists

Dirzo asked the speakers and panelists to provide their thoughts on having a common language and moving toward a common research agenda. Luby said he was struck by how radical listening—the concept of listening and striving to understand the people living in their communities—has been a theme across presentations and reactions to the presentations. This approach differs from expert-driven science, he said. Dirzo added that radical listening leads to co-design and co-definition of solutions and interventions. “I think this is an essential element that we need to be mindful of and elaborate on as much as possible,” said Dirzo.

Sleeman asked the speakers and panelists to comment on how to be more creative at engaging communities and co-creating new change narratives and inspiration, potentially by engaging artists and designers. He also asked them how they might build inclusive relationships that are transparent, equitable, and beneficial for all stakeholders. Fernandez replied that communities are already doing the work; she thinks of herself as a researcher with a toolbox and the community as the experts, and then tries to find how to be helpful. She noted that it is also important to be humble, listen carefully, and be respectful when contributing to the discussion. “That is what works in my community and in many Indigenous communities,” she said, summarizing that practicing humility, listening with true care and intention, and putting in efforts to understand the community’s history to identify opportunities to help are important elements in building relationships.

Fernandez noted that artists and musicians are often involved in activism in their communities and help engage people in various social movements and events. Her advice is to attend these events, listen carefully to what is happening, and use the events as an opportunity to identify ways to help and

Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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.
×

build relationships with the community. She also stressed the importance of community participatory research and the recognition of this in supporting career development trajectories.

Machalaba, agreeing that community participatory research is important, added that researchers should be intentional in the way they build their engagement with the community so it benefits the community and is led by the community’s priorities. She noted that many research teams do not come back to the community to present and discuss the results of their research, which does little to engender trust. She suggested building that longer-term engagement into project budgets to ensure communities sufficiently benefit from the knowledge generated.

Willetts commented that in her experience working in community health centers and community medicine, patients talk about home remedies, alternative remedies, and even ecological remedies that communities and families of different backgrounds use, but there is no way for Western medicine to respond and support traditional medicine. She describes this as a gap because it is an important aspect of traditional knowledge that is often discounted and may even be considered unacceptable to discuss with colleagues.

Guerry noted that there is a new guidebook for universities that aims to help the research community think about new ways of engaging with stakeholders to make a difference in the world. She also pointed to the importance of storytelling as a creative form of engagement that can help stakeholders envision possible futures that might inspire them. As an example, she cited the Seeds of Good Anthropocenes7 project, which collects stories about existing initiatives with the potential to shape a better future and that might serve as an inspiration for rethinking systems and doing things differently based on different baseline assumptions. Dirzo added that many inspirational stories of better futures come from the work of Indigenous Peoples around the world.

Dirzo then commented that in addition to losing biological diversity and ecosystems, the world is losing a great deal of cultural diversity. In his view, this is an aspect that researchers should pay attention to going forward in the quest to address the critical issues of the Anthropocene.

Given the opportunity to provide final thoughts, Webb remarked that local communities often know solutions to the problems they face that will enable them to thrive and their ecosystems to thrive. However, they often are not supported to carry out these solutions, and sometimes are penalized for that knowledge as opposed to being honored, respected, and engaged as full partners. A possible solution to that is radical listening.

Machalaba noted that there are positive initiatives happening and that the One Health coordination platforms coming into existence at the national and even subnational level are powerful because they bring together different stakeholders to share information. These platforms demonstrated their value during the COVID-19 pandemic, but she believes these national platforms are underused for routine management and protection of ecosystems before they are degraded. These platforms can provide the opportunity to look at tradeoffs and co-benefits of different research or policy approaches, with all stakeholders participating in such discussions and bringing their different perspectives to the table.

Dirzo commented that restoring and repairing society to address inequality will be as important going forward as restoring and repairing ecosystems. Sleeman reiterated that the knowledge to solve many problems the world faces exists, but there seem to be barriers to implementing that knowledge. One barrier, he said, is that many people benefit from the status quo and the linear economy. In that regard, it is important to get those groups and industries engaged to enact the change needed to address ecosystem and human health.

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7 See https://goodanthropocenes.net/ (accessed November 24, 2022).

Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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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In that vein, Fernandez said that as a person of privilege herself, thanks to her educational, professional, and economic achievements, she can have influence over a sphere of people and can model what it means to be humble and listen to others. It is important, she said, for those who have achieved success like she has to recognize their own opportunity and positionality and use those in conversations with colleagues and in interactions with people who have different forms of power.

Luby called for having the courage to confront the exploitative, destructive linear economy and believing in the ability to realize a better future. Willetts said that evidence is not enough. It is time to focus on implementation and determine the most relevant engagement venues and the right language to use when proposing an agenda for change. “I think there is a lot of cohesion and convergence on this idea that action needs to happen,” said Willetts. “People just need to make bold moves.”

Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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 28
Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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 29
Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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 30
Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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 31
Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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 32
Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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 33
Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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 34
Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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 35
Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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 36
Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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 37
Suggested Citation:"5 Exploring Challenges, Gaps, and Opportunities for Moving from Knowledge 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 38
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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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