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Suggested Citation:"6 Addressing Knowledge Gaps Through New and Emerging Cross-Cutting Research." 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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6

Addressing Knowledge Gaps Through New and Emerging Cross-Cutting Research

ROOTS AND RELATIONALITY

Presented by Nicole Redvers, University of North Dakota

Western science2 as a paradigm has been limited historically to explaining complex relationships over time, said Redvers, and in some cases it is linear, reductionist, and mechanistic. Often, the overarching interest of Western science, she said, has been to infer phenomena to understand the world,

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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.

2 This term is used to broadly refer to the methods and paradigms derived from the scientific method associated with the European Renaissance. See https://www.ipbes.net/glossary/western-science (accessed March 30, 2023).

Suggested Citation:"6 Addressing Knowledge Gaps Through New and Emerging Cross-Cutting Research." 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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but sometimes there is an underlying implicit interest to influence, control, and perhaps eventually modify these phenomena for human benefit. However, more recently there has been increased focus toward the need for a systems-oriented, ecologically based network approach, which she called the ecoorientation. “This approach might seem more aligned to the complexity of planetary health and other complex systems with which people interrelate,” said Redvers.

Redvers explained that the Indigenous scientific method is contextual, holistic, symbolic, nonlinear, and relational; is not limited by time; and uses the collective observation of its people to explain natural phenomenon through real and metaphoric narratives. She pointed out that society likely cannot solve complex problems using the same worldview that created those problems in the first place, as it will continue to perpetuate a disconnect between humans and the planet as relatives.

Recently, a group of Indigenous scholars, practitioners, land and water defenders, elders, and knowledge holders came together to define the determinants of planetary health from an Indigenous perspective (Redvers et al., 2022). This collective noted the difference between an anthropocentric orientation, which places humans at the top of the hierarchy of different sectors, and a cosmocentric orientation, which centers on the planet and stresses the interconnections between systems (Figure 6-1; Lucero and Gonzalez Cruz, 2020). The result is a framework that focuses on the relationships between variables rather than on the variables by themselves.

Redvers noted that this change in focus combined with the inclusion of traditional Indigenous knowledge systems can lead to improved methods of dealing with multiple crises that the planet is facing. “We need more Indigenous presence and more Indigenous voices amplifying and leading through thought experiments in real-time implementation of solutions on the ground,” said Redvers. “We need Western systems to stand up, step back, and listen to the longest stewards of the land [who] currently host the remaining 80 percent of the world’s biodiversity and [who manage] one-third of the remaining old growth forests.” As an Indigenous elder said to her, “We were born with two ears and one mouth for a reason.”

From her perspective, it was important to point out that her Indigenous ways of being in the world—her ontology—in addition to her way of applying knowledge in the world—her epistemology—have been informed by tens of thousands of years of memories stored in her region’s stories rooted directly in the land. Redvers said one scholar described this relationship by stating that a culture’s vitality depends on individuals in a community connecting with the natural world (Cajete, 2018). In that regard, Indigenous cultures are an extension of the story of the natural community of place, and they evolve according to ecological dynamics and natural relationships.

How Indigenous Peoples formulate their relationships is rooted in a framework of knowing that privileges interconnectedness as a basic and fundamental natural law, Redvers shared. That raises the question of how to turn this interconnected relationship to all entities into a research methodology. However, this methodology already exists because there has been a scientific, evidence-informed method for thousands of years that shows how to live and know in the surrounding world. “Traditional ecological knowledge systems are based on sacred natural laws, which then define traditional protocols that provide a framework for both old-world but also modern world ways of knowing,” she explained. “Yet in the spirit of scientific hegemony that has pervaded most branches of Western research, practice, and inquiry, knowledge democracy has not prevailed,” said Redvers.

The term epistemological pluralism, said Redvers, appreciates and recognizes that in any research or practice context, there may be several valuable ways of knowing; accommodating this plurality can lead to more successful, integrative study and practice. However, current systems of learning or applications in the real world rarely take this approach to solving complex problems. In her

Suggested Citation:"6 Addressing Knowledge Gaps Through New and Emerging Cross-Cutting Research." 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.
×
Image
FIGURE 6-1 The current anthropocentric orientation regarding planetary health compared to the Indigenous cosmocentric orientation.
SOURCE: Lucero and Gonzalez Cruz (2020).

opinion, addressing issues of equity regarding any topic requires first understanding how ways of knowing, being in the world, and even carrying out inquiry are steeped in considerations of social justice in the democracy of knowledge. Indigenous Peoples, said Redvers, understand that a blend of traditional knowledge with modern knowledge is the only way to create a sustainable future for the planet.

To operationalize epistemological pluralism, Redvers said to look no further than the brilliance of Indigenous elders. She used the term “two-eyed seeing” to refer to the practice of seeing the strengths of Indigenous ways of knowing through one eye and the strengths of Western ways of knowing through the other eye and then using both eyes to get the best view of a problem and potential solutions. Two-eyed seeing, she said, is the gift of valuing multiple perspectives treasured by many Indigenous Peoples.

THE EFFECTS OF CLIMATE CHANGE ON CHILDREN

Presented by Judith Van Hoorn, University of the Pacific

Young children are the humans who are most vulnerable to the effects of climate change, yet they have received less attention than adolescents and adults, said Van Hoorn. In fact, the World Health Organization has estimated that children under age six and their mothers will experience more than 80 percent of the effects of climate change on physical health (Xu et al., 2012). These impacts will affect both the physical and mental health of children, with the most vulnerable being children of color, Indigenous children, children from low-income families, children living on their own, and children living in the Global South.

It is easy to forget, said Van Hoorn, that 85 percent of the world’s children live in low- and middle-income nations in the Global South, yet most of the published research focuses on children in the Global North. At the same time, those reports on children in the Global South that exist come from practitioners working in nongovernmental organizations and in local communities. Those reports contain important, creative work that practitioners and academics in the Western world do not see or incorporate in their work. “This is something we can address by collaborating with researchers and practitioners worldwide and stepping out of our silos to have coordinated practice,” said Van Hoorn.

Suggested Citation:"6 Addressing Knowledge Gaps Through New and Emerging Cross-Cutting Research." 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.
×

She then addressed the need for children to receive climate change education, which embodies a sense of action by children, families, and communities. For example, one teacher in Rhode Island asked her students to think about what they could do to solve climate change issues in their state. While she expected her students to be flummoxed and anxious, the children and their families responded to this challenge by contacting the governor and others with actions they would like to see the state take and some actions that they would take beyond recycling at home. In England, elementary school children have had the opportunity to ask experts climate change questions.

The Sandwatch program,3 said Van Hoorn, has students, teachers, and local communities going to areas near the ocean and rivers to implement mitigation projects. Another small project in Peru involved children in caring for their own small plot of land, learning which plants to grow and observing which animals visit their plots.

Van Hoorn said UNICEF has noted that climate change is one of the most intersectional challenges in history, with its causes and effects embedded deeply in the wider systems that shape economic and social inequality. “When we think about the ways to solve this and look at the inequalities that we need to address, we have to focus on communities, families, and children and look at those relationships,” said Van Hoorn.

ECO-ANXIETY AND DISTRESS

Presented by Caroline Hickman, University of Bath

Hickman noted that children see the natural world differently and have different relationships with the natural world than adults. In her experience, children and young people often embody the distress of the planet. As a result, the therapeutic work she does with groups and individual children and young people as guided by an eco-psychotherapy framework—that is, a therapeutic triad involving herself, her client, and the planet.

She explained that eco-anxiety or distress has relatively little to do with environmental problems, though they are rooted there. Rather, the children and young people she speaks with say they would feel okay if people were taking action (Hickman, 2020). “It is the failure of adults, the failure of people in power to act, [and] the failure of the people who were supposed to take care of us,” said Hickman. This betrayal causes a form of distress that “does not fit into the traditional Western medical model of anxiety and depression, and thinking about it that way would be an absolute mistake,” she stated. Eco-anxiety or distress, she added, is a relationship problem.

Seeing eco-anxiety leads Hickman to tell her clients they are feeling anxious and experiencing climate distress because they care. Moreover, she tells them they should feel proud that they care. For her, eco-anxiety is an emotionally healthy, congruent, and morally sound response to the realities that society is facing today, not a pathology. “I do not think we fully understand how this affects young people,” said Hickman. “When we use the Western medical model to frame this distress, we are missing something absolutely crucially important.”

Showing a picture of a small rodent that went extinct because of climate change, Hickman cautioned that while the extinction of this rodent may not have any effect on the human population and health, this complacency could begin to be extrapolated to other animal species such as giraffes and polar bears, or even to entire countries and regions. “I think we need to pay attention to the loss of the

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3 See https://www.unesco.org/en/sids/sandwatch (accessed November 24, 2022).

Suggested Citation:"6 Addressing Knowledge Gaps Through New and Emerging Cross-Cutting Research." 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.
×

small as well as the large. I think this little creature shows us something really important and should be grieved, and we should pay attention to the loss,” said Hickman.

Eco-anxiety is an emergent mental health problem, said Hickman, and there are relatively few experts in this field. She explained that psychologists have long measured mental health by looking at a person’s capacity to respond to external reality, and the external reality around climate change is that it is “scary.” By that standard, eco-anxiety is an emotionally healthy response, and she said that she would worry if people were not feeling this way. As an example, Hickman said she has been working with adult women who are imagining having to kill their children to save them from a worse fate of starvation and social collapse. These women are terrified and traumatized, she said, not mentally ill. Perhaps instead of eco-anxiety, this should be called climate horror or climate devastation, she said. These conditions may require a new framework for understanding climate change–related distress that connects empathically with the urgent issues people are facing. Otherwise, said Hickman, people are left feeling like they are suffering this distress on their own.

Not everyone feels this way about the dangers of climate change or feels the same psychosocial climate anxiety (Box 6-1). In addition, said Hickman, there are important intergenerational differences in feelings about climate change. While adults may have mild feelings about this because they are confident that governments and technology will offer solutions, young people have lost trust in others’ ability to solve climate change issues. For example, a 19-year-old asked her how he was supposed to live in a world that does not care about young people and does not care about young people’s futures.

In a study that Hickman conducted in 2021, she and her collaborators surveyed 10,000 children and young people ages 16 to 25 in a range of countries in both the Global North and Global South (Hickman et al., 2021). She said that massive emotional impact was fairly constant across countries, though the negative effects on daily living were greater in poor and middle-class countries such as India and the Philippines than in the United States and the United Kingdom. The researchers found significant cognitive effects too, with 83 percent of the children and young adults worldwide—80 percent in the United Kingdom and 92 percent in the Philippines—feeling that people have failed to care for the

Suggested Citation:"6 Addressing Knowledge Gaps Through New and Emerging Cross-Cutting Research." 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.
×

planet, 75 percent worldwide thinking that the future is frightening, 56 percent worldwide thinking that humanity is doomed, and 48 percent worldwide reporting they have been dismissed or ignored by others when they try to talk about climate change. “We are silencing children and young people,” said Hickman.

The research team then linked these cognitive effects to government inaction. In the United Kingdom, 65 percent of young people believe that governments are failing them; and just more than a quarter thought governments could be trusted, that they were doing enough to prevent the worse effects of climate change, and that they were taking young people’s concerns seriously. “This is relational fracturing between generations,” said Hickman.

She concluded her remarks with some messages she received from young people around the world after completing the study. One young woman in Germany said that the study’s results made her feel for the first time that she was not alone with a future and the anxiety she experiences every day. A teenager in the Maldives compared climate change to a character in a superhero movie whose ideology was to kill half the world’s population so that the other half can thrive, and the Maldives was in the half being killed. Another teenager in the Maldives saw online that people in Iceland had a funeral for a glacier, and it led the teenager to wonder if anyone would have a funeral for the Maldives, which will soon be underwater.

Q&A DISCUSSION

Moderated by Shanondora Billiot, Arizona State University, and Rodolfo Dirzo, Stanford University

Billiot asked Redvers to talk about the metrics that would be suitable for evaluating how new information advances knowledge and how transdisciplinary and community-engaged scholarship can be improved to advance knowledge, equity, and social justice within planetary health. Redvers said that available metrics are rarely relevant to the communities with which she works. For example, the boys singing to cows metric that one community uses to know it is healthy is not one that conventional measures can capture. She has been trying to work with communities to develop their own relevant metrics for planetary health, which requires a transdisciplinary approach that includes all sectors of a community.

Dirzo asked for the speakers’ thoughts on how to create opportunities for practitioners in the Global North to hear from those in the Global South aside from the scientific literature and meetings. Van Hoorn suggested publishing papers describing projects, not just research results. Van Hoorn, Hickman, and Redvers all thought that having children and young people contribute to research and any resulting publications would benefit practitioners.

When asked to discuss barriers that restrict access to communication tools by which children can connect with policy makers and researchers, Van Hoorn said that intellectual silos keep different communities from expanding their vision and connectedness. One of the biggest barriers, said Hickman, is the assumptions adults make about children’s ability to communicate. One solution is to listen to children and see the way they communicate instead of translating everything they say and do through the adult lens. For example, she asks children to describe climate change as an animal, because this gets to the way children think without scaring or traumatizing them. She also noted that children learn about climate change separately from the ordinary, everyday part of their lives; instead, climate change needs to be taught as part of their everyday lives.

Liz Willetts, from the International Institute for Sustainable Development, asked if presenters could speak to how the medical system views biodiversity and its effects on human health, and whether

Suggested Citation:"6 Addressing Knowledge Gaps Through New and Emerging Cross-Cutting Research." 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.
×

considerations of the effects of biodiversity on human health are being incorporated into medical education. Redvers replied that the Planetary Health Alliance has developed a Planetary Health Education Framework with other organizations and institutions around the world. She noted that the United Kingdom has been progressive in this regard, with efforts underway in Germany, Australia, Canada, and the United States to increase the integration of either climate change and human health or planetary health as it pertains to human health in coursework, and some countries include questions relevant to climate change and health in physician board exams. The challenge, said Redvers, is to include discussions about biodiversity loss and some of the more holistic elements of social justice as part of this integration.

Dirzo pointed out that there are silos even in the conception of ecosystem health and its relationship to human health. Climate change is one factor, but others include land use change, overexploitation of resources, and biodiversity loss. All these factors, he said, interact in complex ways and make the situation even more challenging when looking for ways of connecting them and for moving to action.

When asked for an example of “two-eyed seeing,” Redvers noted one study on fisheries management in the Pacific Northwest, where fishing is a critical cultural practice with relevance to health from an Indigenous perspective. This study incorporated Western and Indigenous research methods (Reid et al., 2021). Redvers said that when taking a two-eyed seeing perspective, it is important to come into that ethical space with respect for knowledge and knowing from both Western and Indigenous approaches and accept that no one “owns that space.” “That is a difficult part when it comes to Western academia,” said Redvers. “When you are working in a two-eyed seeing perspective, dancing in between ethical spaces, there is no ownership in the middle of that knowledge. That is a clearly understood boundary from the Indigenous perspective but not so much sometimes from the Western perspective.”

The key, she said, is to have trusted research teams that work with the community and that can understand ideas of free and informed consent as well as data sovereignty, Indigenous traditional knowledge and intellectual property for communities, and community decisions around how information is shared and disseminated. Being inclusive of multiple perspectives can lead to a better understanding of what reality is and how to better navigate the world. Katie Arkema, from the Pacific Northwest National Laboratory, noted that this blending of knowledge is similar to the challenge of mixing qualitative and quantitative information in scenario development for sustainable development planning.

Suggested Citation:"6 Addressing Knowledge Gaps Through New and Emerging Cross-Cutting Research." 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:"6 Addressing Knowledge Gaps Through New and Emerging Cross-Cutting Research." 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:"6 Addressing Knowledge Gaps Through New and Emerging Cross-Cutting Research." 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:"6 Addressing Knowledge Gaps Through New and Emerging Cross-Cutting Research." 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:"6 Addressing Knowledge Gaps Through New and Emerging Cross-Cutting Research." 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:"6 Addressing Knowledge Gaps Through New and Emerging Cross-Cutting Research." 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 43
Suggested Citation:"6 Addressing Knowledge Gaps Through New and Emerging Cross-Cutting Research." 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 44
Suggested Citation:"6 Addressing Knowledge Gaps Through New and Emerging Cross-Cutting Research." 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 45
Suggested Citation:"6 Addressing Knowledge Gaps Through New and Emerging Cross-Cutting Research." 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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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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