Module 1 - Ecological Health
MODULE 1 | LESSON 1
What is Ecological Health?
At the core of our work is understanding what health means - what does it mean to be healthy?
In the news we are hearing time and time again that “healthy” people are dying. In some cases this might be true, however, some by Centric’s definition of health wouldn’t qualify as healthy. This is not to do with the individual, but the system in which a person lives.
Ecology is defined as the branch of biology that deals with the relations of organisms to one another and to their physical surroundings. Humans, and non-humans, are by definition organisms interacting and relating to their environments. As a society, we have developed a series of environments that have their own characteristics and dynamics; environments that are social, natural, built, economic and political. Therefore to take a biological lens to health is to understand how the physical environments (and the systems that make them) influence health is to see health as an ecological phenomena, not just a behavioural one.
For example, our built environment consists of multiple elements that influence our health.
The allocation of industrial and commercial facilities that emit pollution;
The design of the public realm that allows for all people to have an equal - if not equitable - opportunity to engage in neighbourhood and urban life;
The decision to construct new facilities and buildings, such as housing or offices, that can increase density and put pressure on access to goods and services.
Each environment will have multiple elements that have an influence on our health and wellbeing. From a biological lens, we at Centric Lab focus our understanding through the stress-response-system; a naturally occurring system within the body for millennia helping our bodies dynamically respond to its situation. However, research shows (more on this later) that when these systems have been designed unfairly, there are multiple points where a person’s stress-response is over stimulated and thus causing biological consequences.
We see health is the ability for our biological systems to enter stability after experiencing trauma or stress throughout our entire lifetime, to give us all an equal opportunity to realise our full potential.
What this means is that people should have systemic support to bring their bodies back to equilibrium after experiencing stress from the environments around them. By systemic we mean adequate housing, access to health resources, access to nutritious food, affordances to build strong community ties, clean air, access to restorative spaces like parks, etc.
In doing so a person is able to have the mental and physical attributes to realise a fulfilling and purposeful life. However, in the urban environment of the 21st century, many people are not provided with the affordances to lead a life of health. Often this means living with a chronic disorder from an early age, which can create severe challenges that make life unnecessarily harsh.
Healthcare-as-a-System
This talk by Lab Director Araceli Camargo will help you understand more about the approach to looking at health in relation to the urban experience.
Learning Points
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Inequality is defined as a difference in size, degree, circumstances, etc. An inequality can be demonstrated through the varying sizes of fruits from the same trees, or children from the same family (subject to no external forces influencing the outcome).
Inequity is defined differently. The World Health Organisation (2011) and Braverman (2009) describe health inequities as systematic differences in the opportunities groups have to achieve optimal health, leading to unfair and avoidable differences in health outcomes. Dictionary.com compliments this by giving Inequity a definition of “unfairness; favoritism or bias. an unfair circumstance or proceeding”. Therefore, we need to see the word inequity as the result of avoidable actions taken by upstream decision making.
In a social context it is accurate to use inequality when it refers to differences between groups (where there are similarities in conditions and contexts), while inequity refers to unfair differences between groups (such as financial wealth, geography, employment dynamics).
If you look at media, industry or even academic literature you’ll see the two words ‘inequality’ and ‘inequity’ often used interchangeably without context being given, and this is an error. An error that hides the causes of injustice.
For example, a child from a wealthy neighbourhood and a child from a deprived neighbourhood can both develop asthma. At face value this can be a health inequality. However, if the conditions of the deprived neighbourhood resulted in exposing the child to higher levels of air pollution (including their in-womb experience), then their asthma could have been avoided if more just policies were in place.
Inequity is defined as lack of justice or fairness.
There are many working examples of this semantic differentiation, UCL has the Institute for Health Equity (not equality) as Michael Marmot’s reviews constantly refer to the structural nature in the social determinants of health*.
The reason for this pedantic analysis of these terms is that they sit at the heart of a system that causes health injustices. Language is crucial in everything. Language defines narrative and carries with it past associations.
* Please note, we are not fans of the term social in its use here. Social has a close relationship with interpersonal activities such as the development of social capital amongst friends and neighbours. Whereas, the social determinants of health are generally the result of top-down forces: unemployment is less about a person’s inability to work and as much about the economic and educational distribution across a geographical area. In neoliberal economics, markets decide on investment and if deprived areas are not worth investing in, then economic and employment opportunities will not develop at an equal rate. Therefore, they become inequitable. We would prefer to see a term of socialised used to describe the main SDoH terms and social used in context with the interpersonal human dynamics that shape society.
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Neuroscience is a multidisciplinary branch of biology and is the scientific study of the brain and nervous system. The main neuroscientific approach which can begin to explain how urban environments interact with the human biological system is by looking at the stress response, which is one of the key pathways linking the internal human biological environment with the external environment. In this case, the interest is in how the biological system adapts to urban pollutants such as air, noise, thermal, and light. The use of neuroscience in refining the relationship of place and health comes in three parts.
The first is the generation of insights related to mental disorders such as depression, anxiety or PTSD and how they interact with metabolic disorders such as obesity and diabetes.
The second is knowledge of how urban environments create a health risk for the aforementioned disorders.
Finally, neuroscience can be used to identify areas that pose a health risk.
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To conclude this introductory chapter we want to offer a living definition of urban health. Unique to a general definition of health, urban health is a field of research concerned with the health outcomes of urban residents and dwellers in connection to the systemic factors that influence their lived experiences. This includes not only biological experiences, such as air pollution, the psychological experiences from issues such as marginalization and discrimination, but also the political context that has forced people to dwell in environments that are bad for their health. This last factor draws on the histories of racism, colonialism, classism and impacts of capitalism and poverty. Therefore urban health is contextualised, it is not random or happenstance but the result of many decisions over time.
“The main neuroscientific approach which can begin to explain how urban environments interact with the human biological system is by looking at the stress response. This is one of the key pathways linking the internal human biological environment with the external environment.”
KEY LEARNINGS
Health is more than our behaviours, it’s our biological interactions with the world around us.
The scientific study of the central nervous and regulatory system (neuroscience) allows us to build a biological bridge between the external world and the body.
Health inequalities are the differences within a group of people, whereas health inequities are the differences between groups of people.
QUESTIONS TO ASK YOURSELF
Has your local doctor ever asked you questions about your living and work environments when it comes to your health?
Do you feel it takes a long time for you to decompress/destress after a long day filled with challenges?
When was the last time you saw the terms health inequity and health inequity used with a context given to the term?
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