In the United States, human health has traditionally been considered isolated from its ecological context. During my medical training and subsequent career in Emergency Medicine, issues such as climate change, habitat destruction, species extinctions, pollution, and the depletion of freshwater supplies were primarily treated as outside environmental issues. from the medical industry. Equity has been seen as a primarily political, economic and social issue. Sustainability was rarely considered.

I believe that this point of view must be changed and that not only physicians, but all Americans, have a responsibility to effect this change. Achieving health requires that we address all of these elements in an integrated ecological approach. Our goal must be “healthy people, living in equitable and sustainable societies, in balance with the natural world.” Ignoring any of these elements has profound and unacceptable consequences.

Few people have anticipated these consequences better than my biology professor at Stanford University, Dr. Paul Ehrlich, considered by many to be the father of American ecology. Winner of the Crafoord Prize, the equivalent of the Nobel Prize for his pioneering work in the field of ecology, Dr. Ehrlich delivered an extraordinary speech that was, in effect, an urgent call for an ecological approach to health. I encourage you to click here to listen to this speech delivered in 1970. I think you will be surprised at how contemporary and compelling it is today, almost forty years later.

I would argue, however, that one of the best examples of implementing some of the elements of an ecological approach to health actually anticipated Dr. Ehrlich’s discourse by several decades. As a dependent of the US Army, I traveled to Japan in 1946 with my family to spend three years while my father participated in the effort led by General Douglass MacArthur to implement the Marshall Plan in Japan after World War II. Although most Americans have understood the Marshall Plan as a financial assistance program, it is less well known that its approach was systems-based, comprehensive, and comprised of three distinct components: democratization, decentralization, and demilitarization. To implement the “three D’s,” MacArthur took sweeping steps that affected every aspect of Japanese society. For example, his approach to decentralization reflected an understanding that the concentration of wealth and power in the giant family-owned industrial monopolies, the Zaibatsu, had played a crucial role in the genesis of Japanese fascism. These monopolies controlled the Japanese economy and, among other things, had eliminated unions. MacArthur dissolved these monopolies and addressed their extreme concentration of wealth by imposing a minimum wage, a maximum wage, and redistributing the Zaibatsu’s wealth. He also brought with him universal access to healthcare. The end result of these measures was the transformation of Japan from a nation with one of the widest gaps between rich and poor and the worst health indices (longevity, infant mortality, etc.) in the world, into the Japan of today. Japan is now the nation with the best health indices and the smallest gap between rich and poor in the industrialized world.

Given the current challenges we face as Americans, let’s consider what happened in the United States during this same period. While our nation ranked fifth in the world in 1950 in terms of health indices and had a relatively small gap between rich and poor and a growing middle class, these trends have since reversed. Today our comparative health indices do not exceed 21, below all other developed nations, Costa Rica and Cuba. The gap between rich and poor in our country is now the largest in any industrialized nation. Over the same period, our health care spending has skyrocketed. The United States now spends more than half of all the money spent on health care in the world, the highest per capita of any nation, while accounting for just 4% of the world’s population. By contrast, Japan spends the lowest per capita amount on health care among the world’s industrialized nations, while achieving the best health indices.

Another very different society that employs important aspects of an ecologically sound approach to health is the nation of Bhutan, located in the Himalayan mountains near Nepal. Although Bhutan admits very few visitors in an effort to preserve its cultural traditions, over the past two winters, Mary and Phil of DeReimer Adventure Kayaking have been granted permission to lead groups of kayakers to explore Bhutan’s rivers. I encourage you to visit his website at http://www.adventurekayaking.com for details of his trips.

The significance of his experience from the perspective of an ecological approach to health is that the Bhutanese, who are materially poor by American standards, are comparatively healthy physically and spiritually. To paraphrase Mary and Phil, “the definition of happiness in Bhutan is not ‘to have and receive’, but in their culture wealth has little to do with being happy. On the contrary, they believe that wanting and wanting often causes suffering. This principle is an underlying motivator of behavior with the result that their culture is open, loving, curious, and tolerant. Their government pursues “gross national happiness,” and to promote happiness, the government engages in the implementation of educational, social, and environmental standards that take into account the desire to protect the environment and the cultural traditions of the country”.

The distant Kingdom of Bhutan and the concept of “Gross National Happiness” may seem esoteric to many Americans. However, more than 400 respected American economists, including Nobel laureate Professor Herbert Simon, argue that it would actually be more realistic and useful to substitute our use of Gross Domestic Product (the total of all goods and services produced) by measuring of the Genuine Progress Index. , which attempts to measure the quality of our lives. Comparing these measures over the period since the 1970s is revealing. While the conventional GDPProduct more than doubled, the Genuine Progress Index declined by 45% during this period. Measuring the GPI would have warned us that, contrary to many assurances to the contrary, the US economy was actually undermining our health during this period. Our prosperity was not only unevenly and unsustainably distributed, it was failing to perform its most important role. That function is to support improvements in the health of our population.

Clearly, an ecological and scientific approach to health requires that we define what health is, how best to measure it, and then promote the conditions that achieve it. If we do not do these things, it is logical that we will not achieve health. We must recognize that health is more than the absence of disease. On the contrary, it requires doing things that actively promote it. It is not enough to try to correct the effects of doing things that destroy you.

At Mother Lode, our ongoing commitment is to contribute to this effort, one river-based experience, one charter, one environmentally and socially responsible act at a time. We hope you will bring your ideas and suggestions, and help explore the possibilities. Remember, recreation is just that: “re-creation”, a process by which meaningful and constructive change occurs and a vital part of an integrated and ecological approach to health.

See you at the river!