ABSTRACT Health scholars have long been calling for a new approach to understanding and respondin... more ABSTRACT Health scholars have long been calling for a new approach to understanding and responding to public health challenges, recognizing the dynamic influence of social and ecological processes and the importance of respecting different ways of knowing. With daunting new challenges to collective health, we sought to ascertain how future generations of public health researchers and practitioners are being prepared with the knowledge, attitudes, and skills needed for the tasks ahead. We found that of the 76 graduate level programs listed by the Public Health Agency of Canada, 65% required at least one quantitative methods course, but only 26% required qualitative methods and only 16% required a course in community engagement. While 25% had at least one required course related to social theory or social determinants of health, only 3% required a course on the ecological determinants. Our examination suggests that the majority of schools of public health may still be frozen in old paradigms wherein interdisciplinary inquiry and the development of skills to work with communities to implement and evaluate interventions to promote and protect collective health are still only peripheral considerations. With the intensification of public distrust in experts in this post-truth era, greater emphasis is needed now more than ever to develop skills in understanding and engaging the public in addressing the underlying issues threatening health. We argue that as the challenges of the Anthropocene are upon us, it is urgent that we rethink the skills we are teaching and prepare ourselves to radically adjust our approach.
Ecosystem decline and collapse is not just a plausible alternative future but an unfolding presen... more Ecosystem decline and collapse is not just a plausible alternative future but an unfolding present-day reality. It will be accompanied by the decline and collapse of societies and communities that depend on those ecosystems, and will have a dramatic impact on population health. Decline can be thought of as a form of long, slow crisis or a slowly unfolding disaster, and may be the prelude to collapse. After briefly reviewing the declining condition of some key elements of the global ecosystem, I conclude that we need a game plan to guide us through the ecological decline that we are already experiencing, and through the social changes this will require. I call this 'managing decline'; it begins with a willingness to acknowledge and accept the reality of ecological decline, and may need to include setting up 'decline management' units, rather as we have set up disaster management units, to help us manage the transition through decline and avoid collapse. As with so many important innovations, managing decline will begin at the local level. Indeed, this is beginning to happen, best exemplified by the synergy between healthy and sustainable cities and, more recently, the emergence of the Transition Towns movement. Context: Declines in All That Sustains Life As a health futurist with a particular interest in alternative futures and preferable futures, I have long recognised that 'decline and collapse' is a plausible alternative future that we face (Bezold and Hancock, 1993, 1994). Indeed, we face the real option of both the decline and collapse of ecosystems and the accompanying decline and collapse of the societies and communities that are embedded in and depend on those ecosystems. Yet, it is in many ways the future whose name we
ABSTRACT How we think about the future – including the future of cities and of health – is of gre... more ABSTRACT How we think about the future – including the future of cities and of health – is of great importance. As we enter the Anthropocene, we need to understand how environmental, social, political, cultural and technological forces may shape the future. Alternative futures or scenarios are a useful way to think about the future, and explore possible, plausible and preferable future conditions; the Futures Cone is one way to visualise these alternatives. Based on an understanding of the driving forces, alternative future scenarios may include extrapolative or ‘business as usual’ scenarios; challenging scenarios that include various forms of collapse; and visionary or transformational scenarios that build equity and sustainability. They also enable and encourage a consideration of the underlying values inherent in each scenario. Considering the implications for health and health equity within a scenario is important in our work, and in the context of healthy cities. Preferable futures, when they include commitment to creating them, become shared visions, a projection of values into the future. Rooted in the concept of ‘anticipatory democracy’, our approach has been to help people understand and imagine what may happen, but then to look at their preferred future and what it will take to get there.
As a collective organized to address the education implications of calls for public health engage... more As a collective organized to address the education implications of calls for public health engagement on the ecological determinants of health, we, the Ecological Determinants Group on Education (cpha.ca/EDGE), urge the health community to properly understand and address the importance of the ecological determinants of the public’s health, consistent with long-standing calls from many quarters—including Indigenous communities—and as part of an eco-social approach to public health education, research and practice. Educational approaches will determine how well we will be equipped to understand and respond to the rapid changes occurring for the living systems on which all life—including human life—depends. We revisit findings from the Canadian Public Health Association’s discussion paper on ‘Global Change and Public Health: Addressing the Ecological Determinants of Health’, and argue that an intentionally eco-social approach to education is needed to better support the health sector’s...
This article discusses the components of healthy cities and childrens roles in a healthy citys li... more This article discusses the components of healthy cities and childrens roles in a healthy citys life and growth. Industrialized countries now offer longer life expectancies better nutrition and less work. The advantages in a modern industrialized society are not available to everyone equally and come at a cost. Cities are disinvesting in services and physical infrastructure. Cuts are made in social spending and social safety nets are being eliminated. The number of children aged under 6 years living in poverty increased from 20% to 24% during 1980-95. Approaches to addressing these ills tend to be fragmented and specialized even with political will and economic means. Schools are improved but without attention to the influences of the streets and the mass media that affect childrens beliefs and perceptions. It is better to provide health services in a comprehensive way that include food shelter transportation clean air and water education physical safety and meaningful jobs with suff...
inVIVO Planetary Health is a progressive, humanist scientific movement promoting both evidence an... more inVIVO Planetary Health is a progressive, humanist scientific movement promoting both evidence and advocacy around concepts of planetary health which denote the interdependence between human health and place at all scales. Our seventh annual conference was held in Canmore, Alberta 4-6th April 2018, themed “Transforming Life: Unify Personal, Public, and Planetary Health” included diverse topics and perspectives to emphasise the interdependent vitality of all natural and anthropogenic ecosystems—social, political and otherwise. A key outcome of this meeting was the The Canmore Declaration: Statement of Principles for Planetary Health (published separately) which underscores that improving the health of all systems depends on: mutualistic values; planetary consciousness; advocacy; unity of purpose; recognition of biopsychosocial interdependence; emotional bonds between people and the land; efforts to counter elitism, social dominance and marginalization; meaningful cross-sectoral and c...
Purpose The purpose of this paper is to explore the pressing issues facing health and health syst... more Purpose The purpose of this paper is to explore the pressing issues facing health and health systems governance in the Anthropocene – a new geological time period that marks the age of colossal and rapid human impacts on Earth’s systems. Design/methodology/approach The viewpoint illustrates the extent of various human induced global ecological changes such as climate change and biodiversity loss and explores the social forces behind the new epoch. It draws together current scientific evidence and expert opinion on the Anthropocene’s health and health system impacts and warns that many these are yet unknown and likely to interact and compound each other. Findings Despite this uncertainty, health systems have four essential roles in the Anthropocene from adapting operations and preparing for future challenges to reducing their own contribution to global ecological changes and an advocacy role for social and economic changes for a healthier and more sustainable future. Practical implic...
The Healthy Cities approach has been quite widely—if somewhat inconsistently—adopted in North Ame... more The Healthy Cities approach has been quite widely—if somewhat inconsistently—adopted in North America and has remained alive and reasonably well for a quarter century. It has also been adapted to focus as much or more on smaller communities as on large cities and towns, and to be more community based rather than primarily based in municipal government, and has been adopted by a wide variety of local, state and national partners from the public, non-profit, philanthropic and private sectors. Community initiatives cover a very wide range of environmental, social, economic and other issues and intersect with a number of other city or community-focused initiatives aimed at improving life in cities and communities.
Background: Allergic rhinitis is a global health problem that burdens society due to associated h... more Background: Allergic rhinitis is a global health problem that burdens society due to associated health care costs and its impact on health. Standardized quality (SQ ®) house dust mite (HDM) sublingual immunotherapy (SLIT)-tablet is a sublingually administered allergy immunotherapy tablet for patients with persistent moderate to severe HDM allergic rhinitis despite use of allergy pharmacotherapy. Objective: To assess the cost-effectiveness of SQ HDM SLIT-tablet in Germany for patients suffering from HDM allergic rhinitis. Methods: A pharmacoeconomic analysis, based on data collected in a double-blinded, phase III randomized placebo-controlled trial (n=992), was undertaken to compare SQ HDM SLIT-tablet in addition to allergy pharmacotherapy to placebo plus allergy pharmacotherapy. Quality-adjusted life year (QALY) scores and health care resource use data recorded in the trial were applied to each treatment group and extrapolated over a nine-year time horizon. A series of scenarios were used to investigate the impact of changes on long-term patient health for both treatment groups, which was measured by annual changes in QALY scores. Deterministic and probabilistic sensitivity analyses were also performed. Results: In the base case analysis, compared with allergy pharmacotherapy, SQ HDM SLIT-tablet led to a QALY gain of 0.31 at an incremental cost of €2,276 over the nine-year time horizon, equating to an incremental cost-effectiveness ratio of €7,519. The treatment was cost-effective for all scenarios analyzed; however, results were sensitive to changes in individual parameter values during the deterministic sensitivity analysis. Conclusion: SQ HDM SLIT-tablet in addition to pharmacotherapy is cost-effective compared with allergy pharmacotherapy plus placebo for the treatment of persistent moderate to severe HDM allergic rhinitis that is not well controlled by allergy pharmacotherapy.
Canadian journal of public health = Revue canadienne de sante publique, Jan 20, 2016
pratique, mais des études épidémiologiques ou des enquêtes. Cela nous a amenés à préciser, en rév... more pratique, mais des études épidémiologiques ou des enquêtes. Cela nous a amenés à préciser, en révisant nos lignes directrices aux auteurs, que nous nous intéressons aux innovations qui ont été
ABSTRACT Health scholars have long been calling for a new approach to understanding and respondin... more ABSTRACT Health scholars have long been calling for a new approach to understanding and responding to public health challenges, recognizing the dynamic influence of social and ecological processes and the importance of respecting different ways of knowing. With daunting new challenges to collective health, we sought to ascertain how future generations of public health researchers and practitioners are being prepared with the knowledge, attitudes, and skills needed for the tasks ahead. We found that of the 76 graduate level programs listed by the Public Health Agency of Canada, 65% required at least one quantitative methods course, but only 26% required qualitative methods and only 16% required a course in community engagement. While 25% had at least one required course related to social theory or social determinants of health, only 3% required a course on the ecological determinants. Our examination suggests that the majority of schools of public health may still be frozen in old paradigms wherein interdisciplinary inquiry and the development of skills to work with communities to implement and evaluate interventions to promote and protect collective health are still only peripheral considerations. With the intensification of public distrust in experts in this post-truth era, greater emphasis is needed now more than ever to develop skills in understanding and engaging the public in addressing the underlying issues threatening health. We argue that as the challenges of the Anthropocene are upon us, it is urgent that we rethink the skills we are teaching and prepare ourselves to radically adjust our approach.
Ecosystem decline and collapse is not just a plausible alternative future but an unfolding presen... more Ecosystem decline and collapse is not just a plausible alternative future but an unfolding present-day reality. It will be accompanied by the decline and collapse of societies and communities that depend on those ecosystems, and will have a dramatic impact on population health. Decline can be thought of as a form of long, slow crisis or a slowly unfolding disaster, and may be the prelude to collapse. After briefly reviewing the declining condition of some key elements of the global ecosystem, I conclude that we need a game plan to guide us through the ecological decline that we are already experiencing, and through the social changes this will require. I call this 'managing decline'; it begins with a willingness to acknowledge and accept the reality of ecological decline, and may need to include setting up 'decline management' units, rather as we have set up disaster management units, to help us manage the transition through decline and avoid collapse. As with so many important innovations, managing decline will begin at the local level. Indeed, this is beginning to happen, best exemplified by the synergy between healthy and sustainable cities and, more recently, the emergence of the Transition Towns movement. Context: Declines in All That Sustains Life As a health futurist with a particular interest in alternative futures and preferable futures, I have long recognised that 'decline and collapse' is a plausible alternative future that we face (Bezold and Hancock, 1993, 1994). Indeed, we face the real option of both the decline and collapse of ecosystems and the accompanying decline and collapse of the societies and communities that are embedded in and depend on those ecosystems. Yet, it is in many ways the future whose name we
ABSTRACT How we think about the future – including the future of cities and of health – is of gre... more ABSTRACT How we think about the future – including the future of cities and of health – is of great importance. As we enter the Anthropocene, we need to understand how environmental, social, political, cultural and technological forces may shape the future. Alternative futures or scenarios are a useful way to think about the future, and explore possible, plausible and preferable future conditions; the Futures Cone is one way to visualise these alternatives. Based on an understanding of the driving forces, alternative future scenarios may include extrapolative or ‘business as usual’ scenarios; challenging scenarios that include various forms of collapse; and visionary or transformational scenarios that build equity and sustainability. They also enable and encourage a consideration of the underlying values inherent in each scenario. Considering the implications for health and health equity within a scenario is important in our work, and in the context of healthy cities. Preferable futures, when they include commitment to creating them, become shared visions, a projection of values into the future. Rooted in the concept of ‘anticipatory democracy’, our approach has been to help people understand and imagine what may happen, but then to look at their preferred future and what it will take to get there.
As a collective organized to address the education implications of calls for public health engage... more As a collective organized to address the education implications of calls for public health engagement on the ecological determinants of health, we, the Ecological Determinants Group on Education (cpha.ca/EDGE), urge the health community to properly understand and address the importance of the ecological determinants of the public’s health, consistent with long-standing calls from many quarters—including Indigenous communities—and as part of an eco-social approach to public health education, research and practice. Educational approaches will determine how well we will be equipped to understand and respond to the rapid changes occurring for the living systems on which all life—including human life—depends. We revisit findings from the Canadian Public Health Association’s discussion paper on ‘Global Change and Public Health: Addressing the Ecological Determinants of Health’, and argue that an intentionally eco-social approach to education is needed to better support the health sector’s...
This article discusses the components of healthy cities and childrens roles in a healthy citys li... more This article discusses the components of healthy cities and childrens roles in a healthy citys life and growth. Industrialized countries now offer longer life expectancies better nutrition and less work. The advantages in a modern industrialized society are not available to everyone equally and come at a cost. Cities are disinvesting in services and physical infrastructure. Cuts are made in social spending and social safety nets are being eliminated. The number of children aged under 6 years living in poverty increased from 20% to 24% during 1980-95. Approaches to addressing these ills tend to be fragmented and specialized even with political will and economic means. Schools are improved but without attention to the influences of the streets and the mass media that affect childrens beliefs and perceptions. It is better to provide health services in a comprehensive way that include food shelter transportation clean air and water education physical safety and meaningful jobs with suff...
inVIVO Planetary Health is a progressive, humanist scientific movement promoting both evidence an... more inVIVO Planetary Health is a progressive, humanist scientific movement promoting both evidence and advocacy around concepts of planetary health which denote the interdependence between human health and place at all scales. Our seventh annual conference was held in Canmore, Alberta 4-6th April 2018, themed “Transforming Life: Unify Personal, Public, and Planetary Health” included diverse topics and perspectives to emphasise the interdependent vitality of all natural and anthropogenic ecosystems—social, political and otherwise. A key outcome of this meeting was the The Canmore Declaration: Statement of Principles for Planetary Health (published separately) which underscores that improving the health of all systems depends on: mutualistic values; planetary consciousness; advocacy; unity of purpose; recognition of biopsychosocial interdependence; emotional bonds between people and the land; efforts to counter elitism, social dominance and marginalization; meaningful cross-sectoral and c...
Purpose The purpose of this paper is to explore the pressing issues facing health and health syst... more Purpose The purpose of this paper is to explore the pressing issues facing health and health systems governance in the Anthropocene – a new geological time period that marks the age of colossal and rapid human impacts on Earth’s systems. Design/methodology/approach The viewpoint illustrates the extent of various human induced global ecological changes such as climate change and biodiversity loss and explores the social forces behind the new epoch. It draws together current scientific evidence and expert opinion on the Anthropocene’s health and health system impacts and warns that many these are yet unknown and likely to interact and compound each other. Findings Despite this uncertainty, health systems have four essential roles in the Anthropocene from adapting operations and preparing for future challenges to reducing their own contribution to global ecological changes and an advocacy role for social and economic changes for a healthier and more sustainable future. Practical implic...
The Healthy Cities approach has been quite widely—if somewhat inconsistently—adopted in North Ame... more The Healthy Cities approach has been quite widely—if somewhat inconsistently—adopted in North America and has remained alive and reasonably well for a quarter century. It has also been adapted to focus as much or more on smaller communities as on large cities and towns, and to be more community based rather than primarily based in municipal government, and has been adopted by a wide variety of local, state and national partners from the public, non-profit, philanthropic and private sectors. Community initiatives cover a very wide range of environmental, social, economic and other issues and intersect with a number of other city or community-focused initiatives aimed at improving life in cities and communities.
Background: Allergic rhinitis is a global health problem that burdens society due to associated h... more Background: Allergic rhinitis is a global health problem that burdens society due to associated health care costs and its impact on health. Standardized quality (SQ ®) house dust mite (HDM) sublingual immunotherapy (SLIT)-tablet is a sublingually administered allergy immunotherapy tablet for patients with persistent moderate to severe HDM allergic rhinitis despite use of allergy pharmacotherapy. Objective: To assess the cost-effectiveness of SQ HDM SLIT-tablet in Germany for patients suffering from HDM allergic rhinitis. Methods: A pharmacoeconomic analysis, based on data collected in a double-blinded, phase III randomized placebo-controlled trial (n=992), was undertaken to compare SQ HDM SLIT-tablet in addition to allergy pharmacotherapy to placebo plus allergy pharmacotherapy. Quality-adjusted life year (QALY) scores and health care resource use data recorded in the trial were applied to each treatment group and extrapolated over a nine-year time horizon. A series of scenarios were used to investigate the impact of changes on long-term patient health for both treatment groups, which was measured by annual changes in QALY scores. Deterministic and probabilistic sensitivity analyses were also performed. Results: In the base case analysis, compared with allergy pharmacotherapy, SQ HDM SLIT-tablet led to a QALY gain of 0.31 at an incremental cost of €2,276 over the nine-year time horizon, equating to an incremental cost-effectiveness ratio of €7,519. The treatment was cost-effective for all scenarios analyzed; however, results were sensitive to changes in individual parameter values during the deterministic sensitivity analysis. Conclusion: SQ HDM SLIT-tablet in addition to pharmacotherapy is cost-effective compared with allergy pharmacotherapy plus placebo for the treatment of persistent moderate to severe HDM allergic rhinitis that is not well controlled by allergy pharmacotherapy.
Canadian journal of public health = Revue canadienne de sante publique, Jan 20, 2016
pratique, mais des études épidémiologiques ou des enquêtes. Cela nous a amenés à préciser, en rév... more pratique, mais des études épidémiologiques ou des enquêtes. Cela nous a amenés à préciser, en révisant nos lignes directrices aux auteurs, que nous nous intéressons aux innovations qui ont été
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