We are Nature: Healing People, Healing the Planet

Leslie Solomonian

Introduction

We are in a crisis of collective psychological distress, with myriad consequences for the physical body. We are also in a planetary health crisis. The two are interlinked, and part of the larger global polycrisis.¹ The discipline of Planetary Health seeks to approach health from the perspective that human-built structures and systems interact with natural systems to create shifts in ecology, social structures, and ultimately individual health.² Naturopathic doctors understand this connection; we are comfortable talking about the bidirectional brain-gut axis or the reinforcing cycle between pain perception and psychological distress. We know that stress underpins, triggers, and exacerbates almost every symptom seen in clinical practice.

The impact of human systems on the planet have caused catastrophic and potentially irreparable damage to ecosystems and the health of species, including humans.³ The growing sense of powerlessness in the face of escalating impacts is itself a driver of the mental health crisis.⁴ NDs have an immense array of approaches, individualized to a patient, to promote the health of the mind through the body, and vice versa. However, humans are fundamentally part of nature, and it is impossible for them to be healthy in an unhealthy environment.⁵ What is often pathologized as mental illness may be an attempt by the human brain to cope within a deeply wounded social and ecological environment.⁶

As naturopathic doctors we know that human DNA, along with the cells, tissues, organs, and body systems commanded by its code, evolved to anticipate certain conditions for optimal health. When these conditions are not available, the body and mind activate complex mechanisms to adapt to the perceived threat, manifesting as “disease.”⁷

NDs can only do so much…

Naturopathic doctors generally pride themselves in aligning with “low force” interventions, which conveniently are inherently more sustainable for the planet. (If the healthcare system were a country, it would produce the fifth highest carbon emissions).⁸ We recognize the harms of environmental toxicity. We educate individuals who seek our care to identify obstacles to cure, and seek to promote optimal conditions for health. These optimal conditions, however, are nested within social and ecological determinants; treating the whole requires this perspective.⁹ Deeply embedded factors such as behavioral norms, economic circumstances, educational opportunity, and built environment have far more influence on individual health than most naturopathic doctors tend to acknowledge.¹⁰ If individuals do not have access to clean water and air, quiet, green space, or healthful food it is impossible to optimize their health, and much more difficult to prevent or treat disease.

Individuals who are able to access naturopathic care tend to be better able to choose better conditions through financial or social capital. However, as the many interconnected planetary health crises accelerate–including biodiversity loss, ocean acidification, global warming, toxin accumulation, severe weather, mass migration–conditions of health worsen universally with declining possibilities of reversal or mitigation.^11,12 Increasing levels of personal capital will be necessary to protect oneself from the impacts, further widening already present health inequities.

Unfair & Unbalanced

Health inequities are due to unbalanced and unfair access to social and ecological determinants of health, directly tied to global (and local) systems of capitalism and colonialism.¹³ Communities, places, and populations that are already strategically undervalued (and often referred to as “vulnerable” or “marginalized”) by these capitalistic and colonial systems are the first and most significantly affected by environmental impacts.¹⁴ These communities–in the far north or the Global South, Indigenous communities, racialized people, people living in poverty, and others–experience the earliest and most significant signs of climate collapse in the form of flooding, droughts, famines, and fires. These communities are also underresourced, due to strategic undervaluing and marginalization by deliberate systems of oppression,¹⁵ to effectively cope with consequences.¹⁶

“Health inequities are avoidable health inequalities, and they can also be referred to as socially constructed inequalities. All health inequities share core features: they are the result of societal choices that are systematic, avoidable, modifiable, and unfair.”¹⁵

What else can we do?

Naturopathic medicine is rooted in nature cure: the use of nature’s elements to promote health.¹⁷ However, we must be cautious to not exploit or fetishize nature. We are nature. Most Indigenous Ways of Knowing are rooted in this truth.¹ Individual health–true, holistic health–can only be achieved in the context of good community and planetary health. Only in a reciprocal relationship with land, water, air, and other beings can we truly be healthy. Indigenous communities are dramatically impacted by the planetary health crisis: colonization and imperialism have diminished Indigenous traditions and practices, directly affecting culturally-specific determinants of health, including the destruction of access to traditional lands and resources, the loss of locally relevant food and medicine, the banning of cultural practices, and forced migration of knowledge keepers.

We must also be mindful not to create or perpetuate an inverted quarantine, a phenomenon by which individuals and communities with greater resources are able to protect themselves.¹⁸ North American naturopathic doctors promise to serve humanity, and “preserve the health of our planet for ourselves and future generations.”¹⁹ Deliberate action must be taken by the naturopathic community to improve our relationship with the natural world and all who are part of it. Our patients look to us and trust our voices. There are a variety of ways we can take action; collectively, we must each find our role.

Personal Reflections and Actions

As we know from behavior change theory, any action starts with values. I urge you to seek out resources to challenge your knowledge, attitudes, and behaviors with respect to social and ecological determinants of health. From there, personal level actions may become more clear. Just as doctors who exercise are more likely to successfully promote movement in their patients, the same is true of living in a way that promotes planetary health. Personal actions might include choices like who you vote for, how you commute, whether you choose to fly, the food you consume, the financial institutions you support, and the conversations you engage in. Perfection isn’t required, yet it’s essential to be honest with ourselves about the impact–however small–these choices have on the larger system.

Clinic Level Actions

Ideally, NDs would consider not only how to minimize harm to a patient, but also minimize harm to the planet.²⁰ There are many available toolkits to improve the carbon footprint of a clinical practice (see Table). The set-up of your clinical space also communicates your values, so make your choices explicit. We can consider a socioecological hierarchy of therapeutics, incorporating elements of social or environmental risks and benefits in our discussions of informed consent.²¹ For example, asking questions about the sourcing and manufacturing of natural health products can pressure product companies to improve their ecological and social practices. For inspiration, Common Objective, a fashion-specific resource, offers valuable insights into ethical sourcing and could help shape the types of questions to ask (see Table).

We can seek to further educate our patients, explicitly linking planetary health with personal health in our counseling and communications. Ideally, clinic level actions would be systematized; making sustainable choices becomes easier when the infrastructure supports them. For instance, electronic medical systems can be designed to prompt conversations on sustainability or recommend more eco-friendly management strategies.

Community Level Actions

If social and ecological determinants have the greatest influence on health outcomes, and if we are committed to treating the root cause, we are morally obligated to act in ways that shift those determinants toward collective health promotion and justice. Doctors hold a position of influence with their patients and within the community. We have credibility and the expertise to interpret and explain complex mechanisms of health.

We should actively seek opportunities to speak in our communities on the impacts of social and ecological determinants on health. Participating in and supporting meaningful initiatives for healthier communities, such as festivals or community gardens is one avenue. On an individual level, we can engage in political action, visiting elected representatives, writing op-eds for local papers, or offering testimony and deputations during the political process (especially between elections). It is also vital to encourage our professional associations to advocate for improved health for all.

Many doctors worldwide are also choosing to engage in nonviolent civil disobedience. Whether you agree with direct action or not, it clearly demonstrates the urgency of the crisis,²² and reflects a growing recognition of the need for systemic change to address the intertwined challenges of health, social justice, and environmental sustainability.

Final Thoughts

I have been told over and over again that my thoughts outlined in this article might be viewed as a conflict of interest or “too political.” However, everything is political. Health–and health equity–is primarily shaped by policy.²³ Health experts are ideally positioned to be at the table for all policy discussions. I would argue that naturopathic doctors may be especially well-positioned due to our inherently holistic approach. We have the foundational values, philosophy, and skills to take meaningful action. What we need now is to build our competence to do so. Our home is quite literally on fire. Some are closer to the flames than others, but we are all in danger.

Backgrounders	Toolkits/Resources
Nixon SA. The coin model of privilege and critical allyship: implications for health. BMC Public Health. 2019;19:1637. https://doi.org/10.1186/s12889-019-7884-9       Solomonian L et al. The critical intersection of environmental and social justice: a commentary. Global Health. 2021;17:30. https://doi.org/10.1186/s12992-021-00686-4       Let’s Talk: Health equity. National Collaborating Centre for Determinants of Health. Resource library. https://nccdh.ca/resources/entry/health-equity	CASCADES Sustainable Primary Care Toolkit https://cascadescanada.ca/resources/sustainable-primary-care-toolkit/             Canadian Coalition for Green Health Care. Green Office Toolkit for Clinicians and Office Managers https://greenhealthcare.ca/wp-content/uploads/2023/08/Green-Office-Toolkit-August-17th-2023.pdf             Acme Cape. Climate Change Toolkit for Health Professionals https://cape.ca/wp-content/uploads/2019/05/Climate-Change-Toolkit-for-Health-Professionals-Updated-April-2019-2.pdf             Health Care Without Harm. How to get started as a health professional advocate for climate policy solutions hhttps://noharm-uscanada.org/sites/default/files/HealthProfessionalAdvocate_2020.pdf             Public Health Institute/Center for Climate Change and Health. Physician Action Guide https://climatehealthconnect.org/wp-content/uploads/2016/09/PhysicianActionGuide.pdf             Canadian Nurses Association. Health in All Policies Toolkit https://www.cna-aiic.ca/en/policy-advocacy/policy-support-tools/health-in-all-policies-toolkit Common Objective. How CO Works https://www.commonobjective.co/how-co-works#sustainability-definitions-tab
Courses
Centre for Sustainable Healthcare: short courses in sustainability, health, and healthcare https://sustainablehealthcare.org.uk/courses CASCADES Canada: continuing professional development training programs for individuals in health systems working towards environmentally sustainable healthcare https://cascadescanada.ca/training/ TelessaúdeRS. UFRGS. Planetary Health. Massive open online course (self-directed, asynchronous) https://www.ufrgs.br/telessauders/saude-planetaria/ Yale School of Nursing. Planetary Health for Nurses: continuing education https://nursing.yale.edu/planetary-health-nurses Climate Health Organizing Fellows Program https://www.healthequity.challiance.org/climate-health-2023-24 Project ECHO. Climate Change and Human Health ECHO Program https://hsc.unm.edu/echo/partner-portal/programs/global/climate-change/ Planetary Health Academy https://planetary-health-academy.de/ Taking Action on Planetary Health. Building community to advance planetary health www.planetaryhealthaction.ca

References

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