Promoting Planetary Health: A Necessary Part of Caring for Children
LESLIE SOLOMONIAN, BSC, ND, MPH
The health of individuals is tremendously influenced by the health of their environment. This is especially true in childhood, and the effects last a lifetime. If we aim to fulfill the principles of naturopathic medicine (bolded throughout this article) in our care of children, we must consider how our practices take the health of the planet into consideration.
The practice of pediatrics is the epitome of prevention.1 The seeds of most of the non-communicable chronic diseases that cause such significant morbidity and premature mortality in the world are laid in childhood and during fetal development.2 Through naturopathic care, practitioners have an opportunity to promote optimal conditions for growth and development, allowing the child’s vis to be expressed to its fullest potential. The transgenerational transmission of poor health is well documented.3 In the same way, a healthy pediatric population is more likely to become a healthy adult population, increasing the transmission of determinants of good health into future generations.
However, these determinants of health and disease are not fully within the control of individual families. Children (and the adults they will become) exist as an intrinsic part of the broader environment. The expression of a child’s potential is tremendously influenced by social and ecological determinants of health.4,5 This includes their family, their home, their immediate community and the social, economic, and political structures within it, the health of the natural world within and beyond their community, and the well-being of the planet overall. Personal choice is fundamentally influenced by these broader systems. Individuals can only be as healthy as the environment of which they are part. In the spirit of prevention, and of treating the whole child, naturopathic doctors have a responsibility to look beyond counseling for healthier individual or family behaviors.
Vulnerabilities & Burdens
Poverty is one of the most significant determinants of poor health for children, causing harm through its influence on almost all other factors.6,7 Economic marginalization is associated with worse birth outcomes, poorer nutrition, less physical activity, greater exposure to environmental toxins, greater levels of psychological stress, poorer quality of education (even in a publicly-funded system), and poorer access to health care (ditto).6,7
Most individuals who seek naturopathic care not only have the means to pay out of pocket for health care (or have extended health benefits); they are also more likely to be healthier in the first place and to have the resources (knowledge, time, finances) to implement the recommendations provided. This has been referred to as an “inverse quarantine” – a phenomenon in which those with privilege are able to make purchasing choices to ostensibly protect their families from environmental factors that might cause them harm.8 Even for individuals who have the resources to mitigate or buffer potential harmful social or ecological determinants of health, exposures to chemical and non-chemical toxins (such as electromagnetic radiation, ambient light, persistent stress) are nearly universal.9 The long-term cumulative effects of these exposures on growing bodies remain incompletely understood.10
Although all individuals are impacted by these determinants, children are particularly vulnerable given their unique anatomy, physiology, and behaviors.11
- Children have a higher proportional intake of air, food, and water compared to adults, which results in a proportionately higher exposure to chemicals
- Children play and breathe closer to the ground than adults, where heavier particulate matter tends to accumulate
- Hand-to-mouth behavior increases the likelihood of ingesting chemicals in household products and dust
- Kids have an immature capacity to process physical, chemical, and psychosocial adversity, leading to longer-term changes in structure and function
- Children and adolescents often have less-optimal nutrition habits, which can interfere with detoxification and elimination pathways
- Children are rapidly growing, increasing the likelihood that chemicals will be integrated into tissues
- Because pediatric development is highly flexible, interference due to environmental factors during childhood is more likely to cause persistent problems
In addition to the anatomical, physiological and behavioral attributes that increase the vulnerability of children, the global ecological crisis places a disproportionate burden on the shoulders of youth. The planet is on an accelerating trajectory of increased frequency and severity of “natural” disasters and pandemics leading to loss of biodiversity, food scarcity, mass migration, infrastructure and economic collapse, and widespread conflict and suffering.12 Many of these changes are irreversible and drive population-level health disparities. The climate crisis and global inequity are mutually reinforcing, and are underpinned by deeply inequitable social and economic structures. These complex reinforcing cycles are accelerating, meaning that the cumulative and ultimate impact will be greatest on children.13 These consequences will be experienced to the greatest degree by people who are young now, and their children (if they choose and are able to have them). Surrounded by anthropocentric and materialistic environments, and inundated with technology-obsessed media and cultures, many children will never reach their full inborn potential. The reality of these impacts is already being experienced directly by young people on some parts of the planet. For the rest, it is manifested in rising rates of mental and existential distress.14
Young people have been burdened with a tremendous risk to their health and well-being, as well as the responsibility of mitigating the worst of it, despite not having created the mess. Urgently addressing the ecological crisis is critical to promoting the health of our children. Upon graduation, newly minted naturopathic doctors take an oath that commits them to “preserve the health of our planet for ourselves and future generations.”15 In the spirit of prevention and treating the whole community – both children within our care and otherwise – we have a responsibility to also advocate for the betterment of social and ecological determinants of health.16 This is also in keeping with the principle of primum non nocere and the spirit of the World Health Organization’s assertion that every human being has the fundamental right to “the highest attainable standard of health.”17
Healthcare providers are well positioned and arguably have a responsibility to advocate for planetary health (which encompasses social and ecological elements).18 That children’s health is reliant on the health of their communities and environment is a powerful point of leverage for doing so. Healthcare providers are in a position to provide evidence (docere) of the tight overlap between systems of domination, exclusion, and oppression that cause extensive harm both within our human communities and between modern society and our shared planetary home. Deliberate action can occur at levels ranging from the personal to the local to the global, and should prominently feature at the forefront of our collective priorities as healthcare providers. Global frameworks for governance and rights, such as the Sustainable Development Goals and the Convention on the Rights of the Child, provide a foundation on which to build and effectively coordinate group efforts. Collectives of healthcare providers – which include naturopathic doctors – have proposed principles by which planetary health may be pursued.19
A Model for Advocacy
A “micro-meso-macro” model for advocacy is an apt metaphor for ways in which healthcare providers can simultaneously care for their patients and promote planetary health.20
Since many of the health concerns common in children are influenced by the health of the environment, naturopathic doctors have an obligation to provide explicit education about these connections. Conditions such as allergies, neurodevelopmental challenges, and mental health struggles all benefit from a reduction in environmental toxins and an increase in natural “inputs.”
Naturopathic doctors emphasize informed consent, which requires a fulsome discussion of the costs, benefits, and alternatives of treatment options. Just as costs and benefits may be economic in addition to physical, social and environmental impact should also be included in the discussion. This is an act of docere, enabling children and their caregivers to determine how to weigh their options. Some practitioners may opt to not offer certain therapies due to their environmental or social harms, and to explain this and offer referrals to interested patients. Some considerations for an “environmental hierarchy of therapeutics” could include:
- Quantity and quality of waste generated from the procedure (eg, acupuncture needles, packaging from natural health products)
- Carbon emissions from manufacturing and transportation of products
- Sustainability of agricultural or harvesting practices used for botanical or nutritional medicines
- Social ethics of product manufacturers, such as working conditions, fair compensation, and reinvestment
A specific focus in pediatric practice is that of antibiotic stewardship.21 Unnecessary and excessive use of antibiotics threatens not only our collective ability to treat infectious disease, but also causes harm to our individual and collective microbiome, a core concept of the One Health school of thought.22 Naturopathic doctors have a vital role to play in managing acute pediatric infections without relying on the unnecessary use of antibiotics.
Ideally, practitioners would consider not only how to minimize harm to patients and the planet, but also deliberately seek ways to benefit both.23 When caring for children, there are many recommendations that have co-benefits, particularly since children tend to have a robust vitality and are thus responsive to lower-force interventions. Some examples include:
- Encouraging active transportation
- Encouraging a whole-foods, local/seasonal plant-based diet
- Advising the use of native herbs that encourage biodiversity and ecosystem stability
- Recommending the use of fewer personal care and household products, and recommending those that do not include ingredients that are toxic to the body or the environment
- Avoiding electronic devices, and encouraging exposure to natural light
- Encouraging time in nature, and bringing plants into the home
The set-up of one’s clinical space communicates volumes about the values of the practitioner, and is a key opportunity to model practices that promote health. There are many ways in which a pediatric practice can implement planetary health principles in its structure. Some steps may be obvious to patients; others may need to be made explicit through a posting, or information on a clinic website:
- Provide toys and craft materials that benefit instead of harm the planet (eg, wooden and fabric toys, crayons that are sustainably made), and children’s books that center planetary health in the waiting room
- Use biophilic design principles to integrate nature; even if your budget or space is limited, consider bringing living plants into the clinical space, which is a way to harness the healing power of nature
- Avoid excessive use of air conditioning and heating systems, and post your rationale publicly
- Although it is still unclear if the environmental impact from paper-based offices is greater or less than the energy required to manage data in the “cloud,”24 consider ways to simplify office procedures
- Reduce single-use medical materials as much as possible, instead integrating washable towels, gowns, and drapes
- Choose a financial institution with social and environmentally responsible practices, such as those which do not invest in fossil fuel initiatives, and actively contribute to the health of the local community
- Use a renewable energy service provider to power clinical activities
- Consider volunteering or consulting for local organizations that promote planetary health in your community, such a community garden, or a not-for-profit. Not solely altruistic, prospective patients may be inspired to seek your business because of this.
Ultimately, micro and meso changes will have little impact until the underlying structures driving our collective systems are altered. However, these smaller changes serve to influence others, and shift the narrative and values systems of those with whom we interact. Naturopathic doctors hold a position of influence with their patients; the communication of these values ultimately informs the actions and choices of our patients. These are then contagious within their networks, creating a broader ripple effect. Certainly, our influence on the children in our care can be profound. By encouraging children to revel in the healing power of nature, to have compassion for others, to consider their impacts on the planet, and to have humility for their place in the world, we have the opportunity to influence the next generation to steward the planet more responsibly than has been done recently.25
A Natural Fit
Naturopathic doctors are accustomed to questioning and challenging dominant systems. We know from our botanical training that Latin for “root” is radix. The root causes of planetary distress are capitalism, anthropocentrism, contemporism, and white supremacy.26 In order to truly promote health for all, we must be radical and seek to disrupt these systems of power that lead to poor health. There are many advocacy organizations that welcome naturopathic doctors in their efforts to rattle the structures of power. Although naturopathic-specific advocacy groups exist, there is also value in infusing other groups with naturopathic thinking. Our tendency to think in systems, to value the whole, to prioritize prevention, to seek the root cause of disease, to minimize harm – this is exactly what the children of our planet desperately need.
- Solomonian L. Pediatrics as Health Prevention. Vital Link. 2020;27(1):13-17. Available at: https://www.cand.ca/wp-content/uploads/2020/07/6852_Vital_Link_FINAL_SINGLES.pdf. Accessed May 27, 2021.
- Hoffman DJ, Reynolds RM, Hardy DB. Developmental origins of health and disease: current knowledge and potential mechanisms. Nutr Rev. 2017;75(12):951-970.
- Halliday TJ, Mazumder B, Wong A. The intergenerational transmission of health in the United States: A latent variables analysis. Health Econ. 2020;29(3):367-381.
- Viner RM, Ozer EM, Denny S, et al. Adolescence and the social determinants of health. Lancet. 2012;379(9826):1641-1652.
- Government of Canada. What Makes Canadians Healthy or Unhealthy? Key Determinant 8: Healthy Child Development. Last modified January 15, 2013. Available at: https://tinyurl.com/479e8t2y. Accessed May 27, 2021.
- Council on Community Pediatrics. Poverty and Child Health in the United States. Pediatrics. 2016;137(4):e20160339.
- Kohlhuber M, Heinrich J, van den Hazel P, et al. Children’s environmental health: why should social disparities be considered? Acta Paediatr Suppl. 2006;95(453):26-30.
- Szasz A. Shopping Our Way to Safety: How We Changed from Protecting the Environment to Protecting Ourselves. Minneapolis, MN: University of Minnesota Press; 2009.
- Ford AL. Purity is Not the Point: Chemical Toxicity, Childbearing, and Consumer Politics as Care. Catalyst: Feminism, Theory, Technoscience. 2020;6(1):1-25. Available at: https://catalystjournal.org/index.php/catalyst/article/view/32314/26058. Accessed May 27, 2021.
- Barrett ES, Padula AM. Joint Impact of Synthetic Chemical and Non-chemical Stressors on Children’s Health. Curr Environ Health Rep. 2019;6(4):225-235.
- Bevacqua J. Manufactured environmental toxins and children’s health: an evidence-based review and anticipatory guidance. J Pediatr Health Care. 2013;27(1):13-22.
- Horton R, Beaglehole R, Bonita R, et al. From public to planetary health: a manifesto. Lancet. 2014;383(9920):847.
- Helldén D, Andersson C, Nilsson M, et al. Climate change and child health: a scoping review and an expanded conceptual framework. Lancet Planet Health. 2021;5(3):e164-e175.
- Majeed H, Lee J. The impact of climate change on youth depression and mental health. Lancet Planet Health. 2017;1(3):e94-e95.
- American Association of Naturopathic Physicians. House of Delegates Position Paper. Naturopathic Physicians Oath. 1992. https://cdn.ymaws.com/naturopathic.org/resource/resmgr/documents/governance_docs/physicians_oath.pdf. Accessed May 27, 2021.
- Solomonian L. Eco-reciprocity and the Moral Obligation of Naturopathic Medicine. Vital Link. 2019;26(3):13-16. Available at: http://lesliesolomonian.weebly.com/uploads/3/7/2/5/37254041/6624_solomonian.pdf. Accessed May 27, 2021.
- World Health Organization. Human rights and health. December 29, 2017. WHO Web site. http://www.who.int/mediacentre/factsheets/fs323/en/. Accessed May 27, 2021.
- Veidis EM, Myers SS, Almada AA, et al. A call for clinicians to act on planetary health. Lancet. 2019;393(10185):2021.
- Prescott SL, Logan AC, Albrecht G, et al. The Canmore declaration: statement of principles for planetary health. Challenges. 2018;9(2):31.
- Buchman S, Woollard R, Meili R, Goel R. Practising social accountability: From theory to action. Can Fam Physician. 2016;62(1):15-18.
- Principi N, Esposito S. Antimicrobial stewardship in paediatrics. BMC Infect Dis. 2016;16(1):424.
- Collignon P. The importance of a One Health approach to preventing the development and spread of antibiotic resistance. Curr Top Microbiol Immunol. 2013;366:19-36.
- Xie E, de Barros EF, Abelsohn A, et al. Challenges and opportunities in planetary health for primary care providers. Lancet Planet Health. 2018;2(5):e185-e187.
- Nazaruk Z. Is digital more environmentally friendly than paper? October 18, 2020. Except Integrated Sustainability. Available at: http://www.except.nl/en/articles/763-is-digital-more-environmentally-friendly. Accessed May 27, 2021.
- von Borries R, Guinto R, Thomson DJ, et al. Planting sustainable seeds in young minds: the need to teach planetary health to children. Lancet Planet Health. 2020;4(11):e501-e502.
- Batson L, Franko C, Waunch A, Solomonian L. Through COVID-19 – A Systems Perspective: from Square to Circular Systems. Vital Link. 2020;27(2):39-47. Available at: http://lesliesolomonian.weebly.com/uploads/3/7/2/5/37254041/6906_vital_link_spr__1_.pdf. Accessed May 27, 2021.
Leslie Solomonian, BSc, ND, MPH is a doctor, mother, woman, activist, and human who uses naturopathic principles to help individuals, communities, and the planet reach their fullest potential. She has been on faculty at CCNM since 2005, and has spoken and written widely on the topic of planetary health and pediatrics. Leslie is the author of the textbook Naturopathic and Integrative Pediatrics and is a regular contributor to Ecoparent magazine. Leslie is the co-founder of Naturopathic Doctors for Environmental and Social Trust, and is a board member and past president of the Pediatric Association of Naturopathic Physicians.