Time for an ecosystem approach to public health? Lessons from two infectious disease outbreaks in Canada

Abstract

Ecosystem approaches recognize the complexity of many contemporary public health challenges and offer an alternative for dealing with problems that have proven intractable and unresponsive to conventional public health strategies. Infectious disease outbreaks are among the most dramatic aspects of systems failure, and the Canadian cases of SARS (Severe Acute Respiratory Syndrome) in Toronto, and the E. coli outbreak in Walkerton, serve as useful illustrative examples. This paper examines some of the limitations of current public health approaches, the fundamental tenets of an alternative, transdisciplinary ecosystem approach, and changes necessary for implementation, including those in philosophical approach, communications and education, and, finally, institutions and governance.

Keywords:

• Ecosystem
• public health
• infectious disease
• transdisciplinary
• governance

Acknowledgements

We thank Trevor Hancock, John Last, Dominique Charron, Chris Mills, Glenn Albrecht, Erin Rogozinski, and Jessica Kwik for critical and provocative ideas, intellectual inspiration, and editing.

Notes

1. Some believe that talking of environmental quality is ‘dated’ thinking, a throw back to a time when environment was partitioned into air, land, and water, and ‘quality’ was measured by the absence of ‘contaminants’ with ‘contaminant free’ as the ultimate standard. Some ecosystems are relatively contaminant free (i.e. have good water, air, land quality) and yet are entirely dysfunctional owing to overharvesting, introduction of exotics, or other non-pollutant stresses. Now many recognize this as a highly limited definition. Environmental quality today should be looked at in terms of ecosystems that have maintained their full ‘functions’ and full potential for adaptability to changing environments. By this criteria, most of the planet is rapidly losing ‘environmental quality’.