Chair, Canadian Association of Physicians Ecosystem Health Balancing Climate Change with Health Care John Howard MD, FRCPC Professor of Paediatrics and Medicine Schulich School of Medicine University of Western Ontario Chair, Canadian Association of Physicians For the Environment

Objectives To emphasize that health is not the same as health care To suggest that there are other important issues other than health care

What is Ecosystem Health??

The Evolution of the Doctor-Patient relationship 1) Traditional Medical Model 2) Patient-Centered Model 3) Ecosystem Health Model At Western - Ecosystem Health is an educational system It is a progression of how to teach medical students from... to EH To understand EH, one must understand traditional medical model and PC model

Traditional Medical Model Where we were What is the disease? How do I fix it? HEALTH Disease Patient Ecosystem health model - breaks out the context into different dimensions - this is geographic, but also economic, social, political dimensions examines the interaction of the patient with the context Also can change what the patient is - a family, community (example Walkerton), system Adds two critically important questions With asthma - why is this patient here? why does 1/3 of SW Ontario kids on puffers, Why is asthma so prevalent today? Is it the air, housing, immune development, 5

Patient-Centered Model What is the disease? How do I fix it? What is my patient's unique illness?? How do I help my patient? HEALTH Illness Disease Patient Ecosystem health model - breaks out the context into different dimensions - this is geographic, but also economic, social, political dimensions examines the interaction of the patient with the context Also can change what the patient is - a family, community (example Walkerton), system Adds two critically important questions With asthma - why is this patient here? why does 1/3 of SW Ontario kids on puffers, Why is asthma so prevalent today? Is it the air, housing, immune development, Context

Ecosystem Health The health of the “context” and the interaction of the “context” with human health - the physical, social, economic and political environment Summarize EH is an extension of the Patient-Centred Clinical Method Looks outside the box and looks at determinants of health

Ecosystem Health Model What is the disease? How do I fix it? What is my patient's unique illness?? How do I help my patient? Why is this patient here? What can I do to prevent others from having the same illness? HEALTH Illness Disease Patient Ecosystem health model - breaks out the context into different dimensions - this is geographic, but also economic, social, political dimensions examines the interaction of the patient with the context Also can change what the patient is - a family, community (example Walkerton), system Adds two critically important questions With asthma - why is this patient here? why does 1/3 of SW Ontario kids on puffers, Why is asthma so prevalent today? Is it the air, housing, immune development, Home Community Region World

What is Health?

Health Spiritual Moral Environmental Social Nutritional Community Physical Mental Personal Health Economic Political Societal Health Ecosystem Health

Spiritual Health - Aboriginal The Earth is our Mother, the female giver of Life to all her children, some of whom are human beings. We are related to the animals, the plants, the birds, the insects, and they are related to us. Our lives depend on them.

Cost of global human need programs 6.4 50 Provide safe clean water 19.1 150.5 TOTAL 0.6 5 Eliminate illiteracy 1.3 10.5 Stabilize population 1.9 15 Provide health care 2.4 19 Eliminate starvation and malnourishment 2.7 21 Provide shelter 3.8 30 Retire developing nation’s debt Percent of current military spending Annual cost in billion dollars Cost of global human need programs Moral Health

Is society’s attitude to climate change morally healthy?

Revelations We need to put less money in sickness care! Many/all diseases have a significant Ecosystem Health component We need to put less money in sickness care! Uncertainty is more important than certainty Bigger is better! Things can be done! Accountability should be replaced by responsibility

37%/5years 7.4%/year

Health Sickness

Where are we going? 2016 2010 % of Provincial Budget Year 2044 = 100%

Health Care NOT a determinant of health “The majority of the health care dollar is spent in the last 6 months of one’s life” - 1993 Average health expenditures on people who are in their last year of life is between 50 and 100 times more than expenditures on those who are not. - Health Canada -2005

Is there a crisis? If so what is the crisis? Expectations Expectations

CAPE is a group of physicians, allied health care practitioners and citizens committed to a healthy and sustainable environment. www.cape.ca

We need to care about the unconceived – the future generations