1. 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

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

3. What is Ecosystem Health??

4. The Evolution of the Doctor-Patient relationship 1) Traditional Medical Model 2) Patient-Centered Model 3) Ecosystem Health Model

5. Traditional Medical Model Where we were Patient Disease 1.What is the disease? 2.How do I fix it? HEALTH

6. Patient-Centered Model Patient Disease Illness Context 1.What is the disease? 2.How do I fix it? 3.What is my patient's unique illness?? 4.How do I help my patient? HEALTH

7. Ecosystem Health The health of the “context” and the interaction of the “context” with human health - the physical, social, economic and political environment

8. Ecosystem Health Model Patient Disease Illness Home Community Region World 1.What is the disease? 2.How do I fix it? 3.What is my patient's unique illness?? 4.How do I help my patient? 5.Why is this patient here? 6.What can I do to prevent others from having the same illness? HEALTH

9. What is Health?

10. Health PhysicalMental Nutritional Community Personal Health EnvironmentalSocial PoliticalEconomic SpiritualMoral Societal Health Ecosystem Health

11. 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.

12. Moral Health 6.450 Provide safe clean water 19.1150.5 TOTAL 0.65 Eliminate illiteracy 1.310.5 Stabilize population 1.915 Provide health care 2.419 Eliminate starvation and malnourishment 2.721 Provide shelter 3.830 Retire developing nation’s debt Percent of current military spending Annual cost in billion dollars Cost of global human need programs

13. Is society’s attitude to climate change morally healthy?

14. Revelations 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

16. 37%/5years 7.4%/year

17. Sickness Health

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

19. 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

20. Is there a crisis? If so what is the crisis?

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