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Health systems must recognise the interdependence of humans, animals and the environment

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Professor Mark Tomlinson is co-director of the Institute for Life Course Health Research in the Department of Global Health at the Faculty of Medicine and Health Sciences at Stellenbosch University. These are his personal views.

Currently, much of our response to ill health is a medical one, a treatment approach that ignores the underlying causes of our ill health — poverty, violence, inequality and pollution.

All cultures and peoples have creation stories or creation myths. These stories that provide an anchor in a sometimes frightening world, are usually intimately tied to people’s identities, cultures and, in most cases, to central societal rituals.

Christianity has Adam and Eve, a story of Paradise, of expulsion, of Eve wandering in the wilderness and having to eventually survive through her own toil. Her success is the evidence of human dominion over the animals and nature.

Robin Wall Kimmerer in Braiding Sweetgrass describes a quite different Native American creation myth that tells the story of Skywoman. It is a story of the creation of Turtle Island — the Earth on which we all live. Skywoman fell from the sky at great speed, and unable to control the speed or direction of her descent, landed in the dark water below. As she descended, her fall was observed by the animals which became concerned for her safety. 

When she hit the water, she was held aloft for a time by a gaggle of geese, but they were not strong enough. As she began to sink into the dark depths the otters, the fish and even a turtle tried to return her to the surface, but the depth and the pressure proved too much for them. Eventually, only the weakest swimmer remained — a little muskrat. He volunteered to swim down and save Skywoman.

In this, he was successful, but in doing so he lost his life. Skywoman was deeply moved by his sacrifice for her, a total stranger. She held his body, took the mud from his lifeless hand and spread it all over the shell of the turtle. And from this act, the generosity of the animals who risked (and gave) their lives for her, and the alchemy of this partnership between animals and humans, came Turtle Island, or the Earth. 

The two myths could not be more different. The story of Skywoman speaks to a symbiotic relationship between humans, birds, fish and animals, and the Earth on which we all depend. One is based on gratitude, joint responsibility and a radical form of environmental care.

It is difficult not to imagine that the second creation myth — that of Adam and Eve — is not in some way complicit in the situation in which we find ourselves today. A world in which rivers are places to dump sewage, pristine wildernesses are sources of fossil fuels, oceans are venues for war games, and forests little more than regions to be cleared for cattle farms.

The consequence of this is transformed landscapes, mass extinctions and increasing infectious diseases — Covid-19 being the most recent example.

World Health Day is celebrated every year on 7 April, the anniversary of the 1948 founding of the World Health Organization (WHO). The WHO adopted Health for All in the 1970s in order to highlight the importance of the health and well-being of all people in the world, through primary healthcare.

The 2022 theme was “Our Planet, Our Health” while the theme in 2023 is “Health for All”. Health for All is built upon principles such as holistic health, a whole-of-society and whole-of-government approach to improving the health of everybody.

Of course, Health for All is essential and a noble goal, but more recently there has been a push for an even broader conception of health. The One Health Approach aims for a unified approach to balance the health of the environment, people and animals.

One Health accepts as a given the interdependence of humans, animals and our environment. A second pillar is the explicit acknowledgement that health solutions require much more than simply treating the symptoms of disease, but that they must also address root causes, through multidisciplinary approaches and community-oriented cooperation.

Currently, much of our response to ill health is a medical one, a treatment approach that ignores the underlying causes of our ill health — poverty, violence, inequality, and pollution. Health is socially determined — if you are poor, you are more likely to be sicker and die earlier than if you are not.

Globally, each year, millions of people die from entirely preventable diseases, such as diarrhoea linked to poor quality water, pneumonia due to household air pollution because there are no options other than to burn cow dung for warmth, and a variety of neglected tropical diseases because their prevention and treatment does not provide profits for multinational pharmaceutical companies.

Of course, the most logical response would be to increase global solidarity and cooperation. To realise that we are all in this together and that if we do not cooperate, we are all worse off.

Currently however, the global response to our precarity has been to double down on division, on anger and rancour, to treat the most vulnerable (such as migrants) with disdain at best and callousness at worst, and to increase support for “strong men” fascists such as Donald Trump, Vladimir Putin and Jair Bolsonaro.

The story of human dominion over nature takes us nowhere, save for the creation of the worst kind of nationalism that pits “us” against “them”.

What we need is a coming together. I propose that in terms of health, we have an opportunity, using the One Health approach, to be at the forefront of something different.

Everybody cares about health. Caring for our own health, that of all people, and of the health of our planet will necessitate a radically different relationship to nature, an openness to including indigenous forms of knowledge in our response.

Finally, we need to remember in the midst of our human hubris that “despite all our accomplishments, we owe our existence to a six-inch layer of topsoil and the fact that it rains”, as American radio broadcaster Paul Harvey reminds us. DM

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