Clinical Ecology—Transforming 21St-Century Medicine with Planetary Health in Mind

challenges Perspective Clinical Ecology—Transforming 21st-Century Medicine with Planetary Health in Mind David H. Nelson 1, Susan L. Prescott 1,2,*, Alan C. Logan 1 and Jeffrey S. Bland 1,3 1 inVIVO Planetary Health, of the Worldwide Universities Network (WUN), West New York, NJ 10704, USA; [email protected] (D.H.N.); [email protected] (A.C.L.); [email protected] (J.S.B.) 2 The ORIGINS Project, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia 3 Personalized Lifestyle Medicine Institute, Seattle, WA 98443, USA * Correspondence: [email protected] Received: 17 January 2019; Accepted: 14 February 2019; Published: 18 February 2019 Abstract: Four decades ago, several health movements were sprouting in isolation. In 1980, the environmental group Friends of the Earth expanded the World Health Organization definition of health, reminding citizenry that, “health is a state of complete physical, mental, social and ecological well-being and not merely the absence of disease—personal health involves planetary health”. At the same time, a small group of medical clinicians were voicing the concept of “clinical ecology”—that is, a perspective that sees illness, especially chronic illness, as a response to the total lived experience and the surroundings in which “exposures” accumulate. In parallel, other groups advanced the concept of holistic medicine. In 1977, the progressive physician-scientist Jonas Salk stated that “we are entering into a new Epoch in which holistic medicine will be the dominant model”. However, only recently have the primary messages of these mostly isolated movements merged into a unified interdisciplinary discourse. The grand, interconnected challenges of our time—an epidemic of non-communicable diseases, global socioeconomic inequalities, biodiversity losses, climate change, disconnect from the natural environment—demands that all of medicine be viewed from an ecological perspective. Aided by advances in ‘omics’ technology, it is increasingly clear that each person maintains complex, biologically-relevant microbial ecosystems, and those ecosystems are, in turn, a product of the lived experiences within larger social, political, and economic ecosystems. Recognizing that 21st-century medicine is, in fact, clinical ecology can help clear an additional path as we attempt to exit the Anthropocene. Keywords: clinical ecology; planetary health; high-level wellness; integrative ecological solutions; mutualism; personalized medicine; the microbiome; green prescriptions; holistic bio-psycho-social medicine; long-range thinking; non-communicable diseases; dysbiotic drift; socioeconomic inequalities; biodiversity interdependence; cooperation; integration; value systems; cultural shift 1. Introduction “[The physician] must master a new science focused on the effects that the total environment exerts on the human condition...knowledge of environmental biology must therefore become one of the essential bases of medical science and practice”. [1] In 2015, the Lancet Commission on Planetary Health published its milestone report [2]; the conclusion was simple—the health of human civilization is dependent upon the long-term stability of the Earth’s natural systems. The Report underscored the threat (to natural ecosystems) posed by environmental degradation, climate change, biodiversity losses, and the associated over-exploitation of resources. More recently, the Canmore Declaration formally defined planetary health as the interdependent, Challenges 2019, 10, 15; doi:10.3390/challe10010015 www.mdpi.com/journal/challenges Challenges 2019, 10, 15 2 of 16 Challengessustainable 2019, 10vitality, x of all natural and anthropogenic ecosystems (social, political, and otherwise);2 of 16 moreover, the Declaration underscores that the goals of planetary health include curbing the causes of andthe otherwise); global non-communicable moreover, the diseaseDeclaration crisis, underscores and working that toward the equitygoals inof theplanetary promotion health of high-level include curbingwellness the [3 causes]. of the global non-communicable disease crisis, and working toward equity in the promotionDespite of high-l its importanceevel wellness to all[3]. branches of science and medicine, the relevance of planetary healthDespite to the its daily importance practice to of all front-line branches healthcare of science providersand medicine, may the seem relevance obscure. of Although planetary the health 2015 toReport the dailyacknowledges practice of thatfront-line health healthcare professionals providers can play may an essentialseem obscure. role in Although planetary the health, 2015 theReport only acknowledgesmechanism provided that health is for professionals physicians and can others play to an help essential “integrate role policies”. in planetary Indeed, health, one ofthe the only early mechanismpioneers in provided the planetary is for health physicians concept, and Lancet others Editor-in-Chief to help “integrate Richard policies”. Horton, Indeed, has lamented one of the that earlyplanetary pioneers runs in the the risk planetary of simply health fading concept, into a La “recalibratedncet Editor-in-Chief version ofRichard environmental Horton, has health”, lamented rather thatthan planetary its original runs intent—in the risk of Horton’s simply words,fading into “an inquirya “recalibrated into our version total world” of environmental [4]. Planetary health”, health rathercannot than be its separated original fromintent—in social Horton's and cultural words, inputs “an inquiry at all scales. into our It total emphasizes world” Enlightenment[4]. Planetary healthprinciples—a cannot be universal separated humanity, from social equity, and moderation, cultural inputs humane at all laws,scales. a It high emphasizes level of purpose, Enlightenment decency principles—ain conduct, and universal limitations humanity, on war [equity,3]. Indeed, moderation, planetary humane health is thelaws, study a high of behavior level of and purpose, biology. decencyIn this context,in conduct, the and ‘omics’ limitations revolution on war is providing [3]. Indeed, a deeper planetary understanding health is the ofstudy the exposomeof behavior and and is, biology.in many In ways, this context, making the planetary ‘omics’ health revolution personal, is providing see Figure a deeper1. understanding of the exposome and is, in many ways, making planetary health personal, see Figure 1. FigureFigure 1. 1. TheThe ‘omics’ ‘omics’ revolution revolution isis making making planetary planetary health health personal. personal. Here,Here, we we argue argue that that the the high-level high-level importance importance of of planetary planetary health health can can be be visualized visualized in in front-line front-line healthcarehealthcare by (re)emphasizing(re)emphasizing that that the the prevention prevention and treatmentand treatment of disease—along of disease—along with the promotionwith the promotionof vitality—is, of vitality—is, in fact, ecologic in fact medicine., ecologic Wemedicine. examine We some examine of the some history of the of what history was of once what termed was onceclinical termed ecology clinical and theecology early and origins the of early holistic origins medicine. of holistic Although medicine. well intended, Although these well initial intended, efforts theseto envisage initial efforts health to on envisage an ecologic health continuum on an ecol of person,ogic continuum place, and of planet person, lacked place, an and objective planet science lacked to anbuttress objective its science suppositions. to buttress its suppositions. AsAs we we outline outline here, here, timely timely advances advances in in microbiome microbiome and and related related ‘omics’ ‘omics’ sciences sciences have have allowed allowed cliniciansclinicians toto visualizevisualize the intricatethe intricate connections connectio betweenns between the total livedthe experiencetotal lived over experience time—influenced over time—influencedby the state of the by Earth’s the state natural of the systems,Earth's natural as well sy asstems, ecosystems as well as of ecosystems social, political, of social, and political, economic andstructures—and economic structures—and ongoing biological ongoing changes. biological As such,changes. we argueAs such, that we planetary argue that health planetary is manifesting health isitself manifesting in the ecosystems—healthitself in the ecosystems—health determining, determining, biologically biologically relevant ecosystems—at relevant ecosystems—at the tip of the an tipintestinal of an intestinal villus and villus elsewhere and elsewhere in and on thein and body. on Moreover, the body. the Moreover, emerging the research emerging on environmental research on environmentalepigenetics—and epigenetics—and transgenerational transgenerational transmission—underscores transmission—underscores the critical nature the critical of this nature discourse; of thisthe discourse; clinical relevance the clinical of the relevance planetary of healththe planet conceptary health may beconcept appreciated may be in appreciated research demonstrating in research demonstratingrapid biological rapid responses biological to changing responses environments to changing environments [5,6]. [5,6]. It is our contention that a more widespread recognition that each patient encounter—whether for prevention, treatment or wellness visit—is, in essence, clinical ecology, has the potential to transform

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