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Healthy people, healthy animals, and a healthy environment: One Health

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3020 (Published 12 July 2018) Cite this as: BMJ 2018;362:k3020

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Re: Healthy people, healthy animals, and a healthy environment: One Health

Thank you for your recent thought provoking article on the One Health concept. It’s interesting isn’t it that our economy, our welfare, our very lives depend entirely on healthy ecosystem services and yet at a strategic level in health we barely pay them lip service. I believe part of the reason for this is that as a society we have become disconnected from the natural world. We see nature as a peripheral to our lives perhaps as a middle class lifestyle add on rather than something we are intrinsically part of. Somehow we forget there is no health and well being on a dead planet.

This has led to a collective indifference to the catastrophic demise of our natural environment. We think the world is so large we can never run out of resources. Indeed our entire economic model is based on converting more of nature into money to keep alive the fairy-tale of infinite growth. If we step back and look at changes that have occurred in a generation it really helps to give a context and urgency to the problem

Since the 1950s (when, with the onset of consumer capitalism, we really started maxing out nature's credit card) we have removed at least half of the fish, wild mammals, invertebrates, birds and insects from our planet. In 1976, the year I was born, an oceanographer called Charlie Veron took the first known photograph of coral bleaching. Since then at least 50% of the world’s reefs have bleached. Over a billion people reply on these reefs for their main source of protein. If the trends in environmental degradation coupled with population growth continue it would be an understatement to say our children are going to have a problem!!

Humans are said to have the gift of reason. What more knowledge do we need to recognise that we need to change? As doctors we are in a position of trust and trust is a cognitive shortcut. When information is complex people make decisions based on values and trust. We are in a position to speak out, to be seen as leaders on this agenda, and challenge the status quo. This is not contentious, it is common sense and I struggle to see why it is not more of a priority.

We need to use our influence to embed sustainability in every level of politics and healthcare. We need honest debate around population and discuss whether the essence of consumer capitalism is good for us or our planet. We need to help our patients recognise the value of the natural world for their health and wellbeing and, where appropriate, use it as a therapeutic tool. You mention links with Defra. The 25 Year Environmental plan published this year has a whole chapter on connecting people with the environment for the benefit of health. There is now a wealth of evidence that demonstrates efficacy and cost effectiveness of “green interventions” and we should be embedding the naturally healthy approach in all health strategies. I would love to see a clear strategic steer from NHS England regarding this.

Through Health and Nature partnerships we are moving forward with a number of work streams here in Devon. The beauty of it all is that as well as being evidence based it is just common sense. If we can help our population connect with the natural world they will value it and their health and wellbeing improves. Once they value it they will want to protect it.

I gave a presentation recently to my GP colleagues about the Naturally Healthy program and sustainability. The feedback was very positive. The main theme was - why as this is common sense are we not doing more of it – the answer is simple, short term boom + bust funding cycles do not allow us to look at the bigger picture.

The One Health Concept allows us to begin to see our place in the world again. We need to look at our values and priorities and really think about what matters to us. We are running out of time. Action not more words is what is needed. Our predecessors might be forgiven for taking the Mammoths, the Dodo and the last living Monk seal for lack of understanding of the consequence of their actions. Who will forgive us – do we have any excuse?

Competing interests: No competing interests

18 July 2018
James D Szymankiewicz
GP Combe Coastal Practice Ilfracombe, Vice Chair North Devon GP Collaborative Board, Chair Devon Local Nature Partnership
Combe Coastal Practice, Ilfracombe