Designing an ecological approach to health

I have read many papers during my career, but the opening of one particular article astonished me: “Humans are ecosystems containing trillions of micro-organisms...” I read, wide-eyed.1 Back in 2018, the idea that I was interacting with ecosystems every time I treated a patient was revelatory to me. As I reflected on the importance of biodiversity to microbiome health, I was transported back to memories of time spent in the Amazon rainforest as a student. The scent of petrichor in the air, leafcutter ants creating beautiful patterns on the ground, the cacophony of monkeys and birds…The reverence and awe such memories evoked seemed a world away from the sterile clinic in which I read the paper.

As doctors, we have been trained to see and treat individuals in isolation from their environment. To prioritise industrial standards such as specialisation, efficiency, control. While we must acknowledge the huge advances such processes have enabled, we cannot escape that “human as machine” and “healthcare as factory” are implicit metaphors …