What Are We Thinking? A Call for Integrative Health Care to Consciously Serve Planetary Health

Introduction

The health of people and planet are inextricably linked, yet we continue to live as though this is not true. ¹ Feedback loops between the impacts of human activity, and ecological and planetary systems are increasingly reinforcing each other. ² The impacts show up in both scale and place: geopolitical instability and violence, socioeconomic disparity, environmental degradation, biodiversity loss, and climate destabilization, the list goes on.

The term “planetary health,” which has gained mainstream traction in the past decade, asserts that the health and well-being of people and planet are interrelated, omnidirectional, and essentially indivisible. This understanding of interdependence has been, and remains, the view held by many place-based indigenous cultures around the world. ³ Unfortunately, the Western reductionist way of thinking is disconnected from this highly relational worldview. ⁴

Integrative health care, which is the active collaboration between biomedical and holistic providers, seeks to serve patients holistically. In this article, we argue that as humans, we need to change how we think, and adopt a worldview based on interrelatedness to address the interlocking crises facing our global community. Below, we explore how integrative health care can help us make such a profound shift in worldview. We take the U.S. health care system as an example of how such a change in perspective could produce positive health outcomes for both people and planet.

The Current Reductionist Paradigm Is Delivering Fragmented Health Care

Modern mechanistic science has perpetuated a reductionist worldview where everything can be reduced to the sum of its parts. Our dominant operating framework largely focuses on dissectible, fragmented problems and mechanical procedures, rather than the complex web of interconnected relationships. Such frameworks (and institutional structures) cannot solve the enormous, interconnected challenges noted above.

The U.S. health care system accounts for 17% of national gross domestic product. We have the world's highest per capita health care expenditures, at nearly twice the average cost of care among peer members of the Organization for Economic Co-operation and Development (OECD). ⁵ Unfortunately, this high level of spending does not equate to better health outcomes. Compared to our peers, the United States has the lowest life expectancy and highest rate of disease burden despite the resources we pour into the health care system. ⁶ This trend shows up in countless other metrics including increased rates of infant and maternal mortality, mental health issues, and Type 2 diabetes. The U.S. health care sector also accounts for 8.5% of the country's greenhouse gas emissions, with hospital care, physician and clinical services, and prescription drugs being the main contributors. ⁵

The current U.S. model of conventional health care, treating disease through symptom management, is not working for people or the planet. Incremental policy changes and new program initiatives shaped largely by reductionist frameworks will inevitably continue to deliver fragmented results. A worldview based on human and planetary interrelatedness could improve many of these adverse health outcomes while reducing environmental degradation. ⁷

Definitions of Health Evolve Based on Our Worldview

In 1948, the World Health Organization's (WHO) Constitution defined health as “a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity.” That same year the Hippocratic Oath was updated by the Geneva Convention to include ethical principles for the medical profession. ⁸ In 1980, Friends of the Earth expanded and enhanced the WHO definition by introducing the concept that personal health involves planetary health. ³

In 2020, there were calls to further update the Hippocratic Oath to include safeguarding the health of the planet upon which human well-being depends. ⁸ In addition, Whole Health and Whole Person Health frameworks, currently championed by the Veterans Health Administration (VHA) and the National Institutes of Health's National Center for Complementary and Integrative Health (NCCIH), respectively, are expanding to more biopsychosociospiritual systems and values-based health care models that acknowledge the environment' as influential to human health. The NCCIH's current strategic plan also supports shifting health care research from a historical overemphasis on analysis to synthesis, allowing us to understand the whole person and our constituent “parts” in context. ⁹ Furthermore, at the time of writing, there are signals from NCCIH leadership that “spiritual health” needs to be factored into whole person health research.

While these developments are encouraging, current operating medical frameworks regarding health and well-being still largely focus on human health in isolation. To truly support the flourishing of human health, we need to fully embrace planetary health as foundational for all life.

Worldviews Centering Interdependence

As humans, we need to see ourselves as one of the many interrelated species coexisting across all watersheds, foodsheds, and ultimately lifesheds which encompass all place-based needs for flourishing. ¹⁰ This calls for a profound shift to an ecocentric perspective and subsequent reorientation of self to the world. ⁷ Adopting this orientation will be as significant as the Copernican Revolution that displaced Earth from the center of the universe, and will help lead us out of the Anthropocene and into what some are calling the Symbiocene, defined by “companionship and mutual benefit.” ¹¹

Today, Integrative Medicine can be a vehicle to support this transition. The origins of Integrative Medicine can be traced, in part, back to patient and health care provider contact with indigenous place-based cultures, Ayurveda, and East Asian wisdom traditions.

The values, spirituality, and culture of Indigenous land-based Peoples are guided by the holistic, contextual, nonlinear, and symbolic nature of the interrelationships tied to place. ⁷ This way of knowing is an expression of Living Systems Thinking, based on dynamic, nested patterns of complex adaptive relationships and processes of organisms within their environments. It is characterized by connection, reciprocity, place, and emergent complex systems that lead to interdependent, restorative, and regenerative living systems. ¹²

Likewise, for over 2000 years, East Asian healing systems have focused on balance and harmony between mind, body, spirit, and natural environment as essential to maintaining health, happiness, and well-being.

These traditional approaches, grounded in worldviews of wholeness and interrelatedness, have sown seeds and sprouted in Western health care. Their influence shows up in integrative therapies supporting physical, psychological, and emotional well-being.

Conclusion: Positioning Integrative Health in Service of Planetary Health

Health professionals have historically been trusted members of the community. When the patient–provider relationship is infused with mutual respect, it becomes a crucible for healing and flourishing. Integrative health professionals have the opportunity and indeed responsibility to adopt and work from a worldview based on interrelatedness. This stance, in and of itself, can help counter the fragmentation in conventional U.S. health care.

Integrative therapies including mindfulness practices, self-compassion, somatic healing, nutrition, and art and music therapy, to name a few, offer a doorway to self-awareness and inner resilience and support greater integration with community and environment. Indeed, studies have demonstrated that certain mindfulness practices lead to more prosocial and proenvironmental behaviors. ¹³

By empowering individuals with appropriate integrative therapies to support their own health in mind, body, and spirit, increased personal agency and expanded boundaries of self can extend to caring for other people, species, and our planet. ¹³ By shifting the model of “healthcare” from disease management to supporting well-being, integrative approaches can prevent or retard the onset of disease, thereby helping keep people out of hospitals. Through buoying individual self-efficacy and well-being with integrative therapies, we can also reduce the need for higher-energy intensive pharmaceutical and hospital interventions, thereby reducing the ecological footprint of the current U.S. health care system on the planet. ¹⁴

Shifting our concept of health and well-being, while contingent on our contemplation, needs to be supported by systemwide change through collective action in our practices, medical institutions, and informed by place-based policies. One practical way to start seeding such a deep change is by prescribing therapies that help deepen a sense of connection to place. Nature-based therapy is one such example that strengthens relationships between individuals and ecological communities and supports our innate biophilia, or “love of life.” Indeed, allopathic physicians are increasingly prescribing, with good results, nature therapy to support wellness through pathways such as park prescriptions and forest bathing (Shinrin-Yoku). ¹⁵

To conclude, integrative therapies can open doors to greater self-knowledge and allow our inherent nonseparate nature of being to imbue our consciousness, changing our relationships to self, community, and planet.

If we truly want to leave behind the conflict-ridden and self-serving drivers fueling our international, institutional, and individual spheres of activity, the most important action we can each take is to shift our own way of thinking and being from one based on separation and self-interest, which perpetuates division, to one based on interrelatedness and community which engenders cooperation.