Abstract
The intimate interdependence of human health and the ecosystems in which we are embedded is now a commonplace observation. For much of the history of public health, this was not so obvious. After over a century of focus on diseases, their biologic causes and the correction of exposures (clean water and air) and facilitation of responses (immunizations and nutrition), public health discourse shifted to embrace the concept of determinants of health as extending to social, economic and environmental realms. This moved the discourse and science of public health into an unprecedented level of complexity just as public concern about the environment heightened. To address multifactorial, dynamic impacts on health, a new paradigm was needed which would overcome the separation of humans and ecosystems. Ecosystem approaches to health arose in the 1990s from a rich background of intellectual ferment as Canada wrestled with diverse problems ranging from Great Lakes contamination to zoonotic diseases. Canada’s International Development Research Centre (IDRC) played a lead role in supporting an international community of scientists and scholars who advanced ecosystem approaches to health. These collective efforts have enabled a shift to a research paradigm that embraces transdisciplinarity, social justice, gender equity, multi-stakeholder participation and sustainability.
Key words: Environment, public health, determinants, community participation, social environment, gender identity
Résumé
Il est aujourd’hui courant d’observer l’interdépendance étroite entre la santé humaine et les écosystèmes où nous sommes enracinés. Pendant la plus grande partie de l’histoire de la santé publique, ce n’était pas si évident. Après plus d’un siècle d’attention aux maladies, à leurs causes biologiques, ainsi qu’aux moyens de corriger les risques auxquels nous étions exposés (en purifiant l’eau et l’air) et de faciliter les réponses appropriées (les vaccins, la nutrition), le discours de la santé publique a changé en adoptant le concept des déterminants de la santé, qui s’étendent aux domaines social, économique et environnemental. Ceci a amené le discours et la science de la santé publique à un niveau de complexité sans précédent au moment même où la préoccupation du public pour l’environnement augmentait. Pour aborder ces impacts multifactoriels et dynamiques sur la santé, il fallait un nouveau paradigme qui effacerait la séparation entre l’être humain et l’écosystème. Des approches écosystémiques de la santé sont nées du riche ferment intellectuel des années 1990, alors que le Canada était aux prises avec divers problèmes, de la contamination des Grands Lacs aux zoonoses. Le Centre de recherches pour le développement international (CRDI) du Canada a joué un rôle prépondérant en appuyant une communauté internationale de scientifiques et d’érudits qui ont fait avancer les approches écosystémiques de la santé. Ces efforts collectifs ont opéré un changement vers un paradigme de recherche qui englobe la transdisciplinarité, la justice sociale, l’équité entre les sexes, la participation de groupes à intérêts multiples et la durabilité.
Mots clés: environnement, santé publique, déterminants, participation communautaire, environnement social, identité sexuelle
Footnotes
Acknowledgements: The authors acknowledge collective funding support for the Canadian Community of Practice in Ecosystem Approaches to Health from Canada’s International Development Research Centre (IDRC) with particular acknowledgement of the role that Dominique Charron and Andrés Sánchez have played in fostering the CoPEH-Canada.
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