What kind of response would come in from the call for perspectives (up to 250 words): “How might rapid uptake of the integrative model influence climate change?” My call was stimulated by a commentary from Harvard’s Peter Wayne, PhD and others in the Osher Collaborative for Integrative Medicine in which they boldly assert that Integrative Medicine Is a Good Prescription for Patients and Planet. I opined that I don’t believe that the environmental movement necessarily views the movement for integrative medicine as a core ally, yet that the field would serve itself to up its environmental profile.
The call brought a fine array of responses from a diverse, interprofessional group: American Public health Association integrative health leader Elizabeth Sommers, PhD, MPH, LAc, True Health Initiative founder and long-time Yale-based preventive-integrative-lifestyle medicine leader David Katz, MD, MPH, IM4US president Udaya Thomas, MSN, MPH, ARNP, commons activist and Institute for a Sustainable Future founder Jamie Harvie, Bastyr University faculty and past president of the Dieticians in Integrative and Functional Medicine Mary Purdy, MS, RDN, author author and Vermont Chinese medicine practitioner Brendan Kelly, LAc, and Alaska clinician Emily Kane, ND, LAc.
This is, and must be, an ongoing exploration. If more of you respond, your views will be published. Are these first responders hitting the mark? Did Wayne and his Osher Collaborative team? What are your perspectives? I offer some comments.
Elizabeth Sommers, LAc, MPH, PHD – integrative leader at APHA
Over the past decade Elizabeth Sommers, LAc, MPH, PHD has provided continuous leadership in helping knit integrative health and public health. The Boston Medical Center researcher and clinician first served as an influential chair of the section on Integrative, Complementary and Traditional Health Practices for the American Public Health Association and has since served on an APHA panel that links work of all the sections.
One aspect to consider as we examine the intersection between climate change and integrative health approaches comes from our global colleagues in public health. The perspective of public health considers access and effectiveness of interventions that impact social determinants of health. At this point in time, there may be more questions than answers. Key elements of any interventions or approaches must be grounded in concepts of social justice and health equity.
Because of adopting a comprehensive framework as we do in integrative health and medicine, we can appreciate the variety of approaches and viewpoints inherent in climate change issues. In public health as in life, there is rarely a “one size fits all” solution. Thus, our myriad of disciplines may contribute to addressing meaningful responses to climate change. Some potential avenues to explore include:
- How do we adjust to the increasing scarcity or extinction of medicinal plants and animals? Our colleagues involved in indigenous healing may have powerful insight into this.
- As soil quality undergoes changes, how do we address ensuring that vital nutrients can be supplied?
- In what ways can mindful living contribute to taking individual responsibility that translates into meaningful community-wide changes?
- How do we promote urban green spaces and gardening?
- What is the role of groups like Acupuncturists Without Borders in providing care to first responders and survivors of natural disasters?
- Exploring the junction of climate change and integrative health is an urgent and inconvenient call. Our experience with the tenets of wholism, wellness, and collective action can be crucial in determining ways forward.
Comment: Sommers calls the community out of its clinical confines to engage the ways both human and planetary health are caught in determinants. What then are the steps needed in professional education programs, in continuing education programs?
David L. Katz, MD, MPH – True Health
David Katz, MD, MPH is among the most significant influencers in integrative and lifestyle medicine, especially from his public health grounding. The founding director of Yale University’s Yale-Griffin Prevention Research Center and Yale’s integrative medicine program is also a past-president of the American College of Lifestyle Medicine. He is the founder of the True Health Initiative which he established “to help convert what we know about lifestyle as medicine into what we do about it, in the service of adding years to lives and life to years around the globe.”
Perhaps nothing better reflects the primacy of a holistic view of well-being than this: there are no healthy people on a ruined planet.
Broad as it is, the holistic vista is traditionally narrower than this. Those of us who direct our vision there have long considered a sequence of wholes, each greater than the sum of antecedent parts. The injured or ill body part or system is part of a whole body; that body, the vehicle for a life; that life, a part of a family, community, network- a social environment, and the body politic. Those interactions, in turn, are housed within a local physical and built environment. These, in turn, reside within some ecosystem of policies, practices, priorities, and commerce- collectively, culture.
But all of this, and any hope for more of the same- reside on the one planet we share, and all call home.
There is, thus, a natural symbiosis between the long-espoused aspirations of integrative medicine – the holism, the trans-disciplinary collaboration – and the burgeoning defense of our imperiled planet. Holism must encompass aquifers and ice caps; glaciers and rainforests; permafrost and biodiversity. For there are no healthy people on a ruined planet.
Now is the time to declare this common cause on the common ground of the one and only planet we may yet hope proves fertile to the hopes and dreams of our children, and theirs.
Comment: Is it possible in a field that still defines itself often around scarcity that a key to exiting that mindset is to set a course that leaves the narrow, that more deeply connects with the abundance that still is our natural world?
Udaya Thomas, MSN, MPH, APRN – President, Integrative Medicine for the Underserved
The new president of IM4US, Udaya Thomas, MSN, MPJH, APRN is a primary care nurse practitioner working in a safety-net hospital system in Southeast Florida at Memorial Primary Care. She has just stepped into her role as president of what may be the most significant organization for the future of the field, Integrative Medicine for the Underserved (IM4US). She sent this from her Board retreat, calling it “Change Groups.” IM4US has been a driver for group-delivered services and action.
Climate change has moved us in many ways from tremors in our feet to palpitations in our hearts and dizziness in our heads. It seems like there is little we can do to slow the rising seas and temperatures but at the same time the collective will and energy of our nation’s youth has been a wake up call that we as Integrative Health Practitioners also need to act on, not only on behalf of First Nations and sea level communities but all communities.
Juliana vs the US Government has inspired youth and others to bring to light that without a focus on reducing fossil fuels their future will be of an already obvious and even more drastic changing “land escape!” The case emphasizes the federal and corporate responsibility for supporting industries that perpetuate unsustainable practices vs blaming individuals for their daily habits as they are habits in part because of what is locally available.
The power and influence of each citizen and groups of citizens has spurred the idea that groups, including those that gather at community health centers around the nation can start by assessing their own communities and take action. It can be as small as planting more Black-eyed Susan flowers to help bring back more bees to composting and recycling in our neighborhoods or collecting rain water and supporting solar and wind energy sources through our electric company.
Groups can teach each other, organize each other and empower communities to petition their representatives to reduce reliance on environmentally harmful industries. Groups can also clean greener, eat greener and create more green spaces and urban farms that may slow down the warming of our globe. Know group, believe in group, be in a group!!
Comment: Thomas dovetails the climate theme with another favored theme followed closely and high-lighted here: the move for group delivered clinical services. She suggests the systemic value in bringing groups together, getting people in the habit of co-solutioning, of knowing how to find each other and relate, out of their precious individualism into community action.
Jamie Harvie – Institute for a Sustainable Future
Jamie Harvie, PE is the founder of the Duluth, Minnesaota-based Institute for a Sustainable Future, a not-for-profit that is “focused on systems thinking and interconnectedness” and has initiated the Commons Health Network to build collaboration. Harvie has been an influencer in the development of the Academy of Integrative Health and Medicine where he has spoken to the connection that is the subject of this column.
Central to the question of whether integrative medicine has a role in addressing climate change is whether one appreciates integrative medicine as an approach rather than a prescription. And whether ones sees climate change as the problem or as a symptom. These factors offered a basis for a paper I authored, The Next Health System, and are covered in our piece, Healthy People, Healthy Planet (Harvie and Guarneri), presented at the 2018 Pontifical Academy of Science Workshop on Climate Change, in which holism is offered as a unifying model and requisite process to align and foster individual, community and planetary health as a means to address our existential crisis.
These assertions do not negate the arguments made by Nusrat et al, but rather serve to extend them. Holism is a powerful model of interconnectedness and oneness, reflective of all living systems. Ironically, modern society is designed—from our material economy to industrial agriculture—around a mechanistic model in which the health of people and the planet have been externalized and separated. We operate at odds with the health of a living planet. So, for example, while the notion of prevention through healthy diets is laudable, success is next to impossible without the concurrent redesign to an agriculture system—agroecology—in which the health of people and the planet is designed. Thus, the power of integrative medicine lies within its holistic ideology, which is not only transforming medicine, but also offers a framework to catalyze a systemic approach in which the health of people and the planet are included across economic sectors.
A holistic model requires us to rebalance empirical scientific knowledge by re-prioritizing cultural wisdom and knowledge and embracing diverse expertise and experiential contexts. In our climate emergency, we require all hands, minds and hearts on deck. If we are going to succeed in addressing the human-made challenges of our common home, it seems obvious that a living systems model enables us to realign our ways of operating in accordance with life on a complex planet, reflective of our true nature. Let’s not get distracted by the integrative medicine toolbox; let’s focus on the model.
Comment: Harvie’s comments remind me of a call I had over 20 years ago amidst the founding energy of what was then the Program in Integrative Medicine at the University of Arizona. The then small core team led by then director Tracy Gaudet, MD had just returned from a planning retreat. This was early in the time of “CAM integration” when the “integrative” term was only being formed on the lips of the movement. Gaudet reported enthusiastically (I paraphrase): We got it very clearly. It’s not about the therapies. Our work is not about adding this or that complementary technique. It’s about the approach to patients. Today of course that fundamental insight helped shape the Whole Health program at the Veteran’s Administration. Says Harvie: “Let’s not get distracted by the integrative medicine toolbox; let’s focus on the model.”
Mary Purdy, MS, RDN – Dieticians in Integrative and Functional Medicine
The Bastyr University nutrition faculty Mary Purdy, MSN, RDN is a past chair of Dietitians in Integrative and Functional Medicine and a past president of the Seattle Chapter of the American Dietetics Association.
As a food-as-medicine and Integrative dietitian nutritionist, I have seen dietary shifts transform lives. People become healthier, with fewer symptoms, more energy, and improved clinical signs and labs. They are able to reduce or get off medication, spend less time away from work and take fewer trips to the hospital for treatment. For the most part, nutritional recommendations center around increasing colorful fruits and vegetables, plant-based proteins and high fiber foods which research has shown form the hallmark of disease prevention and optimal wellness. Luckily, these are also the very same foods that may use fewer resources like fossil fuel, land and water, and which can help with carbon sequestration in the soil. Throw in some encouragement for supporting organic farmers and regenerative agricultural approaches and you have even more support for sustaining both human and planetary health.
As integrative practitioners who include the natural environment as an agent for healing, we have both an opportunity and an obligation to support its long term health in addition to the health of our patients. Our food system contributes to at least a quarter of our greenhouse gas emissions, with a substantial amount of that coming from the livestock and agricultural sector. Working with patients to reduce their consumption of meat and incorporate more plant-based options, may be one of the most impactful changes we can promote, with positive implications for health as well. Consumer choice has the ability to drive systemic change and patients both trust and rely on us for guidance. As a true connector to culture, community, and nature, food may be one of the key ways we can bring healing to both people and the planet.
Comment: My interest in this dialogue was to find ways toward greater valuation of the integrative movement among those who are already climate activists. What would it take to make Purdy’s last sentence flow if “the integrative health movement” was substituted for “food”? Purdy is right in her assertion. We see signs here and there of integrative health gaining this stature through a broader framing, yet the field has not yet so boldly embraced this role as connector to culture, community and nature.
Brendan Kelly, LAc – author and clinician, Burlington, VT
In 2015, North Atlantic Books published North Atlantic Books published The Yin and Yang of Climate Crisis, the first book from Brendan Kelly, LAc. an author an clinician who practices out of Jade Mountain Wellness in Burlington, Vermont. He presents his work as “the first book to marry Western environmentalism with Chinese medicine.” He sent a note with his thoughts that his intent here is to share some “ideas of a Chinese medicine based discussion of climate change and it’s connection to the practice of natural medicine” including “a bit about Chinese medicine theory and it’s application to climate change.”
Almost all of what we hear about climate change comes from our usual western perspective. There are important discussions about the need to reduce greenhouse gas emissions, increase carbon sequestration and question continuous economic growth. While these concerns are of real and urgent importance, they focus on the symptoms of the climate crisis rather than the deeper, root causes. If we were to look at climate change from a different view, we could see that what is happening in the environment around us is also happening within us.
Voluminous amounts of climate data from the past several decades indicate clearly that the planet is warming rapidly. What has emerged more recently is that the ability of the planet to cool itself has also become compromised. With the loss of forests, melting glaciers, and acidification of the oceans, the planet is less able to absorb the greenhouse gases we’re emitting. Looking at this dynamic from the view of Chinese medicine, a clear diagnosis of what’s happening emerges.
For Chinese medicine, this excess warmth is associated with too much Yang energy. As it’s synonymous with fire, too much Yang creates too much heat. Within us, heat correlates to physical inflammation as well as mental and emotional over-stimulation. For the planet, it’s expressed as the rapid rise in temperature.
The other part of the diagnosis is the planet’s inability to absorb greenhouse gases. This is a loss of coolant, which Chinese medicine calls Yin deficiency. Yin is the ability to keep things cool and stable within us and within the climate. The decrease in the cooling effects of glaciers, forests, and oceans indicates that the planet’s Yin has been compromised. Together, this increase in temperature and decrease in coolant shows us that the planet’s diagnosis is Yin-deficient heat.
Part of what natural medicine can contribute to the urgent work to address global warming is the recognition that the planet’s rapid warming and lose of coolant mirrors closely similar imbalances within us and within our culture.
Comment: The appeal of the case – “for Chinese medicine, this excess warmth is associated with too much Yang energy. As it’s synonymous with fire, too much Yang creates too much heat” – is too compelling to turn away with the blazes in Australia and California in our minds and the smoke blown over the Cascades to my Seattle home 2 summers ago still frightfully close. We need, in street parlance, to “chill.” And if there was ever a deep threat to capitalism’s pressures to go faster and consume more, it is such chilling out and slowing down. I think of the argument in the commentary from Peter Wayne that stimulated this dialogue: the potential positive climate effects from mind-body that relieves the addiction of shopaholics.
Emily Kane, ND, LAc – Clinician, Juneau, AK
Emily Kane, ND, LAc has been practicing in Juneau and via retreats on Hawai’i’s Big Island since shortly after her graduation in 1992 from Bastyr University. Her focus is “to help you create optimal wellness through individualized health-promoting choices in food, exercise and non-pharmaceutical support.” She was an contributor in the late 1980s to early issues of the magazine of the American Holistic Medical Association and the Townsend Letter for Doctors. The Harvard graduate writes on her website: “In general, the way to go is very slowly when stopping prescription medicine.” Her words were short and to the point.
A responsible, consistent and radically kind treatment of ourselves (guided by physicians who promote true wellness, by teaching patients how to nourish the “soil” of their body/mind) is contiguous with care of Planet Earth which sustains all life as we know it.
Comment: Part of what connected me to my work with the naturopathic doctors in the 1980s – when I met Kane – was the pedestrian shamanic notion that teaching people to treat their health in whole systems way would implant such thinking in the rest of their problem solving. Kane’s brief comment captures this. As above, so below. Can we “solve the climate crisis” if continuous teach reductive responses to complex challenges?
Overall Comment: This past week I began slowly reading a new year’s gift from my younger sister, Vicki Weeks, Charles Eisenstein’s Climate: A New Story. Eisenstein has insightful – and not always salutory (though provoking in good ways when he is not salutory) – comments about integrative practices, while pulling readers into a broad, whole system view in which we each act locally, to protect those natural places that mean the most to us that we each have seen decline. I haven’t read enough to gain comfort with Eisenstein’s whole thesis but have enough to recommend the book to anyone who has made it through this dialogue to be reading this! Meantime, I am wondering about my choice this morning to not join my brother Bob for his stint of volunteerism to help remove invasive species and bring back the Duwamish River.
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Now, just because I can, I offer again one of my own perspectives on integrative health and climate change: A mindfulness study from 2015 that was a retrospective analysis of roughly 4500 individuals who completed a mindfulness integrative group intervention found that the group’s overall consumption of conventional medical services was 43% less than matched pairs. Given that the gross carbon footprint of the medical industry in the United States would rank it 13th among nations in greenhouse gas emissions, what might the effect on these poisons be if the public health campaign for which the authors call — making mindfulness training as ubiquitous as driver’s education or vaccinations — were championed by politicians and rolled out as public policy nationwide? We might also influence that shopaholism, and other addictive, consumptive, less thoughtful behaviors …