International Journal of Epidemiology 2002;31:704-705
© International Epidemiological Association 2002
Book Review |
Ecological Integrity: Integrating Environment, Conservation and Health.
D Pimentel, L Westra, RF Noss (eds). Washington DC: Island Press, 2000, pp. 428, £55.00 (HB). ISBN: 1-55963-8-079; £27.95 (PB). ISBN: 1-55963-8-087.
This book brings together and synthesizes the work to date of the Global Integrity Project, which was started in 1992. The aims of the project, as stated on the back cover of the book, have been ‘... to examine the combined problems of threatened and unequal human well-being, degradation of the ecosphere, and unsustainable economies’. The biographies of the contributors to this edited volume highlight that the project has brought together specialists from the fields of ecology and related biological/environmental sciences, economics, philosophy, epidemiology, ethics and law. Between them the contributors have an equally broad experience of academia, industry, governmental and non-governmental organizations. This bodes well for a project and book that aim to take a transdisciplinary approach to the issues concerned.
I would emphasize now that this is not simply a book that describes which and how environmental factors affect human health today. The whole approach of the book is to focus on definition, measurement and effects of ‘ecological integrity’ and its loss, in the context of which the impacts on human health are considered.
The book has a straightforward structure, similar to that of many edited collections, and is amenable to ‘dipping in’ to chapters of interest. Indeed it may be quite difficult to plough through the book in its entirety. However, I would recommend against health specialists simply heading straight for the chapters that deal explicitly with human health, without some consideration of the remaining content of the book. The book tries to show that human health not only responds to the state of ecological integrity (at whatever scale), but is also an inherent part of it. Focussing solely on the health section would therefore lead to missing the key point of the book. Having said that, there is probably more detail than is needed on ecological theory and specifics such as forestry for even the broadest-minded epidemiologist, but that does not limit the utility of the book as a whole.
The introductory section does a good job of telling the story of what the book is about, while making the argument for why the following chapters are important and how they fit into the story. This is followed by the four main sections of the book: the history and philosophy behind the ecological integrity concept; the concept as applied to natural resource systems, including agriculture, landscape and fisheries; human and societal health; and economic and ethical aspects. The book ends with a final synthesis, which brings together the ideas and summarizes a prescription for action.
In contradiction to my recommendation above, but with a view to the readership of the International Journal of Epidemiology, a brief review of the health-relevant chapters follows. In chapter 14, Professor Tony McMichael sets out to answer the question ‘In what ways do global environmental changes affect the prospects for human health?’ The focus on health prospects highlights that this is concerned with possible environmental effects on health in a long-term, ecological framework rather than measurement of current exposure effects. The chapter provides a neat summary of the manifold means by which public health is likely to be affected by global and regional environmental changes, which will be familiar to anyone who has read McMichael's book Planetary Overload.1 In common with much of the rest of the book, McMichael argues for the need for transdisciplinary, holistic scientific assessment, since these complex and large-scale issues do not fit reductionist and classical linear analyses. He suggests that to assume that things are getting, and will continue to get, ‘better’ because life expectancy is increasing, is to misunderstand the situation, and that public health needs the equivalent of clinical prognostic indicators as well as purely diagnostic ones.
In chapter 15, Soskolne et al. neatly lead on to investigate how we might go about measuring the potential consequences of environmental degradation on human health. While acknowledging the difficulties inherent in this type of science, they suggest that epidemiological methods do provide a means to assess environment-health relationships in this context. They give a simple summary of epidemiological study types, and highlight that epidemiology used in this context can almost never be ‘gold-standard’ (randomized controlled trials), but argue that ecological studies are perhaps the most appropriate, despite limited causal inference.
Laura Westra's chapter that follows on ‘institutional environmental violence’ might sound a little dramatized. However, it puts forward a cogent argument for the consideration of potential and actual public health impacts of activities that are (or were) not illegal or proscribed and are/were viewed as part of a legitimate ‘modern’ lifestyle and of technological progress. She also discusses, at some length, the ethical dimensions of the previous two chapters.
On a personal note, the chapter that I found to be most useful is that by James Karr, who relates ecological and environmental health, and emphasizes the importance of not considering them to be wholly separate entities (the chapter is subtitled The Importance of Measuring Whole Things). This helps the reader to see the links between the explicitly human health-oriented chapters and the remainder of the book.
Given its inherently cross-disciplinary nature, the book appeals to a wide audience, and would be recommended to anyone with in an interest in environmental sciences, sustainable develop-ment, environmental and more general epidemiology, and global public health. A little prior knowledge of ecology may help with understanding some of the concepts, but is by no means essential.
There is a growing awareness of, and interest in, health ecology and taking an ecological approach to epidemiology and public health.2,3 Ecological Integrity delves deeply into these concepts with a very broad remit, that might at some times seem too broad to be of interest to specialists. However, it pulls together a coherent argument, and presents some challenging and very interesting ideas for the ways in which we should approach the future with regard to ecological—including our own—health.
References
1 McMichael AJ. Planetary Overload: Global Environmental Change and the Health of the Human Species. Cambridge: Cambridge University Press, 1993.
2
Susser M, Susser E. Choosing a future for epidemiology: II. From black box to Chinese boxes and eco-epidemiology. Am J Public Health 1996;86:674–77.
3
Torres AM, Monteiro CA. Towards an ecology minded public health? J Epidemiol Community Health 2002;56:82.
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