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Healthy ecosystems as a building block of resilient health systems: Challenging health systems researchers to take action








Reflections on the 2017 Consortium of Universities in Global Health held in Washington DC, USA (April 6-9)


Health systems are getting more complex than ever, encompassing no longer just the typical building blocks of health systems and their interactions, but also venturing to include areas of study on planetary health – or “galactic health” as some speakers called it – at the recent 2017 Consortium of Universities in Global Health (CUGH) Conference held in Washington DC, which we were fortunate to attend. Indeed, the realm of health systems has expanded more than ever to highlight the importance of framing human health within the wider context of the environment and Earth’s natural ecosystems, focusing on how vital this is to save current and future generations. Unfortunately, while ecosystems are undeniably important to the future of humanity, efforts to protect them are continuously threatened by changing political paradigms. Most recently, at the pinnacle of concerns about environmental impacts on health (and related policies) is the new US administration. Coincidentally, the 2017 Annual CUGH Conference was held in the epicentre of U.S. (and to some extent also global) politics – Washington D.C.


Here, we outline our top three takeaway messages for health systems researchers from the conference.


  1. Calling upon health systems researchers to become ecosystem advocates: The current political climate in the United States means there are threats to the funding of key U.S. institutes and agencies involved in global health activities. U.S.-based attendees were urged to contact their Congressperson to advocate for continued funding of global health. We wondered, are there opportunities for other health systems groups to also join this call? More broadly, a strong case has been made for the political argument for investing in global health. Political will and international collaboration led to the MDGs, the SDGs, and even the eradication of smallpox. Public policies affect global health outcomes, and academia (in any field or expertise) has a moral obligation to engage politically, to present the science and evidence that can guide policymaking. As Richard Horton said in the closing plenary session of the Conference, “Science can be a lever for holding those with power accountable for their commitments.” Health systems researchers around the world should heed this message. In the planetary health era, this not only implies advocacy for global health funding and commitment, but also ecosystem advocacy based on the best available science.


  1. Integrating ecosystems in service delivery: Under the planetary health framework, we need a genuinely multi-scalar, transdisciplinary approach to achieve substantial health and environmental gains. EcoHealth and One Health approaches have long since tackled local-level challenges including micro- and macronutrient deficiencies, livestock health, infectious diseases, and land-use change – themes that underscored several conference sessions. Local efforts are best supported by complementary national and international policies – a key principle underlying the planetary health approach. For example, researchers at EcoHealth Alliance highlighted the Global Health Security Agenda, suggesting we can build stronger health systems by accounting for local socio-ecological practices, and incorporating ecosystem and biodiversity disturbance indicators. These systems would in turn be better able to swiftly address pandemic threats on a regional or global level. Without collective action, annual costs of zoonotic spillover events will continue to rise. In this case, a clear economic rationale exists – the hefty cost of inaction far outweighs the cost of cooperative pandemic prevention. The next challenge is to examine the trade-offs and develop the economic rationale for each scenario that contributes to the broader planetary health framework. Ultimately, the goal is to incentivize the global community to adopt and integrate a “planetary health ethos” from consumer behaviour to international policymaking.


  1. Adding environmental vulnerability as a mark of health system resilience: More and more countries are making evidence-based policy decisions on priority-setting of health needs. The Global Burden of Disease (GBD) Collaboration is responding to this need by releasing GBD results yearly, developing more subnational estimates, and refining their methods. As countries focus more of their resources on tackling high-burden diseases, it is important that they do not neglect low-burden diseases that disproportionately affect vulnerable populations, such as neglected tropical diseases that may not rank high in terms of overall burden, but often rank high among the poor or those living in urban slums or hard-to-access rural areas. Investing in upstream policies is also important, such as those addressing planetary health. A health in all policies approach with the inclusion of environmental vulnerability discussions should be the guiding framework, not just in the health sector, but all other related sectors.


Against this backdrop, it was no doubt appropriate that, for the first time, the conference was co-chaired by a member institution from a low- and middle-income country, a practice which they intend to continue in the coming years – the 2018 CUGH conference will take place in New York. As a side note, perhaps this kind of commitment to representation of LMIC institutions as co-organizers or conference hosts could be considered by other upcoming global health conferences, since it exposes participants to the struggles in LMICs (including visa concerns faced by many participants from LMICs when attending conferences in high-income countries).

The need to integrate environmental issues into health systems is more critical than ever. While many engaging and thought-provoking discussions occurred during the conference, some sessions still felt too focussed on the problem, without due attention to the potential solutions. Academics are accustomed to clearly defining the problem, but often feel hesitant to venture into the policy domain. However, as the underlying message of the Conference emphasized, we as academics and as part of the global health community need to engage in political advocacy for better global health policies, inclusive of planetary health. Human wellbeing and health, indeed, are ecosystem services. It is vitally important to keep it that way for the generations that follow.


About Erlyn Macarayan

Erlyn Macarayan was part of the 2014 Emerging Voices program. She is interested in the areas of health systems, epidemiology, and infectious diseases.

About Nel Jason Haw

Nel Jason Haw works in public health in the Philippines and is currently a Masters of Science (MSc) in Global Health student at Georgetown University.

About Mariam Parwaiz

Mariam Parwaiz is a Public Health Medicine Trainee from New Zealand, currently studying towards her MPH. She recently joined the Trainee Advisory Committee of the CUGH, and is also the social media coordinator for Women in Global Health, a global movement that calls for gender equality in global health leadership.

About Latha Swamy

Latha Swamy is Senior Advisor in Planetary Health to Ernesto Zedillo, Chair of the Rockefeller Foundation Economic Council on Planetary Health and former President of Mexico. She also serves as UN Ambassador for Women’s Environment and Development Organization and is a Junior Board Member of EcoHealth Alliance.
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