Time to Regenerate: Ecosystems and Health Promotion

October 2006 | Volume 3 | Issue 10 | e394 The concept of health promotion gradually emerged from the discipline of public health during the 1970s. In the mid-19th century, founders of the growing discipline of public health had stressed the importance of social, political, and environmental factors as key determinants of disease and health. However, as microbiology and epidemiology developed, and as the most egregious examples of environmental and social abuse faded from view in developed countries, emphasis on these factors waned within mainstream public health, which remained best established in industrialised countries. As globalisation gathered momentum, and as decolonisation proceeded, interest in social determinants of health re-surfaced [1], culminating in the primary health care (PHC) movement [2–4] and the seminal Health for All declaration. The declaration, made at the 1978 International Conference on Primary Health Care convened in Alma Ata, Kazakhstan, included the statement that “an acceptable level of health for all the people of the world by the year 2000 can be attained” [5]. The PHC movement called for the balancing of purely medical aspects of health care with greater emphasis upon the social, economic, and political determinants of health, particularly for those members of the global population whose income was low. Eight years later, in November 1986, the Ottawa Charter was signed, and this remains the best-known declaration of the principles of health promotion [6]. This charter asserted that environmental and ecological factors are of fundamental importance for health. Since 1986, the evidence linking health to ecological and environmental factors (such as climate change, biodiversity loss, and the mental health benefi ts of exposure to nature) has strengthened considerably, stimulating a new discipline, sometimes called “ecohealth” (see Sidebar). However, we believe that paradoxically, recognition of the importance of environmental and ecological factors has simultaneously declined among proponents of health promotion. This essay traces and analyses the growing separation between health promotion and ecohealth. We call upon health promotion advocates to strongly re-engage with environmental and ecological issues, and to form active alliances with advocates of ecohealth. We believe this will strengthen health promotion, benefi t ecohealth, and help to promote and protect sustainable global health.