17.3: Coupled Social-ecological Systems and Implications for Health Security

We now turn our attention to the interface between social and ecological systems and implications for health, acknowledging foundational work with direct relevance to health security, and moving to describe the value of considering health security in relation to social-ecological systems and the discourse of resilience. Some would argue that the Ottawa Charter for Health Promotion (WHO, 1986) offers a precursor to a more integrative approach to health security, with its emphasis that improvements in health required a secure foundation in the basic prerequisites for health, listing these prerequisites as: peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity. This emphasis led to the Ottawa Charter’s call for a “socioecological approach” to health, noting:

The inextricable links between people and their environment constitutes the basis for a socioecological approach to health. The overall guiding principle for the world, nations, regions and communities alike is the need to encourage reciprocal maintenance – to take care of each other, our communities and our natural environment. (WHO, 1986, Section 2, Article 2 ‘Create Supportive Environments’, n.p.)

The value of combined social and ecological orientation to health has been echoed and reiterated through subsequent decades of public health efforts. Along with efforts to fulsomely engage with both the ecological and the social determinants of health (see Cole et al., 1999; Edwards & Davison, 2015; Horwitz & Parkes, 2019; McLaren & Hawe, 2005; Parkes et al., 2003), a combined emphasis on the social and ecological determinants of health can be seen across emerging fields of public health research and practice such as ecohealth, environmental health equity, One Health and planetary health (see Buse, Oestreicher et al., 2018). As well as efforts focused on health of humans (and other species), an important concurrent body of work has generated expanding attention to social-ecological systems (SES), change and resilience, and offers a very helpful complement to an integrative understanding of health security. The remainder of this section, provides an overview of the dynamics of coupled social and ecological systems before linking these to the emergent health security dimensions of ecological change, and returning to the benefits of an integrative, social and ecological orientation to health security.

What Are ‘Resilient’ Social-ecological Systems?

SES are complex assemblages of social actors, institutions and bio-geo-physical units, that adapt and respond to shocks or changes based on their composition, function, and spatial and temporal orientations (Berkes et al., 2003; Levin, 1998). In other words, SES refer to the relationships of social systems (i.e. society) to the ecological systems and ecosystem services which provide conditions for life to sustain and flourish (Holling, 2001). Thus, not only are ecosystem processes essential to the functioning of social-ecological systems, but so too are the human relationships, institutions and power dynamics that govern social and ecological systems alike (Cote & Nightingale, 2012; Cretney, 2014; Smith & Stirling, 2010).

SES tend to be nested within multiple hierarchical systems, where smaller systems move rapidly through processes of exploitation, conservation, release and reorganization (Holling, 2001). Holling (1986) famously used the example of forest fires to depict how a forest system would grow, exploiting available resources of oxygen, land and nutrients from the soil, ultimately crowding out other elements and producing competition over resources that requires the forest to ultimately conserve those resources. When triggered under the right conditions, sometimes by an exogenous event such as lightning from a thunder storm, a fire could release the massive amounts of stored energy and potential of the system, ultimately creating opportunities for reorganization into a similar system (e.g. a forest), or into an entirely new system altogether. Termed what Gunderson and Holling refer to as ‘panarchy,’ adaptive SES rely on an ability for systems that operate at different spatial and temporal scales to experiment with novel assemblages at small scales while larger, slower moving systems protect against catastrophic systems change while still benefitting from the innovation, creation and conservation of smaller systems (Gunderson & Holling, 2002; Holling, 2001).

SES rose to prominence primarily when considering the resilience of ecological systems and human communities in relation to natural disasters and resource management issues (Folke, 2006; Gunderson, 2010). SES are often discussed in terms of their resilience, vulnerability and adaptability across time and geographic space (Young, 2014). The resilience approach emphasizes that systems are characterized by non-linear dynamics, thresholds and tipping points for change, uncertainty, and have multiple interactions across time and space (Folke, 2006; Walker et al., 2004). Resilience typically reflects a system’s ability to respond to shocks so as to return to its original function, but has increasingly been recognized that ‘bouncing back’ to a system that is inherently unsustainable may be problematic in the context of SES, and therefore, much conventional scholarship emphasizes the learning of systems and the actors within it and their ability to ‘bounce forward’, learn from shocks and ultimately self-organize to produce a more effective systems response (Berbes-Blasquez et al., 2014). Accordingly, a resilient system is more able to adapt to shocks and could either proactively or reactively respond to systems vulnerabilities to minimize the impacts of the shock across the system or for its specific components. Alongside resilience, a focus on social-ecological change is fuelling necessary attention to understanding processes of transformation in communities and societies (Andrachuk & Armitage, 2015; Chandra et al., 2010; Kull et al., 2018) in ways that are highly relevant to our future health and security.

Recognition of the links among SES resilience, change and the determinants of health is expanding (Berbes-Blasquez et al., 2014; Bunch et al., 2011). Indeed, it has been argued that, within specific SES contexts—for example, catchments and watersheds—that “promotion of health and resilience converge towards a common goal: to cultivate enduring capacity to respond positively to change and challenges” (Parkes & Horwitz, 2009, p. 100). Given that health security will always need to address shocks, change and challenges, we argue that understanding of both resilience and health in SES will be essential if health security is to be understood in a way that actively addresses combined and converging social and ecological change.

Ecological Drivers of Health Insecurity in Coupled Social-ecological Systems

The 21^st century has presented dramatic natural and anthropogenic environmental changes that pose unique risks to human health. For example, climate change has raised global temperatures where 17 of the 18 warmest years on record have occurred since the turn of the 21^st CE (NASA, 2018). As a result of increasing carbon pollution, ocean acidification threatens all forms of marine life, and in 2015 the Great Barrier Reef experienced the largest single bleaching event to ever occur with deleterious effects on marine biodiversity in that area. Further, the use of non-biodegradable consumer items has led to other forms of ecological marine stress. There are now at least five massive garbage patches across the planet’s oceans comprised almost entirely of microplastics and plastic products. This pollution exists on a previously unimaginable scale, impacting marine life and impacting biodiversity of the ocean. On land, deforestation—the permanent destruction of a forest to make way for other land uses—results in an estimated 18.7 million acres of forest loss every year (WWF, 2018) contributing to approximately 15% of global greenhouse gas emissions. Other forms of large-scale resource ‘development’ (e.g. the construction of hydroelectric dams, mines, fracking natural gas, etc.) also contribute to these trends, while creating massive linear disturbances on the landscape for supporting infrastructure, and often contributing to poor air quality and water contamination.

These changes to marine, terrestrial and atmospheric environments are so great, that geologists maintain we now live in a new geological epoch named the Anthropocene where the human species is the driving bio-geo-chemical force for ecological change; (Crutzen, 2006; Lewis & Maslin, 2015). So great is human influence on the planet that some scientists describe our influence on the natural order of the planet as the ‘great acceleration’ (Steffen et al., 2007), whereby at least five planetary system boundaries including climate change, biosphere integrity measured by planetary genetic diversity under what is currently the world’s sixth largest mass extinction, land-system change (i.e. altering natural systems and land cover into other forms that may be incommensurable with the provisioning and regulating services of any given ecosystem), and disruption to biogeochemical flows of nitrogen and phosphorus which regulate numerous processes required to support life on the planet (Steffen et al., 2015).

Growing attention is being paid to the pathways by which environmental or ecological change influences health through the disruption or alteration of ecosystem services (Fisher et al. 2009). Ecosystem services refer to the things that nature provides which allow life to sustain on the planet (De Groot et al., 2002). Food security and water security depend on ecosystem services. Typically, ecosystem services are grouped into several categories of services. Provisioning services refer to the production of food and water for human and non-human species, but also the production of genetic resources and energy. Regulating services regulate control ecosystems and biophysical systems so that they operate within safe limits, such as the regulation of the climate system through carbon sequestration, waste decomposition, or pest and disease control. Supporting services make it possible for services to continue to function through nutrient cycling, habitat provision or pollination, enabling ecosystems to provide other services including both provision and regulation. Cultural services refer to the spiritual, cultural, therapeutic and recreational services provided by nature, predominantly to human populations (Duraiappah et al., 2005).

It can be argued that those fortunate enough to live in countries in stages of advanced capitalism (e.g. primarily the so-called ‘Western’ or ‘Industrialized’ countries) are buffered from the ecological pressures that modify ecosystem services, through infrastructure, social and health services and emergency response management build adaptive capacity to adverse ecological change. Even so, the rate and scale of social and ecological change in a range of contexts is driving growing attention to ecosystem services as a way to understand health impacts across scales (Horwitz & Parkes, 2016) and examples of the health impacts of altering and protecting ecosystem services are expanding (McFarlane et al., in press). Despite the fact that ecosystems are non-negotiable foundations for health and well-being across the planet (Horwitz & Parkes, 2016), much of the attention to, and most pronounced health impacts of, altered ecosystem services will unfold (like the health security discourse) in lower- and middle-income countries. In these contexts, health security challenges are compounded by the fact that capacity for addressing health and its determinants may be more limited compared to The Organisation for Economic Co-operation and Development (OECD) nations, further undermining efforts directed towards the Sustainable Development Goals (see Chapter 3).

For example, Yemen’s on-going humanitarian crisis stems largely from drought conditions that have left 17 million people without adequate nutrition leading to both malnutrition and outbreaks of cholera. The humanitarian crisis in Syria, that—at the time of writing this chapter—continues to unfold, was largely driven by civil discontent stemming from the confluence of dissatisfaction with President Bashar al-Assad and the most intense period of drought Syria had ever recorded resulting in crop failures, rising food prices and migration from the countryside to the city. This ultimately led to a civil war and the need for a mass relocation of 13.5 million Syrians requiring humanitarian assistance, further highlighting the human security dimensions of prolonged environmental change (i.e. drought) which can lead to violent conflict (Barnett & Adger, 2007). Less dramatic has been the situation of Capetown in South Africa, the first city to approach ‘Day Zero’—the day when the city would run out of potable water due to prolonged drought—triggering a series of water restrictions and the need to visit local pumps through a quota system.

Western Africa’s economy was crippled during the 2014 Ebola crisis that killed 11 000 and resulted in US$3 billion in economic losses across the region (Nkengasong et al., 2017). Ebola was driven by fragmentation of West African rain forests through expansion of resource development projects, increasing interaction among animals and humans resulting in incident cases (Rulli et al., 2017) and subsequent rapid rise in incidence (Jones et al., 2013). The spread of infectious diseases such as Ebola also requires significant multilateral containment efforts to be coordinated across the region and internationally (Davies et al., 2015; Kalra et al., 2014; WHO, 2016).

Potential Synergies: Linking Social-ecological Insights with Health Security

Each of the examples listed above demonstrate the complexity in linking large scale, slow moving ecological changes to processes of social change and its impacts on human health in particular global regions. However, no place on the planet is entirely devoid of the health risks from ecological change, but many of the impacts to health security will be place-specific whereby ecological change will interact with unique social and ecological contexts, along with inequities between and within population groups according to the determinants of health and interactions therein (MacIntyre et al., 2018). In other words, the social and ecological components of SES will influence place-specific vulnerabilities and adaptive capacity which ultimately influence the resilience of that system to promote good outcomes for people, other species and the environment (Ellis et al., 2018; Stokols, 1996). Examples of these variations includes the range of responses across Australia, Canada, Europe and the United States, to the expanding impact of significant forest fires in the last decade in association with changing climate (Abatzoglou et al., 2018; Tett et al., 2018). These fires result in loss of life, property and livelihoods with significant implications for mental health and accessing health services during emergencies (Dodd et al., 2018). Climate change further drives extreme heat events, violent weather, and floods and storm surges that are increasingly affecting coastal communities, which each bear impacts that are disproportionately felt by those already most disadvantaged in our society (Watts et al., 2017; Watts et al., 2018).

Thus, the coupled social and ecological change will precipitate further concern for the health of individuals and populations, including a range of equity concerns (consider social and environmental equity, intergenerational equity and interspecies equity), which will, in turn, challenge governance responses to build adaptive capacity among the most vulnerable (Quinn & Kumar, 2014). Not only will these health issues be differentially distributed across population groups and non-human species (environmental and ecological injustice (Low & Gleeson, 1998)), but they will accompany job insecurity and significant psychosocial risks which constitute additional health security threats through direct morbidity and mortality within and between population groups, resulting in rising health and social system costs as we struggle to adapt and respond to ecological change.

These examples underscore a key insight for health security that can be gleaned from understanding of contextual challenges and implications of SES: that is a need for more nuanced attention to the challenge of health security concerns across different scales (see Buse, Smith, et al., 2018), and—in particular—the need to consider social-ecological change and health security concerns, not only at the planetary, or the most local, but also at mesoscale (Galway et al., 2016; Horwitz & Parkes, 2019.