Tools for Thoughtful Action: The Role of Ecosystem Approaches to Health in Enhancing Public Health (Canadian MILESTONE IN POPULATION AND PUBLIC HEALTH Research) (Report‪)‬

Milestones in the advancement of public health have often been marked by trenchant observation (Edward Jenner), application of observationally derived knowledge (John Snow), experimentally derived principles of causation (Robert Koch), new technology (Louis Pasteur) or development of programmatic responses (e.g., smoking bylaws). More subtle milestones have addressed multifactorial and dynamic determinants of health. These developments are especially relevant to populations with broadly "acceptable" water to drink, air to breathe and food to eat, who face the new public health frontier of complex social, economic and environmental interactions, and demand research and action able to engage with real-life, real-time situations. While the separate study of health, economics, ecosystems and society has led to great advances in knowledge, and has also illuminated certain associations critical for population health (for example, poverty-obesity, obesity-diabetes, diabetes-vascular disease, etc.), persistent, interrelated public health challenges demand new approaches. The limits to what can be conceptually and practically achieved by attempting to disaggregate chains of causation between particular influences and the state of a population's health have been reenforced in recent decades. Frustrated by limited efforts to address complex issues such as environmental degradation, sustainability, poverty and chronic illness, scientists, practitioners and policymakers began to encourage integrative science through such mechanisms as the Canadian Tri-council environmental health and sustainability programs of the early 1990s. Subsequently, several lines of exploration have converged into an evolving field of research and practice called ecosystem approaches to health (also known as ecohealth). There is mounting evidence of the effectiveness of these approaches in addressing systemic challenges in population health, particularly among vulnerable populations. The development and application of ecosystem approaches to health has clear relevance to all twelve of the "Great Achievements" outlined by CPHA and warrants designation as a Population and Public Health Research Milestone.