Can an ecosystem approach to health promotion succeed where reductionism fails?

266 Perspectives in Public Health l September 2016 Vol 136 No 5 Copyright © Royal Society for Public Health 2016 SAGE Publications ISSN 1757-9139 DOI: 10.1177/1757913916658626 IntroductIon Reductionism pervades the current Western biomedical health model, whereby complex biological or medical phenomena are deconstructed into many parts in an attempt to focus on a singular dominant factor or root cause of disease.1,2 While this approach has enabled greater understanding of some diseases, it fails to take into account the multi-factorial determinants of complex chronic disorders and co-morbid conditions. For example, it is now wellunderstood that chronic or noncommunicable diseases (NCDs) result from a complex interplay of environmental, socio-cultural and lifestyle behavioural factors. However, the current Western biomedical health model pays limited attention to tackling the multifactorial root causes of NCDs and instead focuses finite resources on treating the symptoms. For example, within the United States, the cost of ‘treating’ NCDs is outpacing the growth of gross domestic product, and NCDs are estimated to become the primary driver of national debt over the next four decades.3,4 The status quo is not sustainable; something has to change. Arguably, to tackle complex NCDs, the focus needs to shift from the individual disease to the whole system (i.e. the individual). For this to occur, a ‘common currency’ would have to be determined, whereby a mutual goal encapsulates all individual parts. Such an approach has been advocated in the environmental sciences, whereby it has been argued that an ecosystem is best managed by recognising the interconnectivity and balance between ecosystem services to produce a net benefit for the entire ecosystem.4 Using NCDs as an exemplar, this commentary will discuss the limitations of the reductionist approach as it is applied to public health, and we will discuss the potential benefits of an alternative approach – the ecosystems approach. Can an ecosystem approach to health promotion succeed where reductionism fails?