Environmentalism as a value pulled me toward the job that drew me into integrative medicine 35 years ago. Part of the magnetism was learning that a primary charge in the field with which I was deciding whether to become involved was to aid and abet the healing power of nature. I surmised that such teaching would make patients of such doctors acolytes of the environment if they weren’t already. For this and other reasons, the environmental movement’s still limited embrace of the broader integrative domain as a core ally has continuously surprised me. If it is science one needs to bind these together, a recent Grand Rounds at Harvard Medical School included intriguing arguments. Peter Wayne, PhD, the interim director of that institution’s Osher Center for Integrative Medicine locked the two movements together through an array of existing, emerging and suggestive evidence.
Wayne is well-suited for the match-making. The t’ai chi and mind-body researcher is an evolutionary biologist by training, He thinks in ecosystems: “Studying mind-body is an ecological endeavor.”
The way Wayne sets the connection is exemplified in a study by complementary medicine and population health researcher Bruce Barrett, MD, PhD at the Department of Population Health at the University of Wisconsin. Barrett’s target is shifting behavior in “the family as the unit of study”. Mindfulness, now relatively well accepted as effective in treating multiple conditions, is the intervention – with the unique addition of climate change awareness training in the form of a Mindful Climate Action Curriculum. The outcomes of the randomized trial include changes in the family’s electric bill, water bill and uptake of healthy activities. Will creating health in the family create health in the environment?
While Barrett’s results are not yet in, creative modelling results by others are. In one, relative to a population in 11 Midwestern metropolitan areas, the team projected likely outcomes if 50% of short car trips (<4 km) in that flatland become lifestyle-changing and health-improving bike rides. The biking was associated both $3.8-billion in health savings and $4.9-billion in from reductions in greenhouse gases. Thus “the combined benefits of air quality and physical fitness >$8-billion.” It’s a powerful public health marriage.
Wayne was the third speaker in an interdisciplinary exploration managed by Aterah Nusrat, MSc and entitled “What’s the Connection between Integrative Medicine and Climate Change?” It included an overview of climate change and the health impacts from Renee Salas, MD, MPH, MS, Harvard Global Health Institute, followed by a view of the environmental harm the medical industry causes and what is being done.
The latter, from Bill Ravanesi, MA, MPH, dropped the bomb that if the US medical industry were a nation, it would rank 13th – between South Korea and the United Kingdom – for its global greenhouse emissions. Consider the immediate positive impacts if the 30%-50% that is waste were eliminated. Ravenesi focused on the hopeful news from the hospital industry’s Health Care Without Harm initiative. With leadership from players like Kaiser and Boston-based Partners Health, the industry make choices – aside from the waste issue – to turn the corner to limit its environmental footprint.
Wayne’s remarks began by placing integrative medicine in a systems biology framework. He referenced the integrative practitioner’s “gardening” role amidst interdependent systems versus specialists in fixing body parts.
He underscored the “duh!” reality that an integrative focus on preventive approaches and lifestyle change “reduces the [medical] industry’s footprint.” He quoted a another Harvard professor, Walter Willett, MD, who through publications in The Lancet and elsewhere make the case that “eating well is good for the planet.” Local farm-to-table eating has multiple environmental benefits. Prevention of disease converts to less need for production of expensive, highly-resourced, and high-waste tertiary care interventions.
I wondered why Wayne didn’t reference a 2015 retrospective analysis from a team that included his Osher Center colleague Darshan Mehta, MD, MPH at the Benson-Henry Institute. That group estimated that the 4452 individuals who had completed their multi-week, multi-modal, mindfulness integrative group intervention reduced consumption of conventional medical services by 43%. Converted those retrospective data into climate-related benefits would reap a healthy bonanza.
Wayne chose to focus the mindfulness lens on other suggestive domains of potentially high magnitude effect. Might evidence of the value of mindfulness approaches to combat addiction shown by Bowen and others lead to value in shifting shopaholic behavior? Billions in climate-changing environmental waste from over-consumption might be avoided. Wayne referenced a systematic review from Luberto and others that suggested the potential for greater empathy and compassion via mindfulness practices. Asked Wayne: “Do these practices that make people more porous and connected extend to the non-human environment?” He urged the audience to consider whether such “pro-social” outcomes might also prompt pro-environmental behavior? Such an investment, he proposed, would lead to “lower carbon happiness.”
The titular question Wayne asked at the beginning of his talk was “Can integrative medicine be a ‘prescription’ for both patients and the global environment?” His impressionistic tour of the potentially powerful reach of integrative practices as tools for limiting climate change leads to a power affirmative response. To put into operation these directions needs to be the business of a whole set of follow-up sessions such as leaders of the Veterans Administration are asking in their move toward a “whole health” model.
If the medical industry and Healthcare Without Harm fully engage limiting their contributions to harming the earth, they need to consider a leap this Grand Round prompts: promoting on integrative health model as their core mission. Harvard Medical School’s inclusion of “well-being” in its new mission is a good starting place. Another would be to push the population health recommendation with which the Benson-Henry group concludes their paper in which they found such astonishing reductions in conventional medical services – and thus of the medical “nation’s” contribution to climate change – thanks to a multimodal, group-based mindfulness interventions:
“The data suggests that mind body interventions should perhaps be instituted as a form of preventative care similar to vaccinations or driver education.”
We may require such a collective integative boost to change our collective habits. Wayne concluded his talk by proposing a slight but powerfully potentiating parenthetical amendment to the environmental movement’s famous call to action: “Think globally and act (extremely) locally.” Both individuals and medical organizations must embody this mission. I add the matter of fact mission through which the naturopathic doctors – whose dedication to the healing power of nature noted at the top of this article helped bind me to work in integrative medicine – fuse the integrative and environmental movements: “We treat disease by restoring health.”