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This is the accepted version of the following article: What Are We Thinking? A Call for
Integrative Healthcare to Consciously Serve Planetary Health which has now been formally
published in final form at Journal of Integrative and Complementary Medicine at
https://doi.org/10.1089/jicm.2023.0518. This original submission version of the article may be
used for non-commercial purposes in accordance with the Mary Ann Liebert, Inc., publishers’
self-archiving terms and conditions.
Title: What Are We Thinking? A Call for Integrative Healthcare to Consciously Serve Planetary Health
Authors:
Aterah Z. Nusrat, MSc., DIC
Director of Integrative Medicine and Planetary Health Programming
Osher Center for Integrative Health at Harvard Medical School and Brigham and Women’s Hospital
*Corresponding author
Email: anusrat1@bwh.harvard.edu
Christine Vatovec, PhD*
Planetary Health Program Director, Osher Center for Integrative Health
Fellow, Gund Institute for Environment
University of Vermont
Email: Christine.Vatovec@uvm.edu
Brenda M. Loew, DAOM, AEMP/L.Ac., Dipl. Ac.*
Osher Center for Integrative Health, University of Washington
Email: brenloew@uw.edu
Janet R. Kahn, PhD, LMT
University of Vermont
Email: jkahn@igc.org
*These two authors contributed equally to this work.
Short Running Title: A Call for Integrative Healthcare to Serve Planetary Health
Keywords: Planetary Health, Living Systems Thinking, Land-based Peoples, Interdependence, Paradigm
Shift, Symbiocene
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What Are We Thinking? A Call for Integrative Healthcare to Consciously Serve Planetary Health
Introduction
The health of people and planet are inextricably linked yet we continue to live as though this is not
true.1 Feedback loops between the impacts of human activity, and ecological and planetary systems are
increasingly reinforcing each other.2 The impacts show up in both scale and place: geopolitical instability
and violence, socio-economic disparity, environmental degradation, biodiversity loss, climate
destabilization, the list goes on.
The term ‘planetary health,’ which has gained mainstream traction in the past decade, asserts that the
health and wellbeing of people and planet are interrelated, omnidirectional and essentially indivisible.
This understanding of interdependence has been, and remains, the view held by many place-based
indigenous cultures around the world.3 Unfortunately, the Western reductionist way of thinking is
disconnected from this highly relational worldview.4
Integrative healthcare, which is the active collaboration between biomedical and holistic providers,
seeks to serve patients holistically. In this paper, we argue that as humans, we need to change how we
think, and adopt a worldview based on interrelatedness to address the interlocking crises facing our
global community. Below, we explore how integrative healthcare can help us make such a profound
shift in worldview. We take the U.S. healthcare system as an example of how such a change in
perspective could produce positive health outcomes for both people and planet.
The Current Reductionist Paradigm is Delivering Fragmented Healthcare
Modern mechanistic science has perpetuated a reductionist worldview where everything can be
reduced to the sum of its parts. Our dominant operating framework largely focuses on dissectible,
fragmented problems and mechanical procedures, rather than the complex web of interconnected
relationships. Such frameworks (and institutional structures) cannot solve the enormous,
interconnected challenges noted above.
The U.S. healthcare system accounts for 17% of national Gross Domestic Product (GDP). We have the
world’s highest per capita healthcare expenditures, at nearly twice the average cost of care among peer
members of the Organisation for Economic Co-operation and Development (OECD).5 Unfortunately, this
high level of spending does not equate to better health outcomes. Compared to our peers, the U.S. has
the lowest life expectancy and highest rate of disease burden despite the resources we pour into the
healthcare system.6 This trend shows up in countless other metrics including increased rates of infant
and maternal mortality, mental health issues, and Type 2 diabetes. The U.S. healthcare sector also
accounts for 8.5% of the country’s greenhouse gas emissions, with hospital care, physician and clinical
services, and prescription drugs being the main contributors.5
The current U.S. model of conventional healthcare, treating disease through symptom management, is
not working for people or the planet. Incremental policy changes and new program initiatives shaped
largely by reductionist frameworks will inevitably continue to deliver fragmented results. A worldview
based on human and planetary interrelatedness could improve many of these adverse health outcomes
while reducing environmental degradation.7
Definitions of Health Evolve Based on our Worldview
In 1948, the World Health Organization’s (WHO) Constitution defined health as “a state of complete
physical, mental and social well-being, not merely the absence of disease or infirmity.” That same year
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the Hippocratic Oath was updated by the Geneva Convention to include ethical principles for the
medical profession.8 In 1980, Friends of the Earth expanded and enhanced the WHO definition by
introducing the concept that personal health involves planetary health.3
In 2020, there were calls to further update the Hippocratic Oath to include safeguarding the health of
the planet upon which human wellbeing depends.8 In addition, Whole Health and Whole Person Health
frameworks, currently championed by the Veterans Health Administration (VHA) and the National
Institutes of Health’s National Center for Complementary and Integrative Health (NCCIH) respectively,
are ushering in more biopsychosociospiritual systems and values-based health care models that include
the environment as influential to human health. The NCCIH’s current strategic plan also supports shifting
healthcare research from a historical overemphasis on analysis to synthesis to see the whole person and
our constituent ‘parts’ in context.9 Furthermore, at the time of writing, there are signals from NCCIH
leadership that ‘spiritual health’ needs to be factored into whole person health research. While these
developments are encouraging, current operating medical frameworks regarding health and wellbeing
still largely focus on human health in isolation. To truly support the flourishing of human health we need
to fully embrace planetary health as foundational for all life.
Worldviews Centering Interdependence
Quote: “When we try to pick out anything by itself, we find it hitched to everything else in the universe.”
John Muir, My First Summer in the Sierra, 1911, The Riverside Press Cambridge
Quote: “I was looking for an English word to describe our deep interconnection with everything else… To
inter-be and the action of interbeing reflects reality more accurately. We inter-are with one another and
with all life.” Thich Nhat Hanh
As humans, we need to see ourselves as one of the many inter-related species co-existing across all
watersheds, foodsheds, and ultimately ‘lifesheds’ which encompass all place-based needs for
flourishing.10 This calls for a profound shift to an eco-centric perspective and subsequent reorientation
of self to the world.7 Adopting this orientation will be as significant as the Copernican Revolution that
displaced Earth from the center of the universe, and will help lead us out of the Anthropocene and into
what some are calling the Symbiocene, defined by ‘companionship and mutual benefit’.11
Today, Integrative Medicine can be a vehicle to support this transition. The origins of Integrative
Medicine can be traced, in part, back to patient and healthcare provider contact with indigenous place-
based cultures, Ayurveda and East Asian wisdom traditions.
The values, spirituality and culture of Indigenous land-based Peoples are guided by the holistic,
contextual, non-linear and symbolic nature of the interrelationships tied to place.7 This way of knowing
is an expression of Living Systems Thinking, based on dynamic, nested patterns of complex adaptive
relationships and processes of organisms within their environments. It is characterized by connection,
reciprocity, place and emergent complex systems that lead to interdependent, restorative and
regenerative living systems.12
“Indigenous Peoples – and long-standing, place-based communities – manage over 24% of land, which
contains ~40% of all ecologically intact landscapes and protected areas left on the planet, and a
staggering ~80% of the world’s biodiversity. In short, evidence suggests that the most intact ecosystems
on the planet rest in the hands of people who have remained close to nature.” 4
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Likewise, for over 2,000 years, East Asian healing systems have focused on balance and harmony
between mind, body, spirit and natural environment as essential to maintaining health, happiness and
wellbeing.
These traditional approaches, grounded in worldviews of wholeness and inter-relatedness, have sown
seeds and sprouted in Western health care. Their influence shows up in integrative therapies supporting
physical, psychological and emotional wellbeing.
Conclusion: Positioning Integrative Health in Service of Planetary Health
Health professionals have historically been trusted members of the community. When the patient-
provider relationship is infused with mutual respect, it becomes a crucible for healing and flourishing.
Integrative health professionals have the opportunity and indeed responsibility to adopt and work from
a worldview based on interrelatedness. This stance, in and of itself, can help counter the fragmentation
in conventional U.S. healthcare.
Integrative therapies including mindfulness practices, self-compassion, somatic healing, nutrition and art
and music therapy, to name a few, offer a doorway to self-awareness and inner resilience and support
greater integration with community and environment. Indeed, studies have demonstrated that certain
mindfulness practices lead to more pro-social and pro-environmental behaviors.13
By empowering individuals with appropriate integrative therapies to support their own health in mind,
body, and spirit, increased personal agency and expanded boundaries of self can extend to caring for
other people, species and our planet.13 By shifting the model of ‘healthcare’ from disease management
to supporting wellbeing, integrative approaches can prevent or retard the onset of disease, thereby
helping keep people out of hospitals. Through buoying individual self-efficacy and wellbeing with
integrative therapies, we can also reduce the need for higher energy intensive pharmaceutical and
hospital interventions, thereby reducing the ecological footprint of the current U.S. healthcare system
on the planet.14
Shifting our concept of health and wellbeing, while contingent on our contemplation, needs to be
supported by system-wide change through collective action in our practices, medical institutions and
informed by place-based policies. One practical way to start seeding such a deep change is by
prescribing therapies that help deepen a sense of connection to place. Nature-based therapy is one such
example that strengthens relationships between individuals and ecological communities and supports
our innate biophilia, or ‘love of life.’ Indeed, allopathic physicians are increasingly prescribing, with good
results nature therapy to support wellness through pathways such as park prescriptions and forest
bathing (Shinrin-Yoku).15
To conclude, integrative therapies can open doors to greater self-knowledge and allow our inherent
non-separate nature of being to imbue our consciousness, changing our relationships to self,
community, and planet.
If we truly want to leave behind conflict-ridden and self-serving drivers fueling our international,
institutional, and individual spheres of activity, the most important action we can each take is to shift
our own way of thinking and being from one based on separation and self-interest, which perpetuates
division, to one based on interrelatedness and community which engenders cooperation.
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Acknowledgments
The authors thank the members of the Osher Collaborative Planetary Health Working Group and Drs.
Peter Wayne and Helene Langevin who generously shared their time in reviewing and providing
feedback on earlier drafts of this work.
Authorship Contributions: Aterah Nusrat: Conceptualization, Project Administration, Writing Original
Draft; Christine Vatovec: Conceptualization, Writing Original Draft; Brenda M. Loew: Conceptualization,
Writing Original Draft; Janet R. Kahn: Conceptualization, Writing Original Draft.
Author Disclosure: The authors declare that they have no disclosures.
Funding Statement: The authors declare that no funds were received to produce this work.
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