| In the United States human health has traditionally | | | | expenditures on healthcare have exploded. The |
| been viewed in isolation from its ecological context. | | | | United States now spends over half of all the money |
| During my medical training and subsequent career in | | | | spent on healthcare in the world, the highest per |
| Emergency Medicine, issues such as climate change, | | | | capita of any nation, while representing only 4% of |
| habitat destruction, species extinction, pollution and | | | | the world's population. By contrast, Japan spends the |
| the depletion of fresh water supplies were treated | | | | lowest amount per capita on healthcare among the |
| as primarily environmental issues lying outside the | | | | industrialized nations of the world, while achieving the |
| realm of the medical industry. Equity has been seen | | | | best health indices. |
| as a primarily political, economic and social issue. | | | | Another very different society that employs |
| Sustainability was rarely considered. | | | | important aspects of an ecologically sound approach |
| I believe this view must be changed and that not | | | | to health is the nation of Bhutan, located in the |
| only physicians, but all Americans, have a responsibility | | | | Himalayan Mountains near Nepal. Although Bhutan |
| to effect this change. Achieving health requires that | | | | admits very few visitors in an effort to preserve its |
| we address all these elements in an integrated, | | | | cultural traditions, over the past two winters Mary |
| ecological approach. Our goal should to be "healthy | | | | and Phil of DeReimer Adventure Kayaking were |
| people, living in equitable and sustainable societies, in | | | | granted permission to lead groups of kayakers to |
| balance with the natural world". Ignoring any of these | | | | explore the rivers of Bhutan. I encourage you to visit |
| elements has profound and unacceptable | | | | their website at for details of their travels. |
| consequences. | | | | The importance of their experience from the |
| Few people have anticipated these consequences | | | | perspective of an ecological approach to health is |
| better than my biology professor at Stanford | | | | that the Bhutanese people, who are materially poor |
| University, Dr. Paul Ehrlich, considered by many to be | | | | by American standards, are comparatively physically |
| the father of American ecology. Winner of the | | | | and spiritually healthy. To paraphrase Mary and Phil, |
| Crafoord Prize, the equivalent to the Nobel Prize for | | | | "the definition of happiness in Bhutan is not "having |
| his pioneering work in the field of ecology, Dr. Ehrlich | | | | and getting", rather in their culture wealth has little to |
| delivered an extraordinary speech that was, in | | | | do with being happy. On the contrary, they believe |
| effect, an urgent call for an ecological approach to | | | | that desiring and wanting often cause suffering. This |
| health. I encourage you to click here to listen to this | | | | principle is an underlying motivator of behavior with |
| speech delivered in 1970. I think you will be amazed | | | | the result that their culture is open, loving, curious |
| at how contemporary and compelling it is today, | | | | and accepting. Their government pursues the "gross |
| nearly forty years later. | | | | national happiness" and to promote happiness the |
| I would argue, however, that one of the best | | | | government engages in implementing model |
| examples of the implementation of some of the | | | | educational, social and environmental programs that |
| elements of an ecological approach to health actually | | | | take into account the desire to protect the country's |
| anticipated Dr. Ehrlich's speech by several decades. As | | | | environment and cultural traditions." |
| a U.S. Army dependent, I traveled to Japan in 1946 | | | | The far off Kingdom of Bhutan and the concept of |
| with my family to spend three years as my father | | | | the "Gross National Happiness" may seem esoteric to |
| participated in the effort led by General Douglass | | | | many Americans. Nevertheless, over 400 respected |
| MacArthur to implement the Marshall Plan in Japan | | | | U.S. economists including Nobel Laureate Professor |
| after World War II. Although most Americans have | | | | Herbert Simon contend that it would actually be more |
| understood the Marshall Plan as a program of financial | | | | realistic and useful to substitute for our use of the |
| assistance, it is less well known that its approach was | | | | Gross Domestic Product (the total of all goods and |
| systems based, comprehensive and consisted of | | | | services produced) the measurement of the Genuine |
| three distinct components: Democratization, | | | | Progress Index, which attempts to measure the |
| Decentralization and Demilitarization. In order to | | | | quality of our lives. Comparing these measures during |
| implement the "three Ds", MacArthur took sweeping | | | | the period since the 1970s is revealing. While the |
| actions that affected every aspect of Japanese | | | | conventional GDProduct more than doubled, the |
| society. For example, his approach to Decentralization | | | | Genuine Progress Index declined 45% during this |
| reflected an understanding that the concentration of | | | | period. Measuring the GPI would have warned us |
| wealth and power in the giant family run industrial | | | | that, contrary to the many assurances to the |
| monopolies, the Zaibatsu, had played a crucial role in | | | | contrary, the U.S. economy was actually undermining |
| the genesis of Japanese fascism. These monopolies | | | | our health during this period. Not only was our |
| controlled the Japanese economy and had, among | | | | prosperity unevenly distributed and unsustainable, it |
| other things, eliminated labor unions. MacArthur | | | | was not performing its most important function. That |
| dissolved these monopolies and addressed their | | | | function is to support improvements in the health of |
| extreme concentration of wealth by imposing a | | | | our population. |
| minimum wage, a maximum wage and by | | | | Clearly, an ecological, scientific approach to health |
| redistributing the Zaibatsu's wealth. He also brought | | | | demands that we define what health is, how best to |
| about universal access to healthcare. The eventual | | | | measure it, and then promote the conditions that |
| result of these measures was the transformation of | | | | achieve it. If we do not do these things, it stands to |
| Japan from a nation with one of the largest gaps | | | | reason we will be unsuccessful in attaining health. We |
| between rich and poor and the worst health indices | | | | must recognize that health is more than just the |
| (longevity, infant mortality, etc.) in the world, into the | | | | absence of disease. On the contrary, it requires doing |
| Japan of today. Japan is now the nation with the | | | | things that actively promote it. It is not enough to |
| best health indices, and the smallest gap between rich | | | | attempt to correct the effects of doing things that |
| and poor in the industrialized world. | | | | destroy it. |
| Given the present challenges we face as Americans, | | | | At Mother Lode it is our continuing commitment to |
| let us consider what has happened in the United | | | | contribute toward this effort, one river based |
| States during this same period. While our nation was | | | | experience, one letter, one environmentally and |
| 5th in the world in 1950 in terms of health indices, | | | | socially responsible act at a time. We hope you will |
| and had a relatively small gap between rich and poor | | | | bring your ideas and suggestions, and help explore |
| and a growing middle class, these trends have since | | | | the possibilities. Remember, recreation is just that: |
| been reversed. Today our comparative health indices | | | | "re-creation", a process by which meaningful, |
| are no better than 21st, below all other developed | | | | constructive change occurs and a vital part of an |
| nations, Costa Rica and Cuba. The gap between rich | | | | integrated and ecological approach to health. |
| and poor in our country is now the largest in any | | | | See you on the river! |
| industrialized nation. During the same period our | | | | |