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Forging Links Between Holism, Integrative Health and the Environment: Is This the Time?

The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series

Summary: Scott Shannon, MD, president-elect of the American Board of Integrative Holistic Medicine (ABIHM) wants to see "ecological medicine" integrated into "the next iteration of holism." A fall conference co-sponsored by UCSF Osher Center and the Whole Child Center led by integrative pediatrician Larry Rosen, MD will explore "ecological health for the whole child." The Integrated Healthcare Policy Consortium is asking members of the integrative practice community if the organization should focus its energy on environmental issues. Something seems to be in the air, deepening the connection between.integrative medicine and these broader ecological themes. The connection is natural, but is this the time for these still young and resource-stretched organizations to be taking on new dimensions?

Recent integrative practice-related developments in certification, education and policy suggest that a stronger connection is presently being forged between integrative medicine, integrative care and the environment.

A strong connection with environmental thinking
I like this. In 1983 when I first became involved with these fields, my background as an activist on toxics issues and renewable energy attracted me to what I was learning about whole person healthcare. The naturopathic physicians with whom I began working educated me about their approach to enhancing what they called "the healing power of nature" or vis medicatrix naturae). Their practices promoted healthy diets and organic foods, created awareness of toxins, educated about the importance of using the least invasive approaches, and empowered people to take charge of their health. All aligned neatly with my politics and world view.

Yet I have some questions about some of the emerging efforts to deepen this connection at this moment.

One trend-sign came via Scott Shannon, MD, president-elect of the American Board of Integrative Holistic Medicine (ABIHM). In an interview in Explore, Shannon outlined priorities for this specialty certifying organization for MDs and DOs. Shannon would like to see "ecological medicine" integrated into "the next iteration of holism" for which ABIHM certifies physicians.

Shannon defines ecological medicine as "understanding the whole person in all the eco-systems in which they exist." These include "body, mind, spirit, community and environment."

Integrative pediatrician Larry Rosen, MD took up a similar theme when describing to me a one-day conference he is co-hosting this October 1, 2010. The meeting is entitled Children First: Promoting Ecological Health for the Whole Child. Rosen will soon take over as chair of the American Academy of Pediatrics Section on Complementary and Integrative Medicine. He says the conference "embraces a holistic, whole-child approach, specifically examining the context - the ecology - in which optimal health and wellness is promoted."

Environment in this whole-system view is not merely about toxins but includes numerous determinants of health.

Rosen: Exploring the ecology of health
Rosen's partners in the conference include the UCSF-Osher Center for Integrative Medicine, directed by former NIH National Center for Complementary and Alternative Medicine (NCCAM) deputy director Margaret Chesney, PhD. Chesney will be among the speakers, as will Wayne Jonas, MD, the former director of NCCAM's predecessor, the Office of Alternative Medicine.

The other partner in the conference is the Collaborative on Health and the Environment (CHE), an organization managed by Michael Lerner's influential Commonweal. CHE describes itself as a "diverse network of individuals and organizations working collectively to advance knowledge and effective action to address growing concerns about the links between human health and environmental factors." The CHE chair and a conference speaker is Phillip Lee, MD, former US assistant secretary of health and former UCSF chancellor. Lee is also speaking at this conference.

I encountered Shannon's priorities, Rosen's conference and Lee's involvement shortly after participating in a 10 question survey from the Integrated Healthcare Policy Consortium (IHPC). IHPC is striving to become a powerful policy influencer for the integrative practice community.

IHPC: Should it engage environmental issues?
This 501c4 lobbying organization is seeking input on the organization's next steps. (You can participate by clicking here.) Initial questions on the survey cover familiar ground. The next 4 focus on the connection between health and the environment. One asks whether IHPC should "move forward on environmental health" as part of the organization's agenda.

While the connection is not new, the action is, particularly for some connected to the integrative medicine field. The definition of integrative medicine used by the consortium of 44 medical schools with integrative medicine programs speaks of integrating therapies and practitioners. The role of the environment is not present. Nor is there reference to socio-economic-enviro determinants except perhaps as a part of a "focus on the whole person."

Yet the ecological connection is clearly a core value to much integrative medical thought. This rapidly became apparent in an open forum at the 2009 North American Research Conference on Complementary and Integrative Medicine led by David Rakel, MD. The plan for the session was to engage the audience in a dialogue on defining appropriate teams for medical homes. Yet the forum quickly moved its focus out of the clinical setting into the community, exploring educational, social and economic factors. Participants spoke of the importance of impacting public schools, agribusiness, advertising and the media. Talk tended toward the ecological determinants.

If such powerful ecological issues are fully embraced, the integrative health movement could transform into a kind of wholistic public health movement. Maybe this is good. Yet there may be some danger of loss of clinical and political identity. The ABIHM's 2008 transition to integrative -holistic from its original identity as the American Board of Holistic Medicine is only now being worked out. ABIHM is still working out how to play a significant role in academic integrative medicine. Only 1300 MDs and DOs have been board certified by ABIHM. Is this the time to add on new dimensions?

For the IHPC, the link with environmental issues could create powerful friends in the environmental movement. Many environmentalists don't yet make this connection to one's approach to heath and healing.

Yet IHPC may have its own timing issue. The organization is only now gathering the energy to powerfully represent integrative practices on the Hill. The Obama healthcare law created new opportunities and a ready made agenda. Is this the time for IHPC to be striking out on a new set of issues and allies?

Holistic and whole person and ecological thinkers tend to like the big picture. Sometimes this gets in the way of managing tasks at hand. The eyes, as my Dad used to say, can be too big for the stomach. My own bias is to see each of these organizations continue to focus, for now, on the perhaps more mundane work of fulfilling their present agendas exceptionally well.

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Resumes are useful in employment decisions. I provide this background so that you may understand what informs the work which you may employ in your own. I have been involved as an organizer-writer in the emerging fields......more