Health Ecology

Since its founding, the World Health Organization (WHO) has set the goal of ensuring the highest possible level of health for all populations. Despite the general increase in well-being, there has been a rise in chronic diseases, once considered marginal, which are now treated with increasingly effective medicines. At the same time, the causes of these diseases have been identified, as well as the behaviors and lifestyles that preserve health.

However, the increase in life expectancy has not translated into a proportional increase in healthy life years. Chronic diseases are not only responsible for the rise in days of illness but also for the current crisis facing medicine in developed countries.

In this context, health ecology emerges as a new scientific discipline focused solely on preserving health rather than curing diseases. By using diseases as indicators of true human and social progress, this discipline seeks a proactive approach to calculate the healthy life expectancy associated with every individual, social, or systemic choice. Its aim is to enable informed decisions in real-time and identify best practices for long-term well-being at both individual and societal levels.

                                            

 Curing Diseases or Preserving Health?

The World Health Organization's objective is to achieve "the highest possible level of health for all populations," defining health as "a state of complete physical, mental, and social well-being," not merely the "absence of disease or infirmity."

In Italy, the increase in life expectancy has led to an average Life Expectancy (LE) of around 83 years. However, when considering Quality Adjusted Life Years (QALY), a significant portion of this lifespan is affected by illness, as the years lived in full health (Healthy Life Years - HLY) amount to only 65. Despite the notable extension of life, we are not approaching the ambitious global health goals outlined by the WHO (1).

 Since the extension of life has not been accompanied by a corresponding increase in healthy years, many studies have focused on the possibility of increasing just the healthy years. Over the last century, our environment has undergone profound changes, leading to a rise in chronic diseases, often referred to as "diseases of affluence," as they are commonly linked to lifestyle changes brought about by technological advances, such as sedentary behavior and an overly rich diet. These diseases cannot be cured by medicine, which instead aims to limit their damage (2).

 The potential for chronic diseases to have a devastating impact on developed nations was already noted in the late 1980s. This concern led the WHO, in 2005, to launch the global project "Preventing Chronic Diseases: A Vital Investment. (3)" Consequently, Europe initiated the "Gaining Health" program, focusing on the prevention and control of chronic diseases, which was approved and implemented in Italy in 2007. Despite institutional efforts and widespread media coverage (4), no tangible goals have been achieved, and the current situation is worse than initially predicted.

 Clinical trials exploring how to improve health have highlighted the preventive potential of healthy habits. A landmark study is EPIC (European Prospective Investigation into Cancer and Nutrition), which showed that a healthy lifestyle can not only prevent cancer but also chronic diseases, extending healthy life expectancy by more than 14 years (5). Therefore, while the increase in life expectancy is primarily attributable to advances in medicine, the extension of healthy life is closely tied to lifestyle choices.

 Once disease sets in, it is theoretically always possible to adopt a healthier lifestyle. However, statistics show that few people succeed, and lifestyle changes do not equate to prevention. Whether it’s dieting or quitting smoking, these decisions are often temporary and yield only partial results.

 Even the COVID-19 pandemic has further highlighted the importance of lifestyle. Comparing data from Italy, Japan, and Bulgaria—the country with the lowest mortality rate in the world and the European country with the highest mortality, respectively—it emerges that nations with higher life expectancy in good health generally recorded lower contagion, morbidity, and mortality rates than those with less healthy habits, regardless of the severity of emergency measures (6).

 The evidence that has driven developments in basic medical research over recent decades led, in 2011, to a new definition of health as "the ability to adapt and self-manage in the face of social, physical, and emotional challenges" (7). This conception emphasizes the active role of individuals in maintaining their well-being, viewing disease not as a random event but as the result of behaviors and choices, both individual and social, as well as environmental conditions.

If lifestyle determines health, and diseases evolve according to how people live in different historical periods, certain indicators take on new meaning. Symptoms are no longer just manifestations of illness but signal a breakdown in resilience, an imbalance in the individual's ecosystem. In chronic diseases, this imbalance suggests the need to change behaviors. On a societal level, diseases reflect the overall functioning of a system, revealing its capacity to adapt to environmental and global ecological equilibrium. Therefore, diseases can be used as indicators of ecosystem quality.

 Every scientific discipline operates based on the goals it sets. Medicine's primary aim is to cure diseases, and even when it pursues other objectives, it remains faithful to this goal. For example, preventive medicine focuses on the use of drugs like antihypertensives, cholesterol-lowering agents, and antidiabetics, along with screenings and early diagnosis. However, neither medications nor early diagnosis fit within a positive vision of medicine that views disease as a failure to be avoided.

Currently, there is a need for a scientific discipline exclusively dedicated to health preservation, grounded in solid and rigorous principles. This new discipline, called health ecology, aims to estimate healthy life expectancy through a comparative analysis of the effects of lifestyle choices on healthy and ill individuals. The approach seeks to evaluate the impact of individual, social, and systemic decisions in real time, rather than retrospectively assessing their consequences.

 Health ecology, relying on retrospective studies, statistical-epidemiological comparisons, and the laws of ecology, aspires to achieve a higher scientific rigor compared to traditional medicine, offering a preventive and proactive approach to health management.

 References:

1. Report on Indicators of Equitable and Sustainable Wellbeing. (2024). Available at: https://www.dt.mef.gov.it/export/sites/sitodt/modules/documenti_it/analisi_progammazione/documenti_programmatici/Relazione-BES-2024_finale.pdf .

2. The OECD. (n.d.). Health status - Potential years of life lost - OECD Data. [online] Available at: https://data.oecd.org/healthstat/potential-years-of-life-lost.htm.

3. World Health Organization. (2005). Preventing chronic diseases: a vital investment: WHO global report. [online] Available at: https://iris.who.int/bitstream/handle/10665/43314/9241563001_eng.pdf?sequence=1&isAllowed=y.

4.Editorial: Preventing chronic disease: a forthcoming initiative. The Lancet Vol 370 August 25, 2007

5. Khaw, K.-T., Wareham, N., Bingham, S., Welch, A., Luben, R., and Day, N. (2008). Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC-Norfolk Prospective Population Study. PLoS Medicine, 5(1), p.e12. doi:https://doi.org/10.1371/journal.pmed.0050012.

6. Università Cattolica del Sacro Cuore. (n.d.). Le morti da Covid-19 nel 2021: un confronto internazionale. [online] Available at: https://osservatoriocpi.unicatt.it/ocpi-pubblicazioni-le-morti-da-covid-19-nel-2021-un-confronto-internazionale#:~:text=e%20Gibilterra%20(Tav.-.

7. ResearchGate. (n.d.). (PDF) How should we define health? [online] Available at: https://www.researchgate.net/publication/51523299_How_should_we_define_health.