Ecohealth awareness influences investigators and their students to engage in ecohealth-related research projects, partnering with multiple stakeholders, including the affected communities. Indeed the ongoing planetary health crises affect the poor the most, and most of the existing ecohealth approaches focus on the global south. But, it is undeniable that the problems are escalating in scale and are increasingly co-occurring in every corner of the plant. Severe drought, flood, heat waves, forest fire, and the spread of vector-borne infectious diseases have become routine phenomena in Europe and North America. In this regard, people from low socioeconomic status, Indigenous backgrounds and people of colors, and people living in remote and rural areas are more disadvantaged. The cocktails of endocrine disrupting chemicals in human blood resulting in a steady decline in sperm counts and rising infertility and the recent discovery of nano-plastics in the blood of the European population are examples of putting commercial interest before public health and eventually exerting enormous financial burden on the health system. The study shows that the member countries of the European Union spend an additional 50 billion Euros on health care for the additional burden of illnesses due to endocrine-disrupting chemicals. The Millennium Ecosystem Assessment (MEA) represents a landmark attempt to link human health and well-being with conservation and more sustainable use of ecosystems. The MEA conceptual framework articulates the relationships between human health and well-being in our ecosystems. However, WHO’s International Health Regulations (WHO 2005) and Commission on the Social Determinants of Health (CSDH 2008) only peripherally addressed the contributions of ecosystems to health, despite their inclusion as part of the Millennium Development Goals (MDGs) and the links made in the MEA. Understanding how people and their health are related to ecosystems is very complex. However, involving medical communities in ecohealth is still very insufficient. Therefore, awareness of the transdisciplinary approach among medical learners has become a top priority in leading medical schools across the continent. The following section will briefly overview various methods to enhance the knowledge and skills about ecohealth.

1. System approach to assessing health risks and actions

Systems thinking considers the relationships among ecological, social-cultural, economic, and governance dimensions and helps apply some order to the complex reality of health in the context of social-ecological systems. For health professionals, systems thinking can lead to a better understanding of the limits of the problem, its scale, and its dynamics. The behavior of individuals in a household, and their interactions within groups in a community, may be determined by gender, ethnicity and culture, residence, and socioeconomic status. For example, the rapidly spreading urban sprawl to rural and forest areas may result in more exposure to ticks and disease-causing mosquitoes. These exposures might also be determined by socioeconomic, ethnicity, and cultural factors, such as preference and affordability to spend more time in outdoor activities, dress codes, and complexion. Thus systems thinking can lead to changes in policies and practices and health promotion activities. The health officials can team up with local veterinarians, town and park officials, family physicians, microbiologists, public health officials, local school district officials, tour operators, media, and prominent community members. The collective efforts will include regular entomological (tick) surveillance, case surveillance, identification of high-risk areas, notification to the public in parks and trails, and public awareness via media, schools, clinics, and tour operators.

1. A transdisciplinary approach to designing health care

A transdisciplinary approach integrates different scientific perspectives, community representatives, and other stakeholders’ knowledge about the health problem and ecosystem perspectives based on their experiences. A transdisciplinary approach while addressing ecohealth perspectives of any diseases will enhance innovations and design strategies to improve health care and environmental conditions in a sustainable, contextually appropriate way. The transdisciplinary approach also provides more opportunities to establish an acceptable process for discussion and negotiation among stakeholders pursuing a new understanding of a given health problem or situation. To achieve a practical transdisciplinary approach, health professionals must draw on a wide range of skill sets that are not usually part of their academic training, including consensus building, negotiation, communication, facilitation, and strategic planning. To lead a multi-stakeholder process, the health professional can develop a framework for group dialogue, social inquiry for development, multi-criteria evaluation for conflict management, and outcome mapping. For instance, endocrine disrupting chemicals wreak havoc worldwide, causing infertility, hypothyroidism, cancer, and poor immune responses – need the active involvement of family physicians, endocrinologists, obstetricians, and public health professionals, laboratory medicine, environmental toxicologists, and analytical chemists. While routine testing of EDCs for infertility and hypothyroidism patients, pregnant women, and infants can generate more substantial evidence of causal relations, eco-toxicological and epidemiological studies will give clear evidence of sources and existing risk factors. Eventually, the transdisciplinary team can play a decisive advocacy role in developing the right developmental policy, including case management protocol, antenatal care, banning or restricting the use of high-risk products, etc.

1. Ensuring sustainability in ecohealth approach

Any ecohealth approach will aim to make it ethical and positive, and its sustainability should be given priority. By sustainability, the initiative implies that these changes be environmentally sound, socially and culturally responsible and appropriate, and economically less burdensome. There may be the possibility of the initiative slipping back into previous negative patterns or relationships; any forms of setbacks or any new forms of problems may arise. The policymakers may face ethical quandaries when people’s short-term needs and priorities are inconsistent with a longer-term process for improving health and the environment. Therefore, ecohealth proponents should anticipate these dynamics and be prepared to learn from them. It is important to note that seeking sustainability is fundamentally challenging and maybe a very lofty goal, mainly when the health issues are complex, multi-sectoral, and multi-generational. For example, addressing food insecurity issues in the Indigenous communities cannot be solved by improving the supply chain and price control due to external factors that cannot be controlled at the local levels (such as global gas prices, poor yields in traditional food production areas). On the other hand, local food production can be a promising solution if scientifically sound. Still, it can only be sustainable if the initiative is participatory, provides economic incentives, and is based on equity and justice.

1. Gender and social equity as a foundation for an ecosystem approach

Any ecosystem approach to health should explicitly address gender and social equity and mainly focus on vulnerable groups in the society based on gender, age, race, ethnicity, socioeconomic conditions, occupation, habitat, and so on. Considerable evidence shows that the differences between members of different socioeconomic classes, ages, and ethnic or gender groups in all societies are reflected in their relationships with ecosystems, exposure to different health risks, health status, and well-being goals. Therefore, the health professionals who lead the ecohealth approach will not only address the existing social inequity affecting the health status of the vulnerable population but should make sure to reduce the gap in the process. Otherwise, any health promotion or disease prevention initiative can be ineffective or counterproductive. For example, imposing a sugar tax on packaged sweet beverages can be a novel approach to reducing obesity and chronic diseases. However, it can be financially challenging for the Indigenous communities living in remote locations without a clean drinking water supply. Perhaps, these communities are compelled to spend on sweetened beverages for drinking since bottled water is more expensive. Therefore, the sugar tax will put an additional financial burden on vulnerable communities.