A lot of Permaculture is about food production, at all scales from a backgarden to a big farm. The systems that we design respect the ethics ‘care for the Earth’ and ‘care for people’. These designed systems are assemblies of different agricultural and gardening strategies. The aim is to create edible and productive ecosystems that are in a dynamic balance, they don’t need the different artificial chemicals that are used in extensive agriculture and market gardening. We also design them to need lower energy inputs, such as diesel and labour, and to produce abundantly.
We calculate yields in terms of the number of people fed per hectare and good health is seen as an important part of total yield. We don’t see this being calculated in as a part of a yield in extensive agriculture nor the global food industry.
I wrote recently about the importance of ecosystemic thinking:
This approach is what guides us when designing a food production system and it is also essential when we turn our gaze to ‘caring for people’. Slowly but surely this paradigm change is spreading into mainstream medecine. An up-to-date dentist will tell us to avoid antiseptic mouthwashes as, in a similar way to broad spectrum pesticides, they kill off everything, the good and the bad. A healthy microbiome in the mouth will mean no gingivitus and caries. We are now told that the best way to cultivate a healthy oral microbiome is good diet, massaging the gums with a toothbrush and cleaning in between the teeth.
Despite all the advances in medicine over the last couple of decades, and in a similar way to extensive agriculture there is resistance to change. Doctors will still try and ‘nuke’ a problem with a range of medications, this is often either useless or damaging to the patients overall health. Take for example ‘pink eye’ which is conjunctivitis, the most common cause of this condition is a viral infection. In 2021 in the USA 72% of children suffering from pink eye were prescribed antibiotics when they visited their doctor’s clinic. This is strange as antibiotics don’t work on viruses and their use is counter to the advice given by The American Academy of Ophthalmology who point out that the condition usually clears up on it’s own. In fact the best treatment is a wet towel and ‘artficial tear’ eye drops. The use of antibiotics will completely upset the ocular microbiome and encourages the proliferation of antibitiotic resistant bacteria.
Another example home birthing. We have been frightened into accepting a highly medicalised and interventionalist approach to giving birth. Yet home birth in many places can be as safe as planned hospital birth. Women who give birth at home have a higher likelihood for a spontaneous labour. 20-60 per cent fewer interventions such as cesarean sections, epidurals and augmentation. 10-30 per cent fewer complications such as post partum bleeding and severe perineal tears.
Iatrogenesis is induced unintentionally by a physician or surgeon or by medical treatment or diagnostic procedures. In the USA it is estimated that the number of iatrogenic deaths are around:
12,000 due to unnecessary surgery
7,000 due to medication errors in hospitals
20,000 due to other errors in hospitals
80,000 due to nosocomial infections in hospitals
106,000 due to non-error, negative effects of drugs
So iatrogenesis may cause as many as 225,000 deaths per year in the USA.
The term was invented by Ivan Illich who contended that industrialised societies tend to mess up our quality of life by overmedicalising human conditions. This means that pharmaceutical companies and medical professionals have a vested interest in maintaining the conditions that make us ill.
There are valid uses for modern medicine, we can do things today that were unimaginable a few decades ago, this article isn’t attacking that. It’s about the misuse of pharmaceuticals to treat illnesses that are caused by the environments and our conditions of life.
Over the last few decades quite a few things have been abandoned, we once thought that life could be explained by biology which could be understood in terms of chemistry which itself could be explained in terms of fundamental physics. This sort of paradigm meant that we often asked the right question but of the wrong people. The quest for crop pest control was handed to chemists and not biologists, (scientific ecology didn’t really exist at the time as an established branch of science). We’ve got this insect pest, develop something which kills it. Ecologists today will point out that an abundance of a crop pest is a symptom of a lack of biological diversity and caused by an ecosystemic imbalance.
Bill Mollison's pointed this out quite succinctly "You don't have a slug problem, you have a duck deficiency,"
In the same way, medicine turned towards chemists and this is still too often the case. A microbe is the ‘pest’ and chemists are set the task of finding something which kills it. We seek a pharmaceutical ‘fix’ for conditions such as obesity whilst knowing that the causes can, in the main, be treated without recourse to medication. People with type 2 diabetes use a range of pharmaceuticals such as Metformin (Glucophage) yet intermittent fasting can reverse the condition quite effectively. “After an intermittent fasting diet intervention, patients achieved complete diabetes remission, defined as an HbA1c (average blood sugar) level of less than 6.5% at least one year after stopping diabetes medication”
This brings up another aspect of iatrogenesis which is what is called iatrogenic poverty. Over 537 million adults worldwide suffer from type diabetes, the medications are expensive leading low income housholds with an added financial burden. In the study above an added benefit was a reduction in the study population of their medical costs by 77%
The environments that we have created take a toll on our health. Living in cities may double the risk of schizophrenia and increase the risks of anxiety disorders (by 21%), mood disorders (by 39%), and depression (by 40%). Depression and anxiety disorders are commonly treated with medication yet there is increasing evidence that resistance training can reduce the symptoms and stop the need for medication.
It’s interesting to note that approximately 280 million people in the world have depression about 5% of the population. Depression is a non-communicable disease and these now make up 7 of the world’s top 10 causes of death, according to WHO’s 2019 Global Health Estimates. Cardiovascular diseases, cancer, diabetes and chronic respiratory diseases plus injuries. The causes of these NCDs are things like environmental conditions (pollution etc), living conditions (crowding etc) and what are called ‘lifestyle choices’. For example eating a diet lacking in fresh vegetables and fruit is seen as being a ‘lifestyle choices’. Yet in many urban areas there are ‘food deserts’ where access to healthy dietary choices is limited or non-existant even if the people could afford them.
Someone living in a ‘food desert’ has access to cheap (compared to fresh fruit and vegetables) ultra-processed foods. Marketing encourages said person to believe the hype that these transformed foods are a valid dietary choice. But there is a strong correlation between consumption of these foods and an increased risk of obesity, diabetes 2, hypertension, diabetes, and dyslipidemia.
An ecosystemic approach to caring for people wouldn’t prioritise finding a medication to treat a dis-ease. It would instead look at the entire environment, food, air, water, employment, inequity/poverty and all the other co-factors.
Mollison described this with his Stress and Harmony Principle: Avoid forcing unnatural functions onto elements. If you take an animal and subject it to living conditions very different to those to which it is adapted to, it will be stressed and will become ill. It’s the same thing for us.
The crop pests in the farmers field didn’t come in because they had a party invitation, they arrived because the artificial conditions suited them. In the same way 7 out of 1O of the top health problems are created by the systems that we have built and live in. Permaculture design seeks to address this in a joined up holistic manner, we are ill because we have created the conditons that lead us to ill-health. Change the conditions, make them ones to which we are more adapted and many of the causes ill-health will disappear.