Reflexos da saúde planetária no processo transdisciplinar entre profissionais de saúde / Reflexes of planetary health in the transdisciplinary process among health professionals

Resumo A saúde planetária vem se consolidando como área transdisciplinar do conhecimento, fundamentada na caracterização e mitigação dos impactos antropogênicos sobre a saúde do ser humano e dos sistemas terrestres. O estilo de vida em sociedades capitalistas impulsiona a degradação ambiental e suas consequências (como emergência climática e perda de biodiversidade), relacionando-se também à alta prevalência de doenças crônicas não transmissíveis. No entanto, essas questões não costumam receber a atenção necessária no processo de ensino e aprendizagem dos profissionais de saúde. Assim, este ensaio objetiva contribuir para sistematização das informações que correlacionam os fatores ambientais e a saúde humana na perspectiva do pensamento sistêmico, destacando a importância de se pensar a saúde sistêmica no âmbito das profissões da saúde. Observa-se que o profissional de saúde, sendo ponte entre o conhecimento científico e a sociedade, pode desempenhar os papéis de mediador do cuidado integral e curador do conhecimento. Além disso, é preciso incentivar o pensamento sistêmico no processo formativo em saúde para que esses papéis sejam alcançados, tanto em atitudes individuais quanto coletivas.

Abstract Planetary Health has been consolidated as a transdisciplinary area of knowledge grounded in characterizing and mitigating anthropogenic impacts on the health of human beings and earth systems. The capitalist lifestyle drives environmental degradation and its consequences (such as climate emergency and biodiversity loss), and is related to the high prevalence of chronic non- communicable diseases. This information, however, usually lacks the necessary emphasis in health teaching and learning process. Thus, this essay aims to systematize information that correlates environmental factors and human health from a systemic thinking perspective, highlighting the importance of reflecting on systemic health within health professions. As the bridge between scientific knowledge and society, health professionals can play the role of integral care agent and knowledge curator. Moreover, we must encourage systemic thinking in health education to achieve these roles, both in individual and collective attitudes.

Reescrever saúde global / Rewriting global health

Resumo O conceito de saúde global popularizou-se mesmo com suas origens sendo alvo de um escrutínio crítico: nomeadamente, suas origens na medicina colonial, suas ligações com a proteção do comércio internacional e da exploração capitalista, seus pressupostos orientalistas. Até que ponto o conceito é, ainda, adequado ou proveitoso? Será possível reescrever a saúde global de forma a reconhecer e contrariar as suas múltiplas violências? Reflito sobre a potencialidade do conceito de saúde global a partir de uma ética da escrita que pretende ser analítica (respeitante à sua capacidade para refletir as tensões sociais, a multiplicidade de experiências, as justificações e reivindicações dos atores, a opressão e o potencial não realizado); crítica (respeitante à sua capacidade de identificar a contradição entre aquilo que os arranjos sociais ostensivamente proclamam e o que produzem de facto); e política (respeitante ao seu potencial emancipatório e de reparação das injustiças históricas). Identifico cinco vertentes importantes para um esforço de reescrever o conceito de saúde global: o global como planetário; o global como coletivo; o global como público; o global como periférico; e o global como cotidiano.

Abstract The concept of global health has become popular even though its origins have come under critical scrutiny: namely, its origins in colonial medicine, its links to the protection of international trade and capitalist exploitation and its Orientalist assumptions. To what extent is the concept still adequate or useful? Is it possible to rewrite global health while recognizing and tackling its multiple forms of violence? I reflect on the potentiality of the concept of global health based on an ethics of writing that intends to be analytical (concerning its ability to reflect social tensions, the multiplicity of experiences, the social actors' justifications and claims, the oppression, and the unrealized potential); critical (concerning its ability to identify the contradiction between what social arrangements ostensibly proclaim and what they actually produce); and political (concerning its potential for emancipation and for the reparation of historical injustices). Five important aspects are identified toward rewriting the concept of global health: the global as planetary; the global as collective; the global as public; the global as peripheral; and the global as everyday.

Time to treat the climate and nature crisis as one indivisible Global Health Emergency

@#Over 200 health journals call on the United Nations, political leaders, and health professionals to recognise that climate change and biodiversity loss are one indivisible crisis and must be tackled together to preserve health and avoid catastrophe. This overall environmental crisis is now so severe as to be a global health emergency.

On the brink: The climate and nature crisis and risks of nuclear war

@#The Russian military invasion of Ukraine on February 24, 2022, and Hamas’ terror attack on Israel on October 7, 2023, signaled the beginning of two of the most recent wars to make international headlines. To date, over 110 armed conflicts are taking place: over 45 in the Middle East and North Africa (Cyprus, Egypt, Iraq, Israel, Libya, Morocco, Palestine, Syria, Turkey, Yemen, Western Sahara); over 35 in Africa (Burkina Faso, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Ethiopia, Mali, Mozambique, Nigeria, Senegal, Somalia, South Sudan, Sudan); 21 in Asia (Afghanistan, India, Myanmar, Pakistan, the Philippines); seven in Europe (Russia, Ukraine, Moldova, Georgia, Armenia, Azerbaijan); and six in Latin America (three each in Mexico and Colombia); with two more international armed conflicts (between India and Pakistan, and between India and China) in Asia.1 This list does not even include such problematic situations as those involving China and the South East Asia region. As though these situations of armed violence were not enough, mankind has already passed or is on the verge of passing several climate tipping points – a recent review lists nine Global core tipping elements (and their tipping points) - the Greenland Ice Sheet (collapse); West Antarctic Ice Sheet (collapse); Labrador-Irminger Seas / SPG Convection (collapse); East Antarctic Subglacial Basins (collapse); Amazon Rainforest (dieback); Boreal Permafrost (collapse); Atlantic M.O. Circulation (collapse); Arctic Winter Sea Ice (collapse); and East Antarctic Ice Sheet (collapse); and seven Regional impact tipping elements (and their tipping points) – Low-latitude Coral Reefs (die-off); Boreal Permafrost (abrupt thaw); Barents Sea Ice (abrupt loss); Mountain Glaciers (loss); Sahel and W. African Monsoon (greening); Boreal Forest (southern dieback); and Boreal Forest (northern expansion).2 Closer to home, how can we forget the disaster and devastation wrought by Super Typhoon Haiyan (Yolanda) 10 years ago to date? Whether international or non-international, armed conflicts raise the risk of nuclear war. Russia has already “rehearsed its ability to deliver a ‘massive’ nuclear strike,” conducting “practical launches of ballistic and cruise missiles,” and stationed a first batch of tactical nuclear weapons in Belarus,3 and the possibility of nuclear escalation in Ukraine cannot be overestimated.4 Meanwhile, in a rare public announcement, the U.S. Central Command revealed that an Ohio- class submarine (560 feet long, 18,750 tons submerged and carrying as many as 154 Tomahawk cruise missiles) had arrived in the Middle East on November 5, 2023.5 Indeed, “the danger is great and growing,” as “any use of nuclear weapons would be catastrophic for humanity.”

A pandemia de COVID-19 e o seu impacto à saúde planetária / The COVID-19 pandemic and its impact on planetary health

A pandemia de COVID-19 deu ao mundo uma imagem clara do que é uma crise multidimensional em escala planetária, revelando o papel central que ocupa o setor de saúde e as profundas desigualdades no acesso aos cuidados em saúde que existem entre os diferentes países, e dentro de cada um deles. Melhorar os efeitos ambientais do setor e reduzir as emissões de gases de efeito estufa pode não apenas melhorar a saúde de todos, mas também reduzir os custos com os cuidados em saúde. O setor de saúde de cada país libera direta e indiretamente gases de efeito estufa ao fornecer seus serviços e ao comprar produtos, serviços e tecnologias em uma cadeia de fornecimento de carbono intensivo. Educar os profissionais de saúde mais profundamente sobre os efeitos das mudanças climáticas pode levar a práticas clínicas mais sustentáveis, melhorando os resultados para os pacientes e fornecendo um impulso substancial para aumentar os esforços para reduzir as emissões de carbono. O setor da saúde deve assumir a responsabilidade por sua pegada climática respondendo à crescente emergência climática, não apenas prestando assistência aos doentes, feridos ou moribundos como resultado da crise climática e suas causas, mas também fazendo a prevenção primária e reduzindo drasticamente suas próprias emissões.

The COVID-19 pandemic has painted a clear picture of what a multidimensional planetary crisis is, revealing the central role played by the health sector and the deep inequalities in access to health care that exist between and within each country. Decreasing the environmental effects of the health sector and reducing greenhouse gas emission may not only improve people's health, but also reduce health care costs. The health care sectors around the world directly and indirectly release greenhouse gases by providing their services and purchasing products, services, and technologies within a carbon-intensive supply chain. Further educating health care professionals about the effects of climate change may lead to more sustainable clinical practices, improving patient outcomes and providing substantial impetus to increased efforts to reduce carbon emission. The health sector must take responsibility for its climate footprint by responding to the growing climate emergency not only by assisting the sick, injured, or dying from the climate crisis, but also by doing primary prevention and drastically reducing its own carbon emission.

Tobacco control measures in COVID-19 recovery: an opportune time to restore equity and planetary health

Tobacco intersects with the COVID-19 pandemic not only in terms of health consequences, but also environmental change and planetary health. Tobacco use exacerbates inequalities, causes catastrophic environmental degradation and climate change and adds burdens to COVID-19-related mortality, which are major challenges to recovery from the COVID-19 pandemic. However, the pandemic has provided a chance to combat tobacco use and accelerate efforts to alleviate these challenges in response. The MPOWER measures introduced by the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) can play a crucial role in COVID-19 recovery to fight tobacco use and contribute to sustainable and equitable development. To accelerate recovery, it is critical to call for actions for governments and policy-makers to strengthen synergies and coordinate policy actions emphasising tobacco control and cessation across equity, public health, and climate actions as global authorities pledge to achieve the Sustainable Development Goals (SDGs) and net zero emissions targets as part of the Climate Change Conference 2021 (COP26).

Saúde Baseada em Evidências e pandemias: dilemas sobre a Saúde Planetária e a decisão individual de impacto populacional / Evidence-Based Health and pandemics: Planetary Health dilemmas and the individual decision of population impact / Salud Basada en Evidencias y pandemias: dilemas de Salud Planetaria y la decisión individual de impacto poblacional

Durante a trajetória na prática clínica e na pesquisa, o médico, professor e pesquisador Airton Tetelbom Stein compreendeu que para ser um bom médico é necessário um embasamento científico aprofundado. Em entrevista à Reciis, Stein discute sobre o conceito de Saúde Baseada em Evidências (SBE) na sua relevância de integrar as melhores evidências com a experiência clínica e os valores e as preferências do paciente. A partir da sua experiência na Medicina de Família e Comunidade (MFC), Stein enfatiza que epidemias e pandemias, como a da covid-19, revelam o impacto das mudanças climáticas na saúde da população. Ressalta que um dos pilares da Atenção Primária à Saúde (APS) é o entendimento sobre as causas do surgimento das doenças no âmbito populacional. Nesse sentido, nas dinâmicas sociais, sobretudo as midiáticas acerca da covid-19, o pesquisador esclarece que as decisões sobre o tratamento precoce, sobre tomar ou não a vacina, dizem respeito à valorização de pressupostos baseados em informações não sistematizadas em detrimento de metodologias robustas, referem-se às decisões individuais que impactam na saúde da população. "As pessoas que têm se negado a realizar a vacinação precisam entender que isso não é apenas uma liberdade individual". Airton Tetelbom Stein é professor titular da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) e médico da família e comunidade do Grupo Hospitalar Conceição.

During his trajectory in clinical practice and in research, the physician, professor and researcher Airton Tetelbom Stein understood that, in order to be a good doctor, a deep scientific foundation is necessary. In an interview with Reciis, Stein discusses the concept of Evidence-Based Health in its relevance to integrate the best evidence with clinical experience and patients' values and preferences. Based on his experience in Family Practice, Stein emphasizes that epidemics and pandemics, such as covid-19, reveal the impact of climate change on the population's health. He also emphasizes that one of the pillars of Primary Health Care is the understanding of the causes of the emergence of diseases within the population. In this sense, in social dynamics, especially the mediatic dynamics about covid-19, Stein clarifies that decisions about early treatment, whether to vaccinate or not, concern the valuation of assumptions based on non-systematized information to the detriment of robust methodologies, refer to individual decisions that impact the health of the population. "People who have refused to vaccinate need to understand that this is not just a matter of individual freedom." Airton Tetelbom Stein is full professor of Public Health at the Federal University of Health Sciences of Porto Alegre (UFCSPA) and a family practice physician at Conceição Hospital Group.

Durante su trayectoria en la práctica clínica y la investigación, el médico, profesor e investigador Airton Tetelbom Stein comprendió que, para ser un buen médico, es necesaria una base científica profunda. En entrevista a Reciis, Stein analiza el concepto de Salud Basada en Evidencias (SBE) en su relevancia para integrar la mejor evidencia con la experiencia clínica y los valores y preferencias del paciente. Basado en su experiencia en Medicina Familiar y Comunitaria (MFC), Stein enfatiza que las epidemias y pandemias, como covid-19, revelan el impacto del cambio climático en la salud de la población. Destaca que uno de los pilares de la Atención Primaria de Salud (APS) es la comprensión de las causas de la aparición de enfermedades en el ámbito poblacional. En este sentido, en dinámica social, especialmente en los medios de comunicación sobre covid-19, Stein aclara que las decisiones sobre el tratamiento temprano, la decisión de vacunarse o no, tienen que ver con la valoración de supuestos basados en información no sistematizada en detrimento de metodologías robustas, se refieren a decisiones individuales que impactan en la salud de la población. "Las personas que se han negado a vacinarse deben comprender que esto no es solo una cuestión de libertad individual". Airton Tetelbom Stein es profesor de salud colectiva en la Universidad Federal de Ciencias de la Salud de Porto Alegre (UFCSPA) y médico de familia y comunidad en Grupo Hospitalar Conceição.

Global Health and Planetary Health: perspectives for a transition to a more sustainable world post COVID-19 / Saúde Global e Saúde Planetária: perspectivas para uma transição para um mundo mais sustentável pós COVID-19

Abstract The manuscript discusses interfaces between academic and practical fields of Global Health and Planetary Health, shedding light on some critical perspectives of cumulative and synergistic causes of global crises, and effects on health and food security, on human rights, on migration, and on environment. Concepts of Global Health and Planetary Health and the path for the Sustainable Development Goals -SDG in the context of the Syndemy of Global Crisis, in particular the COVID-19 pandemic, are presented. COVID-19 lessons highlight challenges of infectious diseases and pandemics of the crisis of food insecurity, and of climate emergency. The manuscript advocates for an innovative approach that simultaneously broader awareness of the interconnected problems and of their complex causes and calls for emancipatory knowledge to face urgent challenges for a transdisciplinary research agenda aiming to tackle enormous planetary problems brought by the Anthropocene. It calls for practical solutions, with examples of some nature-based. It highlights the need of a collective reflection on a viable path to promote changes for a more sustainable, equitable, and adaptive future, bridging gaps from Global and Planetary Health.

Resumo O manuscrito discute as interfaces entre os campos acadêmico e prático da Saúde Global e da Saúde Planetária, lançando luz sobre algumas perspectivas críticas acerca das causas cumulativas e sinérgicas de crises globais e seus efeitos na saúde e segurança alimentar, nos direitos humanos, na migração e no ambiente. São apresentados os conceitos de Saúde Global e Saúde Planetária, e perspectivas para os Objetivos de Desenvolvimento Sustentável (ODS) no contexto de uma sindemia de crises globais, em particular a pandemia de COVID-19, cujas lições lançam luz sobre os desafios relacionados às doenças infecciosas, crise de insegurança alimentar e emergência climática. O manuscrito defende uma abordagem inovadora que, simultaneamente, amplie a consciência dos problemas interligados e de suas complexas causas e fomente o conhecimento emancipatório para enfrentar os desafios urgentes de uma agenda de pesquisa transdisciplinar visando enfrentar os enormes problemas planetários trazidos pelo Antropoceno. Reforça a necessidade de soluções práticas, com exemplos de soluções baseadas na natureza, e de uma reflexão coletiva sobre um caminho viável para promover mudanças para um futuro mais sustentável, equitativo e adaptável, preenchendo as lacunas da Saúde Global e Planetária.

Anti-infective resources among the Philippine Melastomataceae: A scoping review of field studies with an integrated evolutionary and ethnobiological approach

Background@#Despite the mounting studies on the practical use of species of the pantropical family Melastomataceae, especially their medicinal utility, no attempt at compiling the diverse findings has been made to date. Moreover, most reviews of medicinal flora tend to focus more on the biomedical properties of the plants than their equally meaningful evolutionary and ethnobiological aspects. @*Objectives@#This review aimed to describe and synthesize the current knowledge from and trends in medicinal studies of locally relevant members of the Melastomataceae. Specifically, it sought to gather, select, assess, and analyze digitally available field studies about the anti-infective potential of the genera of the Melastomataceae that occur in the Philippines using a combined evolutionary and ethnobiological lens. @*Methodology@#Web-based search was conducted in EBSCO, Google Scholar, PubMed, ScienceDirect, Scopus, and local databases of medicinal ethnobotany for full and original research papers in Filipino or English. Studies were screened and assessed independently based on taxonomic reliability and ethnobiological methodology. Data were analyzed qualitatively using an integrated evolutionary and ethnobiological framework. @*Results@#Thirty-four ethnobiological studies comprising journal articles and theses that surveyed 41 localities and cultural groups from 12 countries were reviewed. Three Philippine native melastome species are used in treating potentially infectious conditions: Dissochaeta divaricata, Melastoma malabathricum, and M. sanguineum. Other genera native to the Philippines with congeneric species used for anti-infective purposes elsewhere are Medinilla, Memecylon, Osbeckia, and Sonerila. Indications with the most cross-regional consensus include cuts, wounds, and skin infections, diarrhea and dysentery, and buccal, respiratory, and urogenital infections.@*Conclusion@#This review revealed that Philippine native melastome genera and species are available for infectious disease mitigation and exhibit high use convergence across geographically and culturally divergent communities but remain untapped. Documenting medicinal flora in an area or community based on their evolutionary relationships and ethnomedicinal usage is significant not only in bioprospecting but more importantly, in preserving indigenous knowledge and natural patrimony, especially amid collapsing socioecological systems and emerging diseases.

The COVID-19 Pandemic and Planetary Health. A Critical Review of Epidemiology, Prevention, Clinical Characteristics and Treatments for Oral, Head and Neck Health Professionals. Do We Have a Roadmap?

Abstract Introduction Coronavirus disease 19 (COVID-19) is potentially the greatest global public health crisis of this century. This disease emerged as an outbreak of pneumonia of unknown cause in Wuhan, the capital city of the Hubei province in China, in December 2019. Otolaryngologists, head and neck surgeons and dentists are at an increased risk of occupational disease. Objective The present review summarizes currently published evidence of Covid-19 epidemiology, clinical characteristics, treatment and prevention. No proven effective treatments for this disease currently exist. Data Synthesis COVID-19 started from a zoonotic transmission event associated with a large seafood market that also traded in live wild animals, and it soon became clear that efficient person-to-person transmission was also occurring. Symptoms are varied, and not all patients develop all of them. Conclusion Social distancing seems to have been successful in several places in the world. However, this recommendation alone is not enough to contain the disease, and it is not a long-term solution. Large-scale testing by health professionals of representative samples of the population may give an estimate of the progression of the disease. Different treatments are under test and bring hope of a cure to the population. However, no current treatments (April 27, 2020) have been proven to be the key to success in the treatment of patients with COVID-19. Planetary health is a useful concept to understand the current drivers of this pandemic and to draw a roadmap for science and healthcare that may guide actions to fight economic depression and ensure a healthy recovery.

The post-pandemic museum in the Philippine context

@#In response to the global crisis brought about by the coronavirus pandemic, the Philippine government declared a countrywide State of Calamity, apart from imposing quarantines of different stringency across regions. As workplaces have been mandated to implement alternative arrangements, these major changes in turn have caused disruptions in, and called for adjustments to, business operations, with museums being among the affected. As museums are venues that store physical collections that call for physical presence and even the tactile involvement of audiences and visitors, their operations will have to be inevitably transformed post-pandemic, as are their visitors, whose mental health are likely to have been affected by the pandemic and resulting quarantine. Using the lens of crisis management, this paper analyzed the museums’ response to the changes brought about by the spread of disease and the resulting imposition of quarantine. Through a review of the responses of several Manila-based museums to the crisis, the paper assessed the readiness of the museums in creating appropriate and effective measures to manage decreased foot traffic and economic impact, among others. The paper asserts that various tactics were used as reactions, instead of proactive steps, to mitigate the effects of the pandemic to museums. The analyses are juxtaposed with degrowth initiatives, which may potentially address the economic issues arising from the pandemic. These initiatives may be of help in resolving the issue of collections management and curatorship, with a focus on the quality, rather than the quantity, of the museum’s collection and profits. Through postmodern and new museology theory, shifts from physical to virtual and other alternative modes of art experience are discussed as possible and effective solutions to this crisis. Overall, the paper aims to propose a revised model of operation that may be useful to museology in particular, and mental and planetary health in general.

The post-pandemic museum in the Philippine context

@#In response to the global crisis brought about by the coronavirus pandemic, the Philippine government declared a countrywide State of Calamity, apart from imposing quarantines of different stringency across regions. As workplaces have been mandated to implement alternative arrangements, these major changes in turn have caused disruptions in, and called for adjustments to, business operations, with museums being among the affected. As museums are venues that store physical collections that call for physical presence and even the tactile involvement of audiences and visitors, their operations will have to be inevitably transformed postpandemic, as are their visitors, whose mental health is likely to have been affected by the pandemic and resulting quarantine. Using the lens of crisis management, this paper analyzed the museum sector's response to the changes brought about by the spread of disease and the resulting imposition of quarantine. Through a review of the responses of several Manila-based museums to the crisis, the paper assessed the readiness of the museums in creating appropriate and effective measures to manage decreased foot traffic and economic impact, among others. The paper asserts that various tactics were used as reactions, instead of proactive steps, to mitigate the effects of the pandemic to museums. The analyses are juxtaposed with degrowth initiatives, which may potentially address the economic issues arising from the pandemic. These initiatives may be of help in resolving the issue of collections management and curatorship, with a focus on the quality, rather than the quantity, of the museum's collection and profits. Through postmodern and new museology theory, shifts from physical to virtual and other alternative modes of art experience are discussed as possible and effective solutions to this crisis. Overall, the paper aims to propose a revised model of operation that may be useful to museology in particular, and mental and planetary health in general.