Water, ecology and health: ecosystems as settings for promoting health and sustainability

Despite the proposed ecological and systems-based perspectivesof the settings-based approach to health promotion, most initiativeshave tended to overlook the fundamental nature of ecosystems.This paper responds to this oversight by proposing an explicitre-integration of ecosystems within the healthy settings approach.We make this case by focusing on water as an integrating unitof analysis. Water, on which all life depends, is not only anintegral consideration for the existing healthy settings (schools,hospitals, workplaces) but also highlights the ecosystem contextof health and sustainability. A focus on catchments (also knowas watersheds and river basins) exemplifies the scaled and upstream/downstreamnature of ecosystems and draws into sharp focus the cross-sectoraland transdisciplinary context of the social and environmentaldeterminants of health. We position this work in relation tothe converging agendas of health promotion and ecosystem managementat the local, regional and global scales—and draw on evidencefrom international initiatives as diverse as the WHO Commissionon Social Determinants of Health, and the Millennium EcosystemAssessment. Using water as a vehicle for understanding the systemiccontext for human wellbeing, health promotion and disease preventiondraws inevitable attention to key challenges of scale, intersectoralgovernance and the complementary themes of promoting resilienceand preventing vulnerability. We conclude by highlighting theimportance of building individual and institutional capacityfor this kind of integration—equipping a new generationof researchers, practitioners and decision-makers to be conversantwith the language of ecosystems, capable of systemic thoughtand focused on settings that can promote both health and sustainability.