Environmental leadership and advocacy: a call for whole systems healing.

A recent report in Lancet (Costello et al., 2009) describes climate change as the biggest global health threat of the 21st century. The authors note that this threat is a result of changing patterns of infection and insect-borne diseases, increased deaths due to heat waves, reduced water and food security, large-scale migration, an increase in extreme climate events, and increased vulnerability for poor communities-all caused by an increase in the earth's average surface temperature. The conclusions of the commission that produced the Lancet report mirror findings in Healthy Hospitals, Healthy Planet, Healthy People, a report by the World Health Organization and Health Care Without Harm (2009) that calls on the health sector to provide leadership in mitigating climate change by addressing issues in health care facilities such as energy efficiency; green building design; alternative energy generation; alternative fuels for hospital vehicle fleets; use of local, nutritious, sustainable food; reduction in waste; and water conservation. Nurses have a history of environmental activism and leadership going back to early nursing leaders such as Florence Nightingale. In Notes on Nursing (1926), Nightingale wrote about the importance of the internal and external environment and emphasized the impact of environmental factors such as air, light, food, sanitation, cleanliness, and water quality on health outcomes. The International Council of Nurses (1992), in a position paper on nurses and the natural environment, noted that the healthy lives of people depend ultimately on Planet Earth-its soil, its water, its oceans, its atmosphere, its biological diversity-all of the elements which constitute people's natural environment. By extension, therefore, nurses need to be concerned with the promotion, maintenance, and restoration of health of the natural environment, particularly with the pollution, degradation, and destruction of that environment being caused by human activities. The American Nurses Association's Principles of Environmental Health for Nursing Practice With Implementation Strategies (2007 ) is a bold call to action that notes the crucial role of nurses in assessing and addressing environmental health issues. The principles address the importance of nurses having knowledge of environmental health concepts and relevant and timely information about potentially harmful products, chemicals, pollutants, and hazards to which they are exposed. It calls on nurses to use the precautionary principle to guide their practice-to use products and practices that do no harm to human health or the environment and to take preventive action in the face of uncertainty. Issues such as climate change and chemical pollution have numerous direct and indirect impacts on the health of individuals, communities and the environment, and demand leadership and advocacy that is based on a whole systems healing perspective. Whole systems healing draws on the principles of wholeness and complexity in addressing problems and issues that require more than simple cause-and-effect analysis-in reality, most problems today. It is based on the understanding that the health of individuals, communities, and the environment are inextricably linked. Application of whole systems thinking and healing requires the ability to apply knowledge and skill in many areas including: * Complexity science-chaos theory * Social network theory * Gentle action (strategic implementation of highly coordinated, low-intensity actions) * Sustainability and stewardship * Social change theory * Disruptive innovation * Reflective-contemplative practices including mindfulness * Social entrepreneurship * Intention and intuition * Interpersonal relational practices: deep listening, presence, circle-council practice, Bohmian dialogue * Restorative justice, including social justice and environmental justice * Creativity Within a whole systems healing framework, new methodologies and strategies draw on the key concepts noted above. …