The Health of Ecology and the Ecology of Health

The health of ecology refers to ecosystem health—an extension of the concept of health to the ecosystem level. Health is reflected in the absence of distress syndrome, and by productivity, organization and resilience that characterize sustainability in the Earth's ecosystems. Transformation of ecosystems under stress from healthy to pathological conditions is often irreversible, even when the initial stress factors are removed. The ecology of health refers to the fact that human health is influenced by ecological conditions. The breakdown of ecosystems under stress are often conducive to an increase in human pathogens, recycling toxic substances, reduced yields and compromised food supplies, scarcity of potable water, and air pollution, all of which increases human health vulnerability. Addressing human health issues from an ecological perspective takes account of the social, ecological, and biophysical determinants. This opens the door to potential interventions “upstream”, in order to prevent illness, in addition to treating the disease once the malady has occurred.     

Self-Rated Health Trajectories in the African American Health Cohort

Background

Self-rated health taps health holistically and dynamically blends prior health histories with current illness burdens and expectations for future health. While consistently found as an independent predictor of functional decline, sentinel health events, physician visits, hospital episodes, and mortality, much less is known about intra-individual changes in self-rated health across the life course, especially for African Americans.

Materials/Methods

Data on 998 African American men and women aged 50–64 years old were taken from a probability-based community sample that was first assessed in 2000–2001 and re-assessed 1, 2, 3, 4, 7, and 9 years later. Using an innovative approach for including decedents in the analysis, semi-parametric group-based mixture models were used to identify person-centered group trajectories of self-rated health over time. Multivariable multinomial logistic regression analysis was then used to differentiate the characteristics of AAH participants classified into the different group trajectories.

Results

Four self-rated health group trajectories were identified: persistently good health, good but declining health, persistently fair health, and fair but declining health. The main characteristics that differentiated the self-rated health trajectory groups from each other were age, education, smoking, morbidity (angina, congestive heart failure, diabetes, and kidney disease), having been hospitalized in the year prior to baseline, depressive symptoms, mobility limitations, and initial self-rated health.

Conclusions

This is the first study to examine self-rated health trajectories separately among African Americans. Four qualitatively distinct self-rated health group trajectories were identified that call into question the accuracy of prior reports that a single, average self-rated health trajectory for African Americans adequately captures their within-group heterogeneity.