Frustrated that conventional medicine had little to offer many of her patients, Daphne Miller, a practicing physician and professor of family medicine at the University of California at San Francisco, decided to take a look at how human health is affected by other natural systems. This led her on a journey of family farms, where she wandered through henhouses, carted produce, and dug in the dirt.
Miller’s findings, gathered in her book, transformed her thinking about stress, resilience to disease, and how a systems thinking approach in the medical community could save money and enhance people’s health. The lessons she found hold insights for the health of business too. Can companies use the vital signs of farms to measure their own wellbeing? And how do externalities help drive greater sustainability?
Why should a doctor think like a farmer?
Agriculture has everything to do with medicine. In fact, I’ve come to see the divisions between the two disciplines as mostly artificial and arbitrary, and am now convinced that a farm internship should be a required part of medical training, and vice versa.
First, there’s the direct connection between the farms where our food is grown and our bodies. Many of us are familiar with the headline-catching links between industrial farming and our physical health: superbugs spawned on large-scale dairies and cattle operations that threaten to infect us, or the chemical runoff that contaminates our drinking water. But beyond these issues, we pay little attention to how decisions made on a farm, [for instance] the choice of seed [or] soil management, positively or negatively affect our bodies.
My time spent learning from farmers and researchers has made me think beyond food as medicine to farm as medicine. I’ve learned how healthy soil can produce a healthy immune system, how microbes on the farm can communicate with our resident microbes – our microbiome – how certain grazing practices can produce food that stress-proofs our nervous system, how the terroir in which an herb is grown can influence its medicinal value, or how inner-city farming delivers unexpected health benefits to the surrounding community.
I also discovered that farming at its best offers a radically new way to think about health and healing. For example, the integrated pest management approach used by a winery in Sonoma gave a group of oncology researchers a more ecological way to understand and treat cancer.
Of two organic egg farms, you say that the one with higher production is the less sustainable. What does this tell us about hidden costs?
The farms taught me how we value short-term productivity at the expense of overall health. The conventional egg farm has higher laying rates and the hens produce larger eggs than the neighboring pasture-based egg farm. But when you take a whole host of factors into account, such as egg taste and quality, market price, fossil fuel inputs, worker health, hen health and environmental health, you realize that pasture-raised is the healthier, more sustainable option.
I often see this thinking applied to human productivity. Many of my patients work for companies where the work ethic is one of intense competition, with 60-80-hour work weeks, all in the name of greater annual profits. They tell me they rarely take vacations and wouldn’t dream of exercising during their lunch break, as that would be interpreted as a lack of dedication to their job.
These patients mortgage their health in order to maximize their work performance and their revenue; they pull all-nighters, skip meals, eat food that offers fuel but few nutrients, use caffeine to stay awake and then alcohol to go to sleep, and rarely move their bodies except to hop on a plane or walk from desk to car. This approach is not sustainable and eventually leads to chronic health problems, including high blood pressure and blood sugar, weight gain, depression, anxiety and sleep apnea.
Not surprisingly, newer research is showing that this is as unhealthy for businesses as it is for individuals. Maximally taxing employees translates into lower work performance and, in the long term, less financial success.
You make an analogy between factory farming and factory medicine. What are the implications for managing healthcare costs?
Eighty percent of health expenditures in the US are spent within the four walls of a medical institution, and they are spent treating disease. This is consistent with the factory model: consolidate and streamline your efforts for maximal impact. But farm health and human health are not just a matter or treating disease, just as business health is not just a matter of tackling problems. I would argue that in all these sectors our money is much better spent on nurturing our environment – our air, our soil, our social institutions, our educational resources – than on fixing end-stage problems.
You say your farm odyssey gave you a new understanding of “vital signs”. Can you explain?
I was fascinated to learn what farmers consider the “vital signs” of a healthy farm ecology: diversity, synergy, and redundancy.
Diversity means not just variability in crops, but also in the populations of microbes and other life forms on the land. Synergy – the whole being greater than the sum of the parts – is why a given farm’s success cannot be predicted simply by looking at its discrete components. Redundancy, or self-sameness, describes the emergence of specific designs within each organism and throughout an entire ecosystem. Recurring patterns are a sign of a system’s resilience: in the event of a failure, one part can provide backup.
These vital signs – diversity, synergy, and redundancy – are rarely discussed within medicine, but I now see them as helpful ways to describe a healthy human. My friends in business who’ve read Farmacology tell me that these same vital signs have given them a useful way to assess the health of their company.