The EARTH Framework - a tool for evaluating health practices
There was a time in my life when I thought that the only thing that stood between the vision that I had of all people being able to have and access to individualized, integrative holistic care was the evidence base to prove that, indeed, these interventions did work.
This is why I spent a few years in my early career learning about and conducting medical research in integrative therapies. I thought that if we only had the studies showing that turmeric helped with arthritis [1] or peppermint oil with IBS, or that it was more cost-effective to offer an integrative clinic-based approach to low back care vs a standard clinic approach [2] then more people would have access to these supplements and services because insurance companies would need to pay for them.
I soon realized that there is rarely any such thing as a definitive study, especially in the area of integrative medicine. Even when studies are consistent and clear in their conclusions, there are almost always critiques of the smallness of the study, the lack of long-term outcome data or the lack of a proper comparison group. Thus, uncertainty about the best or most effective treatments persist - these questions often remain unanswered because research is expensive. There is very little, if any, money to be made in finding out that, for instance, a meditation-based approach to chronic insomnia is as effective as the latest sleep medication (a research study that I was involved in). [3]
These challenges are not isolated to the study of Integrative and Holistic Therapies. They pervade the research enterprise.
Much has been written about the high risk of bias in many medical study designs and the likelihood that many of the conclusions drawn by the medical research literature are false. [4,5]
While I recognize the potential benefits of systematic evaluations of integrative therapies. I also realize the limitations of clinical research and evidence-based medicine alone to dictate what is available to all of us within the heal(ing) care system that so many of us seek. A system rooted in a broad and holistic conception of health, one that is equitable, offers choice and is planet-friendly.
I agree that any new and experimental treatment should be guided by a precautionary principle [6] where there is due diligence to assess its safety and effectiveness before recommending and making it widely available. I also believe that many health-supporting practices have been unnecessarily lumped in with this same biomedical research approach. Why do I say unnecessarily? Because often these are practices that generally have little to no risk of harm and may often have a long history of use within various cultural healing systems.
At Sankofa Healing Arts & Functional Medicine, one of the guiding principles in the work that I do and the services I offer is to increase the knowledge and understanding regarding many simple but effective healing practices and technologies.
The concept of Sankofa (a symbol of the West African Akan people) refers to the teaching that it is important to “go back and get that which is at risk of being left behind”. What are we at risk of leaving behind? The ways in which health is supported by simple and sustaining everyday practices. While I would be remiss if I did not mention that capitalism can ensure that so many of us have diminishing amounts of space and time for some of these health-giving practices to know what we need to prioritize and organize around creating space for in our lives, first requires reconnecting with the knowledge of how important they are.
With this in mind, I created the E.A.R.T.H. Framework, a tool I developed for evaluating health practices. I will use this tool to assess and share information about various health-supporting practices. In addition to looking at individual health benefits, this tool also incorporates information about the ecological impacts and ancestral roots of practices.
What follows is a brief overview of the elements of this framework.
Ecological
Guiding question: What are the potential planetary impacts of the practice?
More and more medicine has to reckon with its role in climate change. Planetary health must be centered as we look at supporting and uplifting practices that benefit our well-being. It is all connected.
Ancestral
Guiding question: What do we know about how or if aspects of the practice are embedded in traditional/indigenous cultural practices?
Indigenous healing practices have often been appropriated. For any practice(s) we may choose to adopt, we continually seek to learn more about its indigenous origins. Many practices have resonance and similarities across cultures. We take this replication and cross-cultural diffusion as another form of evidence base for a practice’s potential healing power.
Resources
Guiding questions: What resources does the practice provide? What resources are required?
There is reciprocity and flow in life. This is the nature of being in relationship. In our relationship with a practice, what does a practice ask of us? Perhaps our time, attention, intention, or space. What does it offer in return?
Therapeutics
Guiding question: What are the therapeutic benefits? How does it work?
What do we know about a practice’s benefits? What does the scientific literature have to say? What does the anecdotal experience of those who have used the therapy have to say?
Health
Guiding question: Are there any safety concerns or cautions?
Are there certain individuals, conditions or circumstances in which caution is needed in adopting this practice?
Well, there is the framework. How does it work. You can read an article about the benefits of humming where I use this framework here. Let me know your thoughts.
What has been your experience when you have been trying to determine if a health practice might be helpful for you? What tools or assessments do you use to decide what practices to adopt?
To your health,
Dr. Nicole🌿
E.A.R.T.H. FRAMEWORK for evaluating health practices