Abstract
Twenty years after the Council of the European Union endorsed overarching values for health systems, Frischhut and colleagues have proposed updating them in response to demographic, technological, geopolitical, and environmental change. 1 Their proposals rightly enlarge the ethical frame of European health policy.Yet one foundation remains insufficiently articulated: the integrity of the ecological systems on which health depends.The European Group on Ethics in Science and New Technologies (EGE), the European Commission's independent ethics advisory body, called for a right to a clean, healthy, and sustainable environment and for plural ways of valuing nature. 2 We argue that ecological integrity supplies a necessary normative and material foundation for making that right consequential in health policy.We use ecological integrity to denote the capacity of ecological systems to sustain biodiversity, essential functions, adaptive resilience, and regenerative processes over time.3 In ecological science, ecosystem integrity is used similarly.Svenning's dynamic account sharpens it by emphasising the continuation of biodiversitygenerating processes and evolutionary lineages through transformation.4 Integrity therefore does not imply pristine nature, an unchanging species composition, or the exclusion of responsible human use.Why not rely on familiar terms?Sustainability is an important but broad aim and can permit ecological losses to be balanced against, or substituted by, economic and social gains.Resilience cannot provide the missing normative anchor.It describes one property of a system, and a severely degraded state can itself be resilient.Plural valuation shows why nature matters in different ways, including relational, intrinsic, and instrumental values.5 Ecological integrity specifies what must endure and when prospective loss should constrain choice.Ecological integrity has three connected roles.It is a normative commitment because ecological systems matter beyond the benefits they provide to humans.It is a biophysical condition of present and future health because functioning living systems regulate climate, water, soils, food production, and disease.It is also a