EcoHealth

EcoHealth is an emerging field of study researching how changes in the earth’s ecosystems affect human health. It has many prospects. EcoHealth examines changes in the biological, physical, social and economic environments and relates these changes to human health. Examples of these changes and their effects abound. Common examples include increases in asthma rates due to air pollution, PCB contamination of game fish in the Great Lakes of the United States, and habitat fragmentation leading to increasing rates of Lyme disease.

Recently virulent new infectious diseases such as SARS, Ebola virus, Nipah virus, bird flu and hantavirus have all been found to result from ecosystem change created by humans. These diseases have high death rates and very few effective therapies.

EcoHealth is bringing together physicians, veterinarians, ecologists, economists, social scientists, planners and others to study and understand how ecosystem changes affect human health. EcoHealth strives to provide innovative, practical solutions to reduce or reverse the negative health effects of ecosystem change.

History

Ecosystem approaches to health, or ecohealth, emerged as a defined field of inquiry and application in the 1990s, primarily through the global research supported by the International Development Research Centre in Ottawa (IDRC), Canada (Lebel, 2003). However, this was a resurrection of an approach to health and ecology that can be traced back, in Western societies, to Hippocrates, and to much earlier eras in Eastern societies. The approach was prominent among many scientists in the 18th and 19th centuries, but fell into disfavour in the twentieth century, when technical professionalism and expertise were assumed to be sufficient to deal with health and disease. In this relatively brief era, evaluation of the negative human health impacts of environmental change (both the natural and built environment) was allotted to the fields of medicine and environmental health. One medicine, as championed by scholars and practitioners such as Calvin Schwabe, was largely considered a marginal activity.

Integrated approaches to health and ecology re-emerged in the 1990s, and included one health, conservation medicine, ecological resilience, ecological integrity, health communities, and a variety of other approaches. These new movements were able to draw on a tradition that stretches from Hippocrates, to Rudolf Virchow and Louis Pasteur, who did not recognize the boundaries between human and animal medicine, and environmental and social change; to William Osler, who was a member of both the McGill medical faculty and the Montreal Veterinary College; Calvin Schwabe, whose 1984 book, Veterinary Medicine and Human Health, is a classic in the field; and James Steele, who founded the first veterinary public health unit in the United States.

Ecohealth approaches as currently practiced are participatory, systems-based approaches to understanding and promoting health and wellbeing in the context of social and ecological interactions. What differentiates these approaches from earlier integrative attempts is a firm grounding in complexity theories and post-normal science (Waltner-Toews, 2004; Waltner-Toews et al., 2008). While a variety of organizations promote integrative approaches such as One Health, the primary funder and promoter of ecohealth in particular, world-wide, is the International Development Research Centre in Ottawa (http://www.idrc.ca/ecohealth/).

After a decade of international conferences in North America and Australia under the more contentious umbrella of "ecosystem health", the first "ecosystem approach to human health" (ecohealth) forum was held in Montreal in 2003, followed by conferences and forums in Wisconsin, U.S., and Mérida, Mexico, all with major support from IDRC. Since then the International Association for Ecology and Health, and the journal Ecohealth have established the field as a legitimate scholarly and development activity (www.ecohealth.net).

How is EcoHealth different?

EcoHealth studies differ from traditional, single discipline studies. A traditional epidemiological study may show increasing rates of malaria in a region, but not address how or why the rate is increasing. An environmental health study may recommend the spraying of a pesticide in certain amounts in certain areas to reduce spread. An economic analysis may calculate the cost and effectiveness per dollar spent on such a program. An EcoHealth study uses a different approach. It brings the multiple specialist disciplines together with members of the affected community before the study begins. Through pre-study meetings the group shares knowledge and adopts a common language. These pre-study meetings often lead to creative and novel approaches and can lead to a more “socially robust” solution. EcoHealth practitioners term this synergy transdisciplinarity, and differentiate it from multidiscipline studies. EcoHealth studies also value participation of all involved groups, including decision makers and believe issues of equity (between gender, socioeconomic classes, age and even species) are important to fully understand the problem to be studied. Jean Lebel (2003) phrased transdisciplinarity, participation and equity the three pillars of EcoHealth.Template:Lebel, 2003 The IDRC now speaks of six principles, instead of three pillars, namely transdisciplinarity, participation, gender and social equity, system-thinking, sustainability and research-to-action (Charron, 2011).

Examples

A short example of a transdisciplinary study in the field of EcoHealth appears below. This is excerpted from HEALTH: An Ecosystem Approach, by Jean Lebel. (IDRC 2003, ISBN 1-55250-012-8.)

“In Mexico in the 1940s and 1950s, close to 24 000 of the 2.4 million people who caught malaria every year died as a result. Massive use of the powerful insecticide DDT was the linchpin of the government's effort to eradicate the disease. Over time, some progress was made against malaria, but the war was far from won. The use of DDT also posed its own threats to the health of the ecosystem. Moreover, as required by the North American Free Trade Agreement, Mexico had to completely eliminate the use of DDT by 2002. To meet this challenge, an EcoHealth research project was set up to pool the knowledge of a team of specialists in epidemiology, computer science, entomology, and social sciences, from both government and academia. This team has accumulated volumes of information about the prevalence of malaria in 2 000 villages. Data from powerful geographical information systems enabled them to conclude that mosquitoes do not travel very much. "If you have a place to lay your eggs and feed yourself, why go elsewhere?" explains Mario Henry Rodriguez, Director of Research on Infectious Diseases at the National Institute for Public Health (NIPH). In addition, as confirmed by Juan Eugenio Hernández, NIPH's Director of Informatics, it is now believed that "human beings are the vectors of malaria," which explains why more cases of malaria are found in villages located alongside roads.” With community help, the team studied the population's living conditions, including behavioural differences between men and women. It was found that while women are more likely to be bitten by mosquitoes early in the morning when they go to fetch water, the men are likely to be bitten in the coffee plantations at night. Several preventive actions have been taken. The scientists have proposed a new insecticide that, unlike DDT, does not persist in the environment. They have also developed a more effective pump that can spray 40 homes a day instead of 8, and uses less insecticide. A new malaria testing kit now detects the presence or absence of parasites in a patient's blood in only a few minutes, unlike laboratory tests that take three to four weeks to confirm a diagnosis. Previously, the need to wait for test results forced the authorities to treat everyone who showed vague symptoms of the illness, such as a high fever or headaches. Now, volunteers administer these tests to the people in close to 60 villages. "We have given communities the means to take care of themselves," says Mario Rodriguez. The fight against malaria in Mexico is now no longer solely the responsibility of government employees. Women also play a role by removing, every two weeks, the algae that harbour mosquito larvae in bodies of water. As a result, the number of cases of malaria in the state of Oaxaca has dropped from 15 000 in 1998 to only 400 today — and all without using any DDT. "Our experience has taught us that we need to bolster the social science research component if we want to extend this program to other parts of the country, while maintaining it in Oaxaca. The challenge is to draw the lessons that will lead to application of the program on a much wider scale," says Dr Rodriguez.”

This study reveals both the nature of the complex interactions of the problem and the extent to which a successful solution must cross research disciplines. The solution involved creative thinking on the part of many individuals, and produced a win-win situation for researchers, business and most importantly, for the community. Although many of the dramatic effects of ecosystem change and much of the research is focused in developing countries, the ecosystem of the built environment in urban areas of the developed world is also a major determinant of human health. Obesity, diabetes, asthma, and heart disease are all directly related to how humans interact with the local urban ecosystem in which they live. Urban design and planning determine car use, food choices available, air pollution levels and the safety and walkability of the neighborhoods in which people live. Other examples of the EcoHealth approach can be found in Linking Social and Ecological Systems: Management Practice and Social Mechanisms for Building Resilience, edited by Fikrit Berkes and Carl Folke (1998, Cambridge University Press, ISBN 0-521-59140-6) and Panarchy: Understanding Transformations in Human and Natural Systems, edited by Lance H. Gunderson and C. S. Holling (2002, Island Press, ISBN 1-55963-856-7).

EcoHealth 101: education for ecosystem approaches

Courses in ecosystem approaches to health have been developed and delivered in several North American and Australian universities. One innovative Canadian course involved a collaboration of all of Canada's veterinary colleges, and focused on integrative field cases in all parts of the country; another Canadian course was a joint effort of the medical school at the University of Western Ontario and the Ontario Veterinary College at the University of Guelph. In the years after 2003, communities of practice for ecosystem approaches to health in Canada, Latin America and the Caribbean, and Africa (largely supported by the IDRC) created intensive graduate level courses that integrated systems approaches with participatory approaches, and used actual case studies so that students gained applied clinical experience in "transdisciplinary" problem solving (see www.copeh-canada.org for one example). CoPEH-Canada organizes a yearly professional development and graduate level intensive training course in ecosystem approaches to health and have created a teaching manual with much of their material which is free on their site in English, French and Spanish (www.copeh-canada.org).

Johns Hopkins Bloomberg School of Public Health and the University of Wisconsin–Madison created a website to promote education in this area EcoHealth (Environmental Change and Our Health). The website examines the changes that are transforming Earth and what they can mean for our health.

This website is geared to middle-school students and their teachers, and delivers scientific information in a kid-friendly, engaging, and visually vibrant manner. Since its initial partnership with the Journey to Planet Earth television mini-series, hosted and narrated by actor Matt Damon and aired on PBS in Spring 2003 and 2004, the website has become an educational complement to this TV series, as well as a dynamic stand-alone tool for students and teachers. Since then, the site's appeal has grown far broader, reaching high-school students, and anyone interested in environmental and health issues—or simply wanting a reliable and fun resource for being able to sort the science from the sound bites. EcoHealth 101 provides the in-depth analysis and context behind today's headline news.

"The idea for the site grew from the positive feedback following public lectures I've given on global environmental health", says Dr. Jonathan Patz, associate professor at the University of Wisconsin & adjunct associate professor at Johns Hopkins Bloomberg School of Public Health. "'Students should really learn about how their health is tied so closely to the global environment,' was the comment I often heard."

"The site is very exciting because it deals with serious and thought-provoking topics", adds Dr. Patz. "Nonetheless, it shows middle-school students how to have fun with the visual elements and discover what potential solutions exist for alleviating the negative effects of climate change and other changes to our planet."

In a rapidly changing world, our school curriculum must expand to include accurate science on global warming, environmental degradation, and its negative effects on human, wildlife and ecosystem health. The mission of EcoHealth 101 is to educate and inform the next generation of leaders who may have the answers to today's problems. Chapters from the website include Global Warming, Stratospheric Ozone Depletion, The Balance of Nature, Modern Agriculture and Drinking Water, and Globalization and Disease Without Borders.

The site was reviewed for accuracy and fairness by science, health, and environmental experts in a wide range of specialties.

Visit http://ecohealth101.org.

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