From Multiple Voices to a Common Language: Ecosystem Approaches to Human Health as an Emerging Paradigm

The International Forum on Ecosystem Approaches to Human Health, held in Montreal, May 18–23, 2003, was one product of a new paradigm or framework linking health, ecosystems, and sustainable development that emerged in recent decades. This profile aims to provide a backdrop for the contents of this supplementary issue by outlining some of the key principles of the Ecosystem Approaches to Human Health (Ecohealth) framework. It also discusses some of the activities supported by the Ecosystem Approaches to Human Health Program Initiative of the International Development Research Centre (IDRC) to build on the success of the Forum. In doing so, the intention is to frame the 2003 Forum as one in a series of opportunities to reflect and learn from precedents of research and practice from an ecohealth perspective and to foster the development of a community of practice on Ecohealth (COPEH). The profile not only places the contents of the supplement and the Forum within a larger context, but also provides an overview of other IDRC activities that are building capacity for future research and practice, and are strengthening the emerging COPEH.     

Ecosystem Approaches to Health for a Global Sustainability Agenda

International research agendas are placing greater emphasis on the need for more sustainable development to achieve gains in global health. Research using ecosystem approaches to health, and the wider field of ecohealth, contribute to this goal, by addressing health in the context of inter-linked social and ecological systems. We review recent contributions to conceptual development of ecosystem approaches to health, with insights from their application in international development research. Various similar frameworks have emerged to apply the approach. Most predicate integration across disciplines and sectors, stakeholder participation, and an articulation of sustainability and equity to achieve relevant actions for change. Drawing on several frameworks and on case studies, a model process for application of ecosystem approaches is proposed, consisting of an iterative cycles of participatory study design, knowledge generation, intervention, and systematization of knowledge. The benefits of the research approach include innovations that improve health, evidence-based policies that reduce health risks; empowerment of marginalized groups through knowledge gained, and more effective engagement of decision makers. With improved tools to describe environmental and economic dimensions, and explicit strategies for scaling-up the use and application of research results, the field of ecohealth will help integrate both improved health and sustainability into the development agenda.     

Dryland Salinity and Ecosystem Distress Syndrome: Human Health Implications

Clearing of native vegetation for agriculture has left 1.047 million hectares of southwest Western Australia affected by dryland salinity, and this area may expand up to a further 1.7–3.4 million hectares if trends continue. Ecosystems in saline-affected regions display many of the classic characteristics of Ecosystem Distress Syndrome, one outcome of which has not yet been investigated in relation to dryland salinity: adverse human health implications. This article seeks to review existing information and identify potential adverse human health effects. Three key potential impacts on human health resulting from dryland salinity are identified: wind-borne dust and respiratory health; altered ecology of the mosquito-borne disease Ross River virus; and mental health consequences of salinity-induced environmental degradation. Given the predicted increase in extent and severity of dryland salinity over coming decades, adverse outcomes of salinity are likely to be further exacerbated, including those related to human health. There is a clear need to investigate the issues discussed in this review and also to identify other potential adverse health effects of dryland salinity. Investigations must be multidisciplinary to sufficiently examine the broad scope of these issues. The relationship between human health and salinity may also be relevant beyond Australia in other countries where secondary soil salinization is occurring.     

Towards Enhancing Community Health in El-Fayoum,Egypt, Using Ecosystem Approaches

Ecosystem degradation caused by factors such as improper natural resources management and contamination with agricultural, industrial, and domestic wastes often results in the creation of an unhealthy ecosystem, a main cause for the prevailing poverty and poor health in many parts of rural Egypt. In collaboration with members of the community in some villages of El-Fayoum province, an interdisciplinary research team is currently employing an ecosystem approach to arrive at an understanding of community health problems with a view to develop resource management interventions and policies aimed at enhancing community health and well-being. Participatory rural appraisal (PRA) and knowledge, attitudes, and practices (KAP) techniques were used to measure the perceptions of the community’s men and women of their health and environmental priorities, and to test their current state of knowledge and awareness of the health-related issues. The results indicate that these perceptions were gender-sensitive and were different from those of Ministry of Health. Spatial and temporal monitoring and assessment of the ecosystem components revealed considerable land and water resources degradation. Presence of water pools and waterways in the vicinity of the residential areas enhanced the risk of water-associated diseases. Although, the disease-carrying vectors of schistosomiasis and malaria were detected in the waterways, the incidence of the two diseases was relatively low in the main village in contrast to the situation in the nearby hamlets. Prevalence of schistosomiasis was substantially higher in these hamlets (20–30% compared to 2–3% in the main village). Such a highly infected community represents a continuous pool of reinfection of the waterways, an issue that needs to be further examined to determine its relation to the hamlets’ specific ecosystem characteristics. A high incidence of hepatitis C and soil transmitted-intestinal parasites were markedly detected. It is concluded that in addition to natural resources degradation, other potential health risk factors were identified including socioeconomic, cultural, and institutional factors. Further studies are being conducted to explore these potential risk factors and their links to human health and well-being.     

Linking Human and Ecosystem Health: The Benefits of Community Involvement in Conservation Groups

This study explored the health, well-being, and social capital benefits gained by community members who are involved in the management of land for conservation in six rural communities across Victoria. A total of 102 people participated in the study (64 males; 38 females) comprising 51 members of a community-based land management group and 51 controls matched by age and gender. Mixed methods were employed, including the use of an adapted version of Buckner’s (1988) Community Cohesion Scale. The results indicate that involvement in the management of land for conservation may contribute to both the health and well-being of members, and to the social capital of the local community. The members of the land management groups rated their general health higher, reported visiting the doctor less often, felt safer in the local community, and utilized the skills that they have acquired in their lifetime more frequently than the control participants. Male members reported the highest level of general health, and the greatest satisfaction with daily activities. Members also reported a greater sense of belonging to the local community and a greater willingness to work toward improving their community than their control counterparts. Of equal importance is evidence that involvement in voluntary conservation work constitutes a means of building social capital in rural communities which may help reduce some of the negative aspects of rural life.     

Ecosystem Health in Professional Curriculum: Experience to Date

In order to present a holistic view of defining problems and exploring long-term solutions for health-related issues, several colleges and universities are adopting an ecosystem health approach. While these curricular offerings are varied in nature, a number of common themes appear to be emerging. The case study is the preferred method for introducing the subject matter as this provides immediate relevance to the student studying within a specific discipline but, when carefully designed, promotes systems thinking and allows exploration of a number of features common to all complex systems. These include: interdependence of system components, complexity, uncertainty, and the need for transdisciplinary thinking when analyzing the issues. The articles appearing in this supplement are examples of how this approach has been introduced into a variety of curricula pertaining to human health, animal health, and other related fields.     

Ecosystem Approach to Human Health in Two Villages of the North Jordan Valley: Scoping the Problems

North Jordan Valley (NJV) is a narrow rift valley that extends from lake Tiberius in the north to the Dead Sea in the south. It follows the River Jordan and contains the most fertile lands in Jordan. With a population around 140,000, primarily working in agriculture, NJV is Jordan’s premier agricultural production area. NJV is an ecosystem that is stressed both naturally and by human activities. Limited precipitation and very hot summer seasons are stresses that are inherent parts of the ecosystem itself. However, human activities like agriculture, poor sanitation, and tourism produce health risks to the people through the pollution and degradation of natural resources. The area also faces several socioeconomic problems such as poverty, large family size, and unemployment. In NJV, women typically work at home as housewives taking care of large families and are engaged in agricultural activities through which they are exposed, along with men and children, to high temperature and high concentration of pesticides. This article presents the findings of a Participatory Rapid Appraisal (PRA) study that focused on assessing local communities’ perception and awareness of the linkages between disruption of the ecosystem and prevailing public health problems. From an academic point of view, one of the key challenges of implementing ecosystem approaches to human health is the incorporation of various stakeholders as full partners throughout the research process rather than as contributors to a research designed from the sole perspective and interests of the academic research team. This study was conceptualized as a preliminary study to guide and inform the design of a larger research study on health and environment linkages in the NJV. The process was considered key for ensuring that research questions would reflect and build upon the priorities of multiple stakeholders, including community members, and would involve them in the design of the research. In addition to the successful involvement of local communities and other stakeholders in the identification of primary health problems and community priorities in the study area, the research played a key role in introducing various stakeholders to the basics of the Ecosystem Approaches to Human Health (Ecohealth) concept. The study took place in two small villages in NJV (Tal Al-Arbaeen and Tal Al-Menteh). The first village is located upstream of the junction point where King Abdullah Canal’s fresh water mixes with marginal quality water of King Talal Reservoir (KTR) while the second one is situated downstream. Results of this study showed that local communities are generally aware of the linkages between the health of the ecosystem and human health and well-being. According to the results of the study, key stressors to the environment (socioeconomic and institutional) include the use/abuse of agrochemicals and household insecticides, spread of flies (associated to organic agriculture), mismanagement of organic fertilizers, lack of sanitation services, unsanitary household conditions, and a serious problem of stray dogs and rodents. Problems associated with poverty and large family size were also commonly mentioned. Diarrhea, respiratory diseases, and infectious and parasitic diseases were believed to be the most common health problems in both villages. Local communities showed great interest and concern for the various health problems to which they are confronted and expressed eagerness to contribute to potential mitigation/intervention measures.     

Silver Discharged in Effluents from Image-Processing Services: a Risk to Human and Environmental Health

In Brazil, only 20.2% of the municipalities have sewage collection and treatment. The use of medical diagnostic by radiographic processing generates effluents which may contain contaminants such as silver (Ag) that causes irreversible damage to health. They can also contaminate soil, water, and food if there is no treatment before disposal. This study aimed to identify and quantify the Ag concentration in radiographic film-washing water and fixer generated from radiographic processing in 12 Brazilian health institutions, in order to offer subsidies to the environmental and public health managers about this issue. The Ag values found in the washing water films samples ranged from 0.1 to 1,785.97?mg?L(-1). In the fixer samples, the values ranged from 435.59 to 16,325.92?mg?L(-1). These data are far above the values required by Brazilian legislation whose limit is 0.1?mg?L(-1) for Ag in effluents released directly or indirectly into the environment. This research reveals that the disposal of Ag in this kind of effluent needs to be monitored and controlled by the Brazilian government in order to protect both the human and environment health from those contaminants.     

Comparison of Contaminated Site Human Health Risk Assessment Approaches in Canada: Application of Provincial Methods to a Hypothetical Site

Human health risk assessment, whether at the screening level or more complex phase, is not an exact science. A wide variety of advice and direction is offered by international, national, and provincial/state environmental agencies regarding the conduct of risk assessment, and different risk assessors access and rely on the available regulatory advice and direction differently. This may result in wide variability in the estimates of chemical exposure and risk. A comparison of human health risk assessment approaches practiced at the provincial level in Canada was undertaken, wherein each jurisdiction's approach was applied to a hypothetical contaminated site. Approaches were found to vary both in terms of methodological considerations, and in matters of policy. The exercise yielded results in terms of estimated exposures and predicted hazard quotients/indexes and incremental lifetime cancer risks that were in some cases quite consistent (varying by a factor of less than 1.5 times), and in other cases remarkably different (varying by orders of magnitude). This article reviews the various approaches/frameworks applied and discusses the results of the hypothetical risk assessments, in terms of both the observed variation and the source of this variability.     

Building Capacity in Small-Scale Mining Communities: Health,Ecosystem Sustainability,and the Global Mercury Project

The Global Mercury Project (GMP) is an initiative of the United Nations in collaboration with numerous government and nongovernment organizations to promote knowledge and capacity building on the links between small-scale gold mining practices and health, ecosystem, and social factors, and to implement interventions that reduce mercury pollution and exposure caused by mining activities in developing countries. Knowledge regarding the use of mercury and the dynamics of complex environmental, health, socioeconomic, and cultural conditions in and surrounding small-scale mining sites is particularly needed for the purpose of developing appropriate community-based measures to reduce mercury-related problems. GMP strategies aim to build upon local knowledge and practices to train miners on the use of cleaner and affordable technologies of mining and mineral processing in order to minimize negative impacts. The initiative is especially proactive in facilitating transdisciplinary and participatory models of community interaction, involving local, regional, and international stakeholders in each of the strategy design, community assessment, and community intervention phases. The six participating countries are Brazil, Indonesia, Lao People’s Democratic Republic, Sudan, Tanzania, and Zimbabwe. This article outlines GMP’s objectives and scope of activities and also highlights achievements, challenges, and opportunities for future development.     

Advancing Ecosystem Science by Promoting Greater Use of Theory and Multiple Research Approaches in Graduate Education

Since the inaugural edition of Ecosystems was published in 1998, ecosystem science has undergone substantial changes including the development of new research methods and an increasing emphasis on collaborations across traditional academic boundaries. In response to this transformation, we reflect on the current state of theory in ecosystem science, and make recommendations for training the next generation of Ph.D.-level ecosystem scientists. Specifically, we call for increased integration of theory into ecosystem science and outline the utility of iterating between theory and data generated by observations, experiments, and quantitative models. We recommend exposing graduate students to these three major approaches for generating data and propose strategies that students, advisors, and departments can employ to ensure this exposure. Ultimately, a successful training program will provide students with an understanding of key theories related to ecosystem science and how they interact with data, an appreciation for the interconnectedness of approaches to scientific inference, and a well-developed skill set in at least one approach—thereby empowering them to confidently tackle our pressing environmental problems. Although this is a daunting list of goals, continuing to advance our understanding of how ecosystems function necessitates a rigorous and well-developed training program.