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.     

Development and Application of a Framework for Analyzing the Impacts of Urban Transportation

To adequately analyze the impacts associated with the rising use of automobiles, an assessment framework is needed that includes environment, health, economic, and sociocultural impacts. Such a framework was developed and applied to a proposed freeway-widening project in Edmonton, Canada. The assessment framework was developed using both Multi-Criteria Analysis and the Ecosystem Approach to Human Health (Ecohealth). Community participation was vital in the application of the assessment framework to this case study. Six stakeholder groups, including community members, City Councillors, and health, environment, and transportation experts, provided needed qualitative data for the assessment framework. Quantitative data were gathered from an ecological study design that associated traffic volumes with respiratory conditions in Edmonton. Community members perceptions about the impacts of the freeway widening differed from those of the expert groups in a number of areas. Environmental and health degradation was more of an issue to community members than to expert groups. Though respiratory conditions were not projected to increase by a significant amount because of the freeway widening, further analysis is necessary on other biophysical and socioeconomic impacts listed in the assessment framework. The divergence in opinion between community members and experts suggests that more communication is needed between these groups in relation to transportation planning. The Ecohealth approach ensures that community concerns are addressed in transportation planning.     

Understanding Land Use, Livelihoods, and Health Transitions among Tibetan Nomads: A Case from Gangga Township, Dingri County, Tibetan Autonomous Region of China

Tibetan nomads in the Tibetan Autonomous Region of China have experienced profound transitions in recent decades with important implications for land use, livelihoods, and health development. The change from being traditional nomads to agropastoralists engaged in permanent agriculture, a sedentary village life (known as “sedentarization”), has been associated with a remarkable change in diet and lifestyle, decline in spatial mobility, increase in food production, and emerging infectious and noncommunicable diseases. The overarching response of the government has been to emphasize infrastructure and technological solutions. The local adaptation strategies of Tibetan nomads through maintaining balanced mobile herding, reindeer husbandry, as well as off-farm labor and trade could address both the cause of environmental degradation and improve the well-being of local people. Drawing on transdisciplinary, preliminary field work in Gangga Township of Dingri County in the foothills of Mt. Everest, we identify pertinent linkages between land use and health, and spatial and temporal mismatch of livelihoods and health care services, in the transition to sedentary village life. We suggest emerging imperatives in Ecohealth to help restore Tibetan livelihoods in transition to a sedentary lifestyle.     

Impact of dry mouth conditions on oral health-related quality of life in older people

Objective: The aim of the present study was to evaluate the impact of dry mouth conditions on oral health‐related quality of life in frail old people, residents at community care centers. Further, reliability and validity of a visual analogue scale (VAS) for dry mouth symptoms were determined within the study cohort. Background: In old people functional, social and psychological impacts of oral conditions are associated with an overall sense of well being and general health. Subjective dry mouth and reduced saliva flow are common disorders in old people caused by disease and medication. Thus, dry mouth conditions may be determinants for compromised oral health‐related quality of life in old people. Method: In total, 50 old people living at service homes for the old people were asked to answer questionnaires on subjective dry mouth (VAS) and Oral Health Impact Profile (OHIP14) for oral health‐related quality of life. Saliva flow was estimated by absorbing saliva into a pre‐weighed cotton roll. Results: The final study cohort comprised 41 old people (aged 83–91 years). Significant associations were identified between both objective and subjective dry mouth and overall or specific aspects of oral health‐related quality of life. Conclusion: Dry mouth (objective and subjective) is significantly associated with oral health‐related quality of life strengthening the value of monitoring dry mouth conditions in the care of frail old people.     

A model framework to estimate impact and cost of genetics-based sterile insect methods for dengue vector control

Vector-borne diseases impose enormous health and economic burdens and additional methods to control vector populations are clearly needed. The Sterile Insect Technique (SIT) has been successful against agricultural pests, but is not in large-scale use for suppressing or eliminating mosquito populations. Genetic RIDL technology (Release of Insects carrying a Dominant Lethal) is a proposed modification that involves releasing insects that are homozygous for a repressible dominant lethal genetic construct rather than being sterilized by irradiation, and could potentially overcome some technical difficulties with the conventional SIT technology. Using the arboviral disease dengue as an example, we combine vector population dynamics and epidemiological models to explore the effect of a program of RIDL releases on disease transmission. We use these to derive a preliminary estimate of the potential cost-effectiveness of vector control by applying estimates of the costs of SIT. We predict that this genetic control strategy could eliminate dengue rapidly from a human community, and at lower expense (approximately US$ 2~30 per case averted) than the direct and indirect costs of disease (mean US$ 86-190 per case of dengue). The theoretical framework has wider potential use; by appropriately adapting or replacing each component of the framework (entomological, epidemiological, vector control bio-economics and health economics), it could be applied to other vector-borne diseases or vector control strategies and extended to include other health interventions.     

Assessing recreational benefits as an economic indicator for an industrial harbour report card

Industrial harbours are a complex interface between environmental, economic and social systems. Trying to manage the social and economic needs of the community while maintaining the integrity of environmental ecosystems is complicated, as is the identification and evaluation of the various factors that underpin the drivers of economic, community and resource condition. An increasingly popular strategy to deal with the identification and evaluation challenges in complex human-environmental systems is to use a report card system which can be used as a summary assessment tool to monitor the health of aquatic ecosystems. To date though these have largely focused on environmental factors, and it is only very recently that attempts are being made to include social, cultural and economic indicators. There has been limited consensus in the selection of social and economic indicators applied in different aquatic report cards but as recreation is such an important activity, typically some measure of recreation benefit is included. However, there has been no commonality in the measures applied to assess its performance as an economic indicator.This paper is focused on the assessment of recreational benefits as an indicator of economic value in the report card for Gladstone Harbour in Queensland, Australia. It is the first aquatic health report card to include an assessment of the nonmarket value of recreation which makes it a more comprehensive indicator of economic value compared to other report cards based on measures of employment, participation or expenditure. There have now been three consecutive years of reporting (2014–2016) of the Gladstone Harbour report card, and the results indicate that the recreation index appears to be effective in monitoring changes over time.     

The Relationship between Economic Status,Knowledge on Dengue,Risk Perceptions and Practices

The reemergence of dengue as an important public health problem reflects the difficulties in sustaining vertically organized, effective, control programs and the need for community-based strategies for Aedes aegypti control that result in behavioral change. We aimed to disentangle the relationships between underlying determinants of dengue related practices. We conducted a cross-sectional study in 780 households in La Lisa, Havana, Cuba. A questionnaire and an observation guide were administrated to collect information on variables related to economic status, knowledge on dengue, risk perception and practices associated with Aedes aegypti breading sites. To test a conceptual model that hypothesized direct relationships among all these constructs, we first used Exploratory Factor Analysis with Principal Component Analysis to establish the relationship between observed variables and the underlying latent variables. Subsequently, we tested whether the observed data supported the conceptual model through Confirmatory Factor Analysis. Exploratory Factor Analysis indicated that the items measured could be reduced into five factors with an eigenvalue >1.0: Knowledge on dengue, Intradomiciliar risk practices, Peridomiciliar risk practices, Risk perception and Economic status. The proportion of the total variance in the data explained by these five factors was 74.3%. The Confirmatory Factor Analysis model differed from our hypothesized conceptual model. Only Knowledge on dengue had a significant, direct, positive, effect on Practices. There was also a direct association of Economic status with Knowledge on dengue, but not with Risk perception and Practices. Clarifying the relationship between direct and indirect determinants of dengue related practices contributes to a better understanding of the potential effect of Information Education and Communication on practices and on the reduction of Aedes aegypti breeding sites and provides inputs for designing a community based strategy for dengue control.     

Philosophy of environmental enrichment: Past,present, and future

The brief tenure of environmental enrichment has been influenced both directly and indirectly by the field of psychology, from the work of B.F. Skinner to that of Hal Markowitz. Research on enrichment supports the supposition that an enriched environment does indeed contribute to a captive animal’s well‐being. Critical elements of effective environmental enrichment are 1) assessing the animal’s natural history, individual history, and exhibit constraints and 2) providing species‐appropriate opportunities, i.e., the animal should have some choices within its environment. This paper presents a historic perspective of environmental enrichment, proposes a broader, more holistic approach to the enrichment of animals in captive environments, and describes a framework or process that will ensure a consistent and self‐sustaining enrichment program. Zoo Biol 20:211–226, 2001. © 2001 Wiley‐Liss, Inc.     

A Framework for Information Systems in Life-Cycle-Oriented Environmental Management

Although business firms have improved their environmental performance, a variety of forces are pushing businesses toward adopting environmental management throughout the entire life cycle of their products and processes. In this article we discuss the information systems elements of an environmental management approach we call "life-cycle-oriented environmental management" (LCOEM).This approach requires the firm to manage the effects of its processes from the creation of inputs to the final disposal of outputs, that is, from cradle to grave. We present a framework of the classes of information systems needed, describe their use in an LCOEM setting and define their inter relationships. We conclude with a discussion of the implications of LCOEM information systems.     

Metacommunity and phylogenetic structure determine wildlife and zoonotic infectious disease patterns in time and space

The potential for disease transmission at the interface of wildlife, domestic animals and humans has become a major concern for public health and conservation biology. Research in this subject is commonly conducted at local scales while the regional context is neglected. We argue that prevalence of infection at local and regional levels is influenced by three mechanisms occurring at the landscape level in a metacommunity context. First, (1) dispersal, colonization, and extinction of pathogens, reservoir or vector hosts, and nonreservoir hosts, may be due to stochastic and niche‐based processes, thus determining distribution of all species, and then their potential interactions, across local communities (metacommunity structure). Second, (2) anthropogenic processes may drive environmental filtering of hosts, nonhosts, and pathogens. Finally, (3) phylogenetic diversity relative to reservoir or vector host(s), within and between local communities may facilitate pathogen persistence and circulation. Using a metacommunity approach, public heath scientists may better evaluate the factors that predispose certain times and places for the origin and emergence of infectious diseases. The multidisciplinary approach we describe fits within a comprehensive One Health and Ecohealth framework addressing zoonotic infectious disease outbreaks and their relationship to their hosts, other animals, humans, and the environment.     

Assessing changes in oral health‐related quality of life and its factors in community‐dwelling older Brazilians

doi: 10.1111/j.1741‐2358.2012.00656.x Assessing changes in oral health‐related quality of life and its factors in community‐dwelling older Brazilians Objective: To describe changes in oral health‐related quality of life and to evaluate the associations of these changes in community‐dwelling older people. Materials and methods: In this longitudinal study a representative sample of 872 older people, living in Brazil, was evaluated during 2004. The follow‐up was carried out during 2008, with 587 older persons evaluated. A questionnaire assessing socio‐demographic information, health history, oral health‐impact profile and number of natural teeth was used. Changes in oral health‐related quality of life were categorized as improvement or deterioration. Data analysis was performed using a hierarchical approach based in a conceptual framework. A hierarchal approach was carried out using Poisson regressions. Results: Older persons living in rural areas, those who reported brushing once a day or less and older persons with fewer natural teeth had an increased chance of reporting deterioration in oral health‐related quality of life. Women and participants who received a minimum wage of less than US$219.50 were more likely to report improvement in oral health‐related quality of life. Conclusion: The results of this study suggest that changes in the oral health‐related quality of life are influenced by many of the variables that were included in the conceptual framework.     

Development of environmental performance indicators supported by an environmental information system: Application to the Norwegian defence sector

Environmental performance indicators (EPIs) can be an important tool for evaluating and reporting the integration of environmental practices and tools in the defence sector, ensuring that environmental issues are being consistently and clearly followed into sector activities on a local and national scale. However, proper use of indicators is dependent on a suitable conceptual framework to manage and assess the environmental performance. Furthermore, monitoring is fundamental to environmental efficiency evaluations both to assess adherence to standards and to support management options. The use of EPI assures that a monitoring system for a public sector addresses only the key variables associated with significant environmental impacts and also improves communication with stakeholders. The main objective of this paper is to develop EPIs supported by an environmental information system (EIS), as a tool for environmental efficiency evaluations in the defence sector. To put the proposed approach into practice, the Norwegian defence EIS is used as a data source – a system developed to increase environmental awareness and to promote environmental efficiency, in the reporting of environmental aspects like use of ammunition, generation of waste, energy consumption, fuel consumption, use of chemicals, and water consumption. Use of real data acquired from the EIS is used to test and evaluate the robustness of the public sector's environmental performance indicator conceptual framework (SEPIIS), used to support the developed indicators. The main findings show how an indicator framework can be effectively combined with the use of an EIS designed to process data from a sector's activities, stressing how environmental issues could be integrated into overall public services performance management. The EPI developed for the Norwegian defence allowed to trace the sector's environmental performance, by comparisons with commissions from the Norwegian Ministry of Defence and national goals for GHG emissions, identifying areas for priority response measures. This joined approach of indicators and information systems could be useful to increase and improve environmental ex post and ex ante assessments, reporting and communication of defence activities.     

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.     

Exploratory Spatio-Temporal Data Analysis (ESTDA) of Dengue and its association with climatic,environmental, and sociodemographic factors in Punjab,India

Routine health data is rich in information but underutilised for research in Low and Middle-Income countries. The present study was carried out to understand spatiotemporal patterns of dengue and its association with risk factors using routine data from health and allied sectors. ESTDA included estimation of dengue incidence rates, time series features and correlation coefficients up to the sub-district level. Scatter plots and correlation coefficients were used to identify relationships between covariates. Dengue incidence in 2015–19 was 47.76, 33.64, 52.03, 49.71, and 33.36 per 100,000, respectively, with a mean (SD) age of 34.33 (16.78) years and the majority being males (63.94%). Dengue had significant cross-correlation, non-linear relationships, and spatio-temporal associations with climatic, environmental, and socio-demographic risk factors. Significant autocorrelation of dengue occurrence was present at a lag of one month with seasonal patterns. The reproducible open-source algorithms add value to existing Routine Health Information Systems, and the findings will enable the development of Spatio-temporal models in future research. The research was done using R version 4.1.0.     

Environmental Health Education: A Participatory Holistic Approach

In response to the lack of theoretical foundations in the emerging field of “environmental health education,” this article presents a proposal for a theoretical framework which integrates complementary elements drawn mainly from the fields of environmental education, health education, and risk education. This framework is centred on a participatory holistic approach; it seeks to stimulate the development of personal and collective competencies for citizen involvement in improving the relationship between communities and their environment in order to simultaneously promote human health and the integrity of the closely interrelated life systems. The development of this proposal is based on an initial theoretical construct, produced from an anasynthesis of existing literature and results of previous projects, that is being validated and enriched by actual empirical fieldwork. The latter involves the collaborative design and experimentation of educational-intervention projects, among social groups in the region of Lac Saint-Pierre, concerning the issue of fish consumption, its benefit, and also the risks associated to lake chemical contamination.     

Temephos resistance and esterase activity in the mosquito Aedes aegypti in Havana, Cuba increased dramatically between 2006 and 2008

Aedes aegypti (L.) (Diptera: Culicidae) control programmes in Cuba rely on the application of the organophosphate temephos for larval control. Hence, the monitoring of resistance to this insecticide is an essential component of such programmes. Here, 15 field populations from different municipalities of Havana City were assayed for resistance to temephos. High levels of resistance were detected in all strains and resistance ratios were highly correlated with esterase activity (P = 0.00001). Populations from three municipalities were tested in both 2006 and 2008; resistance and esterase activities both significantly increased during this 2-year period. Synergist studies demonstrated that neither glutathione transferases nor monooxygenases were associated with the increase in resistance to temephos in this period. The duration of the efficacy of commercial formulations of temephos in controlling Ae. aegypti populations in Havana City was reduced by the high level of temephos resistance observed; hence these data are of clear operational significance for the dengue control programme in Cuba. New integrated strategies to avoid further increases in temephos resistance in Cuba are necessary.     

Approaches to Refining Estimates of Global Burden and Economics of Dengue

Dengue presents a formidable and growing global economic and disease burden, with around half the world''s population estimated to be at risk of infection. There is wide variation and substantial uncertainty in current estimates of dengue disease burden and, consequently, on economic burden estimates. Dengue disease varies across time, geography and persons affected. Variations in the transmission of four different viruses and interactions among vector density and host''s immune status, age, pre-existing medical conditions, all contribute to the disease''s complexity. This systematic review aims to identify and examine estimates of dengue disease burden and costs, discuss major sources of uncertainty, and suggest next steps to improve estimates. Economic analysis of dengue is mainly concerned with costs of illness, particularly in estimating total episodes of symptomatic dengue. However, national dengue disease reporting systems show a great diversity in design and implementation, hindering accurate global estimates of dengue episodes and country comparisons. A combination of immediate, short-, and long-term strategies could substantially improve estimates of disease and, consequently, of economic burden of dengue. Suggestions for immediate implementation include refining analysis of currently available data to adjust reported episodes and expanding data collection in empirical studies, such as documenting the number of ambulatory visits before and after hospitalization and including breakdowns by age. Short-term recommendations include merging multiple data sources, such as cohort and surveillance data to evaluate the accuracy of reporting rates (by health sector, treatment, severity, etc.), and using covariates to extrapolate dengue incidence to locations with no or limited reporting. Long-term efforts aim at strengthening capacity to document dengue transmission using serological methods to systematically analyze and relate to epidemiologic data. As promising tools for diagnosis, vaccination, vector control, and treatment are being developed, these recommended steps should improve objective, systematic measures of dengue burden to strengthen health policy decisions.     

Hybrid Framework for Managing Uncertainty in Life Cycle Inventories

Life cycle assessment (LCA) is increasingly being used to inform decisions related to environmental technologies and polices, such as carbon footprinting and labeling, national emission inventories, and appliance standards. However, LCA studies of the same product or service often yield very different results, affecting the perception of LCA as a reliable decision tool. This does not imply that LCA is intrinsically unreliable; we argue instead that future development of LCA requires that much more attention be paid to assessing and managing uncertainties. In this article we review past efforts to manage uncertainty and propose a hybrid approach combining process and economic input–output (I‐O) approaches to uncertainty analysis of life cycle inventories (LCI). Different categories of uncertainty are sometimes not tractable to analysis within a given model framework but can be estimated from another perspective. For instance, cutoff or truncation error induced by some processes not being included in a bottom‐up process model can be estimated via a top‐down approach such as the economic I‐O model. A categorization of uncertainty types is presented (data, cutoff, aggregation, temporal, geographic) with a quantitative discussion of methods for evaluation, particularly for assessing temporal uncertainty. A long‐term vision for LCI is proposed in which hybrid methods are employed to quantitatively estimate different uncertainty types, which are then reduced through an iterative refinement of the hybrid LCI method.     

A multi-scale comparison of trait linkages to environmental and spatial variables in fish communities across a large freshwater lake

Species present in communities are affected by the prevailing environmental conditions, and the traits that these species display may be sensitive indicators of community responses to environmental change. However, interpretation of community responses may be confounded by environmental variation at different spatial scales. Using a hierarchical approach, we assessed the spatial and temporal variation of traits in coastal fish communities in Lake Huron over a 5-year time period (2001–2005) in response to biotic and abiotic environmental factors. The association of environmental and spatial variables with trophic, life-history, and thermal traits at two spatial scales (regional basin-scale, local site-scale) was quantified using multivariate statistics and variation partitioning. We defined these two scales (regional, local) on which to measure variation and then applied this measurement framework identically in all 5 study years. With this framework, we found that there was no change in the spatial scales of fish community traits over the course of the study, although there were small inter-annual shifts in the importance of regional basin- and local site-scale variables in determining community trait composition (e.g., life-history, trophic, and thermal). The overriding effects of regional-scale variables may be related to inter-annual variation in average summer temperature. Additionally, drivers of fish community traits were highly variable among study years, with some years dominated by environmental variation and others dominated by spatially structured variation. The influence of spatial factors on trait composition was dynamic, which suggests that spatial patterns in fish communities over large landscapes are transient. Air temperature and vegetation were significant variables in most years, underscoring the importance of future climate change and shoreline development as drivers of fish community structure. Overall, a trait-based hierarchical framework may be a useful conservation tool, as it highlights the multi-scaled interactive effect of variables over a large landscape.