Ecosystem Approaches to Health

This paper describes the findings of an eight-year study on human health and community engagement in Anjukudisai, and 'objectionable' slum in Chennai. It shows that human behaviour, constrained by socio-economic factors, often leads to ecosystem degradation and frequently causes reactions that jeopardize people's health. Furthermore, institutional structures often prevent holistic integrated thinking and action. Urban health issues are closely linked to both environmental and socio-economic conditions. The impact of environmental degradation is often most severe on the poorest segments of society: slum dwellers, women, children, and the elderly.

This paper presents the results of a workshop held in August 2002 in support of an action-oriented program of research that adopts an ecosystem approach to human health in Chennai, India. The workshop brought together stakeholders and potential participants in the research program in a collaborative environment to explore environment and health relationships, identify key actors and stakeholders in managing for human health, and develop a conceptual model of environment and health in Chennai. The workshop also introduced the ecosystem approach to workshop participants and explored the feasibility of applying the approach in Chennai. This paper is intended to highlight the use of a stakeholder workshop within an ecosystem approach, as well as techniques employed in the workshop’s working sessions. Influences on the workshop come from soft systems methodology, adaptive management and participatory action research. Working sessions were oriented to problem identification and framing, system conceptualization and visioning. Workshop participants developed a diagrammatic expression of environment and health in Chennai known as a ‘rich picture.’ Important themes in environment and health were drawn from this expression, such as: slums as locations of most -vulnerable populations and objectionable conditions; surface water quality and water bourne disease (e.g., typhoid, cholera, diarrhea, dysentery); public participation in management of environment and health problems; and malaria. Workshop participants also helped to identify a mixed-methods approach to addressing these issues in slum areas. The workshop results are now being used to direct the broader program of research.

Executive Summary

The links between ecosystem approaches to health, natural resource management and poverty reduction are being identified as important and relevant across an increasing number of disciplines and institutions. However, specific implementation guidance is scant. One promising approach to addressing this gap is the integration of two emergent approaches to environmental management: Ecohealth, which argues that human health and well-being are not only dependent on ecosystems but are also important outcomes of effective ecosystem management; and Watershed-based integrated water resources management (IWRM) which is based on the premise that watersheds are appropriate units for managing ecosystems.

Over the past century, the dominant scientific approach to environment and health relationships has been to examine cause and effect relationships between “proximal” environmental exposures and their health effects. Much progress has been made with this kind of work, but the complex, reciprocal interactions among ecosystems, society and health demand a more integrated and systemic approach. Recent convergence of research, policy and practice that re-links the social and ecological context for health lead us to understand that: in coupled social-ecological systems the same driving forces can result in combined social and environmental health inequities, hazards and impacts; policies that decrease social inequities and improve social cohesion have the potential to improve health outcomes and also to minimize and offset the drivers of ecosystem change; and linked social-ecological actions that address both biophysical and social environments have the potential to create a “double-dividend” that improves health by addressing both its socio-economic and environmental determinants, while also promotingsustainable development.

Traditionally, our understanding and management of human health has been organized spatially on the basis of human constructs such as municipalities, counties, health authorities, and provinces or states. While these boundaries do influence environmental and resource management, they often overlook the structure and function of ecosystems, and create a disjuncture between the objects of management and biophysical processes (e.g., between health and nature). A wide range of international reports have now created a demand and imperative to identify specific ecosystem-based contexts in which linkages among health, ecosystems, development and poverty alleviation can be operationalized.

One response to these challenges has been to recognize and prioritize watersheds as appropriate spatial units around which to organize management for natural resources and health.Watershed management and ecosystem approaches offer useful approaches to water management within the physical “place” of the watershed or catchment. Using key management concepts such as resilience, such approaches have the potential to improve our ability to reduce vulnerability to natural hazards, maintain ecological flows of water and the provision of other ecological services, and to promote the long-term sustainability of coupled human and natural systems. Ecosystem approaches and IWRM almost always cite collaborative decision-making and adaptive institutions as central to their approach.Mechanisms to operate such approaches must navigate overlapping jurisdictions, conflicting mandates and multiple interests, while at the same time adapting and responding to new information and operating in contexts of uncertainty.

The challenge remains to establish frameworks and processes that speak not only to public health professionals, but also to ecologists, water managers, planners and the development community. Despite the potential value in explicitly addressing concerns about human health and well-being on a watershed basis, a myriad of challenges exist—many of which reflect the limitations of restricting focus on separate parts of social-ecological systems rather than the interconnections of human and natural systems. These include the challenges of working across jurisdictions and sectors; of integrating academic disciplines and multiple worldviews; of spatial-temporal scale and the relationship between systems defined at different scales; and of the complexity of issues pertaining to each aspect of these social-ecological systems (including climate and atmospheric processes, land uses, ecological processes, social networks, livelihoods and lifestyles). The table below summarizes key issues identified by this report and offers directions for further work.

The manual is a collaborative project amongst researchers
around Canada and course alumni within CoPEH-Canada. It is the result of four years of collective teaching experience designing and facilitating a ten day intensive Short Course in Ecosystem Approaches to Health for graduate students and professionals. The intensive courses emphasize transdisciplinary, collaborative learning by incorporating frequent group discussion, and complex problems or cases that participants work on in small groups throughout the course, enabling ample opportunities for actively working with the course material, and experimenting with applications. The rationale behind the teaching manual was
to transform materials from the intensive courses into a pilot manual that could be tested, refined, and developed in collaboration with others working to develop the field and build capacity. The manual captures the key elements from the courses in a series of modules to assist facilitators in the delivery of ecohealth courses, workshops, or seminars. The modules are modifiable and adaptable to different contexts, and the modular structure offers a robust guide for the development of further modules. Currently the manual
consists of six teaching modules; Health, Introduction to Ecohealth, Complexity, Social Networks, Gender,
and Participation and Research. Also included is a guide for designing and teaching ecohealth case studies, and some transversal activities to support transdiciplinarity, collaboration and reflection.

This module is meant to help trainers teach Ecohealth, by guiding them in the design and delivery of their own Ecohealth courses. This module, unlike the other modules in this manual, is not designed to be taught to the learner/participant end-users. Good Ecohealth courses are designed and taught in ways that facilitate collaborative learning among participants (ideally from different disciplines). To design and teach Ecohealth, trainers need to understand how participants learn, and to develop strategies for facilitating that learning. In particular,
trainers need to appreciate how the subject of Ecohealth demands collaborative and participatory teaching and learning approaches. This module will look at some basic principles of learner-centred approaches, and what is
often called “adult learning” (although is not restricted to adults and can apply to younger learners) and the importance of learning by doing: embodying
Ecohealth principles in the teaching of Ecohealth.
The rationale is that Ecohealth aims to build capacity in participatory, collaborative and transdisciplinary research, meaning participants and researchers need to develop skills such as working together, drawing different kinds of knowledge and “expertise” from different people, and involving different types of stakeholders in the research and learning process. It follows that Ecohealth educational experiences should be taught and designed in ways
which will provide opportunities to develop these skills through practice. Trainers will develop understandings along these lines.

This paper presents the results of a workshop held in August 2002 in support of an action-oriented program of research that adopts an ecosystem approach to human health in Chennai, India. The workshop brought together stakeholders and potential participants in the research program in a collaborative environment to explore environment and health relationships, identify key actors and stakeholders in managing for human health, and develop a conceptual model of environment and health in Chennai. The workshop also introduced the ecosystem approach to workshop participants and explored the feasibility of applying the approach in Chennai. This paper is intended to highlight the use of a stakeholder workshop within an ecosystem approach, as well as techniques employed in the workshop’s working sessions. Influences on the workshop come from soft systems methodology, adaptive management and participatory action research. Working sessions were oriented to problem identification and framing, s...

The field of ecohealth has to do, broadly, with ‘research, practice and knowledge integration at the interface of ecology and health’ (International Association for Ecology and Health, 2013). This phrase, taken from the aims and scope of the journal EcoHealth, is expanded in the front matter of the journal with a couple of dozen examples in the categories of ‘One Health and Conservation Medicine,’ ‘Ecosystem Approaches to Health’ and ‘Public Health, Ecosystems and Society’. The broad definition is similar to the concept of One Health, as a field that addresses ‘interactions between human and animal health that reach far beyond individual clinical issues and include ecology, public health and broader societal dimensions’ (Zinsstag et al., 2011). In practical terms, this can be framed as the ‘added value [in terms of improved human and animal health outcomes, and ecosystem services] of a closer cooperation of human and animal health and other sectors’ (Zinsstag et al., 2012).

We situate our discussion in this chapter within this broad definition of the field of ecohealth, which we are taking to encompass One Health as described in this volume. As discussed earlier in this volume by Zinsstag et al. (Chapters 2 and 5), One Health has come to be seen by many researchers and practitioners as a strategy for achieving, jointly, animal and human health outcomes that would not be possible, or if possible would be more costly and/or less effective, if undertaken by separate initiatives. The selection of outcomes and their sustainability are embedded in much larger and more complex social-ecological systems; grappling with the challenges of understanding this broader context is the subject matter for ecohealth.

The relationship between water resource management and the ‘upstream’ determinants of health is emerging as a new portfolio of research, policy and practice. This development is informed by growing attention to ecosystem management in the context of catchments (also known as watersheds or river basins) and the potential ‘win-win’ of integrated strategies that improve both health and sustainability within these settings. Sustainable and equitable watershed management can be seen as an upstream driver of the determinants of health – with influences ranging from livelihoods and poverty, to cultural values, food security and lifestyles, as well provision of basic water services and infrastructure. Drawing on an integrated framework and the key concepts of ‘living systems’, ‘livelihoods’, and ‘linkages’ between ecosystems and equity, this paper examines integrated catchment management as the basis for an ecosystem approach that promotes water for life, health and sustainability. These concepts will be examined in the context of a community catchment health project in New Zealand, with cross-reference to initiatives in Hawai’i, Ecuador, Canada and the Philippines. Implications will be discussed in relation to capacity building for governance, research and education that values catchment management as a collaborative, cross-sectoral initiative with interrelated benefits for health, ecosystems and society.