Why an “Eco-Health” Approach
Jerry Spiegel MA, MSc, PhDDirector, Global Health Associate Professor
Liu Institute for Global Issues School of Population & Public HealthGLOBAL HEALTH GLOBAL HEALTH RESEARCH PROGRAMRESEARCH PROGRAM
GLOBAL HEALTH GLOBAL HEALTH RESEARCH PROGRAMRESEARCH PROGRAM
Learning Objectives:g j
–To consider :–Why an eco-health approach was developed
–Some applications of the approach
–What the benefits could be
–What the shortcomings could beWhat the shortcomings could be
UNDERSTANDING AND ADDRESSING
(ECOSYSTEM) HEALTH
FROM A GLOBAL PERSPECTIVE
Conversion of forests to farmlands in Santa Cruz, Bolivia
• 1975: Forested landscape
Conversion of forests to farmlands in Santa Cruz, Bolivia
• 1975: Forested landscape
• 2003: Large corporate agriculturalcorporate agricultural fields transform the landscape
Global Movement of Waste
NAVIGATING COMPLEXITYActorsNeedsActivitiesResource statesConcerns
Lack of efficientand regularsweeping exacerbatesgarbagemismanagementSweeper
Help fund
Households
WardCommittee
Sweeper Hierarchy
Dispose garbageinto containers
Dispose fecal matter i l ti b
Set rules andregulations forstreet sweeping
p(loans)
KMCsweepers
Committee
Inspectors(men)
L k f t it
Money to send childrento day care orschool
in plastic bagsin street
Dispose garbagein street
Empty containersinto tractor(once a week)
p
Captain(men)
Cleanliness
Notenough
Lack of opportunityfor education &employment forchildren
Need Protectiveequipment Unblock
Pick up piles
Transport waste to Teku landfill
TractorDriver(men)
Drain CleanlinessOf streets
time to collect garbage
Health impactsof handlinggarbage
time tocollectgarbage
equipment(gloves, masks, shoes)
Hygienetraining
Sweep streets(garbageinto piles)
Unblock drainsUnblockers
(men)
StreetSweepers(women)
Citizens ignorerequest to notcarelessly throw
Massive amountsof garbage fromslaughterhouses
Illiteracyhelps upper castekeep dominationover them
garbage
Garbage containers
Awareness needed at Household level
into piles) Disposevegetablewaste in street
(women)
Expect Sweepers to clean waste
garbage everywherePeople throw garbage outwindow as soonthey see tractors
slaughterhouses
Bell system(does not work)Improved
slaughterhousegarbage management
Literacytraining
Street vendors
- David’s Nepal example
Before an ecosystem approach -lots of scientific information
After an ecosystem approach - lots of positive change
Parks
Composting
Determinants & Points of Intervention
Effi ? Eff ti ?“NEGLECTED” HEALTH SYSTEMS
I f P t
Underlying Proximate DiseasesIntermediate
Efficacy ? – Effectiveness ?Delivery ? – Scale-up ?
Health Diplomacy
Interests of wealth/power
Status of women
Poverty
Disparity
Access to d i
Malnutrition
Water
Sanitation
DiarrheaPneumoniaPerinatal women
Land tenure
Debt-SAPs
education
Job conditions
d
Sanitation
Housing
Health services
conditionsHIV/AIDSInjury
Human Security
Weak governments
Militarism
Gender issues
Civil strife
services
Health behaviors
MalariaMeaslesNTDs
l hImperialism Conflict
Global-National
Community- National
Family-Community
Individual
Health Diplomacy
Community Ecosystem ConceptCommunity Ecosystem Concept
ENVIRONMENTLiveable
COMMUNITY
HEALTH
Equitable Sustainable
Convivial Viable
ECONOMYAdequately prosperous
Source: Hancock, 1993
ECOSYSTEM APPROACH TO HUMAN HEALTHECOSYSTEM APPROACH TO HUMAN HEALTH-- a framework for setting impact objectives a framework for setting impact objectives --
Socio-culturalfactors
Source: Forget and Lebel, 2001
g p jg p j
TransdisciplinarityEquity
factors
Behaviouralf t
Natural ResourceManagement
yParticipation
factors
GlobalUnderstanding the
Determinants of Societal ResponseT H lth dIMPROVED Development
Knowledge
change
Economic
Ecosystem and Human Health
To Health and Human
Development Needs
IMPROVEDHEALTH
Development of Policies
Empowermentfactors
Environmental Human Resource Management
Empowerment
Sustainabilityfactors Management
… and a process for involving key players to achieve impact… and a process for involving key players to achieve impact
malaria
Mining activities poisoning
minersmercury
Mercury in Fishmercury
Gold market
Mercury in FishDeforestationSoil erosionAgricultural
policy, management
mercury in water
gof forest, settlement Agricultural
burningfruit
Human exposureriversides
Mercury poisoning
fruit
p g
Brazil nutChagasDisease
ACTIONSDPSEEA FRAMEWORKDRIVING FORCESDRIVING FORCESGlobal markets (perfect roses)
PRESSURES
Global markets (perfect roses)Neo-liberalism
PRESSURES
STATE
Necessicity for pesticides / Spraying
STATELevel of pesticides in air & flowers
EXPOSURES
p
EXPOSURESInhalation of workplace air
EFFECTSEFFECTSPesticide poisoning
InterpretationEvaluación
ACTIONSDPSEEA FRAMEWORKDRIVING FORCESDRIVING FORCESGlobal markets (perfect roses)DRIVING FORCESGlobal markets (perfect roses)
PRESSURES
Global markets (perfect roses)Neo-liberalism
PRESSURES
(p )Neo-liberalismPoverty, MigrationPRESSURESNecessicity for pesticides / Spraying
STATE
Necessicity for pesticides / Spraying
STATELevel of pesticides in air & flowers
Necessicity for pesticides / SprayingLow salariesSTATELevel of pesticides in air & flowers
EXPOSURES
p
EXPOSURES
Work conditions; Child care; Money anxieties
EXPOSURESInhalation of workplace airInhalation of workplace airIntensity of work; anxiety for kids
EFFECTSEFFECTSEFFECTSPesticide poisoningEFFECTSPesticide poisoningStress
InterpretationEvaluación
ACTIONSDPSEEA FRAMEWORKDRIVING FORCESDRIVING FORCESGlobal markets (perfect roses)DRIVING FORCESGlobal markets (perfect roses)
PRESSURES
Global markets (perfect roses)Neo-liberalism
PRESSURES
(p )Neo-liberalismPoverty, MigrationPRESSURESNecessicity for pesticides / Spraying
STATE
Necessicity for pesticides / Spraying
STATELevel of pesticides in air & flowers
Necessicity for pesticides / SprayingLow salariesSTATELevel of pesticides in air & flowersSTATELevel of pesticides in air & flowers
EXPOSURES
p
EXPOSURES
Work conditions; Child care; Money anxieties
EXPOSURES
Work conditions; ergonomicsChild care; Money anxieties
EXPOSURESInhalation of workplace airInhalation of workplace airIntensity of work; anxiety for kids
EFFECTS
Inhalation of workplace airIntensity of work; anxiety for kidsHandling/contact with flowers
EFFECTSEFFECTSEFFECTSPesticide poisoningEFFECTSPesticide poisoningStress
EFFECTSPesticide poisoningStressBack pain, dermatitis
InterpretationEvaluación
ACTIONSDPSEEA FRAMEWORKDRIVING FORCESDRIVING FORCESGlobal markets (perfect roses)DRIVING FORCESGlobal markets (perfect roses) “Fair trade” – ethical commerce
PRESSURES
Global markets (perfect roses)Neo-liberalism
PRESSURES
(p )Neo-liberalismPoverty, MigrationPRESSURESNecessicity for pesticides / Spraying
Recognition of the FLP flower label program
Alternate technologies
STATE
Necessicity for pesticides / Spraying
STATELevel of pesticides in air & flowers
Necessicity for pesticides / SprayingLow salariesSTATELevel of pesticides in air & flowersSTATELevel of pesticides in air & flowers Better management
gLess toxic pesticides
Higher salaries (unions)
EXPOSURES
p
EXPOSURES
Work conditions; Child care; Money anxieties
EXPOSURES
Work conditions; ergonomicsChild care; Money anxieties
EXPOSURES Training & equipment
gof work processes
Inhalation of workplace airInhalation of workplace airIntensity of work; anxiety for kids
EFFECTS
Inhalation of workplace airIntensity of work; anxiety for kidsHandling/contact with flowers
EFFECTS
g q pMonitoring / surveillance
EFFECTSEFFECTSPesticide poisoningEFFECTSPesticide poisoningStress
EFFECTSPesticide poisoningStressBack pain, dermatitis
Timely diagnosis & treatment a Rotation of work & rehabilitation
InterpretationEvaluación
ACTIONSDIRECT IMPACTSDRIVING FORCES
CAPACITIES TO ACT
FORCES OF GLOBALIZATION (negative & positive)FLOR DRIVING FORCES on DRIVING FORCESRICU
DRIVING FORCESGlobal markets (perfect roses)Neo-liberalism Poverty, Migration
Recognition of the FLP flower label programRecognition of the FLP flower label program FAIR TRADE” – ETHICAL
COMMERCE RECOGNIZED (e.gGerman consumer support
Alternate technologiesLess toxic pesticides
Higher salaries (unions)
LTUR
PRESSURESNecessicity for pesticides / Spraying; Low salaries
STATE
on PRESSURESPressures on unions /demand for cleaner production
on STATERE
I
STATEPesticide Level in air & flowersWork conditions; ergonomicsChild care; Money anxieties
Better management of work processes Technical capacities to
oversee state of processes
on EXPOSURESN
EC
EXPOSURESInhalation of workplace airIntensity of work; anxiety for kidsHandling/contact with flowers
Training & equipmentMonitoring / surveillance
Monitoring capacity, worker committees
on EFFECTS
CUADO
EFFECTS
Stress
Timely diagnosis & treatment a Rotation of work & rehabilitation Occupational health servicesPESTICIDE POISONING
FLP PROGRAM
Interpretation
OR
CASE STUDY
StressBack pain, dermatitis
FLP PROGRAM
Conclusion• Consideration of global forces
(in an era of globalization)
– Enhances understanding
– Enhances capacity to develop/evaluate options
SUSTAINABLY MANAGING ENVIRONMENTAL HEALTH RISKS SUSTAINABLY MANAGING ENVIRONMENTAL HEALTH RISKS IN ECUADOR IN ECUADOR
A communityA community based intercultural and interdisciplinary initiativebased intercultural and interdisciplinary initiativeA communityA community--based, intercultural and interdisciplinary initiative based, intercultural and interdisciplinary initiative to promote human and ecosystem health. to promote human and ecosystem health.
UPCD TIER 1 UNIVERSITY PARTNERSHIP ($5 million, 6 years)
Climate change deforestation
Urbanization; disparity
ENVIRONMENT
AGENT HOSTAGENT HOST
Pathogenicity – e.g. dengue
International trade International travel
DENGUE
ENVIRONMENTENVIRONMENT
VECTORS
CLINICAL
EPIDEMIOLOGICALEPIDEMIOLOGICAL
LABORATORY
Transmission of Dengue Virus by Aedes aegypti
Site control leads to fewer
mosquitoes
Aedes aegyptiFumigation / Larviciding
kills
Mosquito enters ecosystem
kills mosquitoes
Mosquito feeds & acquires virus
Mosquito refeeds & transmits virus
ecosystem
Forced bedrest isolates viremia
Forced bedrest isolates viremia
Extrinsic incubation
period
Intrinsic incubation
period
isolates viremia from vector
isolates viremia from vector
period(~9 days)Viremia
0 5 8 12 16 20 24 28
period (~8 days) Viremia
IllnessDays
0 5 8 12 16 20 24 28
Human #1 Human #2
Illness
Driving Force ActionsDriving ForceUrbanization; Poverty,
climate
Pressure Housing conditions
Improved housing & infrastructurePressure Housing conditions
water handling practiceCommunity empowerment
StatePresence of containers with
water Environmental controls
Environmental surveillance
Exposure
Aedes Aegypti foci
water, Entomological surveillance
EffectDengue; DHF
Clinical-Epidemiological surveillance
g ;Interpretation
Evaluation
Integrated surveillance componentsg p
i t l ill id tifi ti f i k ithi• environmental surveillance - identification of risks within each of the 5 Popular Councils of Central Havana
t l i l ill i ill i h• entomological surveillance –active surveillance in the areas of infestation and appearance of epidemic foci;
• epidemiological / clinical surveillance - collecting and analyzing information on the individuals at risk, probable or confirmed cases, and serological surveillance; and
• community participation “surveillance” - monitoring community capacity and the extent of community participation in the implementation of the strategyparticipation in the implementation of the strategy.
Applying the eco-health approach• When and how to intervene effectively?• Active involvementActive involvement
– decision-makers; community; interdisciplinary
SURVEILLANCE
EnvironmentalSurveillance Entomological
surveillance
Clinical epidemiological
surveillancesurveillance
Social ParticipationParticipation
Applying the eco-health approach i C bin Cuba
Active involvement of decision-makers -community; interdisciplinary
SURVEILLANCE
EnvironmentalSurveillance
Entomologicalsurveillance
Clinical epidemiological
surveillance
Social Participation
Surveillance SystemSurveillance System4 subsystems:
EnvironmentalEnvironmentalEntomologicalClinical-Epidemiological and LaboratoryCommunity Participationy p
Events or conditions to monitor.Work and operation of the systemWork and operation of the system.Information flow and analysis• events to monitor, information sources, frequency of the, , q y
analysis and statisticalMapping the flow of the informationDissemination and feedback of the informationDissemination and feedback of the informationEvaluation of the surveillance system.
DecisionMaking
MINSAPPROVINCIAMUNICIPIO INFORMATION
System sustainabilityEpidemiological alertsMosquito Control Contingency Plan
INTER-RELATIONSHIP OF SUBSYSTEMS
-----------------------------------------------------------------
ClinicalEpidemiology
Contingency Plan
InformationA l i
PREVENTION SOC
-----------------------------------------------------------------
p gyLaboratory
Surveillancesubsystem
AnalysisRisk factor indicatorsCIAL
P
Action
EntomologicSurveillancesubsystem
Information PREVENTION
Risk factor indicators
PARTIC
Analysis
INFOR
-----------------------------------------------------------------
EnvironmentS illRi k f t i di t
Action
Information PREVENTION
IPATIO
Analysis
RMATIO
-----------------------------------------------------------------
Surveillancesubsystem
•Organos PPI f ti
Risk factor indicators ON
y
Action
N
•Organos PP• Organismos
•Consejo Popular
•Comunidad•FamiliaMedia
AcciónInformation:•Macro factors•Micro factors
ECOSYSTEMCommunity
Analysis
Indicators
(UMHE)
Integrated surveillance system for prevention of dengue at the local level
(UMHE)Chief of
Integrated environmtlhygiene program
Municipal hygiene and epidemiology unit (UMHE)
(biologist)Health Area
(Polyclínic) Direction Council
Hygiene Vice director
(biologist)
technical staff
(UMHE)
of hygiene for the health
area Collective analysisGBT*
Supervisor of health area
por GBT*
Chief of BrigadeCouncil of Popular Power
Field workkerGrupos
vecinalesNeighborhood
delegateCMF
DENGUE HOUSEHOLD INSPECTOR & SUPERVISOR WORKSHOPS
NEW INDICATORS INFORMATION SYSTEMS & REPORTINGNEW INDICATORS, INFORMATION SYSTEMS & REPORTING
Surveillance System Monitoring Gráfico 1. Ambiente intradomiciliario por Consejos Populares
90%
100%
Status of Household35,1
86,9
51,6
12,631,4
30%
40%
50%
60%
70%
80%
90%
%
Status of Household Environments by Neighbourhood
33,5
4,7
35,8
8,4
0%
10%
20%
Dragones Los Sitios Cayo Hueso
Ciclos
Malas condiciones Condiciones regulares Condiciones adecuadas
Grafico 2. Ambiente Extradomiciliario por Consejo Popular.
Municipio Centro Habana
90%100%
% St t f O t id61.3
9.2 8.11
38.71 91.9990.8
0%10%20%30%40%50%60%70%80%
Dragones Los Sitios Cayo Hueso
% Status of Outside Environments by Neighbourhood
ciclos
malas condiciones condiciones adecuadas
Trend analysisGráfico 9. Ambiente intradomiciliario por ciclos en los tres
Consejos Populares
70 0
80,0
Household conditions by
30,0
40,0
50,0
60,0
70,0
%
Dragones
Los Sitios
Cayo Hueso
Household conditions by Neighbourhood
0,0
10,0
20,0
74 75 76 77 78 79 80 81 86 87 88 89 90
Ciclos
Gráfico 7. Comportamiento de los focos de Aa por ciclo. Municipio Centro Habana
20
4060 Focos Overall levels of mosquito
breeding site activity
020
72 74 76 78 80 86 89ciclos
Integrating the risk mapping
Identification of “hot spots”Identification of hot spots
