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Chapter 4

RECOMMENDATIONS AND FUTURE DIRECTIONS

A community of Canadian and international scientists and decision-makers is beginning to appreciate the Ecohealth approach. It is also gaining followers in the research and educational communities, as well as among policymakers, who are learning about it in various ways.

Early recognition

In March 2002, at the first meeting of environment and health ministers of the Americas, held in Ottawa, Canada, Mexico's health minister, Julio Frenk, spoke about the success of the Ecohealth approach in solving the dilemma of DDT as a malaria-control agent in Mexico (see Box 7). In Johannesburg in August 2002, Canadian Minister of the Environment David Anderson took up the torch and stressed the pertinence of examining the links between the environment and human health. "The challenge for decision-makers," said Mr. Anderson, "is that too often we only have a very general idea of the links between health and the environment. We have to ensure that government departments coordinate their efforts." He closed by pointing to the importance of the International Forum on Ecosystem Approaches to Human Health in Montréal in May 2003 as an example of an initiative that "will help us reach and share our goals in the health and environment fields."

The Ecohealth approach is also gradually gaining ground in the scientific community. Here are some examples:

• The approach was presented at a panel on research, health, and development jointly organized by IDRC and the US National Institutes of Health (NIH) at the World Summit on Sustainable Development, in Johannesburg, in August 2002.
• It has been adopted by the Special Programmme for Research and Training in Tropical Diseases (TDR), an independent collaborative program cofunded by the United Nations Development Programme, the World Bank, and WHO. With IDRC support, TDR is applying the Ecohealth approach in two research programs in South America.
• In addition, the Pan American Health Organization is providing technical support for the implementation of the approach in two dengue fever projects in Central America and the Caribbean. These projects are also supported by the United Nations Environment Programme (UNEP).

• In August 2002, Mexico's Instituto Nacional de Salud Publica offered a summer course on the Ecohealth approach, attended by some 30 people.
• The American University of Beirut has set up a graduate interfaculty program in environmental sciences that includes the Ecohealth approach.
• In Canada, the University of Guelph, the Institute of Environmental Sciences at UQAM, the faculties of medicine and dentistry at the University of Western Ontario, and various other institutions active in the interplay between health and the environment now offer this type of program.

In addition, a national consultation on the future of transdisciplinary programs in health and the environment, overseen by the Canadian Institutes of Health Research, underscored the innovative character of the Ecohealth approach. In Canada, the Ecohealth approach is "coming out of the scientific closet:" it is being presented to the public at scientific exhibitions, as well as in pamphlets and popular science articles.

Finally, interest in the ecosystem approaches to human health is confirmed by the International Forum on Ecosystem Approaches to Human Health, held in Montréal, May 18­26, 2003. WHO, UNEP, the Ford Foundation, the United Nations Foundation, the Canadian International Development Agency, the Canadian ministries of health and environment, the Québec Ministry of Health and Social Services, UQAM, and the Montréal Biodôme have supported its organization. This forum confirms the existence of an international "Ecohealth approach" community: this forum is its first international meeting.

Challenging scientists

Above all, the Ecohealth approach requires the application of its three methodological pillars: transdisciplinarity, community participation, and gender sensitivity. This does not imply rejecting disciplinary research, which remains essential: each researcher must conserve his or her identity. A delicate balance also needs to be maintained between community needs and the interests of decision-makers and scientists.

Defining a common language calls for a major effort from all concerned. It implies real risks for researchers even within their own institutions since it requires deviating from predetermined research areas and demands a sustained effort. It can lead to delayed publications and uncertain interactions with local people. Finally, it requires learning how civil and political structures operate. In this context, educational institutions must accept the risks by providing the needed resources and assessing results in ways other than simply counting the number of publications generated. These institutions need to allow their academic departments to collaborate beyond multidisciplinarity.

Challenges for decision-makers

At a later stage, the Ecohealth approach will need to see its project results incorporated into larger scale programs and policies. This will require that policymakers well understand the issues and methods associated with this approach. They will need to go beyond the superficial, become full participants in sustainable development, articulate their needs, and, above all, be patient. They will also need to be genuinely interested in the work of the researchers.

Acknowledging that the study of complex problems is a lengthy process is key to the approach's success. For instance, it can take two or three years to set up a trandisciplinary team and define a common language, although this timeframe has been reduced to one year in some recent projects. An encouraging aspect, however, is that the ecosystem approach to human health produces results throughout the project's life, making it possible to take continuous action to improve the health of the community and the environment.

Financial support clearly plays a crucial role. If it is withdrawn during the course of the project, the project simply disappears. Because the continuation of a project is very much dependent on its funding, researchers whose parent institutions do not accept and support the Ecohealth approach are treading on dangerous ground.

The promise of the Ecohealth approach

For municipal, regional, and national decision-makers struggling with situations in which the environment affects human health, the ecosystem approach to human health provides a readily applicable process that can also point the way toward viable long-term solutions.

Decision-makers need practical, adequate, inexpensive, and feasible solutions. The quest for such solutions is at the heart of Ecohealth methodology. Ecohealth teams do not see their task as simply accumulating data; they are continually motivated to find solutions. "Of course, we can study problems," says Dr Oscar Betancourt, director of Ecuador's FUNSAD NGO, "but studies are simply studies." From the outset, Ecohealth projects work toward identifying practical solutions. "It's a technique for finding solutions, not just for describing problems," adds Dr David Waltner-Toews of the University of Guelph in Canada, who is also working to develop research methods that focus on the links between the environment and human health.

For policymakers, the Ecohealth approach offers many potentially important advantages. It allows public servants from various ministries to work together around a common scientific core with groups having different or opposing interests. In Mexico, public servants and other government officials who put Ecohealth principles into practice in the fight against malaria have concluded that it is the right approach. This Ecohealth project has created a negotiated space in which representatives from disparate ministries, departments, and disciplines (agriculture, environment, health) work together. Guided and motivated by a common search for solutions, they can set aside their differences to concentrate on their particular contribution to the problem's solution.

The same is true for various citizens' organizations with clearly defined and sometimes divergent interests. For them also, the project creates a space where they can work together. In some cases, groups that are otherwise in conflict work side by side. In some communities, the project offers a forum for discussion among representatives of business, citizen groups, and government organizations. It can even happen, as in Kathmandu, that the project stimulates dialogue between representatives of castes separated by centuries of contempt.

Ecohealth projects usually begin with an alliance between scientists and community members. These alliances find themselves greatly strengthened when decision-makers agree to participate. Government authorities need to understand that the participation of public servants in such projects is necessary. They also must accept that their staff operate in a new framework characterized by transdisciplinarity, community participation, and social equity. In practice, the initiative can come from any of the partners. Even national authorities, as in Mexico, have launched such projects.

The Ecohealth approach offers a place at the table for representatives of any agency, jurisdiction, or authority interested in helping to improve a situation. Decision-makers are provided with integrated solutions that take into account the various actors, including those over which they exercise direct authority (public servants) and those over which they don't (citizens' groups). When completed, a project can even result in the creation of a new managerial entity, as in the case of southern Ecuador where a new body now represents two communities affected by mining waste. Since representatives of the relevant policymaking authorities are already acquainted with each other and there is eventual consensus on solutions, it becomes easier to harmonize policies -- always a challenge for mayors, governors, and ministers. The program can then be adjusted in response to the needs and new solutions identified during the research.

In the wake of an Ecohealth project in Kenya, a program was launched to study the application of the Ecohealth approach to several communities in that country. As well, the mercury project in the Amazon basin has now had ramifications in Canada. In 2001, the Natural Sciences and Engineering Research Council of Canada (NSERC) supported the creation of COMERN, the Collaborative Mercury Research Network. The network connects researchers from across Canada who are concerned with the safe and sustainable use of our aquatic resources, with a focus on the problems posed by mercury contamination (Figure 7). The integrated ecosystem approach advocated by COMERN includes the active participation of specialists in all fields of the applied sciences, as well as social interveners and political decision-makers in all steps of research development. Many of the Canadian researchers in the network, including the coordinator Dr Marc Lucotte, are also associated with the Amazon project.

Figure 7. COMERN, the Collaborative Mercury Research Network, uses the ecosystem approach to study the movement of mercury through the environment in Canada. (Source: Lucotte, M., personal communication, 2003)

Use of the Ecohealth approach immediately sets in motion a collaborative process whereby all the key players come together around the same table to produce applicable and feasible long-term solutions. Of course, this means taking the risk of placing confidence in a disparate team, investing the time and resources required, and the will to change things.

One of the reasons for the success of the Ecohealth approach is that the proposed solutions take into account local knowledge and the contribution of community members. For example, women from the villages along the Tapajos River in Brazil have spread the word about the species of fish that are less contaminated and therefore safe to eat. In the South, communities are often left to fend for themselves. But if "experts" arrive to study their problems, the Ecohealth methodology creates a space in which decision-makers, community members, and researchers can combine forces.

Accepting that it is their responsibility to change a situation is generally facilitated when people have participated in defining the problem. In Ethiopia, for instance, once the villagers that were the focus of an Ecohealth project realized that their sanitation practices were affecting their health, they took the situation in hand.

Decision-makers obtain a menu of solutions in an area that both families and individuals regard as priority -- their health. The solutions advocated do not deal only with changes in behaviour. They also bear on better understanding the interactions between environmental, social, economic, and political aspects of the problem to be solved. They ensure that the eventual investments in infrastructure and new services will be made in the right places, and in places where people can see immediate results. What's more, the relatively short lapse of time between initiating the process and the first visible results makes it easier to implement longer term interventions.

Of course, when authorities support Ecohealth projects, as described in this small book, they take certain risks -- but one of those risks is success! In Brazil, Cuba, Mexico, Nepal, and a growing number of other countries, success has been achieved. But before launching an Ecohealth project, make sure that there is a leader, supported by his or her institution or community. These leaders exist: they are the driving force of the Ecohealth approach. Increasingly, they are found in research environments, in remedial action programs, and in government policymaking.

For some of them, the Ecohealth approach has already brought prizes, promotions, and recognition. In Mexico, for example, the leader of the Ecohealth project received the prestigious Jorge Rosenkranz Award in 2002. In Cuba, the project leader was given the Cuban Academy of Sciences' Health Award, one of the country's highest scientific distinctions. By encouraging Ecohealth projects, government authorities who successfully associate themselves with the work of researchers and communities make winners out of everyone.

The current results of the ecosystem approach to human health represent a few concrete answers to the challenges of sustainable development. They also provide reason to hope.

Document(s) 7 of 7