Karen Morrison

Strengthening integrated research and capacity development within the Caribbean region

BackgroundThe Caribbean region, like other developing regions of the world, faces significant challenges in conducting research, especially in the context of limited resource capacities and capabilities. Further, due to its diverse and multiple island states, research capacity is scattered and unevenly spread within the region. The Caribbean EcoHealth Programme (CEHP) is a research program that is structured to improve the capacity and capability of health professionals in the Caribbean region to respond in integrative and innovative ways to on-going and emerging environmental health challenges by means of multi-sectoral interventions.MethodsCore parts of the CEHP’s mission are to (1) conduct collaborative research in areas that the region has identified as critical; (2) build and strengthening integrated approaches to research; and (3) develop and enhance basic research capacity within the Caribbean region.Fundamental to the success of the CEHP’s human and resource development mission has been its use of the Atlantis Mobile Laboratory (AML). The AML has allowed the CEHP program to move throughout the Caribbean and be able to respond to calls for specific research and capacity building opportunities.ResultsThe CEHP’s five main research projects have generated the following results: (1) the Persistent Organic Pollutants (POPs) study has evaluated human exposures to POPs, heavy metals, pesticides, and zoonotic infections; (2) the Burden of Illness (BOI) studies have developed protocols for the testing of foodborne microorganisms, strengthen laboratory analytical capabilities, and determined the prevalence and incidence of food-borne illness; (3) the Rainwater Harvesting (RWH) study has evaluated the microbial and chemical quality of rainwater harvesting systems; (4) the Ecotoxicology Water (ETW) studies have provided much needed data on the quality of recreational and drinking water supplies, and (5) the Food Safety Training Program has developed Diploma and M.Sc Agri-Food Safety and Quality Assurance programmes.ConclusionsThe CEHP program provides a successful example of how a collaborative instead of researcher driven research agenda can lead to not only the generation of needed information, but also leave within the region where the research has been carried out the capacity and capabilities to continue to do so independent of outside interventions.

Seroprevalence of Seven Zoonotic Pathogens in Pregnant Women from the Caribbean

Studies examining the prevalence of zoonotic agents in the Caribbean are very limited. The objective of this study was to examine the seroprevalence of seven zoonotic agents among individuals residing on 10 English-speaking Caribbean countries. Sera from healthy, pregnant women were collected from Antigua-Barbuda, Belize, Bermuda, Dominica, Grenada, Jamaica, Montserrat, St. Kitts-Nevis, St. Lucia, and St. Vincent-Grenadines and tested for the presence of IgG antibodies to dengue virus, hepatitis E virus, hantaviruses, leptospiral agents, spotted fever group rickettsiae (SFGR), typhus group rickettsiae (TGR), and Coxiella burnetii (Q fever). The highest seroprevalence values were observed for dengue virus, SFGR, and leptospirosis, although the lowest seroprevalence values were observed for hepatitis E virus, C. burnetii, and TGR. Antibodies to hantaviruses were not detected in any individuals.

Watershed Management and Public Health: An Exploration of the Intersection of Two Fields as Reported in the Literature from 2000 to 2010

Watersheds are settings for health and well-being that have a great deal to offer the public health community due to the correspondence between the spatial form of the watershed unit and the importance to health and well-being of water. However, managing watersheds for human health and well-being requires the ability to move beyond typical reductionist approaches toward more holistic methods. Health and well-being are emergent properties of inter-related social and biophysical processes. This paper characterizes points of connection and integration between watershed management and public health and tests a new conceptual model, the Watershed Governance Prism, to determine the prevalence in peer-reviewed literature of different perspectives relating to watersheds and public health. We conducted an initial search of academic databases for papers that addressed the interface between watershed management (or governance) and public health themes. We then generated a sample of these papers and undertook a collaborative analysis informed by the Watershed Governance Prism. Our analysis found that although these manuscripts dealt with a range of biophysical and social determinants of health, there was a tendency for social factors and health outcomes to be framed as context only for these studies, rather than form the core of the relationships being investigated. At least one cluster of papers emerged from this analysis that represented a cohesive perspective on watershed governance and health; “Perspective B” on the Watershed Governance Prism, “water governance for ecosystems and well-being,” was dominant. Overall, the integration of watershed management/governance and public health is in its infancy.

Adaptive Governance of Dynamic Social-Ecological Systems: The Case of the Ontario Environmental Farm Plan (1992–2011)

The sustainability of environmental stewardship programs is an ongoing concern. The fluidity of multilevel, polycentric social-ecological systems requires partnerships to be flexible and adaptive. As society changes, the foundation of stewardship programs also shift. In this article, Glasbergens (2011) Ladder of Partnerships is applied to the analysis of three governance regime shifts in the agroecosystem stewardship program, the Ontario Environmental Farm Plan (OEFP). Six key-informant interviews with pivotal actors within each phase of the program were conducted along with a review of documents and program data. The study finds that changes in the context for, and the governance of, OEFP are shifting the foundations of the original program. The adverse consequences of these changes for the viability of the program, illustrates the need to understand governance issues. The study supports the call for program analysis that is sensitive to the evolution of the system in question. Specifically, the shifting baseline of social norms and policies that affect the sustainability of stewardship programs that are governmental civil society partnerships. The study concludes that the co-option of bottom up processes and programs by top down government interventions can lead to loss of integrity and legitimacy of the programs.

Connections for Health, Ecosystems and Society leading to Action and Change

The theme of connections has been integral to the field of ecohealth since its inception. At its core, ecohealth is about relationships and systemic interactions between issues, topics and approaches that are too often treated in isolation. As a central theme for EcoHealth 2014, the 5th biennial conference of the International Association for Ecology & Health (IAEH), the emphasis on connections reminds us that we cannot reach our shared goal of ecosystem sustainability, resilience and health— for humans and all species—alone. By focusing on the spaces in between, we are challenged to consider how the meeting of all forms of knowledge can not only increase understanding of complex problems affecting health, ecosystems and society, but also be mobilised to lead to actions to address these issues. Arriving in Montreal in 2014 for an ecohealth gathering prompts reflection on how these confluences and convergences have developed and expanded 10 years since the Montreal EcoHealth Forum in 2003. One indication of this can be gleaned from the range of presenters assembling at the conference. At Ecohealth 2014, the programme not only includes researchers from natural, social and health sciences but also has very explicit inclusion of arts and other forms of practice, as well as representation of private and public sectors, NGOs and community groups. People from over 60 countries, spanning Africa, Asia, the Americas, Europe, Oceania and the Middle East, will present their work at the conference. Of particular note is the renewal and intergenerational spread, ranging from an increasingly strong presence of emerging scholars and practitioners, to an ongoing engagement with ecohealth pioneers. For those interested in connections, reflecting on developments since the 2003 Montreal EcoHealth Forum is less about defining progress and more about identifying consistent patterns of interactions and challenges that a field like ecohealth continues to face. In 2003, just as with all of the biennial conferences of the IAEH (Madison 2006, Merida 2008, London 2010, Kunming 2012), we assembled because of our need for integrative research, education and practice. The continuing excitement and dynamism of ecohealth arise not so much from any one area of expertise but in the fertile terrain of innovation that occurs when we come together to explore other ways of thinking and acting. That anthropogenic environmental degradation impacts human and animal health is increasingly uncontroversial. Ecohealth scholars are tasked with both collecting and synthesizing information to better understand that core relationship. In addition, however, we face the more difficult task of defining what to do with that knowledge. And so in 2014, we challenge ourselves to revisit and make explicit the important features of our ongoing aspiration towards connections. What can we learn from past connections? What types of conceptual and methodological connections are still needed to address the challenging domain that unites human and animal health, ecosystems and society? Whither the humanities as an integral contribution to ecohealth? EcoHealth2014 was proposed as a conference that will address these questions by contributing to ‘the critical development of the field as well as to an international, interdisciplinary and intersectoral conversation about environment (natural and social) and health’. The motivation to leave the comfort of disciplinary or sectoral domains extends beyond interest in the richness of conversations or a commitment to the advancement of knowledge. Rather, we argue that interest in Authors are members of Canadian Community of Practice in Ecosystem Approaches to Health (CoPEH-Canada). Correspondence to: Johanne Saint-Charles, e-mail: saint-charles.johanne@uqam.ca EcoHealth 11, 279–280, 2014 DOI: 10.1007/s10393-014-0945-8

Using participatory epidemiology to assess factors contributing to common enteric pathogens in Ontario: results from a workshop held at the Ontario Veterinary College, University of Guelph, Ontario

BackgroundCommon enteric pathogens that cause gastrointestinal illness are transmitted to humans through food, water or direct contact. This poses a significant concern to public health as enteric pathogens can cause disease in a large number of people, and cost a substantial amount to treat and prevent. In order to gain a better understanding of the occurrence of enteric disease in Ontario, this study explored public health professionals’ perceptions of major contributing factors for common enteric pathogens.MethodsA case study was conducted as part of a two week training workshop in Participatory Epidemiology held at the Ontario Veterinary College, University of Guelph, in May 2013. Eight semi-structured interviews and four focus groups were conducted with representatives from the Public Health Agency of Canada, the University of Guelph, and three health regions in Southern Ontario. Written notes and pictures captured the qualitative information provided. Results were then analyzed using the mixed methods techniques of triangulation, convergence, and paradox.ResultsA total of fifty factors that contribute to enteric disease were identified across all interviews and focus groups. These contributing factors were grouped into key themes (travel, food handling, industry (farm-to-fork), water, geography, demographics, and behaviours) and were categorized as either a risk factor or susceptibility factor. Informants emphasized the complex relationships between the identified factors, and highlighted why these complexities make it difficult to determine where and how a person most likely acquired an enteric pathogen. Workshop participants observed differences in the type and quality of information collected during interviews and focus groups; we hypothesize that this may be attributed to the dynamics between group members (i.e. focus group discussions) as opposed to one-on-one interviews.ConclusionsThe information gathered will serve as a starting point to further explore contributing factors for common enteric pathogens. The identified complexities would be best explored by conducting additional surveillance, as well as interviews and focus groups with a more diverse group of stakeholders. This type of qualitative study can enhance knowledge of enteric pathogen surveillance and contribute to the development of resources and initiatives to holistically address the occurrence of gastrointestinal illness.

Network of Ethical Relationships model for global North–South population health research

ABSTRACT Although a substantial body of literature exists that details how to address ethical issues and provide oversight for traditional research study designs, there currently is very little guidance available to researchers on how to deal with the unique and novel challenges that arise when conducting research that goes outside of these well-defined boundaries. One such example is North–South (N-S) team-based global population health (GPH) research. This paper presents a Network of Ethical Relationships (NER) model which can allow GPH researchers better understand and resolve ethical issues that arise in N-S collaborative research efforts. The NER model elucidates some of the core relationships involved in GPH research and sheds light on the complex milieu of moral, institutional, societal and legal processes in which it is embedded. The utility of the NER model is examined by reviewing 14 GPH research teams, looking at two relationships in more detail – Researcher–Ethics Board, and Researcher–Funder relationships. The paper argues that improved dialogue and flexibility in the application of formal ethical rules and procedures can lead to research being conducted in a more ethical manner since it better accounts for the multitude of voices and perspectives influencing researchers’ choices and actions.

Public Health at the Watershed Scale

Public health is usefully defined and managed at a variety of spatial spaces. This place-based, healthy settings approach has led to the formation of a number of successful programs and policies, such as the healthy cities, healthy neighborhoods, healthy schools and healthy homes movements. The application of a healthy settings approach to watersheds creates a powerful frame for public policy that enhances both natural and social systems, and is particularly relevant to discussions around climate change. Health and well-being are impacted by the governance and management of watersheds, at multiple scales, in ways that go well beyond the traditional focus on flooding or drinking water. Drawing on examples from watersheds, this chapter outlines the policy implications of watersheds as a setting for health and well-being. It highlights the need for a more strategic approach to watershed governance that actively seeks linkages with public health institutions in order to more effectively leverage scarce resources to meet common goals. It fills a gap in our understanding of the links between watershed-level programming and public health.

Partnerships and governance at the environment–health nexus in Ontario: lessons from five case examples

The move towards partnerships and collaborative governance models has been advocated in global health discussions for many years now. A case example methodology was applied to this study. It was composed of a document review and semi-structured interviews with key informants from five environment and public health partnerships in the province of Ontario, Canada. These case examples highlight the merits and the challenges of diverse partnerships, and the importance of governance and leadership models, scaling up (and out) impact, and cross-cultural communications to these arrangements. Further work is required to articulate situations in which public health partnerships can be strengthened.