Margot W. Parkes

EcoHealth: A Transdisciplinary Imperative for a Sustainable Future

The time has come for a scientific journal that recognizes the inherent interdependence of the health of humans, wildlife, and ecosystems, and that provides a ‘‘gathering place’’ for those exploring the perspectives, theories, and methodologies emerging at the interface between ecological and health sciences. EcoHealth responds to this challenge and to the demands of a large and growing community of practitioners and scholars who require a high-quality, authoritative forum for reporting on research and practice that integrates human, wildlife, and ecosystem health. Health can be viewed as a central criterion for judging human sustainability (McMichael, 2002) and its understanding in this context draws on integrative and cross-disciplinary approaches involving both the ecological and health sciences. This understanding requires research on the effects of global change on ecosystem sustainability and on human health; the emergence and effects of pathogens, parasites, and pollutants within human, non-human animal, and plant communities; the interaction between environment, development, and human health; and the management of these challenges across local, regional, and global scales. In the past decade, vibrant, complementary, and overlapping research communities have emerged to address these problems, grouped under several banners, including: conservation medicine; global change and human health; and a variety of integrated studies in ecology, health, and sustainability. The common, overarching purpose of these three overlapping research domains is to better understand the connections between nature, society, and health, and how drivers of social and ecosystem change ultimately will also influence human health and well-being. The reciprocal, often complex, and even messy relationships between and among humans, other organisms, and their surroundings are clearly evident in the widening gap between those who have and those who have not, in the health effects of inequality, and in the environmental consequences of such disparities. The global loss of biological diversity affects the wellbeing of both animals and humans. Habitat destruction and species loss have led to ecosystem disruptions including the alteration of disease transmission patterns, the accumulation of toxic pollutants, and the invasion of alien species and pathogens (Aguirre et al., 2002). Conservation medicine addresses the interactions among human-induced changes in climate, habitat, biodiversity, and ecology; the emergence of pathogens, parasites, and pollutants; and health within human, non-human animal, and plant communities. This is especially relevant in today’s human-modified landscapes, where habitat destruction and degradation, and episodes of emerging human and wildlife diseases are increasing. Conservation medicine embraces participation by practitioners of ecology (terrestrial and marine), biology, epidemiology, veterinary medicine, human medicine, and public health. Perspectives from the social and political sciences are also fundamental in understanding and responding to the underlying drivers of human-induced changes in climate, habitat, and the use of terrestrial and marine ecosystems. Socio-economic change, public health initiatives, and gains in medical care have continued to improve our basic health indexes in recent decades. However, we have begun to understand that economic development can impair public health if environmental and social considerations are marginalized. Increasingly, the health of human populations is influenced by large-scale environmental changes, EcoHealth 1, 3–5, 2004 DOI: 10.1007/s10393-004-0014-9

Water, ecology and health: ecosystems as settings for promoting health and sustainability

Despite the proposed ecological and systems-based perspectives of the settings-based approach to health promotion, most initiatives have tended to overlook the fundamental nature of ecosystems. This paper responds to this oversight by proposing an explicit re-integration of ecosystems within the healthy settings approach. We make this case by focusing on water as an integrating unit of analysis. Water, on which all life depends, is not only an integral consideration for the existing healthy settings (schools, hospitals, workplaces) but also highlights the ecosystem context of health and sustainability. A focus on catchments (also know as watersheds and river basins) exemplifies the scaled and upstream/downstream nature of ecosystems and draws into sharp focus the cross-sectoral and transdisciplinary context of the social and environmental determinants of health. We position this work in relation to the converging agendas of health promotion and ecosystem management at the local, regional and global scales--and draw on evidence from international initiatives as diverse as the WHO Commission on Social Determinants of Health, and the Millennium Ecosystem Assessment. Using water as a vehicle for understanding the systemic context for human wellbeing, health promotion and disease prevention draws inevitable attention to key challenges of scale, intersectoral governance and the complementary themes of promoting resilience and preventing vulnerability. We conclude by highlighting the importance of building individual and institutional capacity for this kind of integration--equipping a new generation of researchers, practitioners and decision-makers to be conversant with the language of ecosystems, capable of systemic thought and focused on settings that can promote both health and sustainability.

A century of hydrological variability and trends in the Fraser River Basin

This study examines the 1911‐2010 variability and trends in annual streamflow at 139 sites across the Fraser River Basin (FRB) of British Columbia (BC), Canada. The Fraser River is the largest Canadian waterway flowing to the Pacific Ocean and is one of the world’s greatest salmon rivers. Our analyses reveal high runoff rates and low interannual variability in alpine and coastal rivers, and low runoff rates and high interannual variability in most streams in BC’s interior. The interannual variability in streamflow is also low in rivers such as the Adams, Chilko, Quesnel and Stuart where the principal salmon runs of the Fraser River occur. A trend analysis shows a spatially coherent signal with increasing interannual variability in streamflow across the FRB in recent decades, most notably in spring and summer. The upward trend in the coefficient of variation in annual runoff coincides with a period of near-normal annual runoff for the Fraser River at Hope. The interannual variability in streamflow is greater in regulated rather than natural systems; however, it is unclear whether it is predominantly flow regulation that leads to these observed differences. Environmental changes such as rising air temperatures, more frequent polarity changes in large-scale climate teleconnections such as El

Diversity, Emergence, Resilience: Guides for A New Generation of Ecohealth Research and Practice

Ecohealth has emerged as a nexus of scholarly and practical effort at a time of considerable transition in research, policy, practice, and education. Amidst this flux, critical reflection is important, especially regarding where ecohealth is headed as a transdisciplinary field and how ecohealth positions itself among a series of iterative and converging efforts. Ten years after founding discussions led to the establishment of the journal EcoHealth, and 5 years from the establishment of the International Association for Ecology & Health, is a timely opportunity to reflect on the past, present, and future of the field and the spaces that ecohealth is growing into. Impetus for the field of ecohealth emerged along with other ‘turn of 21st century’ efforts. When launched in 2004, the journal EcoHealth was noted to draw on the momentum of past work, including the journals ‘Ecosystem Health’ and ‘Global Change and Human Health’, plus growing interest in a journal to represent Conservation Medicine and related fields. By acknowledging these precedents, the founding Editorial of EcoHealth encouraged the emerging field to be seen in the context of parallel and complementary efforts, and described the collective endeavour as a ‘‘transdisciplinary imperative for a sustainable future’’ (Wilcox et al. 2004). The development of ecohealth in research, policy, practice, and education has been heavily informed by scholarly lineages that include the development of ecosystem approaches to health; rapid expansion of the field of disease ecology; richer understanding of complex ecosystem dynamics and their relationships with human well-being across cultures and societies; and the associated recognition of the social-ecological context for animal and human health. Recent efforts to reflect on and consolidate the influence of these precedents provide an overview of some of the foundational lineages of ecohealth (Webb et al. 2010; Parkes 2011; Waltner-Toews 2011; Zinsstag et al. 2011; Charron 2012). Interweaving and building on diverse lines of inquiry and scholarship over the last decade has led to ecohealth being described as a rich ‘tapestry’ of approaches. Among these converging lineages, the influence of international conventions, declarations and assessments should not be overlooked. Ecohealth is emerging as a ‘teenager’ at the same time as other celebrations of international efforts. The Ottawa Charter, providing the foundation for a socio-ecological basis for promotion of health and well-being, has just celebrated its 25th anniversary, and the Rio +20 celebrations provide a potent reminder of the need for practical, integrated, intersectoral actions that recognize the influence of ecosystem sustainability on both social and environmental determinants of health. The interconnections among the Ottawa Charter, the Rio Declaration and other international conventions are highlighted by recent efforts such as the ‘Healthy People – Healthy Wetlands’ efforts of the Ramsar Convention on Wetlands, and the ‘Biodiversity & Health Initiative’ of the United Nations Convention on Biodiversity. Ecohealth offers a scholarly home to examine convergence, synthesis, and commonalities among these and other international initiatives, offering a space for issues that arise at the nexus of the work of International Panel on Climate Change; the Millennium Ecosystem Assessment (2005); the Commission on the Social Determinants of Health (2007),the United Nations Declaration on the Rights of Indigenous Peoples (2007) and the resilience-oriented Hyogo Framework of the International Strategy for Disaster Reduction (2007). Part of the challenge for ecohealth as it matures will be questions of similarities and differences, spaces and EcoHealth DOI: 10.1007/s10393-011-0732-8

Establishing a community of practice of researchers, practitioners, policy-makers and communities to sustainably manage environmental health risks in Ecuador

BackgroundThe Sustainably Managing Environmental Health Risk in Ecuador project was launched in 2004 as a partnership linking a large Canadian university with leading Cuban and Mexican institutes to strengthen the capacities of four Ecuadorian universities for leading community-based learning and research in areas as diverse as pesticide poisoning, dengue control, water and sanitation, and disaster preparedness.MethodsIn implementing curriculum and complementary innovations through application of an ecosystem approach to health, our interdisciplinary international team focused on the question: “Can strengthening of institutional capacities to support a community of practice of researchers, practitioners, policy-makers and communities produce positive health outcomes and improved capacities to sustainably translate knowledge?” To assess progress in achieving desired outcomes, we review results associated with the logic framework analysis used to guide the project, focusing on how a community of practice network has strengthened implementation, including follow-up tracking of program trainees and presentation of two specific case studies.ResultsBy 2009, train-the-trainer project initiation involved 27 participatory action research Master’s theses in 15 communities where 1200 community learners participated in the implementation of associated interventions. This led to establishment of innovative Ecuadorian-led master’s and doctoral programs, and a Population Health Observatory on Collective Health, Environment and Society for the Andean region based at the Universidad Andina Simon Bolivar. Building on this network, numerous initiatives were begun, such as an internationally funded research project to strengthen dengue control in the coastal community of Machala, and establishment of a local community eco-health centre focusing on determinants of health near Cuenca.DiscussionStrengthening capabilities for producing and applying knowledge through direct engagement with affected populations and decision-makers provides a fertile basis for consolidating capacities to act on a larger scale. This can facilitate the capturing of benefits from the “top down” (in consolidating institutional commitments) and the “bottom up” (to achieve local results).ConclusionsAlliances of academic and non-academic partners from the South and North provide a promising orientation for learning together about ways of addressing negative trends of development. Assessing the impacts and sustainability of such processes, however, requires longer term monitoring of results and related challenges.

Promoting the health of marginalized populations in Ecuador through international collaboration and educational innovations

This paper examines two innovative educational initiatives for the Ecuadorian public health workforce: a Canadian-funded Masters programme in ecosystem approaches to health that focuses on building capacity to manage environmental health risks sustainably; and the training of Ecuadorians at the Latin American School of Medicine in Cuba (known as Escuela Latinoamericana de Medicina in Spanish). We apply a typology for analysing how training programmes address the needs of marginalized populations and build capacity for addressing health determinants. We highlight some ways we can learn from such training programmes with particular regard to lessons, barriers and opportunities for their sustainability at the local, national and international levels and for pursuing similar initiatives in other countries and contexts. We conclude that educational efforts focused on the challenges of marginalization and the determinants of health require explicit attention not only to the knowledge, attitudes and skills of graduates but also on effectively engaging the health settings and systems that will reinforce the establishment and retention of capacity in low- and middle-income settings where this is most needed.

Participatory Environmental Health Research in Aotearoa/New Zealand: Constraints and Opportunities

Within the Aotearoa/New Zealand context, this article identifies opportunities for, as well as constraints on, using participatory research to address environmental health concerns. In New Zealand, principles of partnership fundamental to the Treaty of Waitangi, and the requirements for consultation within the Resource Management Act, provide a framework for participatory approaches. Participatory environmental health research integrates knowledge from various scientific and community sources. It also fosters the innovation, evaluation, and sharing of information that new public health approaches demand. As an emerging field in Aotearoa/New Zealand, it must draw on experience from resource management, rural development, and public health research and practice. Water quality is used as an example of the complexity of environmental health issues and of the potential benefits of engaging stakeholders where long-term health and well-being require balancing ecosystem integrity, economic viability, and social processes.

Using expert informed GIS to locate important marine social-ecological hotspots

The marine environment provides significant benefits to many local communities. Pressure to develop coastal waterways worldwide creates an urgent need for tools to locate marine spaces that have important social or ecological values, and to quantify their relative importance. The primary objective of this study was to develop, apply and critically assess a tool to identify important social-ecological hotspots in the marine environment. The study was conducted in a typical coastal community in northern British Columbia, Canada. This expert-informed GIS, or xGIS, tool used a survey instrument to draw on the knowledge of local experts from a range of backgrounds with respect to a series of 12 social-ecological value attributes, such as biodiversity, cultural and economic values. We identified approximately 1500 polygons on marine maps and assigned relative values to them using a token distribution exercise. A series of spatial statistical analyses were performed to locate and quantify the relative social-ecological importance of marine spaces and the results were ultimately summarized in a single hotspot map of the entire study area. This study demonstrates the utility of xGIS as a useful tool for stakeholders and environmental managers engaged in the planning and management of marine resources at the local and regional levels.

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.

Indigenous Perspectives on Ecosystem Sustainability and Health

Indigenous peoples have been guardians of our global envi-ronment and its medicines for millennia—built on a com-munal view of humanity and its links to the ecosystem. Yet asthe new millennium rolls out, Indigenous peoples are amongthose most marginalized within many nation states, theyhave the worst health indicators, and their knowledge con-tinues to be threatened asthe land and resources they dependon are appropriated, developed, degraded, or destroyed.During the United Nations Decade of the WorldsIndigenous Peoples (1995–2005), one response to theseconcerning trends was increased scholarly and policyattention to fields such as traditional ecological knowledge,indigenous health, traditional medicines, and biopro-specting (Janes, 1999; Berkes et al., 2000; Merson, 2000;Subramanian et al., 2006). Yet at the end of this UN decade,an invited Lancet series offered a sobering reminder of justhow much more needs to be done to improve and promotethe health status of Indigenous people worldwide (seeStephens et al., 2006). A significant obstacle to meeting thischallenge has been the predictable tendency to study andanalyze indigenous perspectives and priorities along tradi-tional disciplinary lines, in effect disaggregating holisticunderstanding into academic or thematic silos with mini-mal interaction and a disconnect from pressing, intercon-nected realities of health, culture, and ecology.This edition of EcoHealth has been put together withexplicit interest in (re)integrating indigenous perspectiveson ecosystem sustainability and health. It is timely that theissue was finalized the same week that the United NationsGeneral Assembly adopted the Declaration on the Rights ofIndigenous People, after almost 13 years since the draftdeclaration was proposed in 1994 (United Nations, 2007).The nonbinding declaration passed despite objections fromAustralia, Canada, New Zealand, and the United States,who cited inconsistencies with existing national laws.The controversies and lengthy negotiations to pass theUnited Nations Declaration on the Rights of IndigenousPeoples exemplify the challenges of diversity and contextwhich characterize indigenous issues and demand ongoingattention. The notion of indigeneity is complex and highlycontested. The term Indigenous is used in some contexts torefer to the aboriginal population of a nation or area—-those who were the first-recorded human inhabitants. InAustralasia, North America, and to a large extent LatinAmerica, this interpretation is clearer, drawing a distinctionbetween native peoples and European colonial settlers. Inother areas, including Asia and the Middle East, distinc-tions are less clear. Colonization took place between ethnicgroups within and between countries, and in some casesnative populations were almost entirely eradicated. In othercontexts, social hierarchies such as the Indian caste systemestablish categories of social position at birth, with somegroups recognized as Indigenous or tribal on a sociocul-