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Book review of Ecohealth Research in Practice – Innovative Applications of an Ecosystem Approach to Health by Dominique F. Charron:
1. Thesis
Dominique F. Charron, the author of the book, notes that peer-reviewed scientific results have been published for over a decade but sets herself a goal of combining the sum of the experience gathered in the field of ecohealth into one large publication. The book also sets out to present not only success but also the challenges that arose during the research projects discussed in parts one to four. She aimed to tackle both tasks by writing a well-structured book, divided up in relevant chapters, which allows the reader to connect the experience gathered and draw their own parallels and deductions between them. All chapters include a conclusion with most chapters also including challenges that emerged during the research. By doing this she hopes to give the reader inspiration but also information on how to improve future research and how to avoid common pitfalls.
2. Summary
Starting with a foreword and a preface the book gives us a first broad overview of the history of ecohealth and the background of the book. It also introduces us to the Canada’s International Development Research Centre (IDRC), a large stakeholder in the field of ecohealth and in the research studies reviewed, which is relevant for our understanding of the origin of the field.[1] Chapter one then gives us a more detailed introduction to the origin of the field and most importantly to the approaches used. This is most notably the principles of an ecosystem approach to health: systems thinking, transdisciplinarity, participation, sustainability, gender and social equity and knowledge to action. After getting a theoretical introduction, the next paragraphs describe how to put ecohealth principles into practice including the different phases of an ecohealth research study.[2]
This rather lengthy introduction is followed up by the first part of the book Linking Human Health and Well-Being to Changing Rural Agro-Ecosystems. Four research studies related to food production and its impact on environment and health are thematized in this chapter[3]. The first study is early work in Malawi where declining soil fertility by misuse of fertilizer led to high levels of food shortage and child malnutrition. The researchers worked with the community to inform them about beneficial practices of burying legume residues after harvest and avoiding monocultures. After a few years of change in the agricultural practices, yields and soil improved, and child-malnutrition declined with the increased knowledge given to the community. There were however challenges for the research such as the loss of control villages but also most notably the government undermining the work and the future of the citizens.[4]
The next chapter tackled sustainability of the agro-ecosystem in highland Ecuador. Modernization of potato and horticultural production systems led to decline of production and an increase of pesticide neurotoxicity and poisonings. Community-based education and application of alternative crop-management methods was introduced to improve the situation. Even though it required substantial time, financial resources, and intellectual effort, the strategies and the work between the stakeholders made potato-production more profitable and most importantly safer.[5]
Environmental and health impacts in a floricultural region of Ecuador was the subject of the third chapter in part one. As with the agro-ecosystem in highland Ecuador, pesticides led to decreased soil fertility and neurotoxic health effects. The project identified the causes of environmental and health damage and helped introduce the International Code of Conduct for Cut Flower Production. This allows companies to sell their flowers for a higher price as long as they complied to environmental, occupational and health standards. By doing this they managed to solve the largest challenge which was to give an economic incentive to keep the environment and the workers healthy.[6]
The last chapter of part one is a study about dietary diversity in Lebanon and Yemen. Although the two countries differ in many factors it was found that for both countries many of the health and nutrition issues could be linked to dietary diversity. Working with the communities and especially with the women in these groups, the conclusion was made that relying on and adding more local food to the diet could improve many issues. In Lebanon many of the women involved received training and were able to secure employment in the food sector which pushes the theme of social equity which is as we know, a very important theme in the middle east.[7]
Part II is Natural Resources, Ecosystems, Pollution, and Health. Once again, we look at four study cases, this time with the center of attention on natural resources and its extraction and transformation. The main focus is environmental pollution by mining, which has a large impact on ecosystems and human health.[8] The first case study of part two is about manganese mining in Molango, Mexico. Manganese has been produced and transported in the region since the 1960s. Because of complaints in the 1980s preliminary studies were made and manganese concentration in outdoor and indoor areas and in blood were found to be extremely high. Researchers in the 2000s picked up on the research and applied ecohealth concepts to it. A large amount of knowledge was gained, and a few interventions were made. The researchers however noted that having knowledge and evidence does not equal to solving a problem, especially not over a short amount of time. [9]
In the second study we first look at Asia in a study about health risks of stone quarrying and crushing (SQC). Due to adverse climate change, work and food from agriculture was sparse in Bundelkhand, India, and thus many were forced to look for work in the SQC sector. The workers are not represented by a union and are exposed to a wide range of physical, chemical and ergonomic hazards. Studies of health and social conditions around 13 stone-crushing units showed that noise and especially respirable dust levels were unacceptably high. Interventions were made and stakeholders worked together to create and finance environmentally friendly dust abatement systems. Changes were made but a larger challenge lies in the long term which will need continued investment by the stakeholders. [10]
Chapter 10 in this book looks at mercury exposure from fish consumption in the Amazon. Due to gold mining and the extraction of gold ore, large amounts of mercury were used. mercury in soil, fish and water was at high toxic levels. Later research showed however that mercury rather stemmed from the high natural mercury levels in the soil and from “slash and burn” deforestation. These practices lead to the transfer to rivers and lakes. Notably fish consumption had neurological impacts on the humans in the region. mercury is not solely responsible for the neurological effects, but it was also found that the people in the area had high levels of blood from using low-quality metal plates to produce manioc flour. The communities were instructed on alternative farming techniques to improve soil fertility and reduce soil erosion. Challenges lied in keeping a close relationship to the communities which later showed to be the road to success in this case study.[11]
The last chapter of part two examines impacts on environmental health of small-scale gold mining in Ecuador. The informal small-scale mining began after many of the larger mining companies closed in the 1980s due to a financial crisis in the country. Many health concerns arise since metals and chemicals are used to extract the precious metals from raw ore and additionally mercury, lead, arsenic, manganese and other known toxic substances are also naturally present in rocks and soil. Similar to the results in the Amazon, the toxic substances were found in high concentrations and were found to have neurological impairments on the people living in the area. To reduce the exposure to these substances, interventions such as installation of water filters, alternative sources for water, electrification and road improvements were developed and implemented. The community played a large part in improving the conditions and challenges mostly lied in the identification of the sources of health problems.[12]
In Part III the focus shifts from mining and agriculture to Poverty, Ecosystems, and Vector-Borne Diseases. In wealthier nations, diseases of affluent and sedentary lifestyles such as diabetes, cancer and obesity are growing in numbers. In developing regions however, infectious diseases continue to be the single-most important contributor.[13] Chapter 13 looks at the most well-known infectious disease, malaria, in Uganda and Tanzania. In East Africa, Malaria is the leading public health problem, causing death in one third of the children under 5 years of age and one fifth of deaths among pregnant women. Research on agriculture influence on malaria found that water storage, areas such as depressions, containers that accumulate water, and rice farming have an impact on mosquito productivity and malaria prevalence. By managing water bodies, storage of water and informing communities about the epidemiology of malaria, the people saw improved health.[14]
Shifting back to the American part of the world, chagas disease and possible ecosystem approaches for prevention were researched in chapter 14. Chagas disease is a chronic and debilitating illness caused by the blood parasite Trypanosoma cruzi and is transmitted by several species of insects. The parasite lives in mammal species including people and is transmitted by contact with infected vector excrement. In Guatemala and other areas of Central America, some of the insect vectors are native and can thus re-infest houses after insecticidal treatment. Researchers classified houses inside of the study site into three categories (A, B, or C) depending on condition of house walls and hygiene. Through collaboration with researchers from different fields and the communities, a wall plaster mix was developed. The communities were also informed about hygiene practices and other beneficial techniques to keep bugs out of the houses. In some villages the situation improved but not in all of them. All in all, the exposure of humans to Chagas-disease vectors was reduced by decreasing human-vector contact.[15]
When we think about mosquitos as vectors we often think of malaria, but in many parts of the world Dengue is just as important. Chapter 15 looks at how to prevent dengue in Havana city. Dengue is mainly transferred by the tiger mosquito, Aedes aegypti, and can in its serious form cause the life-threatening disease dengue hemorrhagic fever (DHF). Good adaptation of vector mosquitoes to human environments, climate and land-use change, and urbanization contribute to the situation. Researchers developed an integrated dengue-surveillance system to control the factors that favor vector appearance to prevent the transmission of dengue. It was found that the main factors were related to water supplies, water storage and problems with environmental sanitation. A digital database was used together with software to produce maps and graphs of the data. The community was informed, and unprotected water storage and unhygienic backyards diminished. Up to 74% of the identified environmental problems were solved. There were few challenges thanks to the participation of the communities.[16]
In the last chapter of part three we once again look at dengue, but this time in Asia. More specifically eco-bio-social research in Indonesia. Due to continuous changes in human population, vector population and the virus combined with environmental changes lead to a poor understanding of the contribution of factors to the dengue virus and complicates the control of the virus. Using systemized situation analyses, important data was collected on the different factors such as environmental contribution and vector ecology. Communities in Yogyakarta were informed on the importance of involvement in dengue prevention and control. Households started recycling, covering wells and water tanks, repelling mosquitoes with zodiac plantation, continued with the use of pyriproxyfen and stocked bathwater containers with mosquito larvae-eating fish. The effects of these interventions remain to be seen, but researchers noted that they saw a substantial increase in community participation (from 19.4% to 72.8%).[17]
The last part with case studies is on the topic of Building Community Health into City Living. Urban growth is accompanied by an increase in ecological footprint from higher use and extraction of resources and from higher release of wastes. A large part of people in urban populations live in informal settlements and slums which pose a large risk to the health of humans and our ecosystems. The case studies in this part of the book illustrate common challenges faced by poor urban citizens around the world. [18] The first chapter looks at the rebuilding of urban ecosystems to benefit community health in Kathmandu. A large part of the population in Kathmandu are exposed to tapeworm infections of the type echinococcis and hydatidosis. People who ingest tapeworm eggs may develop cysts which lead to illness. A large contribution to the infection of communities was found in open-air slaughter around riverbanks. Offal was disposed in open garbage containers and often directly in the river, which lead to easy transfer to livestock and dogs. The infect dogs roam freely, women wash clothes in the river and children play in the dirt while the men were exposed due to their work in and around the butchering areas. Studies identified the risk factors and with a large input into communities and the government regulations were introduced. This led to removal of livestock from riverbanks and the banning of open-air slaughter of certain livestock, which opened up the option to transform riverbanks into gardens. Hygienic butchering methods were introduced and much of the waste was recycled. The larges challenges were with the lacking organization of communities and workers.[19]
Chapter 19 once again tackles the theme of water and its connection to people and their health. The case study takes place in Bebnine, Lebanon. The use of water by residents was researched after researchers were informed about high rates of gastrointestinal diseases. Water samples revealed that fecal contamination was extremely high. Interventions were made, Water-disinfection units were built, and the communities were informed about water and its connection to diarrhea, which before was believed to be “God’s will”. This improved water quality, but it was noted that without efforts by the municipality and continued work from the community diarrhea in Bebnine will not be controlled.[20]
The last chapter of part four looks at the link between water, and the health of people with an added focus on waste and children’s health. Yaoundé in Cameroon has seen a rapid growth in size with quickly expanding slums and poorly serviced neighborhoods. Environmental conditions were very poor with poor drainage, recurrent flooding and heavy contamination of surface- and groundwater from pit latrines and household wastewater. There was inadequate access to safe drinking water which forced people to draw water from polluted wells and springs. Researchers monitored water quality, diarrhea and intestinal parasites in children with troubling results. Coliform counts exceeded WHO guidelines by unacceptable amounts. The communities were informed, and water-handling practices were improved. Interventions were also made regarding infrastructure and pedestrian walkways, gutters, improved latrines and extensions of the drinking water system were made while also improving collection and disposal of community wastes. Access to safe water improved and the coliform count in the water was reduced by the introduction of improved latrines. [21]
The last part of the book, part 5 summarizes the experience of Building a New Field in the form of ecohealth. Chapter 21 focuses on field-building networks. As we have seen in the case studies a large part of research in ecohealth relies on relationships between stakeholders and their participation, but also on transdiscipilinarity in form of teamwork between researchers. It. Is noted that collaborative association and partnership typical of ecohealth also seems to be part of a broader scientific trend. The chapter uses examples of different collaborations, e.g. Canadian Community of Practice in Ecosystem Approaches to Health (CoPEH-Canada), and their networking effects on the field. D.F. Charron also talks about defining parts of ecohealth such as Integration of perspectives, knowledge, and methods. The chapter then links back to ecohealth principles described in Chap. 1 and notes that benefits of networking can be seen to relate to integration, participation, and collaboration. At the end of the chapters the conclusion is that “[…] an active peer group seeking to expand and refine their understanding, methods, body of knowledge, and skill-set […]” [22]is needed to avoid stagnation, but also that the evolution and expansion of networks is needed to secure further growth of the field.[23]
To close out the book, Dominique F. Charron presents lessons learned across the different themes, places, and phases of ecohealth research in the last chapter. She notes that applications of ecosystem approaches to health vary but that there are a few strong and recurring themes that can be discerned:” […] innovation; community empowerment and voice; policy influence and systemization; social and gender equity and improved health outcomes.” [24]She also notes that the case studies present technical result and how they were used to achieve set development goals. Next to these technical results other development-oriented activities which don’t appear in technical publications were included, since for a community research questions may not be a top priority and publications appear irrelevant to them. As a pillar of ethical research practice, a project and its resources need to also support the community’s interests and priorities in improving their well-being.[25]
3. Strengths
Dominique F. Charron clearly succeeds in portraying the importance of ecohealth research. Reading multiple case studies from different regions and of different themes shows the link between our health and the health of ecosystems. As a student new to the field many important techniques and systems are introduced and shown in case studies which gives a good dosage of both theory and practical information. She also portrays communities in a very humanitarian way and the reader feels connected to their challenges and successes. For people with more experience in the field, the book can be used for reference because of its well-structured writing. One receives an overview of a whole field but at the same time a detailed view at specific cases and problems if wanted.
4. Weaknesses
The author communicates her goal of summing a large part of ecohealth experience in one book quite early. It is indeed well structured, but sometimes the parts and chapters blend into each other. This of course lies in the nature of writing such an expansive book on studies inside of the same field that share many common denominals. It all comes together in the last 2 chapters of the book which do a good job of drawing conclusions and pointing out similarities in techniques and results, but because of the expansiveness of the book this comes after roughly 150 pages of short introductions and pure case studies. A conclusion at the end of part one to four would have given the reader a reminder of what was discussed in the theoretical introduction of the book and may give the reader a better understanding of the parts and chapters to come. Especially since this book will be read in multiple sittings and many topics will have been forgotten when reaching the end of the book.
5. Conclusion
“Ecohealth Research in Practice – Innovative Applications of an Ecosystem Approach to Health“ is a book which succeeds in many ways. It is expansive but still detailed. As an introduction to the field for a student or a refresher for people already involved, the reader has many options on how to approach the book. As someone new to the field I would definitely recommend the book as a complement to lectures and courses. It communicates the essence of ecohealth and not only the successes but also challenges of research in the field.
[1] D.F. Charron. International Development Research Center, Ottawa, ON, Canada.
[2] D.F. Charron. Ecohealth: Origins and Approach
[3] L. El-Fattal, A. Sánchez. Introduction.
[4] Rachel Bezner Kerr, Rodgers Msachi, Laifolo Dakishoni, Lizzie Shumba, Zachariah Nkhonya, Peter Berti, Christine Bonatsos, Enoch Chione, Malumbo Mithi, Anita Chitaya, Esther Maona, and Sheila Pachanya. Growing Healthy Communities: Farmer Participatory Research to Improve Child Nutrition, Food Security, and Soils
in Ekwendeni, Malawi
[5] Fadya A. Orozco and Donald C. Cole. Tackling Challenges to Farmers’ Health and Agro-Ecosystem Sustainability in Highland Ecuador
[6] Jaime Breilh. Coping with Environmental and Health Impacts in a Floricultural Region of Ecuador
[7] Malek Batal*, Amin Al-Hakimi**, and Frédéric Pelat. Dietary Diversity in Lebanon and Yemen: A Tale of Two Countries
[8] Ana Boischio and Zsófia Orosz. Introduction.
[9] Horacio Riojas-Rodríguez and Sandra Rodríguez-Dozal. An Ecosystem Study of Manganese Mining in Molango, Mexico
[10] Raghwesh Ranjan, K. Vijaya Lakshmi, and Kalpana Balakrishnan. Ecohealth Research for Mitigating Health Risks of Stone Crushing and Quarrying, India
[11] Jean Remy Davée Guimarães and Donna Mergler. A Virtuous Cycle in the Amazon: Reducing Mercury Exposure from Fish Consumption Requires Sustainable Agriculture.
[12] Óscar Betancourt, Ramiro Barriga, Jean Remy Davée Guimarães, Edwin Cueva, and Sebastián Betancourt. Impacts on Environmental Health of Small-Scale Gold Mining in Ecuador
[13] Roberto Bazzani and Martin Wiese. Introduction.
[14] Joseph Okello-Onen, Leonard E.G. Mboera, and Samuel Mugisha. Malaria Research and Management Need Rethinking: Uganda and Tanzania Case Studies
[15] Carlota Monroy, Xochitl Castro, Dulce Maria Bustamante, Sandy Steffany Pineda, Antonieta Rodas, Barbara Moguel, Virgilio Ayala, and Javier Quiñonez. An Ecosystem Approach for the Prevention of Chagas Disease in Rural Guatemala.
[16] Cristina Díaz. Preventing Dengue at the Local Level in Havana City.
[17] S. Tana, W. Abeyewickreme, N. Arunachalam, F. Espino, P. Kittayapong, K.T. Wai, O. Horstick, and J. Sommerfeld. Eco-Bio-Social Research on Dengue in Asia: General Principles and a Case Study from Indonesia.
[18] Andrés Sánchez. Introduction.
[19] D.D. Joshi, Minu Sharma, and David Waltner-Toews. Rebuilding Urban Ecosystems for Better Community Health in Kathmandu
[20] Rima R. Habib. Understanding Water, Understanding Health: The Case of Bebnine, Lebanon
[21] Emmanuel Ngnikam, Benoît Mougoué, Roger Feumba, Isidore Noumba, Ghislain Tabue, and Jean Meli. Water, Wastes, and Children’s Health in Low-Income Neighbourhoods of Yaoundé
[22] M.W. Parkes, D.F. Charron, Andrés Sánchez. Better Together: Field-Building Networks at the Frontiers of Ecohealth Research. p. 250.
[23] M.W. Parkes, D.F. Charron, Andrés Sánchez. Better Together: Field-Building Networks at the Frontiers of Ecohealth Research.
[24] Dominique F. Charron. Ecohealth Research in Practice. p.252.
[25] Dominique F. Charron. Ecohealth Research in Practice.