EcoHealth-OneHealth Capacity Building at CMU and in the ...
Transcript of EcoHealth-OneHealth Capacity Building at CMU and in the ...
EcoHealth-OneHealth Capacity Building at CMU and in the region - Experiences and challenges
Presentation to University of Minnesota (UMN) exchange students under the UMN Veterinary Medicine/Veterinary Public Health Spirit
of Thailand program. EHRC, CMU, Chiang Mai, Thailand
10 July 2013
Fred Unger (ILRI) & Tongkorn Meeyam (CMU)
• Eco Health - OneHealth• EcoHealth-OneHealth Resource Centre• EH case studies
Globalisation & international trade• Intensified long distance travel• Cross border trade (illegal/legal)
Forest habitat alteration/deforestation Human settlement
• Urbanisation Increasing urban or peri‐urban settlements
• Agriculture intensificationConcentrationMixing wild life/domestic speciesWaste management
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Challengestowards Emerging Diseases Threats
• Vector‐borne diseaseMalaria, Rift Valley Fever, Bluetongue, Dengue…Eco System: Temperature, humidity, flood/heavy rain influence seasonal activity, distribution/density of vector population
• ParasitesFascioliasis, Schistosoma, Cysticercosis…Eco System: Temperature, humidity favour intermediate hosts or free living stages
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Ecosystem and EID
• Soil associated• Anthrax, other clostridial disease…
Eco System: Temperature and soil moisture affect spore germination. Heavy rainfall may stirs up dormant spores
• Air associated• Multi‐factorial respiratory diseases…
Eco System: Dust and pollution exacerbating respiratory disease
• Water associated• Cyptosporidiosis, Leptospirosis...
Ecosystem: Disasters. lack of sanitation, floods, higher water temperature may improve survival rate 5
Ecosystem and EID
Eco Health & One Health
• In response to failures of purely system based solutionsto current challenges (e.g. H5N1, EHEC)
• Many similarities
• Different traditions/background
• Integrated approach (scope different)
Eco Health – One Health
• Ecosystem approaches to public health issues acknowledge the complex, systemic nature of public health and environmental issues, and the inadequacy of conventional methodologies for dealing with them. David Walter‐Toews, University of Guelph
• The Ecohealth approach focuses above all on the place of human beings within their environment. It recognizes that there are inextricable links between humans and their biophysical, social, and economic environments, and that these links are reflected in a population's state of health. International Development Research Centre (IDRC)
• EcoHealth is an emerging field of study researching how changes in the earth’s ecoszstems affect human health. It has many prospects. EcoHealth examines changes in the biological, physical, social and economic environments and relates these changes to human health. Wikipedia.
Eco Health – One Health
• One Health is the collaborative effort of multiple disciplines working locally, nationally, and globally, to address critical challenges and attain optimal health for people, domestic animals, wildlife, and our environment One Health Commission (http://www.onehealthcommission.org/ )
• The One Health concept is a worldwide strategy for expanding interdisciplinary collaborations and communications in all aspects of health care for humans and animals. One Health Initiative (http://onehealthinitiative.com/)
Introduction: Ecohealth Theory
• Based on 6 principles:
• Systems thinking• Knowledge to action• Transdiciplinary• Participation• Equity • Sustainability
• 4 interacting sub‐systems influence health
Social
PoliticalEconomic
Ecological
An approach to understand complex systems (socio‐economic, socio‐ecological ect)
Introduction: Ecohealth Practice• System thinking: System thinking suggests that the way to understand a
system is to examining the linkages and interactions between the elements that make up the system.
• Knowledge to action: Knowledge to action refers to the idea that knowledge generated by research is then used to improve health and well‐being through an improved environment.
• Transdisciplinarity inclusive vision of health problems by scientists from multiple disciplines, community and policy actors
• Participation aims to achieve consensus and cooperation within community and scientific and decision‐making groups;
• Equity involves analyzing the respective roles of men and women, and various social groups;
• Sustainability: ecohealth research should aim to make ethical, and lasting changes which are environmentally sound & socially acceptable.
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Human health
Societies, Behaviour,Cultures, Political situation, Crisis/DisastersEducation. Poverty, Economies, Regulations,Institutions, Governance & Policies
Agroecosystem health
AnimalHealth
Vet Pub
Health
INTEGRATIVE APPROACH
Wildlife health
Plant health
ILRI EcoZD project –
Overview, opportunities, case studies
ILRI EcoZD: Overview
General objective: Increase the knowledge, skills and capacity of research and infectious disease control personnel in SE Asia to understand the risks and impacts of Zoonotic Emerging Infectious Diseases (ZEIDs) and how feasible options can best be implemented and adapted.
‘Learning by Doing’ approach; (also for ILRI team)
Regional: Cambodia, Laos, Thailand, Viet Nam, Indonesia, PR China (Yunnan)
ILRI EcoZD: Overview & key components
Appraisal & Consultative Process Scoping Study: Questionnaire survey of representatives from
10-15 key institutions (PH, Vet, Social Science) Outcome Mapping: assists with formulating action plans
focussing on outcomes
• Innovative Eco Health research underway in all 6 partner countries
• Establishment of two Eco Health Resource Centres at Chiang Mai University (CMU) and Universitas Gadjah Mada (UGM) in Indonesia
• Networking with other One Health, EcoHealth initiatives
ILRI EcoZD start-up issues - challengesHuman ResourcesSupply & Demand Allocation of time Language
Identifying Champions (to implement & to mentor)Level of counterparts (senior/junior)
Scope of EcoZD‘Carte blanche’ v flexible adaptive/consultative approachLearning by doingPriority zoonoses +/‐ ZEID (country perspective)
Two‐dimensional capacity‐building requirementTechnical (proposal writing/implementation/methodological/ analysis/paper)EHRC concept
ILRI EcoZD start-up issues - challenges
What language we are speaking… Eg Latin America/ Eco Salud ‘Lost in translation’
Biomedical v Social Sciences Medics & vets (clinical / lab / epi) Quantitative v Qualitative Researchers, Decision Makers, Communities
Novel approaches v “classical” vet science One Health One World/One Medicine Eco Health Broad scope vs. H5N1
Eco Health – One Health Resource Centre
Idea: Establishment of two Eco Health Resource Centres – 2 key universities in the region
Objective: Capacity building on Eco HealthEco Health hub for the region
EcoHealth Resource center at Universitas Gadja Mada
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EcoHealth-OneHealth Resource center at Chiang Mai University
Eco Health – One Health Resource Centre Vision
The EcoHealth Resource Centre takes a transdisciplinary, EcoHealth/One Health approach to bring together health, social, economic, and ecological expertise to support efforts to achieve sustainable improvements in health, well-being, and social equity through research, capacity building, and communication in Southeast Asia.
Chiang Mai University
EHRC – General information
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Established in Oct 2010
To promote
The use of the EcoHealth-
OneHealth approach
EcoHealth concepts
Agreement and collaborative
efforts between experts from
many faculties
Establishment of the EHRC
EHRC – Establishment
Socio-economicdeterminants of health5 researchers
Socio-economicdeterminants of health5 researchers
HumanHealth
4
HumanHealth
4
EcosystemHealth
1
EcosystemHealth
1
AnimalHealth
4
AnimalHealth
4
Socio-economicdeterminants of health5 researchers
HumanHealth
4
EcosystemHealth
1
AnimalHealth
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A first workshop to discuss the idea,held at Chiang Mai University on October 11-12, 2010
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EHRC – Establishment
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Co-located with the Faculty of
Veterinary Medicine, CMU.
Conduct research on and
develop responses to
EcoHealth-related issues.
Promote capacity towards
timely response to emerging
situations in the community,
the nation, and the region.
EHRC- CMU: Structure of the organization
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EcoHealth-One Health Resource CentreChiang Mai University
Advisory Committee
Executive Committee
Working Group
Veterinary Medicine Nursing
Associated Medical Science
Medicine Social Sciences Economic Pharmacy
Vision
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To employ a transdisciplinary, EcoHealth - One
Health approach that brings together health, social,
economic, and ecological expertise to support
efforts to promote sustainable improvements in
health, well-being, and social equity through
research, capacity building, and
communication in Southeast Asia.
Centre capacity building efforts
Capacity building / Training
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Curriculum development
Undergraduate courses Collaborate with VPHCAP to disseminate
EcoHealth to masters in Veterinary Public Health (MVPH) Program
EcoHealth Training Courses
EcoHealth/One Health Lecture Series
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Ecological Epidemiology and the Emergence of Zoonotic Diseases: Toward an Integrative Science
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Ecohealth: global change, local action and the interdisciplinary challenge of global health and sustainability
EcoHealth/One Health Lecture Series
EcoHealth Training Courses
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EcoHealth Manual
Through research
• The Kitchen of the world
Kitchen of the world continued
Working groups: “Kitchen of the world” Framework
High quality food
Safety
Healthy TasteAffordability
Environmental Sustainabilty
Meat Production
chain
Farm
Slaughterhouse
Food vendor/ Market
Working groups: Hill tribe health (animal & human)
Source: Lamar, 2013
Research based learning
Determine research area
Call for a meeting
Brainstorm on research topics
Identify roles of team members
Plan, conduct and evaluation
build trust and relationship
high impact to the local community, common interest
Communication
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http://ehrc.vet.cmu.ac.th
CMU students at UGM
CMU – UGM joint activities
UGM students at CMU
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Annual joint EcoHealth Resource Centre meeting
Lesson learn
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Faculties
Universities
International
Collaboration
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Manual: (Brainstorming, targeted group, content, assignment, lead)
Teaching material for faculty member to integrated with the existing undergraduate course
Key academic actors
Levelo Executive level: dean meetingo Faculties: head of department
Media: e-office, brochure, agenda in meeting
Academic community learning
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A success story
Platform or administrative office for initiating
curriculum, research and training
Assistance in developing a coordinated,
interdisciplinary response
Effectively incorporates social and economic
considerations as well as heath aspects
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Continuing to get out message about EcoHealth approach
Cooperating with professionals from other academic specialties
Demonstrate to health professionals that efficacy can be enhanced by cooperating with professionals from other academic specialties
Engagement of policy makers
Challenges for the future
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Sustain the EHRC Learn to continue operations in the absence of
direct external funding
Centre well settled within CMU and existing
networks to other OH activities in the region
Challenges for the future
Case study examples for integrative approaches
Malaria control and use of DDT in Mexico (classical EH study).
Brucellosis Yunnan
Rabies ‐ Bali
Case study I: Classical Eco Health example
• Malaria control and use of DDT in Mexico (HEALTH: An Ecosystem Approach, by Jean Lebel. (IDRC 2003,ISBN 1‐55250‐012‐8))
• Pool of specialist from epidemiology, computer science, entomology, social sciences, government and Academia background.
• Participatory (Bottom up approach from community level)
• Transdiciplinary (several expertise)• Equity (role of woman and man, behavior related to Malaria risks differed
between gender, e.g. due to differences in mosquito exposure)
Social
PoliticalEconomic
Ecological
Case studies II: Brucellosis in Yunnanadded value of an integrative (Eco health) approach
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Case study II: Brucellosis in Yunnan
Problem:• Brucellosis is emerging in southern China• Some information on prevalence's• Little or no information on perception of involved groups
and stakeholders
Classical vet approach: • Prevalence study in cattle and small ruminants
One Health• Adding human component (e.g. review of cases in
hospitals)
Case study II: Brucellosis in Yunnan
Adding an Eco Health perspective:
Involving of all relevant groups or stakeholders from the begin and throughout the project (participation)
• Farmers: perception (importance of Brucellosis compared to other diseases)
• Involvement of other risk groups (butchers, ... )• Stakeholders: e.g. policy makers (local, national) • Policy (regulations & enforcement) • Ecological aspects (management of aborted fetus ...)• Gender aspects (who sells milk, who responsible for SR or cattle) • Socio economic drivers (Introduction & control)
– Willingness to pay for control or basic bio security
Mapping of stakeholders, partners & groups involved
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Brucellosis control
Public health authorities (central/local officers, local
hospitals)
LS officers (central/local)
Local administration
officers
Policy makers
Socio economic experts
Butchers, meat vendors
Milk vendors, butchers
Farmers/herders
Donors, international
organizations & universities
Associations (if any or to be established)
Communities
Outpatients
Animal husbandry expert
Case studie III: added value of Eco healthOptimizing Rabies Control in Bali: An Ecohealth Approach.”
Case studie III: added value of Eco healthOptimizing Rabies Control in Bali: An Ecohealth Approach.”
The problem: • Rabies is an emerging zoonoses since its introduction• Conventional control measures show limited success
Objective:To help the government of Bali in controlling rabies in dogs through better understanding of the dog population, dog demography in Bali and its relationship with the local community.
Conventional vet approach: Vaccination & population control (sterilisation)
Case studies: EH Framework Optimizing Rabies Control in Bali
Control of Rabies in Bali
Socio‐science
‐Social cultural believes
Environments
Waste problemsMonkeys
Human health
- Capacity
Acceptance
Community
‐ Acceptance ‐ Feasibility
Political perspectives
‐Law and regulation
‐ Enforcement
Vet Science
‐Epidemiologist‐ Practionaires‐ Capacity
Tourism:
‐Major source of income
Private sector
‐ Vaccines
Media
‐Social acceptance
Take Home Messages
• Essentials to practice Eco Health/One Health: Apply integrative approachEngagement & participation
Key for success: Identify/focus on applicable/doable interventions (success is essential)Ensure that all partners are engaged (rather motivation/incentive driven than enforced)
Research Policy
Java Indonesia 2010Yogyakarta
SOP measure Voluntary culling of the infected flock …Will the boy agree?
ILRI and where it works
Head quarter in Nairobi
ILRI outposts in SE Asia:Jakarta, Hanoi, Vientiane, Chiang
ILRI outposts
Thank you
Special thanks to the ILRI EcoZD project team and country partners (YAGAS, CIVAS)