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

4

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

”

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)