EcoHealth–One Health capacity building at Chiang Mai University and in the region: Experiences and challenges
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Presented by Fred Unger and Tongkorn Meeyam to University of Minnesota (UMN) exchange students under the UMN Veterinary Medicine/Veterinary Public Health Spirit of Thailand program. Eco Health/One Health Resource Center, Chiang Mai University, Chiang Mai, Thailand, 10 July 2013.
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EcoHealth–One Health capacity building at Chiang Mai University and in the region: Experiences and challenges
- 1. EcoHealth-OneHealth Capacity Building at CMU and in the region - Experiences and challenges Fred Unger (ILRI) & Tongkorn Meeyam (CMU) 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
- 2. • Eco Health - OneHealth • EcoHealth-OneHealth Resource Centre • EH case studies
- 3. Challenges towards Emerging Diseases Threats 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 intensification Concentration Mixing wild life/domestic species Waste management 3
- 5. 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
- 6. Eco Health & One Health • In response to failures of purely system based solutions to current challenges (e.g. H5N1, EHEC) • Many similarities • Different traditions/background • Integrated approach (scope different)
- 7. 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.
- 8. 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/)
- 10. 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.
- 13. 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)
- 14. 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
- 15. ILRI EcoZD start-up issues - challenges Human Resources Supply & 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 approach Learning by doing Priority zoonoses +/‐ ZEID (country perspective) Two‐dimensional capacity‐building requirement Technical (proposal writing/implementation/methodological/ analysis/paper) EHRC concept
- 16. 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
- 17. 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 Health Eco Health hub for the region
- 18. EcoHealth-OneHealth Resource center at Chiang Mai University EcoHealth Resource center at Universitas Gadja Mada 18
- 19. 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
- 20. EHRC – General information Established in Oct 2010 To promote The use of the EcoHealthOneHealth approach EcoHealth concepts Agreement and collaborative efforts between experts from many faculties 20
- 21. Establishment of the EHRC
- 22. EHRC – Establishment A first workshop to discuss the idea, held at Chiang Mai University on October 11-12, 2010 Socio-economic determinants of health 5 researchers Human Health 4 Animal Health 4 Ecosystem Health 1 22
- 23. EHRC – Establishment 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. 23
- 24. EHRC- CMU: Structure of the organization EcoHealth-One Health Resource Centre Chiang Mai University Advisory Committee Veterinary Medicine Working Executive Committee Nursing Associate d Medical Science Medicine Group Social Sciences Economic Pharmacy 24
- 25. Vision 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. 25
- 26. Centre capacity building efforts
- 27. Capacity building / Training Curriculum development Undergraduate courses Collaborate with VPHCAP to disseminate EcoHealth to masters in Veterinary Public Health (MVPH) Program EcoHealth Training Courses 27
- 28. EcoHealth/One Health Lecture Series Ecological Epidemiology and the Emergence of Zoonotic Diseases: Toward an Integrative Science 28
- 29. EcoHealth/One Health Lecture Series Ecohealth: global change, local action and the interdisciplinary challenge of global health and sustainability 29
- 32. Through research
- 34. Kitchen of the world continued Working groups: “Kitchen of the world” Framework Healthy Taste Affordability Safety High quality food Environmental Sustainabilty Food vendor/ Market Slaughterhouse Farm Meat Production chain
- 36. 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
- 37. Communication
- 38. 38
- 40. CMU – UGM joint activities CMU students at UGM UGM students at CMU 40
- 41. Annual joint EcoHealth Resource Centre meeting
- 42. Lesson learn
- 44. Academic community learning Manual: (Brainstorming, targeted group, content, assignment, lead) Teaching material for faculty member to integrated with the existing undergraduate course Key academic actors Level o Executive level: dean meeting o Faculties: head of department Media: e-office, brochure, agenda in meeting 44
- 45. 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 45
- 46. Challenges for the future 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 46
- 47. Challenges for the future 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 47
- 49. 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. Social Economic Political Ecological • 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)
- 50. Case studies II: Brucellosis in Yunnan added value of an integrative (Eco health) approach ”
- 51. 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)
- 52. 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
- 54. Case studie III: added value of Eco health Optimizing Rabies Control in Bali: An Ecohealth Approach.”
- 55. Case studie III: added value of Eco health Optimizing 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)
- 56. Case studies: EH Framework Optimizing Rabies Control in Bali Political perspectives Socio‐science Media Private sector ‐Law and regulation ‐Social cultural believes ‐Social acceptance ‐ Vaccines ‐ Enforcement Tourism: ‐ Major source of income Community ‐ Acceptance ‐ Feasibility Vet Science Control of Rabies in Bali Environments Waste problems Monkeys ‐Epidemiologist ‐ Practionaires ‐ Capacity Human health - Capacity Acceptance
- 57. Take Home Messages • Essentials to practice Eco Health/One Health: Apply integrative approach Engagement & 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