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Оглавление4 Grappling with Complexity: the Context for One Health and the Ecohealth Approach
MARTIN J. BUNCH1* AND DAVID WALTNER-TOEWS2
1 York University, Toronto, Canada; 2 Ontario Veterinary College, University of Guelph, Guelph, Canada
Introduction
The field of ecohealth has to do, broadly, with ‘research, practice, and knowledge integration at the interface of ecology and health’ (International Association for Ecology and Health, 2013). This phrase, taken from the aims and scope of the journal EcoHealth, is expanded in the front matter of the journal with numerous examples in the categories of ‘One Health and Conservation Medicine’, ‘Ecosystem Approaches to Health’ and ‘Public Health, Ecosystems and Society’. The broad definition is similar to the conception of One Health, as a field that addresses ‘interactions between human and animal health that reach far beyond individual clinical issues and include ecology, public health and broader societal dimensions’(Zinsstag et al., 2011, p. 3). In practical terms, this can be framed as the ‘added value [in terms of improved human and animal health outcomes, and ecosystem services] of a closer cooperation of human and animal health and other sectors’(Zinsstag et al., 2012, p. 2).
We situate our discussion in this chapter within this broad definition of the field of ecohealth, which we are taking to encompass One Health as described in this volume. As discussed in some earlier chapters, One Health has come to be seen by many researchers and practitioners as a strategy for achieving, jointly, animal and human health outcomes that would not be possible, or if possible would be more costly and/or less effective, if undertaken by separate initiatives. The selection of outcomes, and their sustainability, are embedded in much larger and complex social-ecological systems. Grappling with the challenges of understanding this broader context is the subject matter for ecohealth.
To some applied researchers, public and animal health experts and development practitioners, ‘ecohealth’ has a more specific connotation. They refer to the ‘ecohealth approach’ or the ‘ecosystem approach to health and well-being’. This is an approach that began to emerge in the 1990s with: (i) the expression of an ecosystem approach rooted in systems thinking, conceptualizing coupled human and natural systems, operated by collaborative processes and intended to intervene in situations of complexity and uncertainty (e.g. Allen et al., 1994; Kay and Sneider, 1994; Bunch, 2001; Waltner-Toews and Kay, 2005; Waltner-Toews et al., 2008); and (ii) its application to social-ecological systems for the purpose of improving human health and well-being (e.g. Yassi et al., 1999; Forget and Lebel, 2001; Waltner-Toews, 2001; Murray et al., 2002; De Plaen and Kilelu, 2004; Bunch et al., 2006; Boischio et al., 2009; Webb et al., 2010; Charron, 2012; Bunch, 2016; in the 2017 special issue of Acta Tropica on ‘Ecohealth: an African Perspective’; and Zinsstag et al., Chapter 2, this volume).
The ecohealth approach is an applied and action-oriented approach intended to both improve understanding about a situation and intervene to benefit human health and well-being. To date it has mostly been applied in development contexts in the Global South, because of the origins of the approach with a development funding agency in Canada: the International Development Research Centre (IDRC). Dominique Charron, currently Vice President of IDRC, and, for more than a decade, the director of programmes related to ecosystems and human health, defined ecohealth as an approach that:
formally connect[s] ideas of environmental and social determinants of health with those of ecology and systems thinking in an action-research framework applied mostly within a context of social and economic development. Ecosystem approaches to health focus on the interactions between the ecological and socio-economic dimensions of a given situation, and their influence on human health, as well as how people use or impact ecosystems, the implications for the quality of ecosystems, the provision of ecosystem services, and sustainability.
(Charron, 2012, p. 6)
A wide range of researchers, practitioners and teachers have been involved in developing and applying the ecohealth approach, especially those associated with IDRC’s Program Initiative in Ecosystem Approaches to Human Health, the Ecohealth Alliance, Veterinarians without Borders/Vétérinaires Sans Frontières (VWB/VSF) (https://www.vetswithoutborders.ca/ (accessed 3 June 2020)),1 members of the International Association for Ecology and Health and Ecohealth International. Many of these organized into communities of practice in ecosystem approaches to health, in Canada, West Africa, South-east and East Asia, Latin America and the Caribbean (for example see www.copeh-canada.org (accessed 3 June 2020)). Several published training manuals for use in South-east Asia and North America (e.g. McCullagh et al., 2012; Parkes et al., 2017). The websites of these organizations and the journal EcoHealth showcase some examples of applications and development of theory and methods associated with the ecohealth approach.
In this chapter we discuss the nature of the problems that the ecohealth approach is intended to address. We present an overview of the ecosystem approach, a transdisciplinary conception of health, and principles and guidelines that bring these together in the ecosystem approach to health and well-being.
Positioning Ecohealth
For ease of communication ecohealth is sometimes described as an approach to managing environmental and social determinants of health. This is misleading because it implies a linear sequence of simple determinants and that intervention somewhere along that line will improve health. The situations to which the ecohealth approach is most appropriate are instead characterized by multiple diffuse pathways that are difficult to identify and parse, and by relationships that are self-reinforcing and resistant to change. Yet they may be subject to sudden and surprising reorganization resulting from what seem to be simple interventions.
This is because coupled human and natural systems are not merely complicated – they are complex. Complex systems do not behave like machines, with parts connected by causally linear relationships. Instead they are dominated by feedback loops that lead to self-organization and evolutionary behaviour, they have interacting, multi-scalar hierarchical settings, they adapt and evolve, and they are characterized by irreducible uncertainty.2
Such situations tend to defeat our normal approach to problem solving. Since the scientific revolution of the 17th century, we have been trained to deal with problems that can be compartmentalized, isolated and reduced to manageable cause–effect relationships. Furthermore, our institutions (health authorities, planning departments, etc.) are structured and operate in this old paradigm (Bavington, 2002; Berkes, 2003; Innes and Booher, 2010). Because the application of ‘normal science’ (described by Kuhn, 1962) and applied and professional consultancy work rooted in that paradigm is sometimes inadequate, some researchers and practitioners have attempted to find other pragmatic ways to deal with complex problematic situations. In particular, Funtowicz and Ravetz describe a ‘post-normal’ approach (Funtowicz and Ravetz, 1993, 1994a,b, 2003, 2018) that is relevant to ecohealth (see Table 4.1).
Table 4.1. A comparison of the normal applied, professional consultancy and post-normal science (PNS) approaches to environmental problem concerns. From Kay et al. (1999), reprinted with permission.
| Normal applied science | Conventional professional consultancy | PNS and inquiry |
|---|---|---|
| Essentials | ||
| Certainty | Uncertainty (reducible in principle, we lack knowledge) | Uncertainty (irreducible in principle) |
| Low stakes | Intermediate stakes | High stakes |
| Facts: truth found | Solution: client happy, society is satisfied | Resolution: a course of action is chosen |
| Results | ||
| Hard | Try to be hard | Soft |
| Predictable | Error reduced to an acceptable level | Unpredictability a fact of life |
| Quantitative | Quantitative | Quantitative + Qualitative |
| In the service of | ||
| Truth | Client in a societal institutional framework | Decision makers, policy, public |
| Judgement of results | ||
| Truth accepted | No mistakes (i.e. surprises) | Quality of process, integrity |
| Peer review | Holds up in court, client happy | Holds up to public scrutiny, move forward |
| Mode of inquiry | ||
| Hypothesis testing | Problem solving | Ecosystem approach |
| Pursuit of truth | Mission and product oriented | Pursuit of understanding |
| Reductionism | – | Holarchic |
| Analysis | Analysis + Design | Analysis + Design + Synthesis |
| Explanations | ||
| Linear cause and effect | Non-linear, negative feedback | Negative + Positive feedback, autocatalysis, morphogenic causal loops |
| Mechanistic | Mechanistic + Cybernetic | Synergistic, emergence |
| Stability | Control, homeostasis | Change, evolution, ∞ cycles |
| Efficiency | – | Efficiency + Adaptation |
| Extremum principles | – | Local optimum, trade-offs |
| Laws | – | Propensities and constraints |
| Forensics | ||
| Fact | Interpretation | Testimony |
| Characteristics | ||
| Objective, one correct view | Subjective, client-consultant view | Subjective, plural |
| Value free | Limited values | Ethical, integrity |
| Predictive management | Control management | Anticipatory + Adaptive management |
| Physics | Engineering | Ecological economics |
Post-normal science (PNS) is a way of doing policy-related science that is appropriate for cases where ‘facts are uncertain, values in dispute, stakes high and decisions urgent’ (Funtowicz and Ravetz, 1994b). PNS provides a basis for accommodating knowledge provided from multiple perspectives of diverse stakeholders in complex situations. PNS thus offers a philosophical rational for health-related activities where One Health is invoked as a goal and/or ecohealth is chosen as an approach.
For One Health practitioners, this means that the health outcomes selected, and the manner in which they are addressed, become part of the process of investigation. For example, livestock are valued in many different ways, many of them non-economic (Zinsstag et al., Chapter 2, this volume). Cattle, for instance, are valued differently by Maasai in East Africa, Hindus from India, and feedlot owners exporting beef from the USA. Simple appeals to cost–benefit analyses to arrive at strategies for controlling diseases are not always helpful or sufficient. Even within a broad economic perspective, we must ask whether the benefits and costs accrue differently to smallholders, corporations, communities, trading partners and the like. PNS, unlike what has been called normal science, does not argue that there is a single ‘objective’ view of a complex reality that transcends all the others. Conventional scientists contribute a great deal to the overall body of knowledge, but their view does not necessarily negate or subject others. Our understanding of the world emerges from multiple, sometimes conflicting, perspectives, and is characterized by complex uncertainties.
In order to prevent this openness to multiple perspectives from degenerating into a free-for-all mixture of hard-won evidence, misinformation and fantasy, PNS practitioners have developed extended peer networks and sets of guiding principles and questions. Hence the importance of networks and communities of practice that cross not only disciplinary boundaries but also boundaries that have traditionally separated academic scholarship from community-based research and indigenous knowledge (Berger-González et al., Chapter 6, this volume).
The Ecosystem Approach
Ecosystem approaches are distinguished from other approaches in environmental and resources management by the use of the ecosystem construct as a metaphor for holistic thinking, attention to the evolutionary and dynamic nature of complex situations, and the incorporation of processes to accommodate management of such situations with multiple interests and stakeholders, and across multiple jurisdictions (Yaffee, 1999). Figure 4.1 presents a version of the ‘diamond diagram’ that represents the adaptive ecosystem approach that has influenced many ecohealth applications. This version of the ecosystem approach (Bunch, 2001) was based on that developed by James Kay and his colleagues in the 1990s (Kay et al., 1999) and further elaborated in the book The Ecosystem Approach: Complexity, Uncertainty and Managing for Sustainability (Waltner-Toews et al., 2008). This expression of the ecosystem approach is explicitly positioned as PNS and informed by ideas about self-organizing, holarchic and open (SOHO) systems. While challenging to understand for the novice, the language and theory of these systems has provided a useful way to think about, and manage, what might otherwise appear to be a kind of paralysing complexity and to anticipate and plan for unintended consequences.
Fig. 4.1. A framework for an adaptive ecosystem approach. From Bunch (2001), adapted from Kay et al., 1999.
Self-organization is a characteristic of complex systems that leads to emergence, and is related to systems and complexity science concepts such as resilience, adaptation, regime change and tipping points. Within the One Health field, one might think of the health of individual animals and people being embedded in, and interacting with, families or herds, which are nested within larger social and ecological units, which are further nested within – affecting and being affected by – global trading and climate systems. People and individual animals have their own particular characteristics (emergent properties), as do families and herds and so on. Each unit (person/animal, herd/family) can be viewed as both a whole, with its own internal dynamics, and also as a part of something larger. Philosopher Arthur Koestler (1968) referred to such ‘two-faced’ units as holons, and the nested organization as a holarchy.
This way of looking at the world implies the need to identify appropriate scales of attention as well as within- and across-scale interactions – which for many human health and animal health workers is a formalization of common sense. Does one target individuals, households, communities (or their animal counterparts), or some combination? The ‘open systems’ of the SOHO concept refers to the fact that such systems are those in which information, energy or matter (inputs) flow through, are transformed in, and drive the processes occurring within systems. The SOHO concepts are some of the systems thinking ideas used by practitioners throughout the application of the ecosystem approach.
There are three general phases evident in the ecosystem approach framework presented in Fig. 4.1: (i) problem identification and system description (the box at the top of the diagram); (ii) making decisions and taking action; and (iii) ongoing learning, adaptation and management that subsumes and iterates the process. In this general framework methods and techniques are not prescribed, although both systems approaches and collaborative process are intended to operate the approach throughout.
Problem identification and system description (sometimes called a system study) begin the engagement with a messy problematic situation, including stakeholders and actors. An important part of this is the identification and description of the ‘problemshed’. (This may be tied to geographic constructs such as watersheds.) It involves developing an appreciation of the nature and spatial and temporal scales of relationships associated with a problematic situation. It is a collaborative process of discovery to understand historical context, identify and meaningfully engage and empower actors and stakeholders, develop knowledge about key components and relationships, understand pertinent values and preferences and physical and cultural possibilities. This work draws key relationships in the system to the fore, indicating their spatial and temporal footprint and bounding the situation so as to identify the system, its wider systems and environments and subsystems and components.
The social-ecological system identification generates understanding of systemic possibilities that might exist in the situation. From this, researchers work with stakeholders to identify alternative futures (scenarios) that are systemically desirable and culturally feasible. One of these alternatives is selected to inform intervention. This is a different role for researchers than that with which traditional scientists will be familiar, and it is a characteristic of working in the ‘post-normal’ mode in situations of uncertainty and complexity. James Kay (2008), a key formulator of this type of approach, explains that:
Investigators into complexity do not seek prediction, control, right answers or efficiency. These are not sensible goals under conditions of complexity. Rather, the investigators seek understanding, adaptability, and resilience. Scientific inquiry, more than ever, becomes an act of collaborative learning and knowledge integration. The role of the expert shifts from problem solving to an exploration of possibilities and from giving correct advice to sharing information about options and trade-offs. In fact, those who cling to being the old sort of expert lose their expertise.
(Kay, 2008, p. 80)
This new role for experts derives from the failure to manage complex situations using reductionist and mechanistic ways. Such situations are characterized by discontinuities in linear chains of cause and effect. They cannot be managed as if they were sets of levers and cogs in a machine. Instead, complex systems must be encouraged to self-organize around desirable alternative system configurations. A system’s trajectory of change cannot be entirely controlled, and there may be surprises along the way. It is more analogous to raising a baby to adulthood than to sending a spacecraft to the moon. With the rocket, there is a relatively high degree of certainty of the outcome, each successive attempt is similar in critical ways and sending one successful rocket improves the chances of the next. In raising a child, experience and expertise help, but the outcome remains uncertain. Each child is unique and formulae have limited application (Glouberman and Zimmerman, 2002).
Thus, when we attempt to understand and intervene in complex situations, we need to monitor key relationships to learn about system behaviour. This is necessary to be adaptive. Applied research, public health interventions, and other projects that attempt to engage with complex environment-and-health problems must constantly re-evaluate the conceptual model of the system and the efficacy and outcomes of interventions. There should be openness, even an orientation to revising and adjusting the strategy. The ecosystem approach is an adaptive management approach. Practitioners of adaptive management monitor in order to support collaborative learning.
Based on the ‘diamond diagram’ in Fig. 4.1, AMESH (Adaptive Methodology for Ecosystem Sustainability and Health) was developed in the 1990s through a series of community-based projects in Kenya, Peru, Nepal, Canada and several other countries (see Fig. 4.2). AMESH is described in considerably more detail elsewhere (see Waltner-Toews et al., 2008). However, as applied to One Health outcomes, it may be summarized as follows:
Fig. 4.2. The Adaptive Methodology for Ecosystem Sustainability and Health (AMESH). GIS, geographic information system. From Waltner-Toews et al. (2004), reprinted with permission.
• The process begins when local people, researchers or some third-party agency perceive a health-related problem.
• The responders, who could be anyone from international agencies to university-based research scholars, describe the situation systemically, including as many different perspectives and scales as feasible.
• Local stakeholders, together with research scholars and government and non-government agencies identify alternative courses of action that can best accommodate known trade-offs and optimize the achievement of multiple goals.
• They then choose a course of action that can achieve some balance of those different goals, develop a plan that incorporates feedback from which the implementers can learn and adapt, begin implementation, and ensure that governing, monitoring and management co-evolve with the changing situation.
The process, which has been demonstrated to be quite robust, incorporates both conventional investigative scientific and modelling techniques and democratic social processes, and, unlike many scientific investigations, can be altered and adapted to deal with new information and/or changing contexts (e.g. unstable markets for animal products, disease epidemics and the like).
An Integrated and Transdisciplinary Conception of Health
Because ecohealth applications face the danger of exploding in multiple directions at once, practitioners and scholars in the field have developed a variety of ways to set reasonable boundaries and articulate key principles.
Health (good or bad) arises from multiple interrelationships among various human and natural components of social-ecological systems (Whittaker et al., Chapter 7, this volume). In systems terms, community, population or ecosystem health is an emergent property. That is, it is evident at the level of the system but not at the scale of individual components or smaller subsets of relationships. One cannot predict from the individuals what the community will be like. Thus, one way to bound ecohealth work is to find units that are simultaneously useful for study, for administration of programmes, and for investigation of dynamics. This is part of defining the ‘problemshed’ relevant to the situation. Some geographic constructs lend themselves to this application more than others. In environment-and-health situations, watersheds have proven to be such a unit (Davies and Mazumder, 2003; Venema and Bunch, 2011; Bunch et al., 2014; Morrison et al., 2017). Not only are they arranged in a hierarchical manner (with sets of larger encompassing catchments and smaller subwatersheds) that help to frame conversations about external driving forces and upstream/downstream relationships, but water is clearly of central importance to both ecological and human health (Falkenmark and Folke, 2002; Boelee et al., 2019; WHO, 2019).
There are several useful conceptual models of environment-and-health interrelationships and emergence, such as the butterfly model of health (VanLeeuwen et al., 1999), and the Millennium Ecosystem Assessment framework that connects ecosystem services to constituents of human well-being (Corvalan et al., 2005). One current model that we find particularly useful is the Watershed Governance Prism (Fig. 4.3; Parkes et al., 2008, 2010). The prism expresses the potential for relationships among social systems, ecosystems and health with watersheds as an organizing construct that highlights water–land interaction, settings for health and well-being, and scale at which important driving forces (such as climate change) manifest. Although the prism is labelled for ‘watershed’ governance, because watersheds represent a setting to understand social-ecological systems and driving forces acting up on them, this can be substituted for other settings.
Fig. 4.3. The Watershed Governance Prism. From Parkes et al. (2008), reprinted with permission.
The Watershed Governance Prism is useful as a heuristic device to conceive of and guide the search for important relationships in a complex and problematic situation (e.g. among social systems and health, watersheds and social systems; see Table 4.2). Not every axis of the prism will necessarily be identified as important in every situation, but in identifying the problemshed and developing a system description of the issue, the prism can inform our scan of the problem. Furthermore, sets of relationships can be built up to represent common perspectives (e.g. the faces of the prism correspond to common approaches such as: (i) water governance for sustainable development; (ii) water governance for ecosystems and well-being; (iii) water governance for social determinants of health; and (iv) water governance for social-ecological health promotion). The Watershed Governance Prism thus helps to promote the search for relationships corresponding to various prism axes that may exist in a problem context, and also point out what aspects may be missing or neglected. When a conceptual model of a problematic environment-and-health situation is developed, some axes might not appear, but this can be a deliberate and justified choice, avoiding an accidental omission that arises out of ignorance or a narrow perspective.
Table 4.2. Relationships corresponding to axes on the Watershed Governance Prism. Adapted from Parkes et al. (2010).
| Linear connections (prism ‘axes’) | Representative examples of features, issues and characteristics of linear connections’ link to prism diagram |
|---|---|
| Ecosystems–health/well-being | Traditional environmental health relationships linking ecosystems with human health and well-being, with a focus on contaminants, pathogens, disease vectors, toxic or therapeutic agents, extending to health implications of loss of biodiversity and/or ecosystem services. |
| Watersheds–ecosystems | Natural resource and ecosystem management (including land and water use) within the watershed, agroecosystem viability and food security; the protection of baseline or ‘environmental’ water flows, including wetlands; saltwater intrusion/salinization of soil. |
| Watersheds–health/well-being | Water-related services and infrastructure (including source water protection, wastewater, sanitation and hygiene services); direct effects of natural disasters such as flooding, drought, landslides; structural flood defences, drainage and irrigation systems. |
| Watersheds–social systems | Water for socio-economic and community development; water access and water rights (particularly for the poor); public or private exploitation of water for economic gains through dams, reservoirs and hydroelectric power; upstream-downstream equity issues; spatio-temporal variability. |
| Social systems–health/well-being | Social determinants of health; health implications of social policies and socio-political processes, health impacts of socio-economic status, inequities, poverty, social networks and social cohesion; access to health services, health promotion, education, social services and community development. |
| Ecosystems–social systems | Linked social–ecological systems; ecological goods and services (i.e. provisioning, supporting, regulating and cultural services); supply and demand-side management, place-based links of human-natural systems occurring at scales within and beyond watersheds. |
The Watershed Governance Prism and other conceptual models of environment and health promote a holistic and synthetic approach to complement the normal scientific and social science tools that we can bring to bear on environment-and-health issues. This highlights the necessity for inter- and trans-disciplinarity in addressing such problems. The term ‘governance’ also points to the need for collaborative and participatory approaches in the understanding and management of health and well-being as emergent properties of complex and coupled human and natural systems.
Another way (apart from defining organizational or geographic units) to manage the challenging process of doing ecohealth work has been to define basic principles. Dominique Charron from Canada’s IDRC articulated six key principles or guiding considerations (Charron, 2012). These principles echo the ecohealth approach and conception of health presented above. They include:
• systems thinking;
• transdisciplinary research (i.e. research that engages community members and not just scholars) (Berger-González et al., Chapter 6, this volume);
• participation (which is an extension and elaboration of trandisciplinarity);
• ecological sustainability;
• gender and social equity; and
• knowledge-to-action.
Of course, each problematic environment-and-health situation in which we might intervene is unique. Thus, different applications of the ecohealth approach emphasize these principles to different extents and use a wide variety of ways to mobilize these principles. For example, over 5 years, the Dahdaleh Institute for Global Health Research at York University will draw upon complex adaptive systems theory and employ agent-based modelling, developing scenarios to understand climate change impacts and human health in the Chilwa Basin of Malawi. Partnered with Dignitas International and local communities, they are building capacity to understand interactions of extreme weather, ecological services, infectious diseases, food security, clinical public health and disaster risk management to target deficits in ecological services management and clinical and population health interventions (J. Orbinski, 2019, unpublished data). While connecting with all six principles of the ecohealth approach, the systems thinking principle is formally and strongly emphasized in this project.
Waleckx et al. (2015) on the other hand, in their approach to managing Chagas disease in the Yucatan, dealt with systems less formally, mobilizing community knowledge to identify interrelated behaviours, knowledge, attitudes and perceptions of community members, along with environmental factors to inform interventions. They operated an iterative process with local government, social workers, community members, carpenters, the health centre and the research team, in which they explored and agreed upon strategies for intervention. Each stakeholder played a different role in the process, which involved interventions such as installation of window screens and education about cleaning of chicken coops. This project strongly emphasized the transdisciplinary and participation principles.
Another example involving ‘complex adaptive systems’ is offered by an ecohealth project in Chennai, India (Bunch et al., 2005, 2006, 2019; Kumaran et al., 2012). In this project researchers partnered with community members in low-income squatter settlements (‘slums’). Participating communities were formally conceived as ‘social-ecological systems’ that were characterized by recurring outbreaks of cholera and other disease, inadequate solid waste disposal, poor or absent toilet and sewerage facilities, poverty, malnutrition, low levels of literacy, poor access to potable water, and child labour. They faced continued pressures of the caste system, urbanization, political conflict and lack of tenure; they were stuck in a resilient (maladaptive) poverty trap. The partnership worked to build community capacity to manage this situation and improve human well-being. This project looked less to the natural environment and ecological sustainability than did the previous examples, but emphasized gender and social equity more strongly, along with participation and systems thinking.
In these projects and others, given the strong resistance of certain populations to global health and animal health interventions, the involvement of stakeholders and sharing of knowledge as it emerges have been demonstrated repeatedly to be essential not just to generate knowledge (i.e. from a PNS perspective), but also to implement effective programmes.
Future Directions for Ecohealth
Ecohealth and One Health as currently defined are relatively new fields, and the feedback loops between practice and theory are still influencing each other, resulting in both richer theory and more effective practice. Some recent explicitly ‘ecohealth’ research initiatives include projects working with communities to understand and facilitate responses to climate change in equatorial Africa, Canada’s far north and the Peruvian Amazon, connecting conservation and human well-being in Costa Rica, studies on mercury dynamics in the Brazilian Amazon, social-ecological impacts of Agent Orange in Vietnam, and development of interactive, open-source teaching materials in Canada, Africa, Asia and Latin America.
In the realm of One Health, initiatives assume particular goals such as eradication or management of zoonotic and other animal-related diseases. In these cases, clear goals can be set, programmes undertaken, results achieved with some predictability, and the value-added benefit of joint human-animal strategies calculated. In the long run, however, One Health activities will need to be understood in a context of global social-ecological changes, where outcomes are less certain (Zinsstag et al., 2011).
A current example of what can occur when normal, linear science is applied to managing complex systems emerged in late 2019 and early 2020. In 2019, more than 200 million pigs in China died from – or were killed to ‘stamp out’ – African swine fever (ASV). That was about half of the pigs in China and a quarter of all the pigs in the world. In late 2019 and early 2020, hundreds of millions of Chinese people were in markets and malls searching for scarce meat to celebrate the end of the lunar ‘Year of the Pig’ and launch the ‘Year of the Rat’.
While pigs were in short supply, the Huanan Seafood Market in Wuhan, Hubei Province, China, was well stocked with other species to help their customers stock up for the celebrations. These included peacocks, wild rabbits, snakes, deer, crocodiles, turkeys, swans, kangaroos, squirrels, snails, foxes, pheasants, civets, ostriches, camels, cicadas, frogs, roosters, doves, centipedes, hedgehogs and goats.
In January, 2020, the South China Morning Post reported an outbreak of H5N1 avian influenza in Hunan Province, which is geographically adjacent to Hubei Province. Since 2003, tens of millions of birds have died from avian influenza, and hundreds of millions have been slaughtered. The World Health Organization (WHO) has reported that, since 2003, avian influenza has infected less than 1000 people worldwide, killing about half of them.
It should not come as a shock that within weeks, economic anxiety, rather than pandemic death, rose to the top of the headlines. In each area – agriculture, disease control, economic policy – application of good normal science had resulted in improved yields, low disease rates and increased profits.
Responses to these epidemic diseases were targeted on surveillance, containment, vaccine development and the like. These responses are all appropriate as emergency measures based on the best practices of normal science. But what of long-term agriculture, health and economic policies?
For those thinking in terms of PNS, the concurrent emergence of COVID-19, ASV, avian influenza and global economic uncertainty is no surprise. But few have addressed the underlying social-ecological conditions which would be useful for developing linked economic, public health and agricultural policies. Similarly, few have researched those questions in relation to suggestions that entomophagy or veganism could be one-size-fits-all solutions to climate crises, hunger and sustainable development (Waltner-Toews, 2017).
What are the larger implications of choosing certain health-related outcomes such as disease control or food production over others such as local community autonomy and resilience, and equitable and sustainable distribution of both production and consumption? Do shifts towards eating insects, less meat or more almonds result in more resilient social-ecological systems? It is in the context of these larger questions that ecohealth and its theoretical (complexity) and philosophical (PNS) bases are most relevant, and where One Health will ultimately demonstrate its worth.
Notes
1 The Ecohealth Training Manual developed by the South-east Asia Ecohealth Field Building Initiative contains practical elaborations of many of the ideas in this chapter (available at: https://www.vetswithoutborders.ca/library/fbli (accessed 3 June 2020)).
2 This characterization of a complex situation is founded on a tradition of systems thinking and complexity science. It also corresponds well to Alfred North Whitehead’s ‘process philosophy’ – see for example Whitehead (1978) and Barbour (1997).
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