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Оглавление6 Transdisciplinary Research and One Health
MÓNICA BERGER-GONZÁLEZ,1,2,3* KRISTINA PELIKAN,1,2 JAKOB ZINSSTAG,1,2 SEID MOHAMED ALI1,2,4 AND ESTHER SCHELLING5
1 Swiss Tropical and Public Health Institute, Basel, Switzerland; 2 University of Basel, Basel, Switzerland; 3 Universidad del Valle de Guatemala, Guatemala City, Guatemala; 4 University of Jigjiga, Jigjiga, Ethiopia; 5 Vétérinaires Sans Frontières Suisse, Bern, Switzerland
Introduction
One Health raises questions beyond the narrow view of health improvements based on medical interventions: its activities need to be understood in a context of local and global social-ecological changes, where outcomes are less certain (Zinsstag et al., 2011b). We need a range of disciplines to understand the context of health (Allotey et al., 2010). For this purpose, the starting point should not be a One Health approach, but the socially relevant health-related problem and its ecological dimensions. Other socially relevant problems are, for example, hunger, poverty, pollution and migration. In practising One Health, we seek practical solutions, which we most often cannot approach from an academic perspective alone. At this point academic scientists engage with non-academic stakeholders and their knowledge in research to solve practical problems and identify causes at their roots. Our experiences in intercultural and multilingual contexts (Nido Films, 2018) point towards a mindful, culturally and gender sensitive approach, paying particular attention to careful translation and interpretation between the different languages spoken (Zinsstag et al., 2019). The growing awareness of the need to embark in transdisciplinary processes to solve complex problems has invigorated the development and delivery of science-based policy in One Health in the past decade (Oura et al., Chapter 28, this volume; Rinchen et al., Chapter 29, this volume).
Trajectories of Transdisciplinary Research since the End of the 20th Century
Progressive fragmentation of the sciences into more and more specialized disciplines and thematic fields in the 20th century led to the perceived major risk that specialization could not recognize possible negative side effects for modern civilization. The growing awareness of such risks stimulated integrative approaches labelled ‘interdisciplinarity’ or ‘transdisciplinarity’ (see below for how we use these terms). Differences between basic, applied and transdisciplinary research, as specific forms of research, stem from whether and how different scientific disciplines and actors in the life-world are involved in problem identification and problem structuring, thus determining how research questions relate to problem fields in the life-world (Hirsch Hadorn et al., 2008). Transdisciplinarity has become a form of research with the possible association of any discipline. The number of publications using ‘transdisciplinary’ or ‘transdisciplinarity’ has grown rapidly since 1995. The Network for Transdisciplinarity Research (td-net, http://www.transdisciplinarity.ch (accessed 25 May 2020)) publishes these overviews on developments of transdisciplinary research. It was initiated in 2003 by the Swiss Academies of Arts and Sciences to support foresight and the dialogue between science and society. Transdisciplinarity has attracted growing international attention, leading to an international alliance for inter- and transdisciplinarity (http://www.itd-alliance.org (accessed 25 May 2020)) in Gothenburg in 2019 and development of a massive open access online course (MOOC) on transdisciplinarity (https://www.futurelearn.com/courses/partnering-for-change (accessed 25 May 2020)).
Hirsch Hadorn et al. (2008) in their chapter ‘The emergence of transdisciplinarity as a form of research’ and its section ‘From dissociation to transdisciplinary orientation in the knowledge society’, describe the history of transdisciplinary research from Aristotle’s forms of knowledge to today. Transdisciplinarity plays such an important role in One Health that we consider it appropriate to summarize Hadorn’s chapter to provide necessary background without claiming completeness. Natural science in the period since the 17th century has dissociated from philosophy and become concerned with empirical laws. Research is carried out by intervening into nature in technically equipped experimental settings. The concept of positivism postulates that observations are the only source of knowledge. There is a dissociation of science from practical knowledge, or what is also called the life-world. The term ‘life-world’ was introduced by the German philosopher Husserl (1859–1938). In the 19th century the science of society, called sociology, was created. Another German philosopher, Alfred Schütz (1899–1959), introduced the term life-world into sociology as ‘social reality’. The social sciences and humanities put forward the need for interpretation of social and cultural phenomena from an historical perspective. Wilhelm Dilthey (1833–1911) advocated a hermeneutic paradigm to achieve an understanding of cultural ideals. Natural sciences attempt to explain natural phenomena, but hermeneutics attempts to interpret and assign a meaning to social and cultural phenomena from an historical perspective. The debate is about explanation versus meaning.
Sociology was confronted with the social crises of capitalism in the 19th century. The German sociologist Max Weber (1864–1920) recognized practical problems as a stimulus for scientific research. There is an ongoing debate regarding the relationship of empirical science to societal values. Scientists do not limit themselves to describe, for example, poverty; they consider poverty as socially unacceptable and thus do not make a descriptive, strictly scientific, statement, but a normative, value statement. Weber argued that empirical sciences are about what is either true or false, while the normative distinction in the sphere of values is that of right or wrong. Given the progressive fragmentation of the sciences into more and more specialized disciplines and thematic fields, emerging complex phenomena could no longer be recognized, which led to the development of systems theory studies and of multidisciplinary and interdisciplinary thinking. When a variety of disciplines collaborate in one research programme without integration of concepts, epistemologies or methodologies – but link research results – we speak of multidisciplinarity. Interdisciplinarity is also a collaboration of several disciplines, but concepts or methodologies are explicitly exchanged and integrated, resulting in a mutual enrichment (Flinterman et al., 2001; Darbellay and Paulsen, 2008) within scientific context.
Erich Jantsch (1929–1980) sees the triangle of university–industry–government as a ‘transdisciplinary’ triangle organized by general systems theory. In the second half of the 20th century natural resource crises emerged due to, among other forces, rapid population growth. The Brundtland Report from the United Nations World Commission on Environment and Development recognized in 1987 that the complexity of the interactions of a ‘Risk society’ (Beck, 1992) and unintended and poorly understood damage to natural resources and lives require systemic thinking across different academic disciplines and involving societal actors like communities and authorities. The United Nations Conference on Environment and Development in Rio de Janeiro in 1992 promoted sustainable development by involving people from civil society, the private sector and public agencies as actors in participatory deliberation and decision making. Addressing climate change is a formidable example showing the need for normative negotiation and co-producing transformational knowledge for practical solutions.
Social sciences and humanities became involved in activities such as technology assessment and ethical committees on morally sensitive technologies. Mittelstrass (1992) defines ‘transdisciplinarity’ as a form of research that transcends disciplinary boundaries to address and solve problems related to the life-world. Through scientists entering into dialogue and mutual learning with societal stakeholders, science becomes part of societal processes, contributing explicit and negotiable values and norms in society and science, and attributing meaning to knowledge for societal problem solving (Hirsch Hadorn et al., 2008).
Based on their historical review, Hirsch Hadorn et al. (2008) conclude that one can understand why transdisciplinary research is shaped by various lines of thinking and has a variety of definitions. We thus present here the definition derived by the same authors, which is based on a synthesis of what can be found in the literature:
There is a need for transdisciplinary research when knowledge about a societally relevant problem field is uncertain, when the concrete nature of problems is disputed, and when there is a great deal at stake for those concerned by problems and involved in dealing with them. Transdisciplinary research deals with problem fields in such a way that it can: a) grasp the complexity of problems, b) take into account the diversity of life-world and scientific perceptions of problems, c) link abstract and case specific knowledge, and d) constitute knowledge and practices that promote what is perceived to be the common good.
(Pohl and Hirsch Hadorn, 2007, p. 20)
Transdisciplinary research projects consist of different phases of intra-, multi-, inter- or transdisciplinary collaborations (Herweg et al., 2012). The sequences and interactions of these different forms of collaboration need to be iteratively considered by the transdisciplinary team. For this process, aiming to tackle societal challenges and reaching academic success at the same time, several methods have been developed during the last few years (Pohl, 2018). The actors involved learn from each other (mutual learning) and they acquire a new type of learning (Tobias et al., 2019). As research on these actors themselves has shown, there are specific characteristics that are mandatory for being successful in transdisciplinary collaboration (Guimaràes et al., 2019).
Classical disciplinary knowledge is not sufficient in situations of high uncertainties like pastoralist societies facing complex social-ecological challenges (Seid et al., 2016). Hence, we require a dialogue with involved stakeholders as an extended peer community. Funtowicz and Ravetz (1993) introduced the term of ‘post-normal’ science as a concept transcending classical disciplinary academic science, engaging in a dialogue with all who have a stake in technical and normative decisions on problem solving. Transdisciplinary approaches are thus a central element of generating an added value of One Health, progressively strengthening cooperation between human and animal health and other disciplines, between academic and non-academic actors (Zinsstag et al., Chapter 2, this volume; Bunch and Waltner-Toews, Chapter 4, this volume). Next to post-normal sciences, analogous approaches to transdisciplinarity (that recognize the need to integrate disciplines and engage civil society in view of the relevance to the policy problem in question, but also recognize the complexity and uncertainty) are the Science of Team Science in North America, Integration and Implementation Sciences in Australia, and Public Engagement in Europe and elsewhere.
We can distinguish three forms of interdependent knowledge: (i) systems knowledge; (ii) target knowledge; and (iii) transformation knowledge. Systems knowledge relates to questions about the genesis and possible further development of a problem, and about interpretations of the problem in the life-world. Target knowledge relates to questions determining and explaining the need for change, desired goals and better practices, while transformation knowledge relates to questions about technical, social, legal, cultural and other possible means of acting that aim to transform existing practices and introduce desired ones (Pohl and Hirsch Hadorn, 2007). A transdisciplinary approach identifies and structures (providing an account of the state of disciplinary knowledge and actors in society involved in order to define the problem and raise research questions), analyses (providing adequate organization, and indicating which interests and circumstances to take into account) and brings results to fruition (embedding solutions into the social and scientific contexts, and testing the expected impact). Problem identification and structuring can overlap, which makes an iterative rather than a sequential approach more rational for achieving valid results. Unexpected and surprising results are to be expected (Hirsch Hadorn et al., 2008).
Scientists are often overwhelmed by the amount of information in everyday practice and the lack of a common language in specialized fields of expertise. In inter- and transdisciplinary programmes researchers should have: (i) their own in-depth knowledge; (ii) general knowledge of the other disciplines involved; (iii) social and communication skills for the exchange between disciplinary researchers and actors of the life-world; (iv) respect for others; and (v) teamwork and cognitive (or synthesis) skills (Flinterman et al., 2001). Thus, they need to have the mindset of a ‘transdisciplinarian’ (Guimaràes et al., 2019).
Additionally, awareness of the multilingualism within the transdisciplinary team is essential. Transdisciplinary projects mainly consist of actors with various mother tongues and different forms of multilingualism, which can be classified into three types in transdisciplinary collaborations (Pelikan, 2019; Pelikan et al., 2019):
1. Idiolect – Every person has an individual idiolect, consisting of, for instance, mother tongue, dialect and terminologies. This means multilingualism not only appears between and within individual languages, but also within all of us.
2. Intralingual multilingualism – The difference between the styles of thought (Pohl, 2011) and worldviews of the actors involved, leading to various concepts and values that are manifested in language(s) and communication, can only be successful if all involved actors share a defined set of values and concepts – in their individual language. Within every language (and also lingua franca), specific terms are used for all these values and concepts. In addition to the translations between individual languages, intralingual translations are necessary – translations within individual languages. A mindful hermeneutic approach is necessary to understand and translate these concepts into shared understandings between all the cultures, disciplines, etc. involved.
3. Interlingual multilingualism – In multicultural and multilingual and multidisciplinary contexts, the involved project members speak different languages (e.g. English and Spanish), which leads to multilingualism of different individual languages, interlingual multilingualism. Translations play an important role, and the need for a shared language is obvious. However, ‘as participants communicate in a common language, this may create the illusion that they also share a common culture’ (van Mulken and Hendriks, 2017). But the implementation of one individual language (e.g. English) as a shared language, a so-called lingua franca, does not create a shared culture and even causes further difficulties. Some transdisciplinary projects cannot find a lingua franca, as not all actors involved share one individual language (Münch, 2002), and translations into a lingua franca and between other languages are often underestimated since they also deal with intralingual multilingualism.
These types of multilingualism play an essential role in terms of comprehensibility of the communication of and within transdisciplinary projects. Monolingualism by using English as lingua franca is practised quite often in academia, carrying the risk of losing multiple meanings about culture, behaviour, emotions and connotations and disciplinary approaches. Additionally, monolingualism may lead to power issues of differentiated knowledge acquisition: knowledge is not only transferred and acquired through communication, knowledge can also arise through writing – the so-called epistemic writing. Within the process of epistemic writing, the writing person acquires new knowledge while writing. This occurs in writing processes of different phases of projects (Pelikan, 2019), for instance during the data analysis, and less knowledge is acquired when one writes in a foreign language. Efficient language acquisition needs also to be enabled for illiterate partners, who are often part of the collaboration with local communities. In this frame, important power issues and ethical questions need to be discussed for avoiding ‘epistemicide’ (Bennett, 2015), the disadvantage of actors within the collaboration due to their mother tongue within transdisciplinary processes. The functional implementation of multilingualism needs to be planned to reduce power issues and epistemicide. Therefore, project communication needs to be considered from the outset and included in the budget – for every phase of the project. As an example, the project’s budget needs to include translators who are familiar with the concepts involved and equipment to be implemented in all partners’ meetings.
The awareness of these idiosyncrasies, typical of inter- and transdisciplinary collaboration, could increase the potential of partnerships to produce useful outcomes. Taking into account all the different styles of thought and socio-cultural backgrounds of the people involved, manifested in their cultures and languages leads to the concept of intercultural transdisciplinarity. Intercultural transdisciplinarity can be understood as the inclusion of different cultures (e.g national, disciplinary and ethnolinguistic) involved in the transdisciplinary research process by emphasizing and making use of the benefits of their interaction with each other, such as in cases of ‘reverse innovation’ (Zinsstag et al., 2019). This implies attempting to understand the explanatory models and associated values and preferences of all key cultures involved in the transdisciplinary group, what anthropologists refer to as the ‘emic view’ (Pike, 1967). The emic view consists of interpretations from the perspective of an insider of a given culture. Traditionally, scientists are trained to interpret data about the natural and social world studied, and to synthetize it in view of a specific chosen paradigm, thus creating etic constructs or explanatory models to simplify the complexity of observed reality (Headland et al., 1990). In this process between emic and etic views, one culture often reassigns significance over another’s emic constructs, which can sometimes lead to a misrepresentation of a given culture’s knowledge system or to their associated values and preferences being overlooked, potentially leading to a conflict. In pluriepistemic, multicultural settings, transdisciplinary collaboration requires all participants to bring forth their emic and etic explanatory models about the issue at hand and present them to each other, creating in the process many etic interpretations (e.g. traditional healers reinterpreting a biomedical doctor’s explanations about a zoonotic disease, and vice versa). The challenge is to facilitate a process for dialogue where multiple emics of self-representation and etics of otherness-representation can find a common ground for mutual learning, reducing ethnocentric behaviour that leads to bias in research, and aiming towards co-creation of new knowledge to address the target problem (Berger-González et al., 2016). All these approaches need to be part of a concept for project communication (Pelikan, 2019).
Transdisciplinary Research in One Health and Ecohealth
Both quantitative and qualitative approaches enrich our knowledge. True interdisciplinary research programmes in One Health and on zoonoses control are few in number. With some strong exceptions (see Welburn and Coleman, Chapter 21, this volume), so-called ‘socio-economic’ or ‘socio-cultural’ studies on zoonoses are largely questionnaire based, including the knowledge, attitude and practice (KAP) studies, and are often led by veterinarians. These rapid appraisals have several shortcomings, particularly because they do not further describe the context (Allotey et al., 2010). New institutional arrangements between social and biomedical sciences are needed to establish interdisciplinary teams, which can be seen as the motor of transdisciplinary research (Whittaker et al., Chapter 7, this volume). Below we present a few examples of transdisciplinary processes in One Health and ecohealth.
Long-term iterative process in Chad to improve the health of pastoralists and their livestock
Livestock-keeping communities are often excellent observers and know the priority diseases of people and animals in their context. However, in rural and remote rural zones they are confronted with difficulties accessing health services (Danielsen and Schelling, Chapter 14, this volume). To improve health in a credible way in remote rural communities, all health aspects should be reviewed and interventions built on communities’ and authorities’ priorities in a participatory way. Within research partnerships between European and Chadian research institutes, we explored possibilities to improve access to services of mobile pastoralists in Chad, who were previously served by veterinary services but not human health. This aspect was then also one result of an interdisciplinary team including anthropology, social geography, medicine, veterinary epidemiology and microbiology. Other disciplines such as sociology and geography were associated in the further course of the programme with additional funding. Research results also included the absence of a local concept for zoonoses (Krönke, 2004) and that access to key pastoral resources and related conflicts with sedentary communities strongly influenced care-seeking behaviour (Wiese, 2004). Thanks to livestock holders’ reports on perceived poor anthrax vaccine quality, contamination problems in local vaccine production were detected (Schelling et al., 2008). We used the community-based research results to initiate broader collaborations with authorities and scientific experts, and results were reviewed in the communities during focus group discussions and regional workshops to obtain a broader perspective from pastoralist men and women. The research hypothesis and objectives of the complementary studies were guided by the recommendations of the first national workshop in 1998. Indeed, one key recommendation – leading to an advantage of the programme compared with other single-sector studies – was that veterinarians must be associated because livestock, the most important element in the livelihood of mobile pastoralists, could not be excluded.
Repeated stakeholder seminars became crucial elements towards a transdisciplinary process. These allowed the scientists to engage with communities and their representatives and associations, authorities from the Ministry of Health (MoH) and the Ministry of Livestock Production as well as local authorities, technicians and staff, non-governmental organizations (NGOs) working with pastoralists, international bilateral and multilateral organizations such as the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) and donors (Léchenne et al., Chapter 19, this volume). The consultative stakeholder seminars aimed to define priorities of the populations and the authorities jointly, formulating health service priorities from a range of options and readjusting ongoing interventions but also cross-checking the relevance of activities. Pastoralists could express their concerns and needs directly to the authorities and also voice non-health-related demands such as requests for new legislation on land use. The priority-setting process started from health-system-driven approaches – pragmatic in the sense that interventions could be carried out by the health and veterinary services and be validated by involved scientists – and moved incrementally towards the inclusion of other community priorities. The participants identified new research and intervention objectives and, consequently, trust and mutual respect were gradually built. The programme became the interlocutor between pastoralists and the authorities, and the communities were empowered to take their own initiatives (Schelling et al., 2008).
In conjunction with the stakeholder workshop in 2005 a process of inter-ministerial planning of a national action plan to support nomadic communities in Chad started under the leadership of the Ministry of Planning in collaboration with eight other ministries (Fig. 6.1A). However, intersectoral negotiations with so many ministries proved to be too ambitious and were not feasible. The new course, where the MoH took the lead, turned out to be more operational. During the workshop in 2013, the MoH announced the creation of a directorate for the health of mobile pastoralists. Activities that are implemented as a result of the transdisciplinary process, particularly the joint human and animal vaccination campaigns – currently in trans-frontier zones – are maintained and led by the government. There is also a presidential decree for full Expanded Programme on Immunization (EPI) coverage for pastoralist children along with polio vaccination days. The ‘Association des jeunes nomades’ is more active and prominent than ever, regarding the problem of pastoralists as an institutional problem. These dynamics of pastoralist representation would hardly have been possible some years earlier when only a few pastoralists had received higher education. Finally, the stakeholders voiced a desire to seek new innovations such as use of mobile technology to assess demographic and health parameters of pastoralist families and their livestock (Jean-Richard et al., 2014).
Fig. 6.1.(A) Transdisciplinary stakeholder workshop on the shores of Lake Chad, bringing together national Chadian authorities, pastoralist communities and scientists. (B) Stakeholder workshop in Gode, Somali Regional State, Ethiopia. Pastoralist women, health professionals and scientists discuss health care in their communities. Photos courtesy of J. Zinsstag.
The iterative problem-oriented programme aimed at improving access to health care for the nomadic pastoralists of Chad started with little information on important health issues. However, ownership by the communities for interventions was achieved by their participation in knowledge generation as equal partners, together with local authorities and scientists in a transdisciplinary approach. Unexpected outcomes emerged, for example the pastoralist communities organized themselves to provide schooling for their children, which received support from UNICEF. They have also stated that their overall security improved substantially. Generalizations for other settings can hardly be made, but where communities interact with authorities in a process to identify acceptable institutional and legal frameworks, arrangements for social service development in a given context can be achieved. The long-term commitment of all partners continues and has broadened the scope of research to other mobile communities, for example in Somali Regional State in Ethiopia (Fig. 6.1B) as well as seasonal workers and inter-provincial migrants in Vietnam.
Surveillance and response to zoonotic diseases in Maya communities of Guatemala: a case for One Health
The overall aim of a project among Maya communities in the Petén region of Guatemala was to promote a transdisciplinary One Health approach for developing a novel and culturally appropriate surveillance and response system for zoonotic diseases. Participants of a project inception workshop in September 2016 represented: (i) programme and policy-oriented government officials from the Ministries of Health and of Livestock (35%); (ii) Guatemalan academics from the Universidad del Valle de Guatemala interested in zoonosis research (28%); (iii) community representatives including Maya elders from the ACGERS Council seeking to improve health conditions in their towns (17%); (iv) Swiss academics interested in developing surveillance systems using a One Health approach (10%); (v) private industry (Tigo telecommunications company) looking at potential cell phone applications (7%); and (vi) an international development cooperation (3%).
Key steps in a transdisciplinary process are to clarify the interests of the initially identified stakeholders involved, openly discuss these interests, and jointly agree on which ones will be addressed by the forming partnership. Equal footing of all partners was not assumed to emerge naturally in the discussions. Therefore, social scientists analysed how multiple conditions of the project’s partnership related to ethnicity, language use, world-view (cosmology), values (axiology) and epistemology (all of which encompass ‘culture’) affected the participation of stakeholders in the process and subsequent outcomes of the project. Diverging initial interests coexisted according to literacy and education of participants, economic status, degrees of rurality, and ethnic background, and varied also according to participant’s position in hierarchical power structures. Backward planning was used to understand the steering team’s assumptions during different project phases. Figure 6.2 shows the backward planning process starting from the intended goal of having all partners co-define the final project objectives, later assessing underlying assumptions. These were then translated into questions which guided the verification process.
Fig. 6.2. The backward planning process. This was used as transdisciplinary (TD) Moment 1, one of two reflexive moments included in the workshop held at the inception of the One Health project aimed at developing a culturally appropriate surveillance and response system for zoonotic diseases in Maya communities of Guatemala.
From the initial analyses, it was observed that communication across groups was challenged by linguistic diversity, with Spanish as the primary mother tongue of 77% of participants, followed by Maya Q’eqchi’ (13%), Swiss German (7%) and English (3%). Knowing that language use reinforces or leverages existing power differentials and the ability to put forth one’s interests (Brenneis, 1988), on-site translation between Q’eqchi’, Spanish and English was organized during the workshop. Multilingualism was the most immediate challenge to address to ensure equal footing of participants. Context analysis demonstrated a more pervasive problem, that of historical exclusion of indigenous groups and a recent post-war setting that eroded the social fabric, with negative effects in inter-ethnic relations (Flores et al., 2009). Having looked at intersectionality issues, the coexistence of multiple layers of identity that intertwine to create further exclusion (Fiorati et al., 2018), it became evident that factors of ethnicity, rurality, poverty, literacy, gender roles and seniority enhanced power differentials among participants. Mutual trust was not a given and merely being invited to the workshop did not guarantee equal participation. Moreover, a lack of interest in mutual learning due to ethnocentric behaviour had been documented in a similar context (Flores et al., 2009). In response to this contextual complexity, the workshop was planned to include two reflexive moments to make participants aware of the multiplicity of knowledge systems and coexisting values and to realize its richness. One exercise required participants to draw or write names of animals that they liked having around, feared, respected and found useful. Results were shared in small groups, which then presented their agreements to the plenary. This allowed participants to see how their livelihood context and culturally determined values shaped their views, therefore becoming aware of how diverse the human–animal interface was among participants. Another exercise showed six pictures of symbols and situations that belonged to either biomedical or Maya medical knowledge systems, and asked participants to write down what they saw. For example, when projecting a picture of cells under a microscope, participants with a biomedical training identified it easily, while Maya participants described it as a close up of a fungus that grows in corn or water droplets. Similarly, when presenting the Maya Kajtzuk (an ancient symbol with multiple layers of meanings), only those with knowledge of Maya spirituality could recognize it, while others imagined it was a strange Catholic cross. The exercise made participants aware that they were using their knowledge systems as a reference to interpret the same objects. This moment was used to introduce the concepts of emics and etics, commonly known as the insider’s and outsider’s views on an issue. A general awareness concerning the added value of exploring concepts from diverse points of view was reached, prompting from then onwards, community representatives to share their views more comfortably.
After gaining awareness of emic interpretations, the participants were engaged to discuss their genuine interests and demands to enter the transdisciplinary (TD) partnership. To avoid one sector taking over the discussion, and to prevent one group speaking for another (ventriloquism) (Spivak, 1988), each person had three flashcards upon which to write their interests. Once completed, participants joined groups by sector (academic, government, etc.), agreed on common aims, and jointly presented the flashcards they had made to the plenary. Each interest was discussed and placed in a three-column matrix according to: (i) which interests would be addressed by the TD partnership; (ii) which would be referred to other institutional efforts (e.g. initiating contact with an NGO building a school); and (iii) those not to be addressed at all. From this participatory exercise, clarification and agreements of the project’s expectations and limitations emerged. Allowing multivocality leveraged traditional power differentials and enabled usually excluded concerns of indigenous participants to be taken into account. Throughout the course of the project, participants understood the value of diversity and equal representation of Maya and biomedical knowledge systems, so by the last of four TD workshops, held in May 2018, community leaders accounted for 31% of participants, with more women participating.
In summary, offering a platform for balanced participation required modulating power differentials through three mechanisms: (i) inducing self-reflexivity of participants to acknowledge diversity of experiences (the exercise with animals); (ii) participants’ understanding of the difference between emic and etic constructs leading to bias or mutual understanding (the culturally significant picture exercise); and (iii) acknowledging the value of diverse views to address zoonosis as a health topic (through translation and use of flashcards for equal representation of views). Once these three preconditions were met, a successful negotiation of interests (avoiding power overrides) was possible. Figure 6.3 shows the adapted reflexive approach derived from backward planning used to develop specific tools as modulators of change, in order to achieve the desired goal.
Fig. 6.3. Adapted reflexive approach derived from backward planning used to develop specific tools as modulators of change, in order to achieve the desired goal (overlaid with Fig. 6.2). For each condition, workshop participants were asked to define the needed modulator of change.
This reflexive process was used throughout the project life to make sure that the team went from a multicultural approach where many ‘cultures’ or knowledge systems coexisted without cross-over understandings, towards an intercultural approach where mutual learning and knowledge co-production was promoted. The pragmatic value of this approach is seen in the following outcome.
A surveillance system for detecting signs of two targeted zoonoses was implemented. In order to increase sensitivity, case definitions for respiratory, febrile and diarrhoeic syndromes were initially developed by epidemiologists and presented to the multicultural academic team. Maya health personnel discussed among themselves how erroneous the biomedical terms were according to local understandings. Noticing a reluctance to publicly contradict a senior epidemiologist, social scientists developed an exercise inviting each team member to propose new categories for surveillance from their own emic perspectives. What followed was a discussion on 23 different Maya Q’eqchi’ terms that local indigenous people could use to define different types of fever, diarrhoea or respiratory illness. This elaborated range of local terms was used to prepare research instruments to test how local people perceived each syndrome. Results of these analyses were later used to develop materials for communication campaigns for explaining at household level how surveillance would operate. Most importantly, it helped Maya health staff unify recruitment criteria for Maya patients for whom case definitions of the protocol had to be completed. Throughout the project the field team met on a regular basis to discuss new emic categories that emerged during interactions with patients. This increased the cultural pertinence in medical response and provided culturally relevant ‘danger signs’. For example, whenever a patient indicated they had ‘susto’ or ‘itzel yax’, the health team knew it to be an illness in dire need of attention. We could show that awareness of emic categories of disease reduced misconceptions leading to erroneous interpretations of medical data, while it increased mutual understanding between representatives of different epistemic systems (Berger-González et al., 2016; Hitziger et al., 2017). However, this awareness did not occur without facilitation, as depicted in Fig. 6.4. Communications that nullified the experiential reality or identity of indigenous persons, called microinvalidations (Christopher et al., 2008), and attitudes of ‘cultural discounting’ were observed. The latter were based on the assumption that indigenous partners were passive recipients of knowledge to ‘improve’ their livelihoods and could not contribute usefully to the research. The critical analysis of inter-ethnic relations served as a base to modulate spaces for equal participation, which included constant reminders to use all languages, to address all relevant emic categories, and to promote respectful listening skills. This facilitated multidirectional conversations rather than unilateral information transfer. Health teams learned to replicate this process with patients and were rewarded with rich insights into Maya healing systems and a better understanding of perceived desirable outputs in collaborating with the public health system.
Fig. 6.4. Backward planning tool employed to increase sensitivity of the surveillance system implemented for detecting two targeted zoonotic diseases in Maya communities of Guatemala.
Transdisciplinary process in the Jigjiga University One Health Initiative (JOHI)
JOHI is a research-development project currently implemented in the Somali Regional State of Ethiopia to create innovative integrated health systems for improvement of health and well-being of pastoral communities. It is a 10 year (2015–2025) project co-funded by the Swiss Agency for Development and Cooperation (SDC), the Swiss Tropical and Public Health Institute (Swiss TPH) and the Jigjiga University (JJU). The project includes three main actors: (i) JJU for legal status and curricula; (ii) Armauer Hansen Research Institute (AHRI) for policy and research support and technical collaboration; and (iii) Swiss TPH providing technical expertise.
Setting up the project followed a process of extensive consultations with communities, authorities and technical experts within participatory processes in Jigjiga city and Gode, the main city of the study area in Adadle district (woreda). A preparatory workshop took place between representatives of the JJU, AHRI and Swiss TPH together with SDC staff in September 2014. The inception phase aimed to prepare the full project document. A stakeholder workshop in March 2015 in Jigjiga identified the main priorities of communities and representatives of the regional government bureaus. A first batch of PhD and MSc students went to be trained at Swiss TPH in the fields of human nutrition, midwifery, tuberculosis, animal health and rangeland management. Upon their return, the students prepared their field work. In June 2016, the supervisors together with the project accountant visited JJU and the field site in Adadle woreda and met the local authorities and communities.
The field studies and data collection were done as one interdisciplinary team in the Adadle woreda from July to August 2016. The second batch of students was similarly elected, by interviewing candidates. A stakeholder meeting was held in Gode at the end of February 2018, and first decisions were made on proposed interventions based on the research in tuberculosis control, integrated surveillance and response adapted to pastoralists and water and sanitation. Unexpectedly, the mayor of Gode requested support for an abattoir and better meat markets. A steering committee and a further stakeholder workshop were held in Jigjiga in May 2018, and the proposed interventions were further discussed and approved. Interventions were subsequently implemented, and upon the first results, communities and authorities met again with the interdisciplinary research team to discuss next steps together. Communities were faced with the challenge of financing fuel for emergency ambulance services, so JOHI assisted communities in organizing to raise emergency funds. Additionally, the project team engaged in developing an abattoir and a safe meat marketing system, taking up local priorities that were not in the initial plans of the project. All actor groups remain involved in the sharing of knowledge and expressing priorities for further health development actions.
National and regional priority setting in health and food safety
Regarding societal questions about health, priority setting is not only needed in research and action in specific contexts but also on national and regional levels. As such, new public engagement processes can be initiated. For example, the European Food Safety Agency (EFSA) initiated an integrated approach towards risk assessment with a special focus on human health and the whole food chain, as well as on science-based interventions to lower consumer risks. They regularly consult with scientific panels to address complex, multifaceted questions of risk and experiment with how to engage the broader public. This consultation process revealed, among other things, increasing public concerns about the sustainability of livestock production systems, acceptability of food quality and animal welfare issues (Berthe et al., 2013). Donors are encouraging low- and middle-income countries to set up processes of public participation in health-sector priority setting. A recent review, however, showed that to date there is little evidence on how to do this in a less costly way. The authors of the review propose that some of the substantial resources needed for a nationwide public engagement could be used to strengthen the evidence for what works within the realities, using small-scale, community-driven trials (Alderman et al., 2013).
Transdisciplinarity in ecohealth
Transdisciplinarity is well embedded in ecohealth to tackle the non-linear systems dynamics (Bunch and Waltner-Toews, Chapter 4, this volume). The International Development Research Centre framework implies not only a transcendence of disciplines, but also the participation of scientists, communities and policy makers in research (Lebel, 2004). Particular attention is given to gender and social equity and putting knowledge into action through policy change, interventions and improvement of practices (Charron, 2012). Examples of transdisciplinary processes are presented in Charron (2012), Veterinarians Without Borders/Vétérinaires Sans Frontières Canada (VWB/VSF Canada, 2010) and in Bunch and Waltner-Toews (Chapter 4, this volume). Parkes et al. (2005) exemplified the value of transdisciplinarity for emerging infectious diseases. They concluded that with transdisciplinary integration and innovation for infectious diseases it may be possible to harness the good will and teamwork established during an emergency in order to address health issues that develop more slowly. With emerging health threats, the social-ecological and political contexts of global health foster integrated conceptual frameworks and disease control measures (see also Gallagher et al., Chapter 24, this volume). Although complex understandings of social and ecological systems may be informative and better reflect the uncertainty of real life, such approaches may be challenged on the basis that they often do not lend themselves to straightforward, rapidly implemented policies or interventions.
Disciplines and Approaches are Not Static: Intermediary Conclusions
Transdisciplinarity emerged as a form of research at the end of the 20th century because separated disciplines could not grasp the complexity of, for example, the impact of new technologies and natural resource depletion. Such issues could not be tackled from the sphere of individual disciplines. We see health as a life-world problem and believe that transdisciplinarity should be at the heart of One Health studies leading to improved health of people, animals and the environment. The examples in this chapter show that the engagement of other than academic knowledge can lead to problem solving and innovation, as well as unexpected outcomes. For enabling this, efficient project communication including multilingualism is mandatory and needs to be planned from the outset for every phase of the project. Taking a One Health approach can promote development of good partnerships between government agencies as well as engage the public and industry stakeholders in the development and delivery of policy (Rinchen et al., Chapter 29, this volume). It can further increase equity and effectiveness of interventions at national and sub-national levels, because equity can only be defined within a broad transdisciplinary partnership between communities and authorities governed by mutual trust and security. This is similar to what is promoted in the 2008 Report of the WHO Commission on Social Determinants in Health that recognizes civil society as a champion of equity (Jackson et al., 2013). Health equity, in turn, is part of sustainable development and hence directly linked to environmental sustainability and social justice (Zinsstag et al., 2011a).
Participatory stakeholder processes, as discussed above, seemingly have huge potential for practical problem solving but also bear risks. These include raising expectations too high for outcomes of the process and choosing certain health-related outcomes over others such as poverty alleviation (which implies ethical considerations), the stakeholders engaged are not representative for the relevant problem area, and there may be biases in the process due to power relationships, such as dominance of academia and gender issues. These few examples show how important it is to involve social scientists and communication specialists in stakeholder processes and to carefully document the process right from the outset.
Complexity, uncertainty and ambiguity in health and other life-world problems are obviously challenges. How do we deal with corruption or the discrepancy between investments in development of sophisticated, new technological tools, when we do not manage to effectively deliver existing adequate tools, such as measles vaccination? We can deal with complexity by interdisciplinary expert inputs, although we may invite a suboptimal panel of disciplinary experts. Each researcher and actor may locate the problem in an alternative ‘world of relevance’. Validation and quality control may help. Validation of non-scientific knowledge and explanations is a crucial and challenging aspect of knowledge integration within transdisciplinary research. Because different types of explanation play a role, different validation criteria have to be met, both through problem formulations and solutions found. Sometimes a non-scientific explanation can be tested as a hypothesis in a further research process. A continuous dialogue between the parties involved is required, with feedback loops for cross checking previous assumptions, insights and demands (Flinterman et al., 2001). Social scientists appear best situated to monitor the process and identify possible shortfalls that need corrective actions.
Researchers are challenged to cross the boundaries between human and natural sciences to generate results that could not have been attained using a disciplinary or sectoral approach alone. Scientists trained for many years in one discipline must first learn to acknowledge the strengths of other approaches. University curricula, however, rarely enable scientists to communicate with other disciplines, and researchers first need to acquire their own experiences and skills (Conrad et al., 2009; Min et al., 2013). Max-Neef (2005) wrote that this should not represent a problem as long as the higher education received was coherent with the challenge. This is, unfortunately, not the case, since monodisciplinary education is still widely predominant in all universities.
It is encouraging to see that donors explicitly ask for inter- and transdisciplinary research. However, the establishment of these processes requires some additional investments, and donors do not yet readily give more time or money. In any case, transdisciplinary research with its iterative cycles between innovation, application and validation is an integral part of One Health approaches.
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