HESO 449: Ecohealth SDS

What is participatory epidemiology?

Participatory epidemiology is a community based health approach where community members are at the forefront of identifying and addressing solutions to address health and illness in their local population. Participatory epidemiology projects may value local and culturally relevant knowledge (as opposed to the scientifically tested positivist approach) and allow communities to be the driving force behind health interventions.

This way of conducting public health projects is similiar to participatory action research (PAR) in the social sciences where participants of research projects inform the research question through active participation. Ultimately, the hope of participatory research is that the research conducted will have more benefit to the community compared to when formal hierarchicial-based research projects are undertaken. As well, when projects are community driven, some may argue that this increases project sustainability.

PAR researchers often critique formal research projects for valuing the knowedge of ‘experts’ over local or traditional knowledge. The same can be said for participatory epidemiology versus formal epidemiology practices. However, when using participatory action, as in participatory epidemiology, many argue that participatory action is unrealistic, as a hierarchy will always exist between researchers and community members. Instead, public health professionals and researchers should be transparent in their reports about the hierarchy that exists and list their biases upfront as to not misrepresent the equality that actually exists in participatory epidemiology.

This being said, hierarchies should not be regarded as a solely negative aspect of health planning. Hierarchies can be constructive and some may argue, necessary to moving a goal or project forward. In their extensive global research of various hierarchies, Burke and Eichler suggest that hierarchies are functional, but only become a problem when oppression and bias are present within these hierarchies. I find their model quite helpful, which can be found here: http://biasfree.org/who_we_are.html.

Great link April; what I also found really interesting about the Bias Free Cooperative Inc was that they have quite an ambitious mandate to spread their Bias Free framework all around the world: in the past two years they have held workshops for co-op workers in almost a dozen different countries to small private organizations, groups of the UN and large corporations. I noticed a common theme between the mandates of this organization and the examples from the IDRC: tying local circumstances to a more global context. In the case of pesticide education, teams of community members took on a door-to-door approach; they are the ones who can influence their neighbours the best and I really believe this emphasizes the power in an EcoHealth approach. Also, going door-to-door is often underestimated but represents that reoccurring theme of exposing local issues one step at a time.

Education of pesticide awareness goes hand in hand with incorporating new technologies that are at the forefront of diagnosing tropical diseases; in the example of leishmiasis spread I couldn’t help but notice that some funds from the IDRC went toward purchasing an ELISA machine (a laboratory tool to test blood samples; it surprised me for a moment to see that applied outside that context of my bio labs!) It makes diagnoses immensely easier and it would be a first step (an expensive one at that) to advance both research quality and healthcare systems simultaneously in an EcoHealth approach. A region having strained primary infrastructure is not at a blind-end in advancement, as was once commonly thought; it means that these regions need to heavily prioritize in deciding what to integrate in their research, how to effectively reach their people and use their resources optimally (whether it’s volunteer time or funds for continuing sustainable projects).

Participatory epidemiology is integrated in the heart of an EcoHealth approach and active community involvement. Tying this concept into Ben’s research, this field of study involves Ecuador and Canadian Youth to better understand the banana industry and the health effects of pesticide youth in this growing industry. The political ecology of a region is important to take into account, especially when dissecting the motives a country has to perpetuate pesticide use. In a country that has great hopes to improve the quality of life of its population, the Ecuador banana industry has so much potential in addressing that goal. I’m looking forward to hear more about Ben’s research as well as his experience at the EcoHealth conference in the UK!

Most successful public health interventions display a trend: they use local players to motivate and to mobilize the rest of the community. The “participatory” component of the ecohealth approach ensures the use of local players, thus organically bringing about transdisciplinarity by amalgamating a diverse set of values and goals into the project’s cohesive mission.

However, this is easier said than done.
Community mobilization is difficult. The community needs to believe that the issue is important and should be addressed and they also need to believe that they have the capacity to effect change. The community members’ belief in the capacity of their advocacy is integral to their willingness to be involved and active.

This is further complicated by disparities that exist within communities. An issue may be of high importance to a marginalized, minority population in a community, but if the more powerful majority refuses to address the issue, ecohealth practitioners face a major challenge.

I believe that empowerment through education is an effective means of addressing some of these challenges. However, the type of education and its relevancy to the context are key in its success. In his talk, Dr. Spiegel mentioned indigenous populations in the north and their dependence on fish. One of the solutions to the health concerns caused by bioaccumulation in the larger fish was to educate the community about the issue and to encourage consumption of smaller fish. This solution somewhat respects the cultural context, but I can’t help but wonder what the suggestion might to the ecosystem balance.

I’m interested to learn more about how community mobilization is done in ecohealth projects.

I agree with Nadine that participatory epidemiology is integrated into Ecohealth. Both actively incorporate the community and encourage community participation. There is a respect for local concerns and knowledge, which I think is necessary to have a long term effect for community health.

In the article by Cole, Crissman and Orozco they mentioned that the IDRC co-funded a Community of Practice in Ecosystem Health, which “shifted health research funding to focus on ‘upstream’ physical and social factors that impinge on health in the longer term.” This is one example of many instances where organizations are able to mobilize resources and push primary care in an effective long term direction by using the Ecohealth approach.

Brisbois’ project with banana’s in Ecuador is another example of participatory action and the Ecohealth approach. Also, I think this project ties into some sense of political ecology in that he is using “unconventional (i.e. effective) and appropriately- scaled approaches to political and social action on health determinants
in Ecuador.” I think Brisbois’ overall method takes into account social, political and environmental issues of pesticide use and resulting health issues in the banana industry. Participatory evaluation is key in this project and community level research is important to understand political, social and environmental issues within the region.

I am very interested in the talk Ben Brisbois is going to give!

The IDRC’s adoption of an Ecohealth model is intriguing because it can serve as an example of international accountability and concern for international market demands. In the case of the banana industry in Latin America, the Ecohealth model takes into consideration the consequences of a huge North American demand for bananas, on the human and environmental health where bananas are produced.

Community participation, which is at the center of the Ecohealth model, inherently includes political issues in the discussion of an overall issue of environmental and human health. However, as Ben Brisbois points out, the “upstream roots of environmental health” are not always accounted for. I’m definitely interested in hearing more about this topic tomorrow, as I’m not sure I know exactly what is meant by this. One way I interpreted this statement was that the complexities of globalization, including the political accountability of the globalization of pollution and harm to the environment, are not often considered.

To me, participatory epidemiology is a community level approach in which livestock keepers or farmers collaborate with researchers in funding solutions to infectious outbreaks in farms, pesticide overuse, or other agricultural dilemmas. It uses the valuable knowledge of livestock keepers, farmers, or community members have with respect to the issues they’ve dealt with in the past, as well as where they’ve been successful with managing these issues. I would think that it’s aim is to mainly further understanding, as more of a qualitative approach, to better gauge the needs of a specific region or country with the help of those who know it best: the community members themselves, and to consequently find the best means of addressing the issue at hand. I think it’s neat that Ben Brisbois has formulated such a project that universities can collaborate to manage the environmental health risks of pesticide exposure, and other agro-industrial consequences.

Political ecology ties in to the overall political, economic and social factors of environmental health, and is centred on the fact that political or social dynamics, and biological health of the ecosystem, are not mutually exclusive. In that sense, we see similar attributes to the definition of EcoHealth, and what may distinguish it may be how political ecology deals with topics such as resource distribution, and the costs and benefits to environmental policies. The Ecosalud project, for instance, seems to integrate a participatory approach to agroecosystem strategies, since it strives to combine community-level engagement (through education in storage methods, safety clothing) and policy-centered practices (such as the monitoring of pesticide sprays, and the awareness and distribution of alternative technologies).

I am excited to explore these topics further, and perhaps see examples of where participatory epidemiology has succeeded or not succeeded in the past.

As Cole, Crissman and Orozco point out, one of the biggest challenges facing Ecohealth as an approach is dealing with national and global actors, particularly governments and political groups as well as multinational companies. I think it is interesting that Ben Brisbois is actively working through this situation with pesticide companies and Ecuadorian banana workers. I am curious to hear more about how he went about addressing the political influences of the banana supply chain and how both Ecuadorian and Canadian youths worked together on such a big-scale issues as pesticides and the global agro-industry.

With regards to the first question asked, I think Ecohealth addresses the issue of procuring resources when primary structures are limited by engaging local community members and taking advantage of the global community which includes other specialists and NGO’s who can contribute when infrastructure is limited.

Participatory epidemiology (PE) is an emerging field that relies heavily on direct observations and oral evidence from the affected individuals and communities to figure out mechanisms of disease transmission. Participatory approach is one of the three methodological pillars of the Ecohealth approach. Researchers and specialists further deduce possible solutions based on the first-hand information given by the communities. Feasible solutions are then resulted from the participations of the whole community at all levels of the research process, taking local concerns and needs into account. There can be no development without community involvement.

As Natasha mentions, in the case of the emergence of human diseases from domesticated animal populations, specialists collaborate with farmers and livestock keepers to deduce feasible solutions to solve the problem. It is also important to understand the economic drivers faced by the food animal industry and further recognize to importance of implementing preventative policy by the decision makers to reduce effectively reduce zoonotic disease risk.

Use of participatory methods includes informal interviews, visualisation and ranking/scoring methods are all used in PE. These methods enable community members to be actively involved in projects. Here is a website that explains the methods in detail:

http://www.participatoryepidemiology.info/about-participatory-epidemiology/index.html

There are four main uses of participatory epidemiology: community-based animal health systems, impact assessment, participatory disease searching, and research.

Political ecology is the study of the relationships between political, economic and social factors with environmental issues and changes. Political ecology often needs to be taken into account when an ecosystem approach is used.

In addition to what has been mentioned above, I’d like to point out the many benefits to using participatory methods. Despite the bias that may result from participatory epidemiology, it may lead to more useful information collected overall. This is often the best (if not the only) method of gathering information from remote or disaster-struck areas, where results can be made available in a short period of time. Participatory epidemiology is often more affordable and feasible than other methods, such as randomized control trials. As well, it is easier to adapt to new issues that may appear throughout the course of survey.

The whole idea of participatory epidemiology builds on the knowledge of what the local people already know, and allows them to build their own research and methods of environmental and disease control. The act of participation is a tool for empowerment, which is especially important for women and poor populations.

There is a broad interdisciplinary aspect embedded in political ecology, making it a practical approach to integrating economical, environmental and social relationships. It can be incorporated into the foundation of the Ecohealth methodology in developing effective and sustainable systems.

I’m looking forward to tonight’s presentation, and learning more about examples related to successful participatory methods as well!

Hmm I feel my classmates have covered the topics pretty well.

So this will be likely a terrible post that I will get no credit for, but may I ask if we can get credit for either commenting before on the readings, or for commenting after the week’s topic has been discussed?

I think we already talked about this, but I don’t recall the conclusion. Sorry I’m forgetful!

I’m stoked for Ben’s presentation. I think that building international linkages to support grassroots organizations is a great approach to dealing with the political climate of Latin America. I can’t wait to hear what more he has to say.

I’m with Amy and her thoughts about discussion credit. I got to the readings pretty late for this week and once I finished them and read through everyone’s posts, I couldn’t really find anything worthwhile to add.

Either way, I’ll definitely make up for this discussion by having a post-class discussion post instead. I think it’s pretty fair to get credit for either before or after a class for a week’s readings considering that we’ll be continuing the same discussion anyway.

I was really curious about what Ben’s done in terms of participatory epidemiology and political ecology in Ecuador. He had me at social networking and North/South cross border linkages.

The Eco Health approach addresses the issue of mobilizing resources for primary care while dealing with a strained primary infrastructure by proactively re-evaluating the the relationship the ecosystem and health of the community. It fosters and interdisciplinary understanding of public health issues, bringing attention to other areas of aid besides medical. It has redefined the way global and Canadian development agencies view aid and health and helped leaders see the need for allocation of funding in other areas of developing communities (occupational health, environment and health, diseases, agricultural productivity, sustainability, natural resources, etc.). It is vital to the enhancement of the economic and social infrastructure of developing countries and in recognizance of the dangers of trading environmental devastation for development (and in rethinking the developing models). It provides new understanding to current policies and encourages action and collaborative research among disciplines.

Participatory Epidemiology is a part of the Eco health approach that uses community members in diagnosing patients. Using their observations about the affected person question can be helpful to the doctors involved. Political Ecology reflects the EcoHealth approach in that it takes into account the relationship between political, economic, and social factors and the need for contribution from more than one area to analyze environmental issues.

In response to the discussions on credit and when to post for the discussion, I did half of my post a few days ago and then part today. I don’t really know if that is ok or if I have to read over everyone’s before me and contribute a response to them in my post?

Thanks!

Ecohealth approaches primary care issues that have risen from a strained primary infrastructure by employing a number of community involvement methods such as the rapid rural appraisal (RRA) and participatory rural appraisal (PRA) which empowers the local community. In “Philippine Alliance of Fisherfolk: Ecohealth Practitioners for Livelihood and Food Security” by Mario Anabieza et. Al., local fisherfolk faced with decreasing food, health and education quality formed the Pamana Alliance and empowered themselves the right to protect their own food security with the aide of the properly managed marine protected areas (PMAs) policies. With the support of the local government, other corresponding local communities also mobilized themselves to patrol their waters against illegal fishing. The result of the community taking ownership of their own fishing ground’s coastal marine ecology have increased their own food secutiy as well as the sustainability of the resources for their future generations.

Political ecology is a study of the complex interactions between economic, social and political factors that are intertwined with environmental topics. In “Pesticides, People and Power in Ecuador’s Banana Industry: Participatory Epidemiology and Political Ecology Approaches to Occupational Health and Safety” by Ben Brisbois, local occupational health and human rights issues are being proposed to be investigated through its interactions with the global banana industrial economic as well as Ecuador’s political interests. Brisbois proposed to conduct this investigation through the use of participatory epidemiology (PE) which is an emerging field that utilizes the PRA method in harvesting qualitative epidemiological intelligence to improve understandings of veterinary services and animal diseases for developing treatments. Through RPA, local existing veterinary knowledge, cultural practice, observation records and traditional oral history can be used to design successful health projects, treatment delivery systems, local surveillance, and disease control strategies.
http://en.wikipedia.org/wiki/Political_ecology
http://www.fao.org/docrep/003/x8833e/x8833e02.htm
http://www.participatoryepidemiology.info/about-participatory-epidemiology/index.html
https://blogs.ubc.ca/ecohealth449/files/2011/01/Anabieza-et-al.-Philippine-Alliance-of-Fisherfolk.pdf
https://blogs.ubc.ca/ecohealth449/files/2011/01/brisbois2011.pdf

Great discussion guy! I also agree with the fact the participatory epidemiology is part of the Ecohealth approach model. As from Dr. Spiegel lecture and from the last readings, participation is one of the ?three methodological pillars? that makes Ecohealth approach unique. As previously mentioned, participatory epidemiology directly involves the community members and puts them on the front line when determining the health related problem and creating an intervention to eliminate/reduce that problem. I really liked reading about Ben?s project and the fact that it was collaboration between UBC and four Ecuadorian universities. I also liked the ?transformative education? along with ?participatory evaluation? aspect of his intervention and looking forward to hear more about it. His intervention involved many different community members and engagement of many youths from North-South to be involved and aware of the health and environmental related problems.
I also found the same link which Aireen has kindly shared.
I am looking to tonight?s lecture to found out more about Ben?s project.

My reaction to Ben’s presentation was rather gloomy. He talked about the ecohealth issues of the banana industry in Ecuador, he mapped out well what the causes are at the different levels, he indicated the ecohealth approach’s current limitations to make changes at higher levels of organizations, but I received no words of hope!
The World Bank, WTO, international corporations and inter-governmental agreements often either are behind institutional barriers to sovereign communities, or they are the barriers to change. So, what do we do?
The most inspiring discussion I’ve had in regard to community problem solving was last October was with a professor from CATIE (Centro Agronómico Tropical de Investigación y Enseñanza- http://www.catie.ac.cr) . We were discussing their method of creating lasting change from the ground up in communities and hopefully resulting in institutional changes. Basically what CATIE professors and students do (in simplified form) is ask a community what they need, organize the local people into a system that works for them, or get a local person to pilot a project, then present the success to the local government for them to take leadership (government’s love to put their name on proven success!), and then also have an independent funder which allows them to set up an environmental project fund to keep things going.
I guess I just kept waiting for Ben to speak of what’s going to change for the better, instead of simply laying out the problem. Perhaps that was what he was getting at by saying his research is yet to come. If anyone wants to respond to this, a question of mine is: If a wealthy person decided to buy out a banana plantation and turn it into a working farm, is that a tangible solution? The problem of Ecuador’s lack of food sovereignty seems to me to be due to the land and financial hold of the corporation and dependence on the industry for wages to purchase food. I may be over simplifying this but a lot of times for me the shifting of areas where money is spent could just be the solution. The complexity lies in political and business interests of those currently being suited. And just to note, the wealthy philanthropist idea comes to me from the story of the owner of Patagonia (the outdoor gear company). He basically bought a huge stretch of land in Chile in order to take charge of the lack of conservation and to stop the building of major roads or damns in the region.
Pretty cool, pretty random, is it replicable? And is it right that a private citizen from another nation should be the one to protect the future landscape of a country?

Hi Amy,
I think that is a great idea. Shifting the money where its spend could help resolve some of the problem but I think its easily said than done as there are many other interconnected cultural and political factors to consider. About the ethical issue regarding a private citizen from another nation protecting the future landscape of a country, I would say why not as long as they are doing this act to protect the future landscape only and they have no ulterior and self interest motives.