HESO 449: Ecohealth SDS

Sustainable resource management is a significant issue for any country to consider, and I think that the new approach suggested in the paper is a refreshing one since it combines the MFA and QMRA analyses in a novel way to help address this.

The article mentioned a couple of points that may prevent this model from being a feasible one in some cases. For instance, the authors emphasized how important it is for a country to accept the intervention in the first place. I believe that this touches upon the often underappreciated point that although other countries or external organizations have good intentions in improving resource management, their proposed solutions imposed upon a completely different society or country may not always fit with the culture of the people. The article talks about overcoming this by considering illness meanings, behaviors and experiences, as well as the anticipated financial burden this may have on the society in question. I can see the CCP framework being a sustainable one for countries that have the resources to complete their extensive data collection (which may not even be possible for societies that struggle with supporting existing resource management systems, or reaching out to geographically isolated rural populations).

I thought the article mentioned a noteworthy point towards the end, stating that in order to use the CCP framework as a useful planning tool, we need an understanding of how pathogens behave. During last week’s talk, Dr. Teschke brought up the point that different regions/ water supplies/ outbreaks, etc. have distinct pathogens responsible. Since pathogens can often evolve quite rapidly, it may be difficult for models like these to remain valid for a long period of time; it may be necessary for them to adapt alongside these pathogen changes.

In summary, I can see this model being a really useful one, since it combines many different perspectives and disciplines; however, logistical obstacles may make a framework like this, due to its extensiveness, perhaps unfeasible for regions with large rural dispersal or unpredictable pathogen behavior.

I agree with Natasha that proposed solutions of external organizations, although may have good intentions, the implementation of these solutions may not always be appropriate for any given culture. However, I think the CCP approach is going in the right direction. The move towards a more integrated approach will allow a certain area to assess the current status of their sanitation systems, health and well being of the population and the way that both of those are interrelated. Also, I think it’s important that the physical environment, the social, cultural and economic environment, and the health status all be considered, which is what the CCP approach involves. And that different perspectives be taken into consideration as the article mentions.

However, even though I think this approach is going in the right direction, doesn’t mean that it can be applied everywhere. As Natasha mentioned, we need to understand the way pathogens behave. So, to be able to understand that is very region specific and crosses through many cultures. Thus, this is where including the SSA in the CCP approach is useful, which involves approaches of medical anthropology, cultural epidemiology, and social economics.

But all of this involves a lot of research so it may prove to be more difficult in large areas and not be as sustainable if a lot of research goes into one project and the end result is not that useful to a certain culture. I think it really comes down to understanding the culture and involving the community because as we’ve seen, for example, just giving a developing an area a stove that fits perfectly for one culture will not work for another. I’m not sure how comparable that is to understanding pathogen behavior and the CCP approach but I think research in general should consider that dimension.

After reading this article, my first thoughts related right back to a question Dr. Taysheke asked us last class: “which water system is better than the other?” Of course, there is no straight-up right answer until the “fit” of each water system is assessed in each region. I don’t see how the degree of effectiveness of the CCP approach can be measured in its entirety: there are so many contributing factors to take into account and not nearly all of them can be controlled. For example, a water system may be a sustainable one, but how do we know if it is the best fit for that area until we try other systems simultaneously? As for the water systems in BC, we don’t need to try to implement a variety of water sources because they already exist, leaving us to compare their efficiencies. If the CCP approach were to be implemented, the advantages are great: it would take into account the dynamics of our society that are unique from that of any other, and even address some of the controls that could puzzle any researcher (ie. the trends of food poisoning or IBS in a society may correlate with symptoms of drinking contaminated water).

I think that the CCP approach is great move in the right direction, as Siena mentioned, and a sustainable one for any region in which it is implemented. However, because the approach is so broad, the effectiveness of it may be difficult to measure unless we compare it to other regions with similar issues that use different approaches. Natasha mentioned, I agree that it would be a challenge for rural regions to implement CCP, but I still believe that it would allow any region, regardless of economic disparity, the right tools to address public health issues systematically, even if it is just a start. As Siena noted, it provides a well-rounded current status of a region so that effective measures can be implemented.

I was browsing on the WHO website and I saw that CCP is important for preventing food contamination (along the lines of what Natasha mentioned concerning how the prevalence of pathogens evolve across time in a region)
http://www.who.int/foodsafety/micro/en/

I’m glad to see that a biomedical and pathogen-based health model is also incorporating cultural and social factors into its solutions as well. As Natasha pointed out, it will be a challenge to keep up to date with the pathogens development and spread in an urban or peri-urban area. I think another significant challenge is making sure the solutions are culturally acceptable and appropriate, and acknowledging that there may be numerous cultures inhabiting one region and that one solution is likely not well-suited for all of them. This problem could also present itself in regions where pathogen-based diseases are not recognized culturally. Innovative ways to change people’s behavior would need to be made, which is a good reason why medical anthropologists are on board this approach.

The CCP model seems to be popular in the realm of food safety, which I think is an appropriate area because of food’s strong role in health, culture and environmental quality. This model also targets components of water and waste management, which are also linked to food safety and thus hopefully the CCP approach can create a better overall or holistic system for urban and peri-urban communities in developing countries.

To echo the opinions of my classmates, the CCP model seems to over-promise by assuming homogeneity of the multiple environments in which this approach can be sustainable. Although the concept of reconciling cultural, social and geographical relevancy with economic feasibility is an important issue, this article romanticizes the applicability between these ties by failing to provide any substantial support to how this can be achieved. The article’s case studies attempt to illustrate how issues around water planning can be modified in regards to social needs of the at-risk populations. Yet the case studies do not provide concrete or applicable examples of how cultural relevancy is implemented to water planning. Perhaps this is a result of the authors trying to cover too much in one article, in any case, this contributes to the article as unconvincing. The only example of water planning that comes close to taking into account local perceptions and beliefs towards water health is this quoted study: “The first survey focusing on threat appraisal found that people recognize black color and bad smell of wastewater, bad smell of excreta, and inappropriate practice of excreta management, and suspected diseases by contact with excreta wastewater as threats.”, which at best, seems overly paternalistic and says nothing about how culture may affect water usage.

Also, in response to Nadine: although we may not be short of water in southern BC, one could argue that are cultural tendencies as a North American consumer capitalist society have been the driving force behind multiple “run of the river” projects in BC. These are hydro electricity projects contracted out by BC Hydro, for which the surplus of energy is sold to Americans. Degradation of environment and ill-management of water in Canada could lead to a future of uncertainty. Actually it already has, many communities in arctic Canada are currently experiencing water shortages due to sustainability issues of providing water to large communities in an arctic climate.

I agree with the previous posters, the CCP framework is a step in the right direction. A recurring theme in this course is the movement away from “surgical” interventions towards more systematic interventions. The article mentions how a case study on milk contamination in Mali using MFA identified storage and transportation as the critical control points. These CCP’s allow us to detect and stop the problem of contaminated milk, but prevention requires examining the entire pathway from the cows udder to the point of sale.

One interesting application of the CCP framework is in risk management. In North America our waste treatment systems are already carefully controlled in comparison to many places in the world. However one aspect that I find still vulnerable is during emergency situations – for example the BP oil spill in the gulf of Mexico. The engineers and emergency responders responded surgically to the oil spill, employing large quantities of dispersant in the gulf. However, the effects the dispersant may have on the ecosystem and the people living there will not be known for a long time. In terms of risk management I think the CCP framework is something that should be used as a mold to guide us in developing emergency procedures that take into account not just the critical problem at hand, but also the chronic problems that may arise from ill considered solutions.