From Pillars to Principles: Affirming the Field of Ecohealth
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- Horwitz, P. EcoHealth (2012) 9: 361. doi:10.1007/s10393-012-0792-4
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Ecohealth Research in Practice: Innovative Applications of an Approach to Health Insight and Innovation in International Development 1, Dominique F. Charron (editor), International Development Research Centre and Springer, 282 pp.
As researchers, we run an internal dialog with our chosen discipline, questioning and affirming what it demands, how problems are formulated, what it does not seek to do, and where its boundaries lie. Overtime we seem to know implicitly what institutions support our work and who is going to listen to our findings. This book is one for that dialog: asking who are we, what do we do, and with whom should we work? It is a celebration of the growth and maturation of a field of endeavor encapsulated by the term “ecohealth,” made more significant by the central role played by the co-publisher of the book: the Canadian Government’s International Development Research Centre (IDRC).
What is the field? A Foreword by Mario-Henry Rodriguez sets the political context: “Ecohealth research and practice have all the attributes of public health and should be identified as such…but there is an important difference…ecohealth stresses the involvement of communities and seems to have…relegated the role of the state to second place in the solution of the problem.” While this is an important and astute observation, it is not the only trait that separates ecohealth, as Dominique Charron puts clearly: “…positive outcomes through a new understanding of health and its dependence on ecosystems, or at the very least its relationship to degraded environments.” These characterizations belie further differences: Charron’s introductory Chapter “Ecohealth: Origins and Approach” is field-defining, and sets forth six principles: systems thinking, transdisciplinary research, participation, gender and social equity, sustainability, and knowledge to action. These are much more than concepts or approaches; principles imply an imperative. They are foundational truths for a chain of reasoning and they play out in different ways in different settings and contexts.
Structurally the book has good symmetry. The front end defines and sets the scene. The final two chapters, in a separate section entitled “Building a New Field,” include an analysis of the nature of Ecohealth networks followed by an overview of case studies, the main part of the book. Fifteen case studies are organized into four sections: ecosystems approaches to health as they apply to: (i) rural agro-ecosystems, (ii) natural resources and pollution, (iii) poverty and vector-borne diseases, and (iv) urban living. Those who have undertaken the research write the case studies and they often synthesize their own literature and other sources to best characterize “what happened.” Each synthesis is relatively short—each around 10–12 pages in length—designed to tell the story in a reasonably consistent—but never identical—way: the way the research problem was formulated, the methodology, and the way ecohealth principles were adopted; the findings; and the outcomes, achievements, lessons learnt. The reference sources are varied; they include standard literature published in books and journals, and unpublished government reports, project reports, and materials found on websites. The interested reader will readily find most of the material, but some key reports cited may be less available.
It is hard to overstate the value of these case studies; they are breathtakingly successful in demonstrating the outcomes of a commonly- and deeply held motivation to improve the lives of people. In reading them I found myself quietly cheering. They repeatedly show that health outcomes are transformative where the interventions are so embedded in local communities, with deliberative participatory approaches, constantly seeking collaborations, that they achieve a long-enduring capacity for change. This is one hallmark of the principle of sustainability. Most ecohealth practitioners will be able to choose from among them exemplars for their own work, as they represent a variety of settings, each with a mélange of principles and approaches that reflect the context of the setting and the nature of the problem. My choices would be written summary descriptions of two well-known ecohealth stories: “A Virtuous Cycle in the Amazon: Reducing Mercury Exposure from Fish Consumption Requires Sustainable Agriculture” by Jean Remy Davée Guimarães and Donna Mergler, is a research programme that started in 1994; and “A Virtuous Cycle in the Amazon: Reducing Mercury Exposure from Fish Consumption Requires Sustainable Agriculture” by D. D. Joshi, Minu Sharma, and David Waltner-Toews, which commenced in 1991. Both these stories give me a deeper sense of from where this field has come and who has had a pronounced influence upon it. Arguably without these profound programmes of work, ecohealth in its current form may not exist, as they tell the stories of some of the founding figures in the field.
The final section is a critical reflection. The chapter by Margot Parkes, Dominique Charron, and Andrés Sánchez on networks and forms of collaboration is a valuable examination of the nature of “participation.” It develops the concept of trade-offs as costs and benefits of involvement in networks and communities of practice, drawing from the literature five questions to assess added-value of research programmes. Their conclusion is that groups resulted in opportunities to “know more, differently, more quickly, and more widely than if they had not existed” where the catalog of collaborations provide a clear sense that this conclusion is warranted.
The analysis begs for more evaluation, and guidance on how we can evaluate these projects; a broader evaluation is required, perhaps in the form of a true meta-analysis. Which achievements demonstrated in the book have been dependent on the roles of academia or the intellectual or the local personalities, the scientific disciplines and their associations, a critical international agency that provides leadership and funding, and the personalities of the leaders themselves? These questions seem to go begging in the book. Many of the answers to these questions will revolve around power and the political economies of intervention. Charron’s final chapter hints at these; modesty of the contributors, and the constraints and limitations associated with provision of funding and government support for programmes, probably prevented this analysis in this forum.
Charron provides an eloquent reflection on some more practical components: a “blind spot” in ecohealth research and practice—that wider ecological changes or dynamics are not explicitly addressed in most case studies. She also pinpoints “…a clear need (and opportunity) to strengthen economic analyses and argument for ecohealth,” a depth of gender and social analysis which remains superficial in many cases, and underemphasized ethical considerations. One can add to this list: this book will not necessarily be used as a source of information on the role of leadership, the centrality of sense of place, spiritual well-being or mental health issues, that play out in ecohealth research and practice. Again Charron pre-empts these potentials and opportunities; like the reflections of all good leaders, her emphasis is on a field, which is a work in progress—so much done successfully and so much more to do.
So the bottom line is “watch this space.” The progressions from the work that began in the early 1990s to Lebel’s (2003) benchmark discussion of “pillars” and from that to the ecohealth “principles,” case studies, and reflections in this book augur well for a third decadal installment. I am looking forward to it.