Introduction

Conservation medicine is the study of health relationships occurring at the interface of humans, animals, and ecosystems. It may be considered a meta-discipline: a field of study that incorporates the tools and perspectives of as many different scientific disciplines as necessary in order to address challenges or test hypotheses related to global health issues. Conservation medicine shares a similar philosophy with EcoHealth, One Health, and Global Health, all of which recognize the clear relationship between human and animal health; however, conservation medicine is also closely allied with the values of conservation biology, and recognizes that health and disease are fundamentally related to the integrity of ecosystems. Thus, understanding the importance of ecosystem functionality in the context of health is essential to conservation medicine, and it draws on the principles of both ecology and applied medicine as an approach to human and animal disease issues.

A conservation medicine professional is someone with expertise in one or more scientific disciplines, who uses their expertise to collaborate with other scientists (physicians, biologists, virologists, geologists, anthropologists, veterinarians, etc.) to comprehensively address a health-related issue within an ecological context. The result is more than a collection of individual disciplinary perspectives; it aims to produce a fully integrated interdisciplinary analysis of a complex problem informing a practical applied conclusion (i.e., the whole is more than the sum of its parts). Many scientists have naturally cultivated a broad-based view of science throughout their careers, and some have worked as part of large-scale, multi-dimensional teams. Professionals from different fields that are practicing in a conservation medicine setting have generally developed their careers through perseverance, experience, and sometimes through the pursuit of multiple academic degrees. However, most will admit that experience and determination alone may not provide the necessary tools and skills that could be better developed through a focused academic training program.

Since the advent of conservation medicine (ca. 1997), few formalized graduate training programs have been specifically designed to train people in the field of conservation medicine. We contend that such a program could provide the scientific cross-training and interdisciplinary approaches that are missing from traditional academic programs. A training program that concentrates specifically on fundamental conservation medicine skills could accelerate achievement and more effectively provide the versatility that is needed to adequately address the challenges in conservation medicine. Just as conservation biology struggled to establish itself in the 1980s as a new interdisciplinary field, beginning with 16 programs in 1990 and growing to more than 108 programs in 99 colleges and universities (Meine et al. 2006), conservation medicine is now facing similar academic scrutiny and needs a place in the scholarly arena to support its legitimacy.

Conservation Medicine in Action

Here we present three examples of applied conservation medicine projects to illustrate the value of this approach and demonstrate some of the skills required in a conservation medicine practitioner: (1) uncovering the emergence of Nipah virus, (2) linking bushmeat hunting and zoonotic disease emergence, and (3) using seabirds as sentinels for ecological health.

Uncovering the Emergence of Nipah Virus

Nipah virus was first discovered during an outbreak of encephalitis among pig-farmers in Peninsular Malaysia (Chua et al. 2000). Following the initial outbreak investigation, a large-scale multi-year collaborative study was launched by the Henipavirus Ecology Research Group (HERG—http://www.henipavirus.net). This group used a conservation medicine approach to test two major hypotheses for Nipah virus’ emergence. The first postulated that Nipah virus emerged due to climatic effects from El Niño-caused forest fires that created tremendous atmospheric haze, driving Nipah virus-infected bats from Sumatra to Malaysia (Chua et al. 2002). The second hypothesis was that the size, structure, and management of the pig farm where Nipah emerged had allowed the virus, once introduced to pigs by fruit bats, to persist and cause a wide-spread epidemic (Daszak et al. 2006). Epidemiology, veterinary medicine, and ecology were involved in examining the health data and management practices of the pigs on the index farm. These data were incorporated into a mathematical model which simulated the introduction and spread of the virus in pigs on the farm (Pulliam et al. 2007). Wildlife biology and ecology were used to study the population demographics and dynamics of the pteropid fruit bat and better understand the risk of future outbreaks (Epstein et al. 2007). Molecular biology, epidemiology, and classical virology were used to study Nipah virus in wild bat populations and peri-domestic animals using population-based studies and laboratory-based experimental infections. These studies gave the team a better understanding of the dynamics of the virus in wild populations, as well as the pathogenesis of Nipah virus in bats and its ability to survive in the environment under various experimental conditions (Epstein et al. 2007; Halpin and Mungall 2007; Fogarty et al. 2008). Ultimately, all aspects of the study were necessary to understand the factors that caused Nipah virus to emerge and also the risks associated with future outbreaks [Pulliam et al., submitted for publication].

Linking Bushmeat Hunting and Zoonotic Disease Emergence

Bushmeat hunting is widely considered a socially, economically, and nutritionally significant activity throughout much of the developing world (Asibey et al. 1974; Juste et al. 1995; Davies 2002). The practice of hunting and consuming wild animals potentially places hunters or market workers at particularly high risk of exposure to animal pathogens (Wolfe et al. 2005a), in addition to threatening the health of endangered animal populations (Milner-Gulland and Akcakaya, 2001; Brashares et al. 2004). Transmission of pathogens such as HIV-1 (Hahn et al. 2000), HTLV (Wolfe et al. 2005b), Simian Foamy virus (Wolfe et al. 2004), SARS coronavirus (Li et al. 2005), and Ebola (Leroy et al. 2004) have been linked to bushmeat hunting and the wild animal trade.

Investigation of zoonotic viral transmission from nonhuman primates to bushmeat hunters in Cameroon provides a second example of a trans-disciplinary study that combined epidemiology, molecular biology, and virology with medical anthropology. The research included sampling both hunters and nonhuman primates and testing them for novel pathogens, conducting extensive surveys of hunters designed to assess demographic and socioeconomic factors that contributed to bushmeat hunting practices, as well as determining the frequency and types of animals encountered in the bushmeat trade in rural Cameroon (Wolfe et al. 2005b; LeBreton et al. 2006). This study of bushmeat hunters and wildlife traders has been extended beyond Cameroon to several countries through a network of unified research sites as part of a multi-institutional research collaboration (http://www.gvfi.org).

Monitoring Seabirds As Sentinels for Human and Ecological Health

A final example of applied conservation medicine is the Seabird Ecological Assessment Network (SEANET) project. This project links marine ecological health and human health by monitoring seabird mortality in the coastal eastern U.S.A. and Atlantic Canada. The network includes more than 60 seabird and ecological health organizations from Canada to Florida, and over 300 “Citizen-scientist” volunteers that participate in regular beached bird surveys. Pathology is conducted on selected specimens and all data is entered online and housed at the United States Geological Survey (USGS). The information is used to establish morbidity and mortality, determine the causes of aberrant mass mortality events, and discover options for using seabirds as sentinels for larger environmental events. Data is also used to create a “normal” baseline against which impacts, such oil spills, disease outbreaks, contaminants, and algal blooms, can be assessed and to focus further investigations and inform new policy or conservation measures to counteract identified threats.

This collaborative effort has generated several research projects, including: (1) identification of a diversity of zoonotic agents including antibiotic resistant bacteria, Brucella spp, Leptospira spp, Giardia spp, and Cryptosporidium in marine mammals and birds (Bogomolni et al. 2008); (2) obstruction and starvation of seabirds associated with plastic ingestion (Pierce et al. 2004); (3) the first published report of a fungal aneurism in a wild bird (Courchesne and Garner, in press); (4) a microbial source tracking study that suggested that gulls obtain fecal bacteria from waste water (Nelson et al. 2008); and (5) potential discovery of new pathogens involved in Common Eider die-offs [Courchesne and Ellis, under investigation].

Conservation Medicine Training

As illustrated above, conservation medicine practitioners have to deal with policy and outreach as well as science (Deem et al. 2000). Consequently, a good start to a career in conservation medicine would be through a broad-based, liberal arts undergraduate education, because it exposes the student to a multitude of viewpoints and perspectives, opening their eyes to the wider societal concerns that intersect with conservation efforts. Efforts are needed to bring the concepts of conservation medicine and ecosystem health into the undergraduate curriculum. Using real-life examples of team-based conservation medicine problem solving in the undergraduate classroom will highlight the importance of communication and networking between community partners, organizations, agencies, and scientists. Early exposure to these concepts will provide students with a framework for problem solving that they can bring into their professional or graduate training, or pursue jobs that allow them to apply those values, and will introduce them to the options for incorporating conservation medicine into their future career goals.

Many institutions have begun to integrate conservation medicine material within their traditional curricula. For example, Tufts Cummings School of Veterinary Medicine has incorporated conservation medicine concepts into the core and elective veterinary curriculum (Kaufman et al. 2004). Other institutions are creating training opportunities by developing new elective courses and curriculum that supplement traditional offerings at both the undergraduate and graduate level. Another example is at the Nelson Institute of Environmental Studies at University of Wisconsin which encourages the cross-disciplinary approach in its undergraduate and graduate programs to foster translational skills in environmental sciences. Programs such as the Certificate on Humans and the Global Environment were created as supplements to any graduate major on campus to prepare students to effectively devise solutions to interdisciplinary environmental problems. Other opportunities exist in targeted technical training programs (nurses, research technicians, lab technicians); certificates and diplomas; short courses and workshops; traditional degree programs from bachelors degrees to doctoral degrees; and combined degree programs such as MD or DVM/MPH, and MD or DVM/PhD.

However, there are significant limitations to adding material to a traditional academic or professional program. Programs are already saturated by content and operate within a rigid academic curriculum necessary to produce qualified graduates within an existing discipline. Time constraints make it difficult to justify adding new courses, or even new material within existing courses, at the expense of well established core topics. In addition, cross-fertilization between departments, schools, and programs remains a challenge for all of these programs. Creating opportunities for interdisciplinary interaction with other programs may be logistically impossible and require innovative solutions such as exploring the use of distance education or website-based courses to provide material to students. Administrative structures between disciplines within universities can also present significant barriers to program development for faculty interested in interdisciplinary collaborative research and teaching. This occurs despite major funding initiatives calling for institutions to develop collaborative multi-disciplinary programs, such as the Integrative Graduate Education and Research Traineeship (IGERT) grants program offered by National Science Foundation (NSF 2006) which funds students involved in interdisciplinary PhD programs.

Since the concept of conservation medicine was introduced and broadly promoted through publications such as Conservation Medicine: Ecological Health in Practice (Aguirre et al. 2002), several academic institutions have been developing focused conservation medicine and ecosystem health programs (Table 1). Currently, there are only a few programs worldwide that offer an advanced degree specifically in conservation medicine, and most of these have been created by veterinary schools. For example, Murdoch University in Australia offers a Master of Veterinary Studies in Conservation Medicine, as well as a pared down “Postgraduate Certificate in Veterinary Conservation Medicine”; The University of Liverpool offers a “Veterinary Conservation Medicine” program as an intercalated honors course attached to a Bachelor of Veterinary Science degree (BVSc). Both programs incorporate the overarching philosophy and multi-disciplinary nature of conservation medicine and offer options of “field placement or a research project,” but are only open to veterinarians. Other graduate programs incorporate principles of conservation medicine, but are not exclusively devoted to this topic. Yet other programs facilitate an individual graduate student to customize their program to include conservation medicine, such as Michigan State University’s (MSU) Graduate Specialization in Fish & Wildlife Disease Ecology & Conservation Medicine. Although conservation medicine implies a medical degree, the interdisciplinary nature of this field should not require it and, in fact, should encourage more cross-fertilization. Opportunities for non-veterinarians are more limited and need to be encouraged to effectively engage other critical disciplines.

Table 1 Current Educational Programs that Have a Conservation Medicine Focusa
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Designing a Conservation Medicine Program

Graduate education is the best way to attain a high level of training in an area of expertise that includes conservation medicine, but currently, a single graduate degree may not be able to provide the necessary disciplinary focus plus the additional skills to work in the interdisciplinary context. This situation is similar in other bridge fields. For example, results of a survey on training recommendations for careers in wildlife medicine (Mazet et al. 2006) suggested that a second graduate degree is one of the most important types of additional training for success in this specialized field of veterinary medicine. What type of additional degree is most appropriate and most useful? For a large proportion of students completing a graduate or professional degree such as a PhD, MD, or DVM, a second round of four or more years in graduate school for another degree is often not practical. In some cases, institutional constraints in two separate degrees may still not easily enable the interdisciplinary perspective that is required by conservation medicine. Alternatively, 1–2 years of intensive scholastic training following a primary graduate or professional degree could be sufficient to obtain the skills required to successfully augment an individual’s expertise with a conservation medicine approach.

Designing an effective conservation medicine training program requires identification of the core tools or skills that conservation medicine health professionals need, independent of their specific discipline or specialization. Some of these tools and skills are listed in Table 2.

Table 2 Core Tools for Conservation Medicine Professionalsa
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In addition to core tools and skills, there is a fundamental need for developing a common language of conservation medicine, a necessary tool for successful communication in interdisciplinary work (Weiler 2007). The conservation medicine community needs to define the terminology and concepts that are directly applicable to the field. This will certainly be a composite of vocabulary and concepts from other areas of science, but it may also lead to new hybridized terminology and concepts that more easily bridge disciplinary gaps. Finally, to develop the communication skills essential to working in diverse groups, a training program should also create situations where students from different educational backgrounds are required to work together on common problems and apply their individual skills in the development of a team product.

Career Opportunities

Where are the opportunities to work or conduct research in conservation medicine? The first place to look is at the work of some of the organizations and institutions that are now practicing this approach (Table 3). Additional opportunities exist in settings where employers may be seeking conservation medicine skills, but may not use conservation terminology nor explicitly describe the skills in position descriptions. A recent review of U.S. Department of Labor (DOL) and the State of Minnesota statistics conducted by the authors in the spring of 2008 (DOL, 2008), found information on applicable environmental, conservation and wildlife occupations, including: “Zoologists & Wildlife Biologists,” “Conservation Scientists,” “Environmental Engineers,” “Environmental Scientists and Specialists, including Health,” “Natural Science Managers,” and “Forestry and Conservation Science Post-Secondary Teachers.” Natural Science Managers were included in this review since a substantial number of job postings were for managerial-type positions that often required higher education in the relevant science. No DOL statistics were available for “Wildlife Veterinarians.” Two of these DOL occupations, “Environmental Engineers” and “Environmental Scientists and Specialists,” were among the top 25 fastest growing occupations nationally, both had projected growth rates of 25% from 2006 to 2016. All other environmental or conservation occupations examined had positive projected national growth rates. These data suggest that environmental, wildlife, and conservation sciences will see overall growth and increased job opportunities.

Table 3 Examples of Organizations that Practice Applied Conservation Medicinea
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Conservation medicine practitioners should take the lead in bringing their skills into traditional settings, building conservation medicine principles and approaches into preexisting positions, and promoting their strengths to employers that may not realize the value of this approach. For example, a veterinarian with conservation medicine interests might pursue a traditional state wildlife veterinarian position, or veterinary public health position, even though conservation is not mentioned in the job description. Once in the position, she or he may be able to incorporate conservation medicine principles as they conduct research, create policy, and implement decisions in their agency. It is expected that more agencies and employers will begin to seek out these skills in the future as the approach becomes wider known and proven effective.

Federal health and research agencies (e.g., Centers for Disease Control and Prevention, National Research Council, Institute of Medicine), major scientific funding agencies (e.g., National Institutes of Health (NIH), National Science Foundation), and professional medical organizations (e.g., American Veterinary Medicine Association, American Medical Association) have also come to the realization that global health problems require multidisciplinary strategies. This has resulted in calls for new initiatives (AVMA 2008) and new funding opportunities that support academic programs and positions in conservation medicine. Some examples include the NSF’s IGERT program mentioned above, the NSF/NIH Ecology of Infectious Diseases program, and NSF’s Dynamics of Coupled Natural and Human Systems program. In addition, more professional societies and peer-reviewed publications are including conservation medicine topics in their focus, such as the Conservation Medicine section in the Journal of Wildlife Diseases (Wildlife Disease Association), and the EcoHealth journal (International Association of Ecological Health) which is specifically devoted to the principles of conservation medicine. As the opportunities increase for peer-reviewed publication and unique interdisciplinary funding opportunities, universities will be encouraged to support research programs within their institutions.

Summary

Conservation medicine, as a discipline, is at the early stages of development. Academic programs are beginning to incorporate conservation medicine concepts into their curricula, funding agencies are beginning to encourage trans-disciplinary approaches to research, and journals are emerging that are devoted, wholly or in part, to conservation medicine. As seen in the early stages of the establishment of Conservation Biology, a more coordinated effort from academia is required to help this growing field become established.

Academic program development in conservation medicine is needed at several levels. It is imperative that scientists, practitioners, and educators work together to establish the common language of key concepts that should form the basis for this new field, and can be used as a framework for curricular efforts in both undergraduate and graduate education. A broad-based undergraduate education is desirable for future practitioners of conservation medicine because it strengthens the ability to communicate across diverse disciplines and leads to a greater appreciation of the value of multiple disciplines in problem solving. Undergraduate resources should be developed to introduce the basics of conservation medicine, appropriately orient students for employment in this area, and lay the foundation for graduate work.

Specialization in one of the key disciplines involved in conservation medicine should be a goal for graduate level study. To apply this expert knowledge using the conservation medicine approach, an additional skill set that incorporates the defined core tools is highly desirable. This skill set, if not acquired through a traditional graduate program, could be attained through an additional 1–2-year conservation medicine training program.

In addition, concerted efforts to educate potential employers, granting institutions and foundations, and professional associations is warranted. Directors of training programs need to promote conservation medicine as a valuable approach in order to build recognition for new certificates, diplomas, and degrees that provide this training. Presentations and workshops at professional meetings will help to build support for novel programming at the academic level and also foster appropriate career opportunities.