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Borderland highlander ethnic minorities of northern Thailand in transition: Livelihoods, livestock, and human health
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Borderland highlander ethnic minorities of northern Thailand in transition: Livelihoods, livestock, and human health


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Presented by Manoj Potapohn, Kwanchai Kreausukon, Chongchit Sripun Robert, Lamar Robert, Akeua Unahalekhaka, Sumalee Lirtmunlikaporn, Jennifer Steele, Karin Hamilton, Tawatchai Apidechkul and Bruce A. …

Presented by Manoj Potapohn, Kwanchai Kreausukon, Chongchit Sripun Robert, Lamar Robert, Akeua Unahalekhaka, Sumalee Lirtmunlikaporn, Jennifer Steele, Karin Hamilton, Tawatchai Apidechkul and Bruce A. Wilcox at the Ecohealth 2012 conference held at Kunming, China on 15-18 October 2012

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  • 1. Borderland Highlander Ethnic Minorities of Northern Thailand in Transition: Livelihoods, Livestock, and Human HealthManoj Potapohn1, Kwanchai Kreausukon1, Chongchit Sripun Robert1, Lamar Robert1, Akeua Unahalekhaka1, Sumalee Lirtmunlikaporn1, Jennifer Steele2, Karin Hamilton3, Tawatchai Apidechkul4, Bruce A. Wilcox5 EcoHealth-One Health Resource Center, Chaing Mai University, 2Cummings School of Veterinary Medicine at Tufts 1 University, 3College of Veterinary Medicine, University of Minnesota, 4School of Health Science, Mae Fah Luang University, 5Cummings School of Veterinary Medicine,Tufts University and Faculty of Public Health, Mahidol University Ecohealth 2012 conference, Kunming, China,15-18 October 2012
  • 2. Outline of the presentation 1. Problem definition and significance 2. Research approach/ method 3. Implementation of an Ecohealth research & preliminary results 4. What is next?
  • 3. 1. Problem Statement Thailand’s Borderland Highlander ethnic minorities represent a diverse set of populations that are part of a distinct social ecological system (coupled human-natural system) characterized by: Shared history of dependency on nature, migration, & marginalization Subject of 30+ years of intensive “development” intervention Common set social, environmental, and health challenges and risks Lack of a coherent strategy that integrates health into “development” Such a strategy calls for situational understanding and practical interventions that clearly require transdisciplinarity and an ecosystem approach as advocated by ecohealth.
  • 4. Challenge of the hill tribes problem• Distinct socio-cultural settings – Eating habit – Belief/tradition• Poor and most vulnerable to diseases – Globalization – Market pressure – Lack of education – Lack of basic sanitation/weak public health infrastructure – Lack of citizenship/social exclusion – Language barrier
  • 5. Identities and home of the hill tribes Estimated hill tribe population in Thailand Provinces Village Household Population (%) (%) (%) Chiang Mai 571 58,245 244,291 (27.16) (25.22) (25.32) Chiang Rai 290 28,160 130,054 (13.80) (12.19) (13.48) Mae Hong Son 322 25,670 109,119 (15.32) (11.11) (11.31) Others 919 118,921 481,452 (43.72) (51.48) (49.89) Total 2,102 230,996 964,916 (100) (100) (100) Source: Highland Research and Development Institute (2007)
  • 6. The Distribution of Hill tribe villages in Chiang Mai, Chiang Rai and Mae Hong Son
  • 7. Human face of the hill tribe
  • 8. 2. Research Approach and MethodsAssemble a team, identify experts and stakeholdersDefine the study problem, system, and its boundaries using an ecosystem approachExplore existing information and expert knowledgeSeek applicable models/theoryIdentify research needs and opportunities exemplifying Ecohealth The above were mainly carried out iteratively—e.g., personnel were added and their roles and tasks refined as the study problem and system came into focus.
  • 9. Hill Tribe Health Project First phase goal: Develop a synthesis* of existing knowledge including “hill tribe situation” and pertinent concepts and theory potentially providing a basis for integration – a conceptual framework. Conduct pilot studies (participatory and in the “field”) using this framework as our basis – the results of two of which will be presented today along with the results of the synthesis to date: Social ecological dimensions of indigenous pig raising and trichinosis risk - Chalisa Geographic study of HIV in Chiang Rai Highlanders – Dr. Soe (Dee) *Synthesis, n : a putting together. The creation of a new entity or idea from elements not previously joined. (Mosbys Dental Dictionary, 2nd edition. © 2008 Elsevier, Inc.)
  • 10. Transdisciplinary Research PlatformA major goal is to develop a research “platform” consisting of problemframing, data, and analytical results along with a community ofresearchers and practitioners involved in ongoing collaborations on manyprojects. Experiment, Study, Experiment, Study, Experiment, Study, Experiment, Study, MS/PHD MS/PHD MS/PHD MS/PHD Dissertation/MSS Dissertation/MSS Dissertation/MSS Dissertation/MSS 1 2 3 4 Integrative research framework – Overarching theory (described in a synthesis publication)
  • 11. Major Transition Components Main macro-level components of the transition: Land use and natural resources Shifting  settled agriculture Diminished access to forests with increasing agricultural intensification Degradation of native forest, biodiversity, water quality, and soils Economics: Increased connectivity and mobility Market access – for buying and selling Extra- village/household income, remittances Availability and desire for consumer products Technology and knowledge Access to transport, equipment, machinery, etc Access to new knowledge. Human and animal health Exposure to modern risks – livestock, human, and zoonotic Potential and unrealized access to modern medicine Governance Incorporation into Thai municipal administration Integration of traditional with modern system of Thai leadership/organization Shift from clan/ethnic group affiliation to Thai nationality
  • 12. Relevant Theory – Conceptual Framework Sustainable Livelihoods – Draws on concepts and theory from a variety of areas to mainly address the problem pressures (stress) on rural populations/communities’ economic wellbeing associated with population, natural resource dependency and the challenge of transiting from traditional to modern world including the effects of globalization. Chambers and Conway (1992) Regional Environmental Change and EIDs – Population growth, consumption, and other forces drive urbanization, agricultural intensification, and deforestation, which in turn alter landscapes, ecological communities, and host-parasite relationships bringing about disease emergence (Wilcox and Gubler 2005, Wilcox and Colwell 2005). Environmental Risk Transition - Industrialization, urbanization, and agricultural modernization bring attendant environmental pollution hazards that cause mainly "modern" diseases (Smith and
  • 13. Thailand Borderland Highlanders in Transition The Kuznets CurveInequity Increasing Wealth Simon Kuznets, Nobel Economist, writing about 1960
  • 14. Operationalizing Ecohealth (=Ecosystem Approach) (Charon 2012)Ecosystem approaches to health focus on the interactions between the ecological and socio-economic dimensions of a given situation,…their influence on human health……how people use or impact ecosystems…… the implications for the quality of ecosystems……provision of ecosystem services, and sustainability.…defines boundaries of ecosystems according to the context of the problem under attention… and efforts to understand them draw on …contemporary literature that addresses complexity and systems thinking as part of ecosystem approaches… * ystem_Approaches_to_Human_Health/Pages/default.aspx
  • 15. Operationalizing the Ecosystem Approach Ecosystem approach means to apply an understanding of the properties of a whole entity of relevance to the health problem of concern Contextualize a problem by situating it geographically Identify the biophysical as well as sociocultural and economic conditions and forces contributing to veterinary or human public health issues. proximal as well as distal causative factors how they interact to bring about the problem all the potentially relevant underlying factors as well as the source or origin of the agent(s) responsible. Isolate the variables primarily responsible Develop an intervention accordingly that targets the critical variables Adapted from: B. A. Wilcox, A. Aguirre and P. Horwitz. 2012. Ecohealth: Connecting Ecology, Health and Sustainability. A. Alonso Aguirre, R Ostfeld et al (Eds). 2011. Conservation Medicine. 2nd Edition. Oxford University Press. Pp. 17-3)2
  • 16. Thailand Borderland Highlanders in Transition The Disease Emergence “Ecosystem Contextual determinants: Social, political, economic,Commerce, trade, Global and environmental forcesdevelopment,agriculture, natural distalresources and Land Regionaluse policy determinants Landscape proximal Livestock, farm, determinants production system, foodHost-parasite relations, Local chainPathogen transmission Focalcycles Methods of analysis at different levels: , agriculture economics, environmental change, livelihoods, landscape/spatial epidemiology, transmission mode/dynamics, host-pathogen ecology, pathology
  • 17. Social and Institutional Influences and Land Use Changeunwittingly driven in part by development and policy misperceptions, e.g., highlandersswidden practices are responsible for deforestation .
  • 18. Incentives and Pressures for Land Use Change • Population Growth and Migration • Internal growth: mountains faster than lowlands • In-migration: • Agricultural Expansions, Commercialization, and Capitalization • Down from the ridges • Up from the valleys • Infrastructure & Public Services • Transportation, communication, health, education, registration • Urbanization, Industrialization and Tourism • Tourist industry, speculation, “land as an asset” •. Forest Policy and Administration • Watershed and forest zoning, expansion of protected area system • Illegal logging, narcotics, and national security • Environmentalism • Public awareness, populist vs “deep green” environmentalism
  • 19. Environmental & Health Issues Hill Tribes face significant challenges in terms of improving and sustaining livelihoods, health, and well-being—not unlike nearly all rural people in the rapidly urbanizing and globalizing world. •New health and disease risks (foods, pathogens, pesticides) •Environmental degradation and resource depletion (reduced water quality and quantity •Loss of soil fertility, forests, and biodiversity Declining population health, livelihoods, and biodiversity—all . interdependent—for which rural people traditionally have been the stewards as well a dependent upon.
  • 20. Human Health in the Highlands •Highlanders historically have been outside the government health cares system due to their: •Geographic isolation and lack of government PH outreach •Language barrier •Lack of Thai citizenship •Lack of knowledge or information on modern health risks/treatment •Highlanders historically, and today often remain, dependent of traditional healing systems. This is changing dramatically yet:. •No general health profile of highlanders exists •No systematic health assessment has been undertaken •Epidemiological surveillance and studies tend to not differentiate between lowlanders and highlanders.
  • 21. Human Health in the Highlands- conclusion •Isolation and accessibility to health care has dramatically improved •Health status varies substantially among highlander villages •Patterns can been seen among ethnicities, geography, and socioeconomic status (e.g., pockets of HIV) – also “modern” chronic diseases are emerging. •Health profile of villages appears to partially fit Smith’s environmental risk transition model – they suffer from both. traditional and modern diseases (not transitioning). •As the public health surveillance systems, which included zoonoses has begun to extend to the highlands an opportunity now exists to begin systematic human health assessment including the emerging disease risk.
  • 22. Conclusions: Ecosystem Approach• Sustainable livelihoods theory compliments social-ecological systems and resilience theory • Systems approach is key • Vulnerable community can develop capacity to deal with stresses• Neither theory directly addresses health • But…can be applied to many health problems • Health outcomes depend on an entire system including natural resources, developmental transitions, globalization, climate change, natural disasters.• EcoHealth and One Health approaches • Employ systems thinking • Integration of natural and social sciences • Consider social equity
  • 23. Conclusions: Ecosystem Approach to Hill Tribe Health• Hill tribes in transition – Traditional to modern – Health risks are associated with transition – Natural resource limitations – Increasingly affected by globalization – Socially disadvantaged.• EcoHealth and One Health approach – Consider connection between environment, human, and animal health – Apply integrative idea of “health”
  • 24. 4: Next step:• Blood sampling for prevalence on the trichinosis on pigs• Comparing with a new sets of villages, likely to be in Mae Hong Son• By April 2013, the project ends – results disseminated as research paper informing the academic, community and the policy makers
  • 25. Thank you, for your attention Acknowledgment: