Eubiosys: a proposal for sustainable development based on education and health that takes into account the environment, community and water. Carlos-Augusto Gonzalez-Correa 1*, Luz-Stella Velásquez-Barrero 2 and Liliana Robledo- Palacio 3.1* Research Group on Electrical Bio-Impedance, University of Caldas, Calle 65 # 26-15, Laboratory Building, Office 601, Manizales-Caldas-Colombia-South America; firstname.lastname@example.org, Telefax.: +57-6-8781500 Extension 14160.2 Institute of Environment Studies (IDEA), National University, Manizales, Caldas, Colombia, email@example.com Unemployed, Calle 54 # 23-39, Manizales-Caldas-Colombia-South America; firstname.lastname@example.org.Received: / Accepted: / Published: Abstract: One paragraph only (Maximum 200 words).Keywords: shared environmental administration; biodiversity; environmental education; territorialplanification; eubiosis; disbiosys; sustainable development; education, health; community; water.1. IntroductionBacteria are the most ubiquitous living organisms in Gaia (Margulis and Chapman 2009). We, animalhumans, being mammals, are surrounded by them, both internally and externally. In recent years, theconcepts of microbiota (and its functioning as a metaorgan), microbioma, metagenomics, eubiosis,disbiosis, pathobiota, eubiota and micro-ecology, have emerged in the scientific literature in relation tothe bacteria that inhabit our body surfaces: skin and the different mucosae (alimentary, respiratory andreproductive). Microbiota is the pool of bacteria present in a specific environment (Paliy and Agans2012), microbiome is its study and characterization through its genetic content (Floch 2012, Yuan etal 2012, Cani and Delzenne 2011), metagenomics are techniques and methodology used for it(Maccaferri et al 2011, Simon and Daniel 2011); eubiosis (Zawodsky 1966) is the dynamic andcomplex equilibrium between what some authors call pathobiota (bacteria that can do harm to us) andwhat we would like to call eubiota (bacteria that can be considered as beneficial for us, as, forinstance, what is now known as probióticos, mainly lactobacillus and bifidobacteria). Disbiosis occurswhen the harmonic balance among a bacterial complex community is lost, giving rise to disease
Sustainability 2012, 4 2(Hawrelak and Myers 2004, Zawodsky 1966). Intestinal microbiota, in general, but, more specifically,that of the colon, is being now considered as a kind of metaorgan, with more extended functions thatthose traditionally assigned to it. In fact, an old concept of its key role in health and disease has begunto be reinforced. Many authors have begun to use more frequently the term micro-ecology (Floch2012) to refer to the scientific study of the relations between the living microorganisms inhabiting ourbody, both among themselves and with our own cells. Micro-ecology could also be referred as endo-or internal ecology, while macro-ecology could be referred as exo- or external ecology. Some otherauthors refer to human beings (and mammals in general), as super-organisms conformed by our ownpool of cells (all of them sharing a common genoma) and the microbiota that inhabit our internal andexternal surfaces. There are even some who suggest that “…large mammals including ourselves servemainly to provide them [the bacteria] with their anaerobic environment.” (Margulis Lynn, quoted byLovelock 2000).We can, then, extend the scope of the definition of eu- and dys-biosis to any biotic system. Therefore,we can talk of internal eu-biosis and internal dis-biosis (endo- or micro-eubiosis and endo- or micro-dis-biosis) as well as external eubiosis and external dis-biosis (exo- or macro-eubiosis and exo- ormacro-dis-biosis). If both systems (macro and micro) present internal equilibrium/disequilibrium(within themselves) and are in equilibrium/disequilibrium with each other, we could talk of a systemiceubiosis/disbiosis, two new concepts that we would like to call eubiosys (with “y”), meaning globaleubiosis or systemic eubiosis (or Eu-Biological-System), and disbiosys (also with “y”) meaningglobal disbiosis or systemic disbiosis (or Dis-Biological-System). We illustrate the concept ofEubiosys in figure 1. Figure 1. Eubiosys as global eubiosis. Global eubiosis = EUBIOSYS Internal eubiosis External eubiosis (micro-ecology) (macro-ecology)In physiological conditions, the intestinal eubiota controls the pathobiota, and we could say, therefore,that it constitutes the first line of our defensive system. When either the former is debilitated, or thelatter strengthened, or both, the result is disbiosis. When this occurs, the pathobiota crosses the mucousbilayer that covers our intestines (our second line in defense), and, at this point, our immunologicalsystems has to intervene. This, in turn, produces a general state of inflammation named meta-inflammation (Scrivo et al 2011, Hotamisligil 2006), meaning a general, chronic and subclinic
Sustainability 2012, 4 3inflammation, a condition that, when advanced, produces different chronic ailments and diseases,depending on what organs are attacked. Target organs depend on the individual genetics, life history(via of birth delivery, lactation, medicaments consumed, etc.) and the particular macro environment inwhich s/he lives. The scientific evidence of metainflammation as a common way towards chronicdiseases is increasing. We summarize these concepts in Figure 2. Figure 2. The Tree of Life and the Tree of Death. What we have now is a NCDs pandemic, caused by risk factors that produce microdisbiosis. Our organism responds with metainflammation and this is expressed as NCDs which imply early disease and death (entire arrows, the Tree of Death). The way to revert this situation (doted arrows) is transforming risk factors into healthy ones to produce eubiosis and fertilize the Tree of Life, which will produce general well being, health and longevity. See text for more details. NON-COMMUNICABLE DISE ASES: degenerative, cardiovascular, TREE OF DEATH: TREE OF LIFE: metabolic, psico-affective. Early disease and Well being, death health and longevity HUMANS AS SUPER-ORGANISMS Human Genoma: (immune system, epithela) Mucous bilayer Meta- inflammation Intestinal Microbiota (10X more cells, 100-150x mores genetic information, > 500 0- 35000 diferent spe scies Eubiosis Disbiosis Factors: Healthy Unhealthy (risk factors) Heredity, macroenvironment, lifehistory, lifestyle and habits, personality.It is now accepted that both environments (micro-, internal- or endo- and macro-, external- or exo-)interact and influence each other. For instance, the quality of food, water and air that come into ourorganisms, influence the composition of the microbiota. In turn, the conditioning of what individualsconsume, in part mediated through their microbiota composition, affects the planet (type of food thatwe consume or demand and therefore type of food that we produce and the way we do it).Some clear consequences of what we are inflicting to our planet are global warming, the destruction ofbiodiversity, the uncontrolled growth of humans and the pandemic of chronic diseases (in the case ofhyperadiposity, some authors use the term globesity to refer to it). All these are interconnected and,
Sustainability 2012, 4 4therefore, a global action ought to take place if we are to reestablish some kind of eubiosys. Politiciansworldwide, based on scientific evidence, are beginning to show some consciousness about it. As anexample, the declaration emanated from the UN General Assembly in September 2011 about non-communicable diseases (NCDs) is somehow encouraging (UN 2011). Clear key points stated in it are: • As elements of the problem, NCDs have huge socio-economic impact (low productivity and huge economic costs needed to deal with them and their consequences), share common risk factors, mainly hiperadiposity, poor diet and sedentarism, they have collapsed health systems and threaten to collapse the economies; • As elements in the solution, global action is needed at all levels (locally, nationally and internationally), with decided participation of all actors: government, academia, civil society and, when appropriate, private sector; • Actions needed involve, among others: health promotion and disease prevention, creation of more healthy environments and promotion of better life styles, including the consumption of healthier food, mainly based on local products, more physical activity both in workplaces and in public sites as parks and sport facilities; research is needed, as well as the supporting of actions that show beneficial and successful.A multidisciplinary group of researchers in Manizales, Colombia, South America, has been developinga long term and broad scope action and research program that aims at integrating all the abovementioned elements. The concept of Eubiosys was born in the academic discussions that have takenplace in the development of the proposal and it is precisely the name that we gave to it. The programcan be considered as a local sustainable development proposal based on education (as the mainvehicle to implement it, but education in its true meaning as the process of ethically forming humansand not only instructing them), health as the probably best indicator of well being, community as thekey actor of the whole process, environment (both external and internal, macro and micro) as adeterminant of development and health, and, finally, water as the essence of life and the element thatshould be taken as the key factor to define a territory for socio-economic (human) organization.The Eubiosys group is proposing two levels of action: a) a regional level where we are proposingactions that involve what is known as the Colombian Coffee Ecoregion, and b) a local level to developa model for small communities organized around what we call hydrographic micro basins. At aregional level, we are proposing the creation of a Coffee Region Centre for the Study, Prevention andControl of Chronic Diseases and, at the local level, we are concentrating our efforts around a projectcalled Central Eco Park. In this paper we will present some results related to the latter.We conceive a city as a complex system where two main orders interact: the ecosystemic order and thecultural order, where the former is mainly the geographic space and macro biotic system before humanintervention, and the latter the man made artificial structure made of technology, the economic, socialand political relations, and the symbiotic expression of all them (Velásquez-Barrero 2010, p. 18). In itspresent form and functioning, cities are not viable. We propose the concept of Biocity as an alternativemodel for environmental sustainability, where the following considerations have to be integrated:
Sustainability 2012, 4 5Reduction of urban social marginality, improvement of the physical infrastructure, monitoring ofgovernmental intervention, and investment in the environmental quality of human settlements. A Bio-city is conceived, thus, as a place: a) for and pro-life, b) with a healthy environment, c) technicallydeveloped, d) economically efficient, e) socially fair, and f) democratically governed, e) where itsinhabitants are healthy and enjoy an state of well being. We also propose six structures that we need totake into consideration and where some strategies are defined: geological, hydrologic, green (biotic),built, circulatory and socio-economical, where the first three can be considered as par of theecosystemic order (non-human structures), while the last three can be considered as part of the culturalorder (i.e., specifically human structures). In table 1 we show some considerations, principles andstrategies (proposals) to adopt in relation to each of these structures.2. MethodologyNowadays, with seemingly increasing activation of massive geophysical liberations of planetaryenergy (volcanoes, earthquakes, storms), in conjunction with the global warming phenomena (which istraduced in an accelerated water cycle causing massive rains and, with these, landslides and floods),geo- and hydro-logical risks seem to be operating in a synergistic way. This is why we are proposingto introduce both factors into the planning of sustainable development. We are, in consequence,proposing that spatial planning should be undertaken under the principle of water circulation, i.e.,according to the hydrological basins. This applies especially in cities like Manizales, located on thesteep Andean hills (elevation of 2150 m), where an initial proposal of this methodology was made byAgredo 2008. This proposal diverges from traditionally concepts, where boundaries set to divide theterritory into administrative sub-units usually only take in consideration urbanistic and socio-economicreasons.According to our methology, 14 different micro basins have been identified in the municipality ofManizales, one of them pertaining to the Stream of “San Luis” (Quebrada San Luis). Some interestingfeatures of the territorial area that it covers are: campuses of two public universities are located in it(University of Caldas and National University of Colombia-Manizales branch), it coversapproximately one half of the urban area of the city, and it has a protected natural area where we areproposing the creation of what we call the Central Eco-Park (CEP). In this specific project, we want tofurther develop the community integration approach that we have used in other occasions (see, forinstance, Velásquez LS 1999). In this experience, nine phases for the environmental action plan for thecommune Olivares (1997-2000) were designed: a) Induction, b) Dissemination of the plan, c)Environmental education and training for active participation in the plan, d) Creation of a politicalculture, e) Updating of the commune’s environmental profile (“Enviromental quality traffic lights”), f)Preparing the commune’s environmental agenda, g) Plan Implementation, h) Monitoring andevaluation, i) Decisions about priority programs and projects.It can be seen that at least the first four phases of this proposal are educational actions. Thus, at thispoint, we have to clarify that we understand for education the deliberated societal transmission ofknowledge, skills, customs and moral values. Regrettably, the Colombian formal education system, as
Sustainability 2012, 4 6those of many other countries, has hypertrophied the two first components (knowledge and skills),neglecting the last two (customs and moral values). In order to educate biocitizens, we ought,therefore, to begin by initiating a dialogical interaction with the community that we aim to work with.This implies that we will approach the persons treating them as thinking beings and equalconversational partners. In this way, we are rescuing the following two main themes: a) ethicalliteracy (difference between modernization, modernity, pre-modernity and post-modernity; theconcepts of human dignity, moral, ethics and difference between the last two; moral values; valuesinherent to a civic ethics: liberty, equity, solidarity, respect and dialogue; citizenship, and moraldevelopment); and B) civic ethics (role of the citizens against governmental institutions; differencebetween private and public spheres; dialogic search of the common good; citizen empowermentthrough free vote; implications of civic participation without ethical commitment; the danger ofunethical strategic agreements; the value of mistake recognition; justice as the core value; normacceptance as the basis for living in community). Once the ethical foundation has been covered(customs and moral values), we can proceed to implement the transmission of knowledge and skills,firstly in the fields of human and environmental health.In summary, what we have in mind is a policy of shared environmental management, guided by ourexperience in territorial environment planning. All this has to be done with the active participation ofthe community inhabiting the micro basin area, the only way to incorporate it in the project is througheducation, as a liberating and empowering action: not just imposing the transmission of emptyknowledge (the banking concept of education), but making people aware of their role as bio-citizens,as dignified human beings, who should be the main actors of the everyday life, as well as of allgovernmental decision, both at a local and at a global level. We, therefore, aim at educating peoplefrom the perspective of the moral values of a civic ethics, as defined by the Spanish thinker AdelaCortina (1998).
Table 1. Considerations, principles and strategies for six different structures of the ecosystemic and cultural orders ECOSYSTEMIC ORDER CULTURAL ORDER Structures Geological Hydrologic Green Built Circulatory Human (Socio- (macro biotic) cultural)Considerations Geological risks: Basins, wetlands, Relationship Urban Topography, Different socio- geological faults, flooding and between external infrastructure, geological and economic classes steep hillsides, landslide risks, (macro) and industrial hydrological risks. inhabiting the instable soils, ground water and internal (micro) architecture. Safety as a key micro basins. landslides, seismic aquifers. ecosystems. factor for adequate Energy and raw factors, volcanic use. materials sources, activity. waste production and management.Principles Geology should be the Water is basic for A dynamic Buildings should Need of lowering Community and starting point of any life but, at the planetary (Gaian) be efficient, fossil energy. civil society as the consideration about same time, with the and micro aesthetic, Active transport as key actor of the the use of the soil. global warming, is equilibrium comfortable and a key contribution whole project. a threat to life. (EuBiosys) is need healthy, in to reduce the Welfare principles to obtain well harmony with the impact on health of and bioethical being and health. environment. sedentary lifestyle. moral values.Strategies Integration of a Aqua parks, Ecoparks. Bioarchitecture, Alternative public University for and(proposals) geological perspective communal Biological conservation of the transport (bicycle pro life (UniBios), into the soil use. aqueducts. Urban corridors. architectural paths, aerial trams, empowerment of hydrographic Urban agriculture heritage, urban urban walks, the civil society, basins as and tree planting. revitalization and biotourist paths, development and administrative and Food security and restoration. street parks. appropriation of a
Sustainability 2012, 4 8 integrating units sovereignty. civil ethics. Civic for sustainability. observatory.
3. The Central Ecopark (CEP)Laying on the upper right corner of South America, Colombia is crossed from South to North by theAndes mountains, considered as the largest mountain range in world. In the south of Colombia, thisrange divides in three branches (cordilleras in Spanish): Eastern, Central and Western, being thecentral one the highest of all three and harboring part of what is known as Northern Volcanic Zone(NVZ) of the Andean Volcanic Belt (AVB). The volcano Nevado del Ruiz (Coordinates: 4°53′43″N75°19′21″W) is the northernmost member of the NVZ, and Manizales (Coordinates: 5°06′N 75°33′W)is located on the western (left) slope of the Central cordillera, along a watershed between the riverChinchina on the south, and the stream Olivares on the north, both of them running from east to west.Total area of the municipality of Manizales is estimated as 508 km2, divided into urban and rural. Theformer is, in turn, divided into eleven communities (“Comunas”), each of them comprising severaldistricts (“Barrios”)1. According to the Colombian National Department of Statistics (DANE)projections, the population of Manizales should be by 2012 around 400.000 people (391640). The cityshows 8 different micro climates, and its average temperature is around 18°C (64°F). It high rain fallsfavor a vegetation of wet tropical forest, and it has a bimodal weather pattern, with two main rainseasons around the two equinoxes (21st of March and 22nd September) and two wet seasons aroundthe two solstices (22nd of June and 21st of December). Climate change and global warming havebegun to show their effects in the form of massive landslides and the melting of the glacier coveringthe volcano Nevado del Ruiz, which in only a quarter of a century has been reduced from about 20km2 to about half of that. The area where the CEP project operates lies in the south east part of the city of Manizales, at thesouth of the mentioned watershed, and forming part of the hydrographical micro basin of the San Luisstream (SLS). This location is schematically represented in figure 3. In figure 4. we locate the projectusing maps.1 By law, each community has the right to elect, through popular vote, a Local Administrative Board (Junta Administradora Local or JAL), while each district can also elect Communal Action Board. The regulation of the latter boards has been established by the national law 743 from 2002. These two kind of entities operate nationwide, as mechanisms to encourage and increase civil participation in administrative tasks. See appendix 1 for more information
Figure 3. Location of the Central EcoPark in Manizales, Caldas, Colombia, South America. Cauca river Magdalena river Guacaica River Olivares stream Manizales SLS CEP Chinchiná river Western Volcano NevadoCordillera del Ruiz Eastern Cordillera Central Cordillera
Figure 4. Location of the Central EcoPark in Manizales, Caldas, Colombia, South America. MANIZALES COLOMBIAMICRO BASIN SAN LUIS(The source and initial part ofthe stream is delimited by theyellow line. Reproduced with permission from Suarez- Hincapié 2008 CENTRAL ECO PARK
To the present, some research has been carried out on different aspects of the microbasin and we wantto briefly summarize them, before we describe our intended agenda to fully implement and test ourproposed model. Basically, the first three structures mentioned in table 1 have received some partialattention: geological (Sánchez-Zapata 1997), hydrologic (Suárez-Hincapie 2008) and green (Boada &Sánchez 2011).3.1. Geological StructureFrom the deepest to the more superficial, the geological profile of the San Luis Stream’s microbasinpresents the following strata, as illustrated in figure 5: Manizales formation (Late Miocene and EarlyPliocene), Casabianca formation (Upper Pliocene and Pleistocene), pyroclastic deposits (from at leastseven pyroclastic eruptions) and anthropic fillings (mainly dating from the second half of the 20 thcentury). These antrhopic fillings began from the watershed downwards, involving deeper layers of thepyriclastic deposits and, probably, from the Casabianca formation as they descended. Anthropic fillings Alluvial deposit Piroclastic deposits Casabianca formation Manizales formation Figure 5. Geological profile of the San Luis stream microbasin. Modified with permission from González-C et al 200.The author (Sánchez-Zapata) also notes that the riverbeds of the river Chinchiná and its affluents havevery steep slopes, a torrential hydraulic regime and, therefore, a great erosive power. He differentiatesthree zones according with their prevalent slopes: a) upper, with very low or low slope, b) middle withlow to moderate slopes, and c) lower, with high slopes. Among the conclusions of his work, we wouldlike to highlight the following two: a) the slopes of the microbasin show a very precarious stability, b)although he considers that the antrhopic adaptation of the soil for urban construction is adequate in thatit began from the top to the bottom, it is inadequate because the soil preparation before the fillings wasnot.
3.2. Hydrological structureSome physiografic characteristics of the microbasin are: altitudes oscillate between 1930 and 2170(average 2095) m above the sea level. The stream is approximately 1244 m long from the source to themouth, as estimated for the year 1996, although the estimation for 1949 is of 2235 m. It covers an areathat is estimated as 0,9705 km2 for 1996 and as 0,9489 Km2 for 1949. The width of the basin is0,7801 km. Average slope of its bed is 17,4%, while average slope of the sides is 24,6%, with astandard deviation of 21,45 and a predominant slope of 11%. (Data from Loaiza-Romero andCastañeda-Castro 2003).Some of the conclusions by González-C et al (2000) in their study of the actual source of the SLS are:1. the urbanistic grow of the city of Manizales did not take in consideration high threatening situations due to mass movements, and it has dramatically changed the slopes of the microbasin, obstructing the drainages, and the distribution of fillings and dumps;2. There is an increased mainly due to waste waters, thus contributing to the widening of the riverbed and favoring denudation of the soil and erosive phenomena;3. Underground waters are very rich in oxides;4. Environmental aspects of the basin merit to be studied in detail.Some of their recommendations are:1. The dumping of debris to the slopes of the basin have to be avoided at any cost;2. If fillings are to be done, water has to be adequately channeled;3. The microbasin has to be cleaned,4. An appropriate draining system should be constructed.3.3. Green structureIn 2010, Boada and Sánchez (2011) carried out a research in part of the territory included in theproposal of the EPC, namely the Botanical Garden of the University of Caldas. They applied themethodology described by Boada y Capdevila (2000), where, basically they establish what they callthree worlds: gray (man constructed structures), green (the biota) and blue (water). In each world, thereis possible to define different biotopes, which, for this specific place, they identify as:Gray world: buildings, walls, vial infrastructure, underground systems, streets and squares;Green world: fallows, buildings sites, parks, wooded land, gardens and forest;Blue world: fountains, springs, artificial lakes and streams.These authors aimed at identifying the main plant and animal species of the studied area, as anindicator of the urban system sustainability and quality of life. With their won observations and
information taken from some work carried out by local groups, the identified 637 different taxas, asshown in table 2. Table 2. Taxas (species, families, gender) found in the Botanical Garden of the University of Caldas FLORA PLANTS FUNGI Families 55 Families 21 Gender 65 Gender 33 Species 84 Species 36 FAUNA Presence of Andean forest fragments Birds Small mammals Amphibia Species 117 Species 17 Species 6 All pertaining to anuridae. Quiroptera having the Colombia is the first Representing 28,39% of the species largest number of country with more registered for Manizales species (7) amphibia species (669) Arachnidae Other non vertebrae Reptils Morphoarachnidae 40 Species 149 Ophidiae 10 60 of the are Scorpia 2 butterflies Sauria 2 Source: After Boada and Sabchez (2011), with permission.3.4. The agendaAs the integration and active participation of the community and the civic society is in the core of ourproposal, our first an main task is to integrate the community in the project. We want to firstconcentrate our efforts in the territory and community living around the area of the EPC, as to workwith the whole territory of the microbasin would involve approximately a third of the city and itspopulation. At present, the territorial division of Manizales is made of communities (comunas) thatintegrate different districts (barrios). There are 8 districts around the area covered by the EPC (inparenthesis, total estimated population living in the district, according to information provided on lineby the Manizales local government –Alcaldía de Manizales): Versalles (2372), Arboleda (1970), Belén(1501), Palogrande (920), Fátima (5614), Betania (1190), Kennedy (2663) and Persia (4397). In thefirst four districts, people living there pertain to the middle class, while the people living in the lastfour districts are mainly working class. The sum of the population of these eight “Barrios” would be,then, 20.627 people. Interestingly, only the four working class communities have Community ActionBoards while the middle class communities do not. Therefore, we aim at, firstly, integrate the existingCABs to the project, and, secondly, promote the organization of the CABs in those districts where theydo not exist.
We are in a position of offering an initial pedagogic and motivational action, mainly throughtheoretical and practical workshops, where practical activities will be developed and the followingthemes will be dialogically discussed:a) Education (Ethics): modernity, pre modernity and post modernity (concepts and differences); moral, ethics, values (specially those of a civic ethics: freedom, equity, solidarity, respect and dialogue), red codes; citizenship, biocitizenship and physical, human and social capital; welfare state and synergy between civil society, state, biocitizenship and opinion groups.b) Environment: What is it?; water as the key element for life, both planetary and individually; our ecosystemic patrimony; our built patrimony; risk management; Biomanizales and its observatories.c) Health: atoms, molecules and life; nutrients and food; structure and functioning of the human body; body composition; microbiota and immune system; nutritional status and physical condition; life styles: a healthy diet and physical exercise.Once these two first steps have been initiated, the following step will be the shared constructions of anew agenda, with the active participation of the community4. ConclusionsThe municipality of Manizales-Caldas in Colombia-Soutn America, has a relatively long regionalhistory of achievements in the fields of education, environmental activities and health. We aim atintegrating these three key elements needed for a sustainable development into a comprehensiveaction-research proposal with the active participation of the civil society through the involvement ofdifferent actors as non-profitable organization, universities, local government and community actionboards (Juntas de Acción Comunal or JACs).In the last 20-30 years we have gained a lot of experience in different fields, and we are nowintegrating it in a model that we expect to develop further and go beyond the theoretical frametranslating it into action. The participation of the community is pivotal for success and we will initiallywork with those that live around the CEP in an attempt to validate our vision of a better future basednon sustainable development, or, maybe, we ought better say a healthy development, both at planetary(Gaian) level as well as at a community and individual level. Health is perhaps one of the bestindicators of welfare and wellbeing, and, therefore, we emphasize this aspect. Finally we stress ourconviction that, in order to achieve this integral healthy development, education is the key element, buteducation meant as ethical formation of the individuals and communities, and not the meretransference of empty knowledge and mechanical skills.AcknowledgmentsMain text paragraphConflict of InterestThe authors declare no conflict of interest.
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Annex 1. Colombian entities elected by popular vote. President (Country) National level Parliament Governor (Department) Regional level Departmental Assembly Mayor (Municipality) City Consejo Local level Community (JAL) District (JAC)