EcoHealth-OneHealth Capacity Building at CMU and in
the region - Experiences and challenges

Fred Unger (ILRI)  & Tongkorn...
• Eco Health - OneHealth
• EcoHealth-OneHealth Resource Centre
• EH case studies
Challenges
towards Emerging Diseases Threats
Globalisation & international trade
• Intensified long distance travel
• Cros...
Ecosystem and EID 
• Vector‐borne disease
Malaria, Rift Valley Fever, Bluetongue, Dengue…
Eco System: Temperature, humidit...
Ecosystem and EID 
• Soil associated
• Anthrax, other clostridial disease…
Eco System: Temperature and soil moisture affec...
Eco Health & One Health

• In response to failures of purely system based solutions
to current challenges (e.g. H5N1, EHEC...
Eco Health – One Health
•

Ecosystem approaches to public health issues acknowledge the complex, 
systemic nature of publi...
Eco Health – One Health
• One Health is the collaborative effort of multiple disciplines 
working locally, nationally, and...
Introduction: Ecohealth Theory
• Based on 6 principles:
•
•
•
•
•
•

Systems thinking
Knowledge to action
Transdiciplinary...
Introduction: Ecohealth Practice
• System thinking:  System thinking suggests that the way to understand a 
system is to e...
INTEGRATIVE APPROACH

Human 
health

Vet 
Pub
Health

Animal
Health

Wildlife 
health

Societies, Behaviour,
Cultures,  
P...
ILRI EcoZD project –
Overview, opportunities, case studies
ILRI EcoZD: Overview
 General objective: 
Increase the knowledge, skills and capacity of research 
and infectious disease...
ILRI EcoZD: Overview & key components
 Appraisal & Consultative Process
 Scoping Study: Questionnaire survey of represen...
ILRI EcoZD start-up issues - challenges
Human Resources
Supply & Demand



Allocation of time 
Language

Identifying C...
ILRI EcoZD start-up issues - challenges
What language we are speaking…



Eg Latin America/ Eco Salud
‘Lost in translati...
Eco Health – One Health Resource Centre
Idea: 
Establishment of two Eco Health Resource Centres 
– 2 key universities in t...
EcoHealth-OneHealth Resource
center at Chiang Mai University

EcoHealth Resource center at
Universitas Gadja Mada
18
Eco Health – One Health Resource Centre
Vision 

The EcoHealth Resource Centre takes a transdisciplinary,
EcoHealth/One He...
EHRC – General information
 Established in Oct 2010

 To promote


The use of the EcoHealthOneHealth approach



EcoHe...
Establishment of the EHRC
EHRC – Establishment
A first workshop to discuss the idea,
held at Chiang Mai University on October 11-12, 2010

Socio-eco...
EHRC – Establishment
 Co-located with the Faculty of
Veterinary Medicine, CMU.
 Conduct research on and
develop response...
EHRC- CMU: Structure of the organization
EcoHealth-One Health Resource Centre
Chiang Mai University

Advisory
Committee

V...
Vision
To employ a transdisciplinary, EcoHealth - One
Health approach that brings together health, social,
economic, and e...
Centre capacity building efforts
Capacity building / Training


Curriculum development

 Undergraduate courses
 Collaborate with VPHCAP to disseminate
E...
EcoHealth/One Health Lecture Series
 Ecological Epidemiology and the
Emergence of Zoonotic Diseases:
Toward an Integrativ...
EcoHealth/One Health Lecture Series
 Ecohealth: global change, local action and
the interdisciplinary challenge of global...
EcoHealth Training Courses

30
EcoHealth Manual

31
Through research
• The Kitchen of the world
Kitchen of the world continued

Working groups: “Kitchen of the world” Framework 
Healthy

Taste

Affordability

Safety

H...
Working groups: Hill tribe health (animal & human)

Source: Lamar, 2013
Research based learning
Determine research
area
Call for a meeting
Brainstorm on research
topics
Identify roles of team
me...
Communication
38
http://ehrc.vet.cmu.ac.th
CMU – UGM joint activities
CMU students at UGM
UGM students at CMU

40
Annual joint EcoHealth Resource Centre meeting
Lesson learn
Collaboration


Faculties



Universities



International

43
Academic community learning


Manual: (Brainstorming, targeted group, content, assignment, lead)

 Teaching material for...
A success story

 Platform or administrative office for initiating
curriculum, research and training
 Assistance in deve...
Challenges for the future
 Continuing to get out message about EcoHealth approach

 Cooperating with professionals from ...
Challenges for the future
 Sustain the EHRC
 Learn to continue operations in the absence of
direct external funding
 Ce...
Case study examples for integrative approaches 

Malaria control and use of DDT in Mexico 
(classical EH study). 
Brucello...
Case study I: Classical Eco Health example 
• Malaria control and use of DDT in Mexico 
(HEALTH: An Ecosystem Approach, by...
Case studies II: Brucellosis in Yunnan
added value of an integrative (Eco health) approach
”
Case study II:
Brucellosis in Yunnan
Problem:
• Brucellosis is emerging in southern China
• Some information on prevalence...
Case study II:
Brucellosis in Yunnan
Adding an Eco Health perspective:
Involving of all relevant groups or stakeholders fr...
Mapping of stakeholders, partners & groups involved
Public health authorities 
(central/local officers, local 
hospitals)
...
Case studie III: added value of Eco health
Optimizing Rabies Control in Bali: An Ecohealth Approach.”
Case studie III: added value of Eco health
Optimizing Rabies Control in Bali: An Ecohealth Approach.”
The problem: 
• Rabi...
Case studies: EH Framework
Optimizing Rabies Control in Bali
Political perspectives
Socio‐science

Media 

Private sector
...
Take Home Messages
• Essentials to practice Eco Health/One Health: 
Apply integrative approach
Engagement & participation
...
Java Indonesia 2010
Yogyakarta

SOP measure 
Voluntary culling  of 
the infected flock …
Will the boy agree?
ILRI and where it works

Head 
quarter in 
Nairobi

ILRI 
outposts

ILRI outposts in SE 
Asia:
Jakarta, Hanoi, 
Vientiane,...
Thank you

Special thanks to the ILRI EcoZD project team and country partners (YAGAS, CIVAS) 
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EcoHealth–One Health capacity building at Chiang Mai University and in the region: Experiences and challenges

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Presented by Fred Unger and Tongkorn Meeyam to University of Minnesota (UMN) exchange students under the UMN Veterinary Medicine/Veterinary Public Health Spirit of Thailand program. Eco Health/One Health Resource Center, Chiang Mai University, Chiang Mai, Thailand, 10 July 2013.

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EcoHealth–One Health capacity building at Chiang Mai University and in the region: Experiences and challenges

  1. 1. EcoHealth-OneHealth Capacity Building at CMU and in the region - Experiences and challenges Fred Unger (ILRI)  & Tongkorn Meeyam (CMU) Presentation to University of Minnesota (UMN) exchange students  under the UMN Veterinary Medicine/Veterinary Public Health Spirit  of Thailand program.  EHRC, CMU, Chiang Mai, Thailand 10 July 2013
  2. 2. • Eco Health - OneHealth • EcoHealth-OneHealth Resource Centre • EH case studies
  3. 3. Challenges towards Emerging Diseases Threats Globalisation & international trade • Intensified long distance travel • Cross border trade (illegal/legal) Forest habitat alteration/deforestation   Human settlement  • Urbanisation  Increasing urban or peri‐urban settlements  • Agriculture intensification Concentration Mixing wild life/domestic species Waste management 3
  4. 4. Ecosystem and EID  • Vector‐borne disease Malaria, Rift Valley Fever, Bluetongue, Dengue… Eco System: Temperature, humidity, flood/heavy rain  influence seasonal activity, distribution/density of vector  population • Parasites Fascioliasis, Schistosoma, Cysticercosis… Eco System: Temperature, humidity favour intermediate  hosts or free living stages 4
  5. 5. Ecosystem and EID  • Soil associated • Anthrax, other clostridial disease… Eco System: Temperature and soil moisture affect spore  germination. Heavy rainfall may stirs up dormant spores  • Air associated • Multi‐factorial respiratory diseases… Eco System: Dust and pollution exacerbating respiratory  disease • Water associated • Cyptosporidiosis, Leptospirosis... Ecosystem: Disasters. lack of sanitation, floods, higher water  temperature may improve survival rate 5
  6. 6. Eco Health & One Health • In response to failures of purely system based solutions to current challenges (e.g. H5N1, EHEC)  • Many similarities • Different traditions/background • Integrated approach (scope different) 
  7. 7. Eco Health – One Health • Ecosystem approaches to public health issues acknowledge the complex,  systemic nature of public health and environmental issues, and the  inadequacy of conventional methodologies for dealing with them. David  Walter‐Toews, University of Guelph  • The Ecohealth approach focuses above all on the place of human beings  within their environment. It recognizes that there are inextricable links  between humans and their biophysical, social, and economic environments,  and that these links are reflected in a population's state of health. International  Development Research Centre (IDRC) • EcoHealth is an emerging field of study researching how changes in the  earth’s ecoszstems affect human health. It has many prospects. EcoHealth  examines changes in the biological, physical, social and economic  environments and relates these changes to human health. Wikipedia. 
  8. 8. Eco Health – One Health • One Health is the collaborative effort of multiple disciplines  working locally, nationally, and globally, to address critical  challenges and attain optimal health for people, domestic  animals, wildlife, and our environment  One Health Commission (http://www.onehealthcommission.org/ )  • The One Health concept is a worldwide strategy for expanding  interdisciplinary collaborations and communications in all  aspects of health care for humans and animals. One Health  Initiative (http://onehealthinitiative.com/) 
  9. 9. Introduction: Ecohealth Theory • Based on 6 principles: • • • • • • Systems thinking Knowledge to action Transdiciplinary Participation Equity  Sustainability • 4 interacting sub‐ systems influence  health Social Economic Political Ecological An approach to understand complex systems (socio‐economic, socio‐ ecological ect) 
  10. 10. Introduction: Ecohealth Practice • System thinking:  System thinking suggests that the way to understand a  system is to examining the linkages and interactions between the  elements that make up the system.  • Knowledge to action: Knowledge to action refers to the idea that  knowledge generated by research is then used to improve health and  well‐being through an improved environment.   • Transdisciplinarity   inclusive vision of health problems by scientists from  multiple disciplines, community and policy actors  • Participation aims to achieve consensus and cooperation within   community and scientific and decision‐making groups; • Equity involves analyzing the respective roles of men and women, and  various social groups; • Sustainability:  ecohealth research should aim to make ethical, and  lasting changes which are environmentally sound & socially acceptable. 
  11. 11. INTEGRATIVE APPROACH Human  health Vet  Pub Health Animal Health Wildlife  health Societies, Behaviour, Cultures,   Political situation,  Crisis/Disasters Education. Poverty,   Economies,  Regulations, Institutions,  Governance &  Policies  Plant health Agroecosystem  health 11
  12. 12. ILRI EcoZD project – Overview, opportunities, case studies
  13. 13. ILRI EcoZD: Overview  General objective:  Increase the knowledge, skills and capacity of research  and infectious disease control personnel in SE Asia to  understand the risks and impacts of Zoonotic Emerging  Infectious Diseases (ZEIDs) and how feasible options can  best be implemented and adapted.  ‘Learning by Doing’ approach; (also for ILRI team)  Regional: Cambodia, Laos, Thailand, Viet Nam, Indonesia, PR China (Yunnan)
  14. 14. ILRI EcoZD: Overview & key components  Appraisal & Consultative Process  Scoping Study: Questionnaire survey of representatives from 10-15 key institutions (PH, Vet, Social Science)  Outcome Mapping: assists with formulating action plans focussing on outcomes • Innovative Eco Health research underway in all 6 partner  countries  • Establishment of two Eco Health Resource Centres  at  Chiang Mai University (CMU) and Universitas Gadjah  Mada (UGM) in Indonesia • Networking with other One Health, EcoHealth initiatives
  15. 15. ILRI EcoZD start-up issues - challenges Human Resources Supply & Demand   Allocation of time  Language Identifying Champions (to implement & to mentor) Level of counterparts (senior/junior) Scope of EcoZD ‘Carte blanche’ v flexible adaptive/consultative approach Learning by doing Priority zoonoses +/‐ ZEID (country perspective) Two‐dimensional capacity‐building requirement Technical (proposal writing/implementation/methodological/ analysis/paper) EHRC concept
  16. 16. ILRI EcoZD start-up issues - challenges What language we are speaking…   Eg Latin America/ Eco Salud ‘Lost in translation’ Biomedical v Social Sciences    Medics & vets (clinical / lab / epi) Quantitative v Qualitative Researchers, Decision Makers, Communities Novel approaches v “classical” vet science     One Health One World/One Medicine Eco Health Broad scope vs. H5N1
  17. 17. Eco Health – One Health Resource Centre Idea:  Establishment of two Eco Health Resource Centres  – 2 key universities in the region Objective:  Capacity building on Eco Health Eco Health hub for the region 
  18. 18. EcoHealth-OneHealth Resource center at Chiang Mai University EcoHealth Resource center at Universitas Gadja Mada 18
  19. 19. Eco Health – One Health Resource Centre Vision  The EcoHealth Resource Centre takes a transdisciplinary, EcoHealth/One Health approach to bring together health, social, economic, and ecological expertise to support efforts to achieve sustainable improvements in health, well-being, and social equity through research, capacity building, and communication in Southeast Asia. Chiang Mai University
  20. 20. EHRC – General information  Established in Oct 2010  To promote  The use of the EcoHealthOneHealth approach  EcoHealth concepts  Agreement and collaborative efforts between experts from many faculties 20
  21. 21. Establishment of the EHRC
  22. 22. EHRC – Establishment A first workshop to discuss the idea, held at Chiang Mai University on October 11-12, 2010 Socio-economic determinants of health 5 researchers Human Health 4 Animal Health 4 Ecosystem Health 1 22
  23. 23. EHRC – Establishment  Co-located with the Faculty of Veterinary Medicine, CMU.  Conduct research on and develop responses to EcoHealth-related issues.  Promote capacity towards timely response to emerging situations in the community, the nation, and the region. 23
  24. 24. EHRC- CMU: Structure of the organization EcoHealth-One Health Resource Centre Chiang Mai University Advisory Committee Veterinary Medicine Working Executive Committee Nursing Associate d Medical Science Medicine Group Social Sciences Economic Pharmacy 24
  25. 25. Vision To employ a transdisciplinary, EcoHealth - One Health approach that brings together health, social, economic, and ecological expertise to support efforts to promote sustainable improvements in health, well-being, and social equity through research, capacity building, and communication in Southeast Asia. 25
  26. 26. Centre capacity building efforts
  27. 27. Capacity building / Training  Curriculum development  Undergraduate courses  Collaborate with VPHCAP to disseminate EcoHealth to masters in Veterinary Public Health (MVPH) Program  EcoHealth Training Courses 27
  28. 28. EcoHealth/One Health Lecture Series  Ecological Epidemiology and the Emergence of Zoonotic Diseases: Toward an Integrative Science 28
  29. 29. EcoHealth/One Health Lecture Series  Ecohealth: global change, local action and the interdisciplinary challenge of global health and sustainability 29
  30. 30. EcoHealth Training Courses 30
  31. 31. EcoHealth Manual 31
  32. 32. Through research
  33. 33. • The Kitchen of the world
  34. 34. Kitchen of the world continued Working groups: “Kitchen of the world” Framework  Healthy Taste Affordability Safety High quality food Environmental Sustainabilty Food vendor/ Market Slaughterhouse Farm Meat  Production  chain
  35. 35. Working groups: Hill tribe health (animal & human) Source: Lamar, 2013
  36. 36. Research based learning Determine research area Call for a meeting Brainstorm on research topics Identify roles of team members Plan, conduct and evaluation build trust and relationship high impact to the local community, common interest
  37. 37. Communication
  38. 38. 38
  39. 39. http://ehrc.vet.cmu.ac.th
  40. 40. CMU – UGM joint activities CMU students at UGM UGM students at CMU 40
  41. 41. Annual joint EcoHealth Resource Centre meeting
  42. 42. Lesson learn
  43. 43. Collaboration  Faculties  Universities  International 43
  44. 44. Academic community learning  Manual: (Brainstorming, targeted group, content, assignment, lead)  Teaching material for faculty member to integrated with the existing undergraduate course  Key academic actors  Level o Executive level: dean meeting o Faculties: head of department  Media: e-office, brochure, agenda in meeting 44
  45. 45. A success story  Platform or administrative office for initiating curriculum, research and training  Assistance in developing a coordinated, interdisciplinary response  Effectively incorporates social and economic considerations as well as heath aspects 45
  46. 46. Challenges for the future  Continuing to get out message about EcoHealth approach  Cooperating with professionals from other academic specialties  Demonstrate to health professionals that efficacy can be enhanced by cooperating with professionals from other academic specialties  Engagement of policy makers 46
  47. 47. Challenges for the future  Sustain the EHRC  Learn to continue operations in the absence of direct external funding  Centre well settled within CMU and existing networks to other OH activities in the region 47
  48. 48. Case study examples for integrative approaches  Malaria control and use of DDT in Mexico  (classical EH study).  Brucellosis Yunnan  Rabies ‐ Bali
  49. 49. Case study I: Classical Eco Health example  • Malaria control and use of DDT in Mexico  (HEALTH: An Ecosystem Approach, by  Jean Lebel. (IDRC 2003,ISBN 1‐55250‐012‐8)) • Pool of specialist from epidemiology,  computer science, entomology,  social sciences, government and  Academia background.  Social Economic Political Ecological • Participatory (Bottom up approach from community level) • Transdiciplinary (several expertise) • Equity (role of woman and man, behavior related to Malaria risks differed  between gender, e.g. due to differences in mosquito exposure)
  50. 50. Case studies II: Brucellosis in Yunnan added value of an integrative (Eco health) approach ”
  51. 51. Case study II: Brucellosis in Yunnan Problem: • Brucellosis is emerging in southern China • Some information on prevalence's • Little or no information on perception of involved  groups  and stakeholders Classical vet approach:  • Prevalence study in cattle and small ruminants One Health • Adding human component (e.g. review of cases in  hospitals) 
  52. 52. Case study II: Brucellosis in Yunnan Adding an Eco Health perspective: Involving of all relevant groups or stakeholders from the  begin and throughout the project (participation) • • • • • • • Farmers: perception (importance of Brucellosis compared to other  diseases) Involvement of other risk groups (butchers, ...                   ) Stakeholders: e.g. policy makers (local, national)  Policy (regulations & enforcement)  Ecological aspects (management of aborted fetus ...) Gender aspects (who sells milk, who responsible for SR or cattle)  Socio economic drivers (Introduction & control) – Willingness to pay for control or basic bio security 
  53. 53. Mapping of stakeholders, partners & groups involved Public health authorities  (central/local officers, local  hospitals) Local  administration  officers Outpatients Donors,  international  organizations &  universities Policy makers  LS officers  (central/local) Brucellosis  control Socio economic  experts  Farmers/ herders Communities Animal husbandry  expert Milk vendors,  butchers  Associations  Butchers, meat  vendors (if any or to be  established) 53
  54. 54. Case studie III: added value of Eco health Optimizing Rabies Control in Bali: An Ecohealth Approach.”
  55. 55. Case studie III: added value of Eco health Optimizing Rabies Control in Bali: An Ecohealth Approach.” The problem:  • Rabies is an emerging zoonoses since its introduction • Conventional control measures show limited success Objective: To help the government of Bali in controlling rabies in dogs  through better understanding of the dog population, dog  demography in Bali and its relationship with the local community. Conventional vet approach:   Vaccination & population control (sterilisation)
  56. 56. Case studies: EH Framework Optimizing Rabies Control in Bali Political perspectives Socio‐science Media  Private sector ‐Law and regulation ‐Social cultural  believes ‐Social  acceptance  ‐ Vaccines ‐ Enforcement Tourism: ‐ Major source  of income Community ‐ Acceptance  ‐ Feasibility Vet Science Control of Rabies  in Bali  Environments  Waste problems  Monkeys ‐Epidemiologist ‐ Practionaires ‐ Capacity  Human health - Capacity Acceptance
  57. 57. Take Home Messages • Essentials to practice Eco Health/One Health:  Apply integrative approach Engagement & participation Key for success:  Identify/focus on applicable/doable  interventions (success is essential) Ensure that all partners are engaged  (rather motivation/incentive driven than enforced)  Research  Policy  
  58. 58. Java Indonesia 2010 Yogyakarta SOP measure  Voluntary culling  of  the infected flock … Will the boy agree?
  59. 59. ILRI and where it works Head  quarter in  Nairobi ILRI  outposts ILRI outposts in SE  Asia: Jakarta, Hanoi,  Vientiane, Chiang 
  60. 60. Thank you Special thanks to the ILRI EcoZD project team and country partners (YAGAS, CIVAS) 

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