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

• Eco Health - OneHealth
• EcoHealth-OneHealth Resource Centre
• EH case studies

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

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

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

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)

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.

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/)

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)

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.

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

ILRI EcoZD project –
Overview, opportunities, case studies

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)

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

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

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

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

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 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

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

Establishment of the EHRC

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

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

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

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

Centre capacity building efforts

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

EcoHealth/One Health Lecture Series
 Ecological Epidemiology and the
Emergence of Zoonotic Diseases:
Toward an Integrative Science
28

EcoHealth/One Health Lecture Series
 Ecohealth: global change, local action and
the interdisciplinary challenge of global
health and sustainability
29

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
High quality food
Environmental
Sustainabilty
Food vendor/ Market
Slaughterhouse
Farm
Meat
Production
chain

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
members
Plan, conduct and
evaluation
build trust and relationship
high impact to the local
community, common
interest

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 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

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

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

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

Case study examples for integrative approaches
Malaria control and use of DDT in Mexico
(classical EH study).
Brucellosis Yunnan
Rabies ‐ Bali

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)

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'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)

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

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

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:
• 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)

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

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

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, Chiang

Thank you
Special thanks to the ILRI EcoZD project team and country partners (YAGAS, CIVAS)