Borderland Highlander Ethnic Minorities of
Northern Thailand in Transition: Livelihoods,
Livestock, and Human Health
Manoj 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

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?

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.

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

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)

The Distribution of Hill tribe villages in Chiang Mai,
Chiang Rai and Mae Hong Son

Human face of the hill tribe

2. Research Approach and Methods
Assemble a team, identify experts and stakeholders
Define the study problem, system, and its boundaries using an
ecosystem approach
Explore existing information and expert knowledge
Seek applicable models/theory
Identify 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.

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. (Mosby's Dental Dictionary, 2nd edition. ©
2008 Elsevier, Inc.)

Transdisciplinary Research Platform
A major goal is to develop a research “platform” consisting of problem
framing, data, and analytical results along with a community of
researchers and practitioners involved in ongoing collaborations on many
projects.
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)

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

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

Thailand Borderland Highlanders in Transition
The Kuznets Curve
Inequity
Increasing Wealth
Simon Kuznets, Nobel Economist, writing about 1960

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…
*http://www.idrc.ca/EN/Programs/Agriculture_and_the_Environment/Ecos
ystem_Approaches_to_Human_Health/Pages/default.aspx

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

Thailand Borderland Highlanders in Transition
The Disease Emergence “Ecosystem
Contextual determinants:
Social, political, economic,
Commerce, trade,
Global and environmental forces
development,
agriculture, natural
distal
resources and Land Regional
use policy determinants
Landscape proximal Livestock, farm,
determinants production
system, food
Host-parasite relations, Local chain
Pathogen transmission Focal
cycles
Methods of analysis at different levels: , agriculture economics,
environmental change, livelihoods, landscape/spatial
epidemiology, transmission mode/dynamics, host-pathogen
ecology, pathology

Social and Institutional Influences and Land Use Change
unwittingly driven in part by development and policy misperceptions, e.g., highlanders
swidden practices are responsible for deforestation
.

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

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.

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.

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.

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

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”

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

Thank you, for your attention
Acknowledgment: