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But this success can also be attributed to good timing.
The project capitalized on concurrent national and international trends in health and development policy. The case studies also illustrate that applying systems thinking in ecohealth research can present challenges in practice. It can be difficult to set the boundaries for the study, refine the study design and conduct the analysis, and interpret the results. Choices and trade-offs need to be made between inclusiveness and feasibility, based on the time, skills, and resources available. Transdisciplinary research helps achieve an improved understanding of health in the context of coupled social—ecological systems, and the real world that such systems approximate.
It also enhances the resulting innovations and the design of strategies to improve health and environmental conditions in a sustainable, contextually appropriate way. Community representatives and other stakeholders possess knowledge about the problem that is informed by their experience. They will necessarily have a role and a stake in achieving a better understanding of a problem and in designing strategies to resolve it.
A transdisciplinary approach integrates different scientific perspectives Parkes et al ; Wilcox and Kueffer and provides a formal platform for stakeholder participation in the research and in the development of new information, ideas, and strategies, their testing, and eventual application. Transdisciplinary research involves the integration of research methodologies and tools across disciplines and includes non-academic perspectives and knowledge. The research team includes these different perspectives, and ideally functions as a cohesive collaborative unit from design, to data collection, to development of strategies for change, to implementation.
As highlighted by Bopp and Bopp : health and natural resource management professionals, and the technical solutions they create, cannot, by themselves, solve many of the problems communities face. To be effective, solutions have to address a complex set of variables that may be largely invisible to professionals from outside the communities. When scientists working in interdisciplinary teams involve community members, decision makers, and other non-scientific stakeholders, they are engaging in a transdisciplinary research process.
They are creating new knowledge and theory around a set of common questions Pohl and Hirsch Hadorn Transdisciplinarity takes time to build into an ecohealth research process. The core research team almost never initiates a project with the ideal mix of scientists and key stakeholders. Even the most experienced teams evolve over time as relationships develop, contributors are added or changed, and new understandings, theories, and methods are applied. In practice, the priorities of stakeholders tend to evolve with the emergence of this new understanding, which helps build trust and respect.
Thus, transdisciplinarity is less about addressing the priorities of all and more about establishing an acceptable process for discussion and negotiation among the actors who are in joint pursuit of a new understanding of a given problem or situation. To achieve transdisciplinarity, researchers must draw on a wide range of skill sets that are not usually part of academic training, including consensus building, negotiation, facilitation, communication, and strategic planning.
There are a variety of methods for achieving effective multistakeholder processes, a necessary component of transdisciplinary research. For example, Social Analysis Systems Chevalier and Buckles provide a framework for group dialogue and social inquiry for development; multicriteria evaluation has proven useful for conflict management Paruccini ; and outcome mapping Earl et al. Most of the projects presented as case studies in this book emphasize the process by which transdisciplinarity was achieved.
As just one example, the Malawi case study on improving soils and nutrition achieved an integrated research design that linked improvements in soil quality with improved yields, changes in dietary habits, and improved child health, while integrating local knowledge and capacities. Transdisciplinarity and participation go hand in hand as part of an ecosystem approach to health. Stakeholder participation adds to the knowledge generated by the research and enhances the action that can result from, or be integrated into, the research. Participation, a principle of ecohealth, reflects broader current trends in research for development.
Community initiatives and wider social movements are recognized to lead to innovation strategies not otherwise discernable to experts or consultants. Such participation leads to locally rooted forms of innovation and increases the impact of the benefits of innovation STEPS Centre In theory, appropriate stakeholder engagement enhances the likelihood of finding and using new knowledge. More important than the number of stakeholders, however, is the process of engagement. There are strategically and ethically charged decisions to be made that also affect the research process: Who convenes?
How is participation decided? What will be done if participation is not constructive or is used to advance particular interests that obstruct or derail the change sought by the majority? Some of these aspects of participative process in ecohealth are discussed in Mertens et al. Change in various forms is the intent of ecohealth research. The participation of actors living with the consequences of a problem or issue, those contributing to it, and those influencing and bringing about change are vital to a research process that strives for change.
Community participation came into public health practice in following the Alma Ata Declaration WHO , but it has waxed and waned in practical implementation ever since Draper et al. Although participation is central to ecosystem approaches to health, not all communities are equally able or prepared to engage in such processes. A variety of tools are available to assess such capacities Bopp and Bopp Participatory action research seeks effective stakeholder participation in research and beyond, and is rooted in the notion that those who are affected should be part of the process of defining not only the problems, but also their solutions.
Participatory Rural Appraisal PRA methodology Chambers provides one effective framework for incorporating the community into a research process. The Ecosalud Ecuador and Malawi soils, food and health case studies both illustrate the effective use of PRA in ecohealth research. Participation can lead to cooperation, collaboration, and eventually, to breakthroughs in resolving long-standing differences that impede progress.
The case study of open-air slaughtering practices in urban Kathmandu illustrates the power of engaging multiple actors in community change. A participatory process helps develop a shared understanding of the socio-political environment that surrounds a particular development problem and its associated social and health problems. In this case, full participation of various groups led to their political empowerment and later to effective negotiation between community groups, community leadership, and the government Neudoerffer et al.
Morrison et al. Goy and WaltnerToews present a multilevel stakeholder analysis pertaining to environment and health in Peru. Participatory processes also help identify barriers to change, clarify information and knowledge gaps, and provide means to negotiate concrete steps for moving forward. Community representatives, government, and mining company officials were brought together to overcome decades of inaction on this pollution problem.
Backed by scientific evidence, they developed a risk-management plan to reduce impacts from mining. Some changes in policy and practice to reduce different exposure routes are underway, while others remain under negotiation. There are practical limits to a participatory research process. Community priorities may not be aligned with the problem that is motivating the researchers.
The interests and intentions of different actors researchers included sometimes clash with scientific relevance or methodological requirements. Every stakeholder has particular concerns and interests, which are sometimes compatible with those of other stakeholders, but frequently conflict, and need to be resolved.
Some participating stakeholders may also have motives that are incompatible with the research agenda or the change being sought by other stakeholders. Therefore, levels and terms of participation vary and may need to be renegotiated repeatedly, which can interrupt data collection or project timelines. Finally, community expectations for change may not be attained by the research, leading communities to experience disappointment or to feel exploited — an undesirable outcome of any project.
The iterative nature of ecohealth research can accommodate many of these issues, but not without transactions. Transaction costs are high in participatory research, requiring time, and sometimes presenting unforeseen and frustrating delays. The contribution of community participation to project outcomes is challenging to assess, although tools used in public health program evaluation may be useful in this regard Draper et al.
An ecosystem approach to health is predicated on an understanding that protecting ecosystems and improving degraded environments are fundamental requirements for human health and well-being now and for future generations. Sustainability ecological and social is part of the change sought through ecohealth research and action, and seeking such change motivates many in the field of ecohealth Soskolne et al.
As research for development, ecohealth research aims to make ethical, positive, and lasting changes. Sustainability implies that these changes be environmentally sound and socially sustainable socially and culturally responsible and appropriate, as well as easily systematized.
Another sustainability issue relevant to research for development pertains to the uptake and use of research results for achieving change. In Kathmandu, ecohealth research led to the apparently permanent transformation of an entire neighbourhood and catalysed substantial modernization of the meat-processing sector across Nepal. Despite social and environmental problems in riverside slums in Nepal, there appears to be no going back to the original situation, at least in the two municipal wards where the project was initiated.
However, change may not always be clear or clearly attributable to ecohealth research or any research-for-development process. Change processes are not linear. There may be slippage back into previous, negative patterns or relationships; setbacks as well as leaps forward; and new problems may arise. Ecohealth researchers should anticipate these dynamics and be prepared to learn from them.
A fundamental challenge arises when seeking sustainability. Environmentally and socially sustainable development is a very lofty goal. The dynamics of social—ecological systems are entrenched and not easily changed where people live in extreme poverty with very limited access to resources and even fewer choices in livelihoods.
Researchers will face ethical quandaries when the short-term needs and priorities of people are not consistent with a longer term process for improving health and environment. Ecohealth research can provide some insights by addressing both local concerns and the wider forces that maintain cycles of poverty, environmental degradation, and ill health. A focus on achieving change locally can sometimes help shift perceptions and motivate people to tackle wider issues.
There is a need for even more strategies that reach beyond the community to levels of the system where a wider difference can be made over the longer term. Improving livelihoods and economic conditions with inadequate attention to environment and social inequities can imperil health and become unsustainable over time. Ignoring the drivers of environmental and social conditions when trying to improve health can be ineffective. But, there are trade-offs to be made in achieving sustainable development; gains in one dimension health or economic can come at a cost in other dimensions ecological or social.
There are setbacks caused by unforeseen events natural disasters or otherwise unpreventable ones crisis in the world financial markets. Flexible and adaptive governance mechanisms are required. Ecosystem approaches to health contribute to an evidence base to better inform communities and decision makers, and to foster conditions for improved sustainability and health.
An ecosystem approach to health explicitly addresses unequal and unfair conditions impinging on the health and well-being of women and other disadvantaged groups in society. The differences between members of different social, economic, class, age, or gender groups in all societies are reflected in their relationships with ecosystems, their exposure to different health risks, their health status, and their well-being goals.
In implementing this principle, research not only documents social and gender differences in causal pathways, outcomes, and proposed interventions and actions but it takes on ethical dimensions by becoming oriented toward reducing inequities. Together, inequity and degraded environments contribute to ill health and poor life expectancy, economic woes, and conflict. The ongoing high levels of ill health among poor people, and the pronounced health gradient according to wealth within and between countries, are due to inequity.
Power, income, goods, and services are unfairly distributed and this affects ecosystems and how they are used. There are inequities in access to health care, education, and work and living environments. The combined impacts of various inequities affect the power people have to improve their circumstances. The CSDH report urges action for health by reducing inequities through better social policies and programs, improved economic arrangements, and political will. Greater attention to environmental quality must also be a priority for equitable development, and ecosystems need to be restored and protected so that they may continue to support flourishing societies and improved health.
The point is that the CSDH does not address environmental drivers of inequity or of poor health. In most developing countries, women represent the largest segment of society facing persistently unequal and unfair access to opportunity and to health. Women hold most of the responsibility for the health of their families, the social fabric of their communities, and the socialization and education of children. They suffer greater levels of violence, malnutrition, and with their children, represent almost all the deaths from malaria worldwide WHO Nearly all of the more than half a million maternal deaths every year occur in developing regions WHO b.
Women are at greater risk of bearing the negative health impacts of climate change WHO c. Women have less land, wealth, and property in almost all societies, yet in all countries almost always carry a double burden — they are responsible for caring for the household, for children and elders, and for earning wages or income. Women are penalized in the workplace when family demands or their own health prevent them from working. However, women are also agents of change and a resource that is often underutilized to achieve development goals UNEP Healthier and productive ecosystems provide more livelihood opportunities for women and more resources for the household.
Reductions in the burden of childhood diseases the majority of which can be linked to poor ecosystem conditions relieve women of the burden of care, improve survival of children, and reduce pressure on women to have large families. The time saved can be spent in economic activities that generate income and promote gender equality. It also reduces pressure on ecosystems. In practice, changes in social and gender inequalities and resulting unfair health status are not easily achieved. The reasons for these inequities are often deeply rooted in multifaceted economic and cultural patterns that stubbornly resist change.
Although most ecohealth research demonstrates awareness of the possible importance of gender or social difference in a particular context, it struggles to address inequity beyond the consideration of gender or social group in risk-factor analyses. Some of the case studies demonstrate how ecohealth research has addressed gender inequity in a more integrated manner. They must raise children, they are responsible for family health care, and also provide most agricultural labour.
While elder women hold considerable power over household decision-making notably in child rearing , women in general have little say in how meagre household income may be used. This dynamic contributed to chronic malnutrition and stunting of children. The Malawi case study describes how both women and men were engaged in developing strategies to introduce high-protein legume crops.
Over time, relationships between men and women changed and led to better conditions for women. There is a need for more gender and social analysis in ecohealth research; however, methodologies and tools remain few WHO a. Although not focused on health, the World Bank and partners have developed an extensive agriculture and gender sourcebook that includes training modules for many different contexts relevant to ecohealth research gender and food security, livelihoods, and crises World Bank, FAO, IFAD Others have presented the case for integrating social and gender analysis in development research Vernooy Beyond the development and adaptation of analytical tools, there is a need for further conceptual development of the implications of gender and social inequities in ecohealth research, education, and practice.
This appears to be an area ripe for new contributions from experiences in ecohealth research. The notion that knowledge from research is used to improve health and well-being through an improved environment is fundamental to an ecosystem approach to health. A variety of terms are used to describe this process, but in the context of ecohealth, knowledge-to-action is preferred to the commonly-used knowledge translation. The point is not to achieve some near-prefect level of knowledge before making a change the translation.
In transdisciplinary and participatory research involving decision-makers, the situation may be changing while new knowledge is being produced over time through a series of research—action cycles. Other authors have defined knowledge-to-action in health research to include trailoring of knowledge and a defined number of steps for sustained use of knowledge Graham et al.
That research conditions change at the onset of participatory research is widely understood in social science research e. Bernard , but is not as commonly considered in public health. Many of the case studies in this book describe in detail how the research became an ongoing intervention process, and yet some of them also invoke epidemiological designs like case-control studies, wherein conditions are assumed to remain the same or where changes are measured and controlled in the analysis. This tension between scientific endeavour and action to improve sometimes terrible conditions of people and their environment is characteristic of eco-health research.
Researchers have a responsibility to be aware of this tension and to document both pre-existing conditions and changes wrought by the research process.
Outcome mapping Earl et al. The innovations, actions, and changes that result from ecohealth research involve multiple sectors, agencies, and stakeholders. In addition, ecohealth research may generate unintended positive and sometimes negative outcomes that can be difficult to link to the results of research or to the original research question. Ethical dilemmas are expected to arise — and researchers who anticipate and consider these beforehand are sometimes better equipped to navigate them Funtowicz and Ravetz ; Lambert et al.
There is already a strong emphasis on uptake and application of knowledge in public health Pablos-Mendez et al. Knowledge translation is gaining particular prominence as a rubric for operational research and for developing and assessing the effectiveness of interventions Tugwell et al. Understanding how knowledge is used is an active field of study that contains many different fields of thought Ottoson Sudsawad and Tetroe explore a variety of knowledge translation models in public health.
Health sciences are generating knowledge translation tools that could potentially be adapted to an ecohealth research context e. Campbell et al. Lavis et al. Three different drivers of knowledge translation are reflected in examples from ecohealth research: 1 research pushing new knowledge forward into policy and action many examples in this book ; 2 policy requesting new knowledge alternatives to DDT sought after NAFTA 2 — not in this book — Chanon et al.
Formal policy processes and legal frameworks need to be engaged to achieve the far-reaching and permanent changes required for a more sustainable future Soskolne Policy influence and change are important elements to successfully move research results into action, but knowledge can move without the help of policy. The Malawi case study illustrates how innovations from ecohealth research can be disseminated by socializing and institutionalizing in the community.
The case study illustrates how the use of legumes to improve soil fertility and local diets was spread by word of mouth to several neighbouring communities. In the case of manganese mining pollution in Mexico, the project worked over several years to develop both the evidence base that indicated harm from manganese-laden aerosols in the mining region, and a platform for policy and private-sector engagement with the community.
The process of achieving change in policy is ongoing, but has encountered setbacks due to political change and jurisdictional disputes. Researchers necessarily represent only a fraction of the inputs and shaping forces of policy processes. These include the broader economy and societal context, the qualities of political leaders, and their responses to political pressure. The case studies describe many conditions that hinder the uptake of research by policy including: lack of demand for research; lack of knowledge translation processes or inadequate capacity in governmental institutions to act on research; lack of recognition by government of the importance or relevance of research findings; and the research community being perceived as hostile to government Carden Available at: www.
There are several strategies to overcome these pitfalls, and these too are exposed in the case studies. It helps if the project formulates an intent to influence policy and action. Researchers that employ networks for research collaboration can use these for policy advocacy see Chap. A communication and dissemination strategy that systematically introduces research into the policy process is also important Carden The preceding principles form the basis for implementing research using ecosystem approaches to health.
They are couched in an understanding that humans, and our social and economic systems, are embedded within ecosystems, and that these coupled social—ecological systems behave as complex systems. The knowledge generated by ecohealth research is intended for use by local communities and policymakers at local and wider scales. This set of principles is useful to understand the intent and process of ecohealth research, and to inform practice.
However, researchers seeking to design and implement ecohealth research also need some understanding of process. Since the s, many different frameworks have been developed to apply ecosystems theory to other problems, particularly those of environmental management. A framework facilitates the structuring of a research process so that findings may be ordered and systematically recorded.
Frameworks also inform the learning process because they provide a common language and set of methods and tools to allow different participants to share insights and learn together. Several research frameworks are consistent with an ecosystem approach to health. The process of choosing and adapting a framework can help develop or refine lines of inquiry and expose assumptions, omissions, and other potentially important information before the research gets underway.
Some frameworks address health, environment, and development issues e. WHO b , but do not meet the needs of researchers trying to make links between interacting social, economic, and ecological processes, and their influence on human health. Many researchers have since contributed important and practical lessons that informed the development of more explicit guidelines for implementing ecosystem approaches to health. But only a few practical manuals with a how-to approach have been developed e. Waltner-Toews A more explicit how-to approach can be found in adaptive methodologies for ecosystem sustainability and health AMESH , which guides investigators through an iterative process of understanding the interlinked social and ecological dynamics of the problem Waltner-Toews et al.
Many of the case studies in this book reflect research that was initiated before the publication of most of these frameworks. Many of them included an initial extensive conceptual phase of research that aimed to gather data to more fully describe the coupled social—ecological system context of the problem at hand. The case studies on malaria in East Africa, mercury in the Amazon, and urban ecosystem health in Kathmandu provide some salient examples, although this aspect receives limited treatment in the text due to space limitations.
The eco-bio-social study on dengue in Asia is based on a framework that emphasizes integration of methods to address the large and complex data sets generated in ecohealth research. It is not the intent of this book to identify a single preferred framework for implementing an ecosystem approach to health.
Few of the case studies in this book refer to any formal conceptual research framework beyond citing an ecosystem approach to health. However, some common patterns in the process of ecohealth research can provide insights on how positive outcomes can be achieved. This can be useful for researchers new to this approach as well as for those more experienced and interested in further reflecting on and refining their approach.
It is not meant to replace other frameworks. To do so would be a disservice to ecohealth researchers who seek to ensure that their research is appropriate to the problem and its context, and to others diligently striving to develop better frameworks and methodologies in this young field. Rather, the purpose is to map a common process of ecohealth research to assist in understanding how the case studies unfolded.
It may also inform further development of ecohealth research and practice, but this is not the goal. Many of the case studies point to this in their description of research that occurred in phases over several years. The studies on gold mining and pollution in Ecuador, drinking water quality in Lebanon, and mercury toxicity in the Amazon are cases in point. Each cycle consists of four overlapping phases: participatory research design; knowledge development; intervention strategy development and testing; and systematization of knowledge.
Within each phase there may be several iterations and adaptations of the process. Theoretically, an ecohealth research process can begin in any phase Fig. The process is not particularly unidirectional, and the demarcation between phases is not very distinct. The research process tends to move back and forth between these phases, for example jumping ahead to seize an opportunity for piloting interventions while still pursuing the collection and analysis of data.
The more transdisciplinary and participatory the project, the more likely will be the integration of data collection and analysis, the consensus around findings, and even the strategies for acting on the findings. This is because effective mechanisms for addressing different points of view and trade-offs around possible actions will have been developed over time through an ecohealth research process.
The transitions between phases seem to offer opportunities to reflect on what has happened and what has been learnt monitoring and evaluation and to validate the findings through peer-review, ground truthing, expert and stakeholder discussion , ideally coming to some consensus with relevant stakeholders on relevance and the way forward. But the case studies reveal that in practice it is hard to achieve this with any predictable rhythm or regularity.
Ecohealth research could be initiated in any quadrant, but tends to start in the top left with a participatory design phase. All of the case studies in this book represent research that included a participatory design phase. However, in quite a few cases, this came after a more conventionally academic initial design. The participatory design phase captures a series of activities common to most ecohealth research of this nature. During this part of the process, the investigation team becomes organized; ecohealth principles and frameworks are discussed and applied; and stakeholders are identified and included.
The team strives for consensus around goals of the research, possible methodological approaches, and consideration of the end-users of the research results. The research questions and methodologies are initially defined, with attention to integration across disciplines. The research team may consider a plan for transdisciplinary practice, integrated analysis, end-user engagement, and monitoring and evaluating progress toward project goals.
Data collection occurring in this phase informs a full description of the system context for the problem at hand. Social and gender inequities and ethical issues are considered in the design phase. There may be a redefining of research priorities or a narrowing of the elements of the system that will be studied.
Stakeholder power dynamics come into play and affect both team dynamics and the research design. A common vision for the way forward may be developed. As the research shifts into active discovery mode, this marks a new phase: knowledge development. This phase necessarily overlaps with its neighbouring phases because of the complex reality of field research. Although the knowledge development phase is familiar and exciting for most academic researchers, it is sometimes frustrating for community members awaiting some sort of change to occur in their problematic conditions. During this phase, research instruments are developed, integrated across disciplines, challenged, tested, and applied; samples taken and data collected; and gender and social analysis applied.
Analyses are undertaken, and new knowledge begins to emerge that informs a new understanding of the behaviour of the system, and the reasons for the problem. Research may be redesigned or new components added. Findings and progress are tracked, and refinements to methodological protocols recorded.
Research findings may generate new questions and trigger additional research. Through processes that were planned and evolved throughout the research, findings are systematically shared and validated among researchers, the community, and other stakeholders. As consensus emerges around various findings, strategies for action begin to emerge. Ideally, before any intervention begins, there is an opportunity to reflect on and disseminate knowledge gained and other progress made, and to revisit stakeholder analysis and the participation of stakeholders in developing a common vision for action.
The intervention phase describes a period of activities targeted at making a change. In participatory research, some aspects of intervention are likely to be underway at the same time as the discovery phase. In other cases, an intervention phase begins once enough knowledge has been acquired and validated to develop an action plan, or at least to begin testing various intervention ideas e.
The implementation of this plan ideally occurs within an evaluative framework so that its effectiveness can be gauged. The observed effects of these interventions and other actions contribute more information. But if successful, the ecohealth research process can move into a broader systematization of new knowledge and lessons learned about what works and what does not work. In the systematization phase, the knowledge gained from research and action is applied on a wider scale. Advocacy for policy change or new programs may be successful, resulting in new policies and programs based on research evidence.
There may be opportunities to test and apply knowledge and replicate interventions in other contexts. Knowledge translation is not relegated to the very end of the project. In participatory processes like those described here, there appear to emerge fast cycles generation of knowledge that requires immediate action and implementation and slower cycles that result in broader ecological, health outcome, and policy changes Gitau et al. To maintain long-term credibility as well as ethical conduct, it is often essential for the researchers to respond to the short-term implications of their findings, and sometimes to questions or needs not directly related to the main research question, as illustrated in the Bebnine, Lebanon case study.
The case studies reveal many idiosyncrasies that belie their common application of an ecosystem approach. The case studies in this book, each in their own way, reflect many principles of ecohealth research, but they do not all necessarily share a common framework or methodology. All of them have involved communities and other stakeholders in executing the research. All have strived for effective transdisciplinarity.
They have used different methodologies and tools to arrive at various kinds of results. Hundreds of IDRC projects and many others around the world have implemented these, and other, complementary approaches to develop the field of ecohealth. The field has emerged at the intersection of several others, including conservation medicine Aguirre , ecosystem health Rapport et al.
In keeping with the richness to be found among many different perspectives, there is more than one ecosystem approach to health. Likewise, there are many related schools of thought with a common goal to work across disciplines in pursuit of knowledge to help improve human health, ecosystems, and their sustainability. In addition, other recent ideas in public health, such as One Health Conrad et al. As such, they do not explicitly or equally emphasize each of the six principles of ecohealth research presented earlier — this framing of ecohealth principles is a new contribution of this book.
The case studies differ in style, with some emphasizing quantitative results, and others providing reflection on process. They are illustrations of experience, and are not intended to provide the reader with a road map to replicate the research. Other platforms exist to cover those needs, such as peer-reviewed technical publications, and most of this research can also be found there. Rather, for the first time, this book captures the accumulated experience in ecohealth research of dozens of researchers, working in four continents, over more than a decade.
Arranged in four thematic sections, the case studies bring experiences from the field where efforts to improve the lives of the poor are ongoing in response to agricultural transformations, pollution and environmental change, infectious diseases, and urbanization. With experiences from developing regions around the world, they illustrate how scientists from different disciplines and different countries have collaborated with communities and with leaders from industry and government to address tough problems of health related to environmental pollution, degradation, or change.
The case studies are followed by a chapter exploring the added value of ecohealth networks and their significance as part of an evolving trend in development research. The book concludes with a discussion and synthesis of lessons from the case studies, and implications for the field of ecohealth. Aguirre, A. Editor Conservation Medicine: ecological health in practice. Allen, T. Toward a Unified Ecology. Complexity in Ecological Sciences Series.
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