Borderland Highlander Ethnic Minorities of Northern Thailand in Transition: Livelihoods,

Livestock, and Human Health

1EcoHealth-One Health Resource Center, Chaing Mai University, 2Cummings School of Veterinary Medicine at Tufts 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

Manoj Potapohn1, Kwanchai Kreausukon1, Chongchit Sripun Robert1, Lamar Robert1, Akeua Unahalekhaka1, Sumalee Lirtmunlikaporn1, Jennifer Steele2, Karin Hamilton3, Tawatchai

Apidechkul4, Bruce A. Wilcox5

Ecohealth 2012 conference, Kunming, China,15-18 October 2012

Outline of the presentation1.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.

• 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

Challenge of the hill tribes problem

Estimated hill tribe population in Thailand

Provinces Village (%)

Household (%)

Population (%)

Chiang Mai 571 (27.16)

58,245 (25.22)

244,291 (25.32)

Chiang Rai 290 (13.80)

28,160 (12.19)

130,054 (13.48)

Mae Hong Son 322 (15.32)

25,670 (11.11)

109,119 (11.31)

Others 919 (43.72)

118,921 (51.48)

481,452 (49.89)

Total 2,102 (100)

230,996 (100)

964,916 (100)

Source: Highland Research and Development Institute (2007)

Identities and home of the hill tribes

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 MethodsAssemble 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 ProjectFirst 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, MS/PHD Dissertation/MSS

Experiment, Study, MS/PHD Dissertation/MSS

Experiment, Study, MS/PHD Dissertation/MSS

Experiment, Study, MS/PHD 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 agricultureDiminished access to forests with increasing agricultural intensificationDegradation of native forest, biodiversity, water quality, and soils

Economics: Increased connectivity and mobility

Market access – for buying and sellingExtra- village/household income, remittancesAvailability 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 administrationIntegration of traditional with modern system of Thai leadership/organizationShift 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

Increasing Wealth

Inequity

Simon Kuznets, Nobel Economist, writing about 1960

Thailand Borderland Highlanders in TransitionThe Kuznets Curve

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/Ecosystem_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 factorshow 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 responsibleDevelop 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

Contextual determinants: Social, political, economic, and environmental forces

Regional

Global

Landscape

LocalFocal

Commerce, trade, development, agriculture, natural resources and Land use policy

Livestock, farm, production system, food chain

distal determinants

proximal determinants

Methods of analysis at different levels: , agriculture economics, environmental change, livelihoods, landscape/spatial epidemiology, transmission mode/dynamics, host-pathogen ecology, pathology

Host-parasite relations,Pathogen transmission cycles

Thailand Borderland Highlanders in TransitionThe Disease Emergence “Ecosystem

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”– Operational definition of health as the whole hill

tribe ecosystem – Sustainability of hill tribe ecosystem and its health

depends on a systems approach

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: