A call for reflections in Ecohealth research

The 21st century presents us with some of the most profound global challenges including food insecurity, climate change, emerging diseases, and antimicrobial resistance. Agriculture can be considered a nexus between these challenges and is both parts of the problem and the solution. For instance, intensifying agricultural food production (i.e. increasing use of inputs for higher yields per area) is essential to meet the current and future threats to food security. However, the intensive use of water and modern inputs such as pesticides and fertilizers can also lead to environmental degradation (1–3) and public health risks (4,5). Furthermore, in recent decades, agricultural intensification processes have been linked to climate change exacerbation, zoonotic disease emergence, and antimicrobial resistance (5–7).

Agriculture systems in developing areas, such as Southeast Asia, are especially vulnerable to the trade-offs between food security and ecosystem functions. Southeast Asia is a region facing rapid economic, population, and urban growth; resource competition and scarcity; and environmental change. Sustainably intensifying agriculture while maintaining ecosystem resilience will be challenging, yet urgently needed, given Southeast Asia’s complex developmental context and reliance on agriculture as the primary source of livelihood in the region (8). Indeed, Goal 2 of the Sustainable Development Goals is to “end hunger, achieve food security and improved nutrition, and promote sustainable agriculture” by 2030. Achieving this goal will require a better understanding of the intersection between human behaviour and motivations, health, ecosystems, and agriculture.

Ecosystem approaches to health (or Ecohealth for short) can be a way to address challenges facing sustainable agriculture, which calls for silos across human, animal, and ecosystem health to work together (9). Ecohealth projects initiate research and interventions that respond to an increasingly recognized gap: the need for systems thinking in addressing the roots of complex developmental challenges, and for regional transdisciplinary collaborations to define a common vision, co-generate evidence, and promote the translation of research findings into policy and action. Applying Ecohealth approaches to tackle complex issues, however, is a challenging undertaking, often requiring awareness and understanding of Ecohealth, commitment to Ecohealth principles (systems thinking, transdisciplinary, participation, gender and social equity, knowledge-to-action, and sustainability), and individual, institutional, and country capacity.

Ecohealth approaches have been developed in Latin America and Africa since the 1990s and were led mainly by Canada International Development Research Centre (IDRC). Its introduction to Southeast Asia was more recent in the late 2000s (10). Since then, more than 20 Ecohealth initiatives have been conducted in Southeast Asia with projects primarily focused on (re-) emerging infectious diseases. While Ecohealth approaches are widely being promoted, few have critically examined the tensions and challenges that Ecohealth approaches bring (11). Furthermore, although Ecohealth projects are designed to follow the six principles underlining Ecohealth approaches, a recent review found that many projects still fail to truly demonstrate transdisciplinary, participation, and equity (12). Incorporating a regional perspective in research, training, and policy translation have been suggested as a way forward to advancing Ecohealth (10).

As more and more projects are embracing Ecohealth approaches to address complex challenges such as agricultural intensification in Southeast Asia, there is a need to critically examine the lessons learned and challenges of such initiatives. This also means going beyond simply documenting successes and challenges to critically reflect on the processes of Ecohealth approaches. Our recent paper on applying Ecohealth approaches to address sanitation in the context of Vietnam attempts to capture some of these reflections (13). Such critical reflection is essential if we are to learn from our experiences and provide a foundation for future projects that seek to work within Ecohealth approaches and at the interface between agriculture, health, and the environment.



  1. Piya S, Kiminami A, Yagi H. Sources of Agricultural Productivity Growth in South and Southeast Asia. Trends Agric Econ. 2011;4(1):18–29.
  2. Tilman D, Cassman KG, Matson PA, Naylor R, Polasky S. Agricultural sustainability and intensive production practices. Nature. 2002;418(6898):671–7.
  3. Hoai PM, Sebesvari Z, Minh TB, Viet PH, Renaud FG. Pesticide pollution in agricultural areas of Northern Vietnam: Case study in Hoang Liet and Minh Dai communes. Environ Pollut. 2011;159(12):3344–50.
  4. Lam S, Nguyen-Viet H, Tuyet-Hanh T, Nguyen-Mai H, Harper S. Evidence for Public Health Risks of Wastewater and Excreta Management Practices in Southeast Asia: A Scoping Review. Int J Environ Res Public Health. 2015;12(10):12863–85.
  5. Richter CH, Custer B, Steele JA, Wilcox BA, Xu J. Intensified food production and correlated risks to human health in the Greater Mekong Subregion: a systematic review. Environ Health. 2015;14:43.
  6. Jones B a, Grace D, Kock R, Alonso S, Rushton J, Said MY, et al. Zoonosis emergence linked to agricultural intensification and environmental change. Proc Natl Acad Sci U S A. 2013;110(21):8399–404.
  7. Garnett T. Three perspectives on sustainable food security: Efficiency, demand restraint, food system transformation. What role for life cycle assessment? J Clean Prod. 2014;73:10–8.
  8. FAO. How to Feed the World in 2050. Food and Agriculture Organization. Rome, Italy; 2009. Available from: http://www.fao.org/fileadmin/templates/wsfs/docs/expert_paper/How_to_Feed_the_World_in_2050.pdf
  9. Charron D. Ecohealth research in practice. Innovative applications of an ecosystem approach to health. Ecohealth Research in Practice. IDRC; 2012. 305 p.
  10. Nguyen-Viet H, Doria S, Tung DX, Mallee H, Wilcox B a, Grace D. Ecohealth research in Southeast Asia: past, present and the way forward. Infect Dis Poverty. 2015;4:5.
  11. Anticona C, Coe A-B, Bergdahl I a, San Sebastian M. Easier said than done: challenges of applying the Ecohealth approach to the study on heavy metals exposure among indigenous communities of the Peruvian Amazon. BMC Public Health. 2013;13:437.
  12. Richter CH, Steele J a., Nguyen-Viet H, Xu J, Wilcox B a. Toward Operational Criteria for Ecosystem Approaches to Health. Ecohealth. Springer US; 2015;12(2):220–6.
  13. Pham G, Lam S, Tung DX, Nguyen-Viet H. (2018). Evaluation of an Ecohealth approach to public health intervention in Ha Nam, Vietnam. J. Public Health Manag. Pract. 24: S36-43.

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