We naturally and naively think that both environment and health are important. We imaginably and instinctively know that they are mutually linked positively; good health is being sustained by sound environment, and sound environment is indispensable for good health. But, the contrary happened in the past if we see the phenomena in the global level as shown below. The profound issue of "global health and global environment" is the lack of novel health concept suitable for the era of global environmental changes. We are stuck in the 20th century's health and development model. This RIHN project would like to propose "ecohealth" as the novel concept of environment and health for the future relation of humanity and nature.

 

In the last 200 years or so, especially in the 20th century, human health and hygiene indicators such as life expectancy and sanitation coverage improved dramatically (Riley, 2001), while the global environment has been deteriorated under the name of "development". Life expectancy is longer in the developed countries than the developing (or under-developed) countries, whereas ecological footprint or burden to the local, regional, and global environment is much bigger in the developed countries. According to the 20th-century's health and development model, development was thought as the solution for ill-health and poor hygiene. In this model, to be developed, to be industrialized, to be market-oriented, to be rich, to be clean, and to be healthy are thought as the inseparable, achievable and desirable goal, progress, and virtue for the human society as well as for the human life.

 

Innovation in science and technology, especially in the medical field, promoted this model. The modern health concept, that health is scientifically and objectively measurable, thus universal, pervaded . With the modern health concept, people started to be aware of their health, and put the value on it. Diseases became the problem which should be treated scientifically by trained specialist. Laymen were not allowed to raise objections against the decision of specialists. Then, the medical-oriented approach dominated the national and international health realm. Even the "Health for All by the Year 2000" and the "Primary Health Care (PHC)" advocated by World Health Organization (WHO) and UNICEF rely too much on the universal medical measures. The world believed that there is the universal and common goal of human health, and that the measures to attain it should be same. Control of infectious diseases such as malaria and filariasis was conducted by the standardized method all over the world. The medical-oriented approach based on the modern health concept was very successful in some parts and less successful in other aspects and areas. The outcome is the present world health situation.

 

While we (or some of us) are enjoying prosperity and health, there are large and ever-widening health divide/gap between rich and poor countries, and between rich and poor people within a country. To make things worse, the medical-oriented approach, being once thought as successful in the well-off countries, started to be less successful. With the demographic and societal changes, medical expense is rapidly increasing, and the medical service provision system is no more sustainable without further economic development. Should we count on further economic development? Does wealth enhance health in developed countries? The effect seems doubtful, witnessing the worldwide pandemic of obesity and other lifestyle-related diseases.

 

Limitation of the 20th-century's health and development model is now well-recognized. It does not pay attention to the environmental costs. It does not have the long-term sustainable view of the global level. Facing with the global environmental change (GEC), we need to change our way of life to mitigate GEC and adapt our societies to the coming GEC. We need to have the 21st-century's health and environment model. In order to do so the RIHN Ecohealth Project thought that we need to rethink the modern health concept itself.

 

Medical science, which is the foundation of the modern health concept, operationally see a living organism as an individual entity relatively independent from environment. it is prone to neglect personal historical experiences. Otherwise, medical science cannot deal it objectively. Medical science examines human itself with the same manner as examining cells, tissues, organs, or systems. We need not to blame medical science because of these. But, health concept in the 21st Century should not be based only on the medical science. As human health is related strongly with their ecosystem/environment, we should see human health and the ecosystem/environment as an integrated entity. This is the concept of "ecohealth"

 

The RIHN Ecohealth Project "Environmental Change and Infectious Disease in Tropical Asia" has conducted field researches in tropical monsoon Asia In summary, the field findings would be interpreted as follows: The health profile of a human population is a product of the human ecosystem (social-ecological system). Therefore, environment and health should not be separately studies. It should be recognized as an entity of ecohealth. From this viewpoint, ecohealth is unique for each ecosystem and each population. This means that strategies to promote good health should be unique for each ecosystem/environment. This view is very different from the universal goal and strategy of medical-oriented health.

 

What is needed now is, while understanding the diversity and uniqueness of local and regional ecohealth, to pursue the universal goal of sustainable global health for all. The project could not reach to this point. The project, however, accumulated the field data to elucidate the linkages between environmental changes and human infectious diseases in various setting of the tropical monsoon Asia. We think that this diversity of ecohealth itself characterizes the tropical monsoon Asia. The RIHN Ecohealth Project established good platforms and networks of ecohealth in this region. Using these platforms and networks, the project members both inside and outside Japan shall expand and deepen the scientific understanding and education/communication of ecohealth in this region.

The project has conducted field researches in Lao PDR, Vietnam, Bangladesh, and southern China in collaboration with various government and non-government institutions and projects. Main topics studied in Lao PDR were liver fluke and malaria infection in Savannakhet province. In the final report, we focused on conferences and meetings where the project results were presented.

 

Ⅰ. Studies in Lao P.D.R. : 1) National Institute of Public Health, Ministry of Health (NIOPH) and Savannakhet (SVK) Provincial Health Department were the major counterparts In Lao P.D.R. Japanese Consortium of Lao Health Research (JC-HR- Lao) was established and meetings were held 3 times in Japan with the participation of Lao counterparts 2) Since 2007 (the PR period), NIOPH organized the National Health Research Forum (NHRF) annually in collaboration with the RIHN Ecohealth Project. The NHRF is the first annual international gathering in the field of public health in Lao, offering the very unique and good opportunities especially for young Lao researchers and health staff. The number of participants were around 150. 3) The 6th NHRF was held in Savannakhet in September 2012. Many young researchers from NIOPH and health staff from the district level of SVK province participated in the forum. Some made poster presentation. 4) Results of the project study in the Lahanam HDSS (Health and Demographic Surveillance System) covering 7,000 people, and in the Sepon HDSS covering 4,500 people were reported. 5) By introducing the finger-vein bio-metric identification to the HDSSs (2012), linkage among various epidemiological data sets became feasible both in Lahanam and Sepon. 6) These HDSS sites are the first two HDSSs in Lao, and offering the study fields for PhD and Master course students both from Lao P.D.R. and Japan. 7) Follow-up parasitological stool examination for school children/students and their parents in Lahanam was conducted together with ecohealth education in schools. The same operation will be done in Sepon in March 2013. 8) Environmental liver fluke egg contamination study was advanced applying the environmental DNA analysis and the water analysis for E.coli. 9 ) Hazard map of potential Ov infection based on distribution of intermediate host snails in the water body was advanced. 10) Village health volunteers and health staff are getting active through the mobile-phone network and training/communication meetings. The fund for constructing the Sepon VHV training center is under review in MOFA, Japan. 11) Fact-finding investigation for bed-net use was conducted. 12) In the national level, in collaboration with Lao National University Faculty of Education, ecohealth curriculum and proposed and pre-tested. 13) The national first study on HIV and sexual behavior of sex workers were done in SVK in collaboration with National Center for Global Health and Medicine (NCGM). The Asia HIV/AIDS Research Network Meetings were held in 2011 and 2013. 14) Water quality map making was started in SVK covering all the health centers. 15) Research funds for continuing the similar studies were obtained. Then, the ecohealth study in SVK based on HDSS will continue.

 

Ⅱ. Studies in Vietnam (with the Khan Phu Malaria Research Center, Quang Tri Province)

1) The RIHN Ecohealth Project supported the multidisciplinary study in Khan Phu Malaria (ACHIEVEMENTS IN FULL RESEARCH, CONTINUED 1)

Research Center, by hosting the first Vietnam-Japan symposium on monkey forest malaria in 2010. Then, the JSPS AA-platform program was started. The two project collaborated and advanced the integrated malaria study in this area. The 2nd symposium was held in Nha Tran in February 2012 and the third one in Inuyama in December 2012. 2) The Border malaria control and joint research is now active between Sepon, SVK, Lao P.D.R. and Quang Tri, Vietnam. 3) Malaria study in Quang Tri Province, Vietnam was conducted and data on Lao patients were also collected. 4) Entomological study collaboration was started between Lao P.D.R. and Vietnam. 5) DNA of monkey malaria Pk was found in Vietnam and in Lao. But, we could not find monkey malaria Pk itself from human in these countries. This is very different from east Malaysia. 6) The Japan-Vietnam (and Lao) research team will continue to make this research after finishing the RIHN project.

 

Ⅲ. Bangladesh: Climate change and human health : Bangladesh International Symposium on Neglected Tropical Diseases (NTDs) were held in 2008, 2010, and 2012 in Dhaka. The project contributed much for this. 2) Japanese Consortium for Bangladesh Health Research (JC-HR-Bangladesh) was established in 2012 with the name change from Filaria-Free Bangladesh (established in 2008). 3) The collaborative research with ICDDR,B (International Center for Diarrhea Disease Research, Bangladesh) on climate/weather and health was advanced. 4) Filariasis study was advanced in north-western part of Bangladesh. Savar Filaria and General Hospital was open in the suburb of Dhaka. Further collaborative study on ecohealth is planned there. 5) Ecohealth environmental community activity named "Beautiful Bangladesh Ecohealth Initiative" to control mosquitoes and flies was started. The Initiative are involving filariasis victims/patients as community workers. 6) The project collaborated with the SATREPS Leishmaniasis Project in Bangladesh. A RIHN researcher will join to this project after finishing this project.

 

Ⅳ. Studies in China : Biannual International Congress on Ecohealth (Ecohealth 2012) was held in October 2012 in Kunming, China. The project participated in it as the only group from Japan. 2) Ecohealth community monitoring was conducted in 10 villages in Yunnan in collaboration with YHDRA, Yunnan Health and Development Research Association. A book was published. 3) Collaboration with Chinese CDC (Center for Disease Control and Prevention), Chinese Preventive Medicine Association, Hainan Provincial CDC, Fujian Medical University, Yunnan University, Kunming Medical University was promoted. The project results were reported at the first international forum for tropical diseases and the 4th international forum for sustainable vector management. Three group of the CDC delegates visited RIHN. 4) Other infectious disease network (mainly on HIV/AIDS) with Beijing, Shanghai, Fujian were made. 5) The history team collected data/reports on disease control in China (Schistosomiasis et al .)

 

Ⅴ. Ecohealth profile of the tropical monsoon Asia and global environmental change: 1) The project is establishing a network of ecohealth research in the Greater Mekong Sub-regions. 2) Through this network, we will continue to find out ways to provide solution for "health and ecosystem/environment" of resource-poor people to increase their capability and preparedness for coming local and global environmental changes.

Activities scheduled in FY2013: CR-1 will be conducted.

 

Other related projects are as follows:

 

1) DIAS-GRENEei Ecohealth Project (2012-2015) with the University of Tokyo 

 

2) Geo/Eco-health Project on Water Quality in Lao P.D.R.

 

On October 15-16, We shall join the 7th National Health Research Forum in Vientiane with NIOPH, and JCHR-Lao P.D.R.