This article is the main component of a special supplement to the IJOEH. It is written by two scientists associated with the International Development Research Centre (IDRC), and outlines the origins, development, advantages and challenges of the IDRC's Ecohealth approach. It begins by tracing the evolution of Canadian thinking on the determinants of health, and the growing recognition of biophysical and social environments as health determinants. This is linked to the growth of concern for the natural environment in global and North American contexts, and the development of an holistic, multi-stakeholder, complex systems approach to environmental management by the International Joint Commission for the Great Lakes. The authors then briefly summarize relevant concepts such as nested hierarchies, the definitions of “an ecosystem” and “ecosystem health”, ecosystem services, and risk analysis, before reviewing some global environmental changes with health implications, and management frameworks (such as the WHO's DPSEEA approach) for dealing with them. This fairly lengthy discussion serves as justification for an approach to improving human health through environmental management, which is said to sometimes be more cost-effective than more traditional primary health care interventions. This approach – which serves as the basis for projects funded through the IDRC's Ecohealth program – is said to necessitate “transdisciplinarity”, community participation, and analyses that are disaggregated by gender and other relevant social divisions. These concepts are explained and justified in more detail, and demonstrated through the use of multiple case studies included as boxes in the main text. The authors then speak explicitly from their position as IDRC research personnel about the types of funding applications the Ecohealth program typically receives, and the ways in which these research projects typically evolve. Projects are originated by either health or environment specialists, who are said to often underestimate the complexity of the situations they are proposing to study, and the breadth of disciplinary expertises necessary to adequately manage them. The authors conclude by positioning research funded through the Ecohealth program within the broader field of sustainable development. They emphasize that Ecohealth projects aim to enable communities to continue ecosystem management beyond the end of the research's funded lifecycle, but that bilateral and multilateral development agencies should also contribute to ongoing programming based on Ecohealth results.
Reviewed contributed by Ben Brisbois