At the beginning of the 21st century, 191 nations committed to significantly reduce poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women. Since then, these Millennium Development Goals (MDGs) have served as a source of inspiration, guidance and frustration to governmental and non-governmental organizations. Progress has been made toward achieving some goals; others appear to remain stubbornly out of reach. In part, this has occurred because, while we have improved in our ability to articulate and measure MDGs, much less attention has been directed at how such complex, interacting goals can be most effectively achieved. The global Ecohealth community, with a strong history of investigating and testing processes to achieve such complex goals at the intersection, can contribute significantly to attaining the MDGs in a timely fashion.
What does Ecohealth have to offer?
The achievement of health as expressed in the MDGs is dependent on creating and maintaining healthy environments and societies. This requires broad cooperation among agencies and practitioners from a wide variety of intergovernmental, nongovernmental, and governmental departments and agencies, bringing a diverse set of skills and expertise to bear on the complex challenges posed by these lofty goals.
The challenge accepted by the International Association for Ecology & Health (hereafter ‘The Association’), and by ecohealth practitioners, is to bring these relevant sectors together in a meaningful way.
The Association acknowledges, and endorses, the long tradition of international and intergovernmental organizations that have recognised the link between human health and the environment, expressed as a series of statements, declarations and agreements (Supplementary Appendix A).
The Association reaffirms its commitment to a Call for Action from the International Ecohealth Forum in Merida in 2008 (Supplementary Appendix B).
Ecohealth research and practice has emerged with the concepts and instruments to be able to cross the boundaries formed by sectors, disciplines and knowledge cultures. It has all the attributes of public health, ecosystem management and sustainable development, and should be identified as belonging to these fields of human endeavour. Yet it has emphases that are beyond them in isolation. It stresses i) an understanding of the dependence of health on ecosystem services, ii) the centrality of social determinants of health, and iii) the involvement of communities in the solution of the problem of the human condition.
What is needed for the MDGs now, and what will the next iteration require?
Because of their inter-relatedness, and because they are deeply embedded in global progress toward sustainable development, we believe that the MDGs need to be explicitly situated within the Sustainable Development Goals proposed in The Rio+20 Outcomes Document, The Future We Want. Explicitly relating the MDGs to each other, and to the more broadly articulated SDGs, will enable more effective, integrative, sustainable action by all organizations involved. According to Paragraph 247 of the Rio+20 report, the SDGs ”should be action oriented, concise and easy to communicate, limited in number, aspirational, global in nature and universally applicable to all countries while taking into account different national realities, capacities and levels of development and respecting national policies and priorities.”
What contributions could be made now to improve MDG outcomes by 2015?
[The below is just an example ... simultaneous emphasis on process and outcome & relationships]
Undertake health impact assessments for policies and developments, incorporating an assessment of ecosystem services. Where trade-offs are being made, human health for ecosystem services, or vice versa, they need to be considered and valued according to principles of sustainability and equity rather than ignored or dealt with on financial terms only.
A people-centred approach in ecosystem management, which does not diminish the importance of biodiversity, will help achieve co-benefits of sustainable ecosystem management and the Millennium Development Goals. Resolving matters of trade-offs across levels of human involvement from the personal to the global, is achievable with dialogue, using a deliberative rather than hierarchical approach, to ensure the local interests of people are not marginalized by more powerful forces.
What could ecohealth contribute to the formulation of SDGs?
[Again, the below are just examples for discussion. These may change. Others may need to be added.]
Policy interventions are proposed to promote multiple interacting outcomes, cognizant of trade-offs, and hence be targeted at promoting cross-sectoral governance, organizational change to better enable collaboration across bureaucratic mandates, and action-oriented teams, with an overall goal to maximize the likelihood of ecosystems and human health co-benefits.
Ecohealth researchers and practitioners will facilitate the conceptual and structural move of research and action towards one that is adaptively oriented, and action-research based. Such a shift should occur not only at academic levels, but most importantly at civil society level, government (national, regional, local) and international (intergovernmental, non-government and multinational corporate) levels. Leaders in ecohealth will emerge at all of these levels and should be recognised accordingly by organisations proclaiming an ecohealth approach.
The strategic development of appropriate mechanisms to enable health costs to be satisfactorily included in development options and ecosystem management is recommended.
Rationalized incentive structures need to exist for the ecosystem services that currently sit outside of markets, in order to adjust inappropriate personal and institutional behaviours. Payments for ecosystem services that align incentives with conservation needs, and elimination of subsidies that promote excessive use of ecosystem services, are some of the policy approaches that can be taken. Incentive schemes and policies must aim at measures to reduce consumption, raise awareness, develop curricula, empower communities, promote participation in issues where the ecosystem - human health nexus exists.
Cross-sectoral partnerships for capacity building: improving communication, and empowerment of groups particularly dependent on ecosystem services or affected by their degradation, including women, indigenous people, and young people, will improve the likelihood of a double dividend: improved health outcomes and better management of the ecosystems that provide ecosystem services.
Identifying principal partners and responsible stakeholder groups, often across disciplines and between sectors where barriers and boundaries exist, requires a particular form of engagement and skill set: humour, patience, tolerance, and a willingness to reciprocate. These engagement skills need to form part of national curricula, a form of sustainability literacy.