Conference Material > Abstract
Hopkins S, Hazel A, Pourtois J, Chamberlin A, Gajewski Z, et al.
MSF Scientific Day International 2023. 2023 June 7; DOI:10.57740/vj1f-v594
INTRODUCTION
An undervalued role of rural healthcare provision is its impact on forests and carbon balance. In addition to the effects of healthcare provision and livelihood programmes on improved human health, these programmes can also reduce forest degradation and prevent deforestation-related carbon emissions, since unaffordable healthcare drives logging as a source of rescue income. Shocks such as the Covid-19 pandemic may exacerbate this dynamic. Health In Harmony and Planet Indonesia are two planetary health non-governmental organisations (NGO’s) that work together with communities living in and around tropical rainforests in West Kalimantan, Indonesia.
METHODS
We used a cross-sectional mixed-methods survey in November-December 2021 to evaluate healthcare access and livelihoods in 1,016 households across six NGO-affiliated villages and four unaffiliated control villages. Additionally, satellite-generated imagery retrieved between January 2018 and December 2021 was used to contrast relative deforestation rates in 28 NGO-affiliated and 1,421 unaffiliated control villages bordering protected rainforests across Kalimantan.
ETHICS
This study was approved by the Stanford University Institutional Review Board and by the Institut Pertanian Bogor Ethical Review Board.
RESULTS
After accounting for environmental variables that affect deforestation, satellite analysis suggested that prior to the Covid-19 pandemic, average weekly deforestation rates in NGO-affiliated villages (0.018%; 95% confidence interval (CI), 0.012-0.026%) were 70% lower than in unaffiliated villages (0.062%; 95%CI, 0.045-0.078%; p<0.0001). Following the WHO pandemic declaration, deforestation rates dropped and then gradually rebounded in both NGO-affiliated and unaffiliated villages, with NGO-affiliated villages maintaining significantly lower average deforestation rates (0.008%; 95%CI, 0.005-0.011%) during the pandemic than unaffiliated villages (0.026%; 95%CI, 0.019-0.032%; p<0.01). Survey results indicated that clinic visits, out-of-pocket healthcare spending, and the proportion of households unable to access healthcare increased across all villages during the pandemic. The main reasons given for access problems were around fears of contracting Covid-19, unaffordability, or clinic closure. Throughout the pandemic, households affiliated with Health In Harmony, which runs a health clinic, were less likely to report barriers to affordable clinic access than households in unaffiliated villages (14% vs. 29%; odds ratio (OR); 0.41,95%CI, 0.2-0.69). Households in NGO-affiliated villages were more likely to do jobs with low environmental impact (e.g., small-scale farming, conservation; OR 1.61,95%CI, 1.15-2.24). Half of households in both groups reported income loss from at least one source during the pandemic, but households in NGO-affiliated villages were more likely to gain alternative income from multiple job types, especially resource-neutral jobs (e.g., public servant, sales, services). Additionally, households in NGO-affiliated villages had more sources of economic support, such as government programmes, co-operatives, family and NGO’s (OR 1.36, 95%CI, 1.11-1.69).
CONCLUSION
Communities with better access to healthcare and livelihood support were associated with significantly lower deforestation rates prior to the Covid-19 pandemic, and this lower reliance on forest-degrading income was resilient to the pandemic shock.
CONFLICTS OF INTEREST
None declared.
An undervalued role of rural healthcare provision is its impact on forests and carbon balance. In addition to the effects of healthcare provision and livelihood programmes on improved human health, these programmes can also reduce forest degradation and prevent deforestation-related carbon emissions, since unaffordable healthcare drives logging as a source of rescue income. Shocks such as the Covid-19 pandemic may exacerbate this dynamic. Health In Harmony and Planet Indonesia are two planetary health non-governmental organisations (NGO’s) that work together with communities living in and around tropical rainforests in West Kalimantan, Indonesia.
METHODS
We used a cross-sectional mixed-methods survey in November-December 2021 to evaluate healthcare access and livelihoods in 1,016 households across six NGO-affiliated villages and four unaffiliated control villages. Additionally, satellite-generated imagery retrieved between January 2018 and December 2021 was used to contrast relative deforestation rates in 28 NGO-affiliated and 1,421 unaffiliated control villages bordering protected rainforests across Kalimantan.
ETHICS
This study was approved by the Stanford University Institutional Review Board and by the Institut Pertanian Bogor Ethical Review Board.
RESULTS
After accounting for environmental variables that affect deforestation, satellite analysis suggested that prior to the Covid-19 pandemic, average weekly deforestation rates in NGO-affiliated villages (0.018%; 95% confidence interval (CI), 0.012-0.026%) were 70% lower than in unaffiliated villages (0.062%; 95%CI, 0.045-0.078%; p<0.0001). Following the WHO pandemic declaration, deforestation rates dropped and then gradually rebounded in both NGO-affiliated and unaffiliated villages, with NGO-affiliated villages maintaining significantly lower average deforestation rates (0.008%; 95%CI, 0.005-0.011%) during the pandemic than unaffiliated villages (0.026%; 95%CI, 0.019-0.032%; p<0.01). Survey results indicated that clinic visits, out-of-pocket healthcare spending, and the proportion of households unable to access healthcare increased across all villages during the pandemic. The main reasons given for access problems were around fears of contracting Covid-19, unaffordability, or clinic closure. Throughout the pandemic, households affiliated with Health In Harmony, which runs a health clinic, were less likely to report barriers to affordable clinic access than households in unaffiliated villages (14% vs. 29%; odds ratio (OR); 0.41,95%CI, 0.2-0.69). Households in NGO-affiliated villages were more likely to do jobs with low environmental impact (e.g., small-scale farming, conservation; OR 1.61,95%CI, 1.15-2.24). Half of households in both groups reported income loss from at least one source during the pandemic, but households in NGO-affiliated villages were more likely to gain alternative income from multiple job types, especially resource-neutral jobs (e.g., public servant, sales, services). Additionally, households in NGO-affiliated villages had more sources of economic support, such as government programmes, co-operatives, family and NGO’s (OR 1.36, 95%CI, 1.11-1.69).
CONCLUSION
Communities with better access to healthcare and livelihood support were associated with significantly lower deforestation rates prior to the Covid-19 pandemic, and this lower reliance on forest-degrading income was resilient to the pandemic shock.
CONFLICTS OF INTEREST
None declared.
Conference Material > Video
Bhutta ZA
MSF Paediatric Days 2022. 2022 November 30
English
Français
Journal Article > ResearchFull Text
Environ Health Perspect. 2003 August 1; Volume 111 (Issue 10); 1306-1311.; DOI:10.1289/ehp.5907
Muntean N, Jermini M, Small I, Falzon D, Fürst P, et al.
Environ Health Perspect. 2003 August 1; Volume 111 (Issue 10); 1306-1311.; DOI:10.1289/ehp.5907
A 1999 study heightened long-standing concerns over persistent organic pollutant contamination in the Aral Sea area, detecting elevated levels in breast milk and cord blood of women in Karakalpakstan (western Uzbekistan). These findings prompted a collaborative research study aimed at linking such human findings with evidence of food chain contamination in the area. An international team carried out analyses of organochlorine and organophosphate pesticides, polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs), and polychlorinated dibenzofurans (PCDFs) on samples of 12 foods commonly produced and consumed in Karakalpakstan. Analysis consistently detected long-lasting organochlorine pesticides and their metabolites in all foods of animal origin and in some vegetables such as onions and carrots--two low-cost components of many traditional dishes. Levels of PCBs were relatively low in all samples except fish. Analyses revealed high levels of PCDDs and PCDFs (together often termed "dioxins") in sheep fat, dairy cream, eggs, and edible cottonseed oil, among other foodstuffs. These findings indicate that food traditionally grown, sold, and consumed in Karakalpakstan is a major route of human exposure to several persistent toxic contaminants, including the most toxic of dioxins, 2,3,7,8-tetrachlorodibenzo-p-dioxin (2,3,7,8-TCDD). Intake estimations demonstrate that consumption of even small amounts of locally grown food may expose consumers to dioxin levels that considerably exceed the monthly tolerable dioxin intake levels set by the World Health Organization. Data presented in this study allow a first assessment of the risk associated with the consumption of certain food products in Karakalpakstan and highlight a critical public health situation.
Journal Article > CommentaryFull Text
Lancet Global Health. 2016 October 4; Volume 4 (Issue 10); e680-681.; DOI:10.1016/S2214-109X(16)30173-5
Stoett P, Daszak P, Romanelli C, Machalaba C, Behringer R, et al.
Lancet Global Health. 2016 October 4; Volume 4 (Issue 10); e680-681.; DOI:10.1016/S2214-109X(16)30173-5
Journal Article > ResearchFull Text
PLOS One. 2014 April 16; Volume 9 (Issue 4); DOI:10.1371/journal.pone.0093716
Greig J, Thurtle N, Cooney L, Ariti C, Ahmed AO, et al.
PLOS One. 2014 April 16; Volume 9 (Issue 4); DOI:10.1371/journal.pone.0093716
In 2010, Médecins Sans Frontières (MSF) investigated reports of high mortality in young children in Zamfara State, Nigeria, leading to confirmation of villages with widespread acute severe lead poisoning. In a retrospective analysis, we aimed to determine venous blood lead level (VBLL) thresholds and risk factors for encephalopathy using MSF programmatic data from the first year of the outbreak response.
Journal Article > CommentaryFull Text
J Clim Chang Health. 2023 September 9; Online ahead of print; 100270.; DOI:10.1016/j.joclim.2023.100270
Schwerdtle PN, Devine C, Guevara M, Cornish S, Christou C, et al.
J Clim Chang Health. 2023 September 9; Online ahead of print; 100270.; DOI:10.1016/j.joclim.2023.100270
Journal Article > LetterAbstract
Public Health Ethics. 2013 April 23; Volume 7 (Issue 3); DOI:10.1093/phe/pht014
Wurr C, Cooney L
Public Health Ethics. 2013 April 23; Volume 7 (Issue 3); DOI:10.1093/phe/pht014
Journal Article > Meta-AnalysisFull Text
Int Health. 2023 January 11; Volume 15 (Issue 5); 537-546.; DOI:10.1093/inthealth/ihac088
Perrocheau A, Jephcott F, Asgari-Jirhanden N, Greig J, Peyraud N, et al.
Int Health. 2023 January 11; Volume 15 (Issue 5); 537-546.; DOI:10.1093/inthealth/ihac088
BACKGROUND
Outbreaks of unknown aetiology in complex settings pose challenges and there is little information about investigation methods. We reviewed investigations into such outbreaks to identify methods favouring or impeding identification of the cause.
METHODS
We used two approaches: reviewing scientific literature and soliciting key informants. Case studies were developed through interviews with people involved and triangulated with documents available from the time of the investigation.
RESULTS
Ten outbreaks in African or Asian countries within the period 2007–2017 were selected. The cause was identified in seven, of which two had an unclear mode of transmission, and in three, neither origin nor transmission mode was identified. Four events were caused by infectious agents and three by chemical poisoning. Despite differences in the outbreaks, similar obstacles were noted: incomplete or delayed description of patients, comorbidities confounding clinical pictures and case definitions wrongly attributed. Repeated rounds of data collection and laboratory investigations were common and there was limited capacity to ship samples.
DISCUSSION
It was not possible to define activities that led to prompt identification of the cause in the case studies selected. Based on the observations, we conclude that basing case definitions on precise medical observations, implementing initial comprehensive data collection, including environmental, social and behavioural information; and involving local informants could save precious time and hasten implementation of control measures.
Outbreaks of unknown aetiology in complex settings pose challenges and there is little information about investigation methods. We reviewed investigations into such outbreaks to identify methods favouring or impeding identification of the cause.
METHODS
We used two approaches: reviewing scientific literature and soliciting key informants. Case studies were developed through interviews with people involved and triangulated with documents available from the time of the investigation.
RESULTS
Ten outbreaks in African or Asian countries within the period 2007–2017 were selected. The cause was identified in seven, of which two had an unclear mode of transmission, and in three, neither origin nor transmission mode was identified. Four events were caused by infectious agents and three by chemical poisoning. Despite differences in the outbreaks, similar obstacles were noted: incomplete or delayed description of patients, comorbidities confounding clinical pictures and case definitions wrongly attributed. Repeated rounds of data collection and laboratory investigations were common and there was limited capacity to ship samples.
DISCUSSION
It was not possible to define activities that led to prompt identification of the cause in the case studies selected. Based on the observations, we conclude that basing case definitions on precise medical observations, implementing initial comprehensive data collection, including environmental, social and behavioural information; and involving local informants could save precious time and hasten implementation of control measures.
Technical Report > Policy Brief
Smiley S, McIver L, Schwerdtle PN, Lugli M, Claire A, et al.
2021 October 21
This brief details MSF’s experiences providing humanitarian assistance in contexts heavily affected by climate change; adapting our operations to climate-related threats; and working to reduce our environmental impact. Much like the process of ‘greening’ this vast, global movement, this brief is incomplete, imperfect: it tells an infinitely complex story from a limited range of perspectives, and poses more questions than it answers as we grapple with emergent facts. Given the imminent existential threat presented by current levels of environmental degradation, these limitations can probably be forgiven. But as we witness the human toll and deep injustice of the climate crisis, silence is, once again, not an option.
Journal Article > ResearchFull Text
BMC Medical Ethics. 2015 June 2; Volume 16 (Issue 1); DOI:10.1186/s12910-015-0032-x
Shanks L, Moroni C, Rivera IC, Price DJ, Clementine SB, et al.
BMC Medical Ethics. 2015 June 2; Volume 16 (Issue 1); DOI:10.1186/s12910-015-0032-x
Community consultation is increasingly recommended, and in some cases, required by ethical review boards for research that involves higher levels of ethical risk such as international research and research with vulnerable populations. In designing a randomised control trial of a mental health intervention using a wait list control, we consulted the community where the research would be undertaken prior to finalising the study protocol. The study sites were two conflict-affected locations: Grozny in the Chechen Republic and Kitchanga in eastern Democratic Republic of Congo.