Improving food safety in Asia through increased capacity in ecohealth
Vol. 5(8), pp. 336-340, August 2013
DOI: 10.5897/JPHE12.009
ISSN 2006-9723 ©2013 Academic Journals
http://www.academicjournals.org/JPHE
Journal of Public Health and
Epidemiology
Full Length Research Paper
Improving food safety in Asia through increased
capacity in ecohealth
David C. Hall1*, Hung Nguyen-Viet2, Iwan Willyanto3, Dinh Xuan Tung4 and
Suwit Chotinun5
1Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary,
Alberta, Canada.
2Department of Environmental Health, Hanoi School of Public Health, Hanoi, Vietnam.
3Iwan Wilyanto, Animal Health Consultant, Surabaya, Indonesia.
4Department of Economy, Environment and Farming Systems, National Institute of Animal Science, Hanoi, Vietnam.
5Department of Food Animal Clinic, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai, Thailand.
Accepted 26 June, 2013
Interest has increased considerably in the last five years in transdisciplinary approaches to
addressing the precipitating factors of emerging infectious and zoonotic diseases. During this time,
several One Health and ecohealth initiatives have begun in Asia. This paper reports on
recommendations coming out of one such initiative (the Building Ecohealth Capacity in Asia project)
and outlines a strategy for promoting an ecohealth approach in research and in practice relevant to
prioritized concerns relating to reducing zoonotic disease in Asia. The three main aspects of the
strategy that are presented and discussed include: (1) Promote transdisciplinary approaches to
understanding the complexity of zoonotic disease that compromise food safety; (2) increase teaching
and application of ecohealth in medical sciences and other subjects relevant to food safety; and (3)
bring ecohealth and One Health approaches into health policy discussions, particularly where these
discussions influence policy formulation. Main constraints to applying such a strategy include limited
awareness and knowledge of ecohealth and One Health, lack of willingness to engage in a
transdisciplinary setting, restricted capacity to change academic curricula, rigid institutional
frameworks for problem solving, and availability of funding. Suggestions for reducing these
constraints are addressed.
Key words: Ecohealth, one health, food safety, zoonoses, medical education, Asia.
INTRODUCTION
Considerable interest has been generated in the last
decade in transdisciplinary approaches (crossing of
disciplines to generate a holistic approach) to address the
precipitating factors of emerging infectious and zoonotic
diseases (Charron, 2012; Hall et al., 2011). This has
been punctuated by a rapid growth of interest in One
Health and related philosophies, formation of several One
Health and ecohealth (Ecohealth is the participatory
transdisciplinary approach to understanding and
promoting health, including social-ecological interactions,
in the context of complexity of the interactions of animals,
humans, and the environment) initiatives in Asia,
*Corresponding author. E-mail: [email protected]. Tel: 1-403-210-7589. Fax: 1-403-210-9740.
Hall et al.
337
Questionnaire and follow-up
development of related networks, launching of
workshops, and creation of centres of excellence. Most, if
not all of these networks and collaborations recognize
that a joint approach to preventing and responding to
zoonotic disease requires improved communication,
sharing of knowledge and resources, agreement to work
together, and building capacity in skills and institutional
response to hazards and outbreaks.
Questionnaires handed out to workshop participants were also
used to gather data regarding views on the general usefulness of
the ecohealth approach, expected application, consideration of
working with other health and related disciplines other than one’s
own, and demographic data. At each of the first two workshops, 35
questionnaires were returned anonymously. Participants were free
to provide open comments. Follow-up with key participants was
also conducted on an email or personal communication basis to
solicit opinions regarding the potential applications of an ecohealth
approach. These data and observations were valuable to
developing some of the recommendations in this paper. As well, an
evaluation of the impact of the training and information received by
Vietnamese participants was conducted. The results of that
evaluation were also used for this paper.
Many of the hazards addressed by these One Health
and ecohealth initiatives are linked to food safety issues.
For example, microbial contamination of livestock
products, socio-economic factors related to marketplace
structure and producer involvement in participatory
surveillance programs. This paper offers suggestions for
the role of ecohealth in improving food safety in Asia,
based on discussions and other activities that have taken
place within the framework of one of the new ecohealth
initiatives in the region, the Building Ecohealth Capacity
in Asia (BECA) project. The BECA project, funded by the
International Development Research Centre (IDRC) and
AusAID, aims to build capacity for ecohealth research
and application through partnering with six Asian
countries (Cambodia, PR China, Indonesia, Lao PDR,
Thailand, and Vietnam). International trade in food
products, both imports and exports, will be an
increasingly important element of Asian economies over
the next decade (Hertel et al., 2007); building capacity in
ecohealth will support this growth while contributing to
national and regional ability to develop and comply with
food safety standards of local, regional, and international
stakeholders, improving food safety for Asian consumers.
RESULTS
From questionnaire results gathered at the BECA
Researchable Issues workshop, the three most important
researchable ecohealth issues identified are: (i)
prevention and control of emerging infectious diseases;
(ii) zoonotic disease including food borne disease; and
(iii) better understanding of the epidemiology of infectious
diseases. All of these researchable issues have clear
relevance to controlling food borne disease and to
improving food safety in Asia. Nevertheless, if research
and application in ecohealth in Asia is to be effective in
improving food safety, a number of additional issues
need to be addressed.
Institutions, complexity, and transdisciplinarity
MATERIALS AND METHODS
Workshops and discussions
A factor that complicates the application of an ecohealth
approach to food safety management is the level of
interaction that should occur within and between
institutions. This will not be news to anyone who has
worked with public health issues. It is not uncommon that
a single major public health concern, food safety for
example, is the charge of numerous agencies, ministries,
academic institutions, and industry representations.
Considering food safety, there are easily at least two
ministries involved in each of the Asian countries in this
study, and usually more (Table 1). The Government of
One of the main sources of motivation for the recommendations in
this paper is observation by the author during a series of workshops
held by the BECA project from 2010 to 2012 as part of training in
ecohealth. The ongoing workshops are designed to increase
knowledge in ecohealth and to generate interest in applying
ecohealth to local problems. Presentations from regional
participants emphasize application of principals to solving problems
that may engage participants in their respective agencies and
countries. Three workshops have been conducted (Fundamentals
of Ecohealth, Research Issues in Ecohealth, and Ecohealth
Influencing Policy) and the general stream of discussion during
these workshops added to some of the basis of this paper. More
than 100 participants have attended the workshops, and several
participants have attended more than once. Discussions during
workshops have been stimulated by task oriented problem solving
and break-out sessions, usually directed at applying some
component of an ecohealth approach to a particular health problem.
It is worth noting at this point the five pillars of ecohealth: (i)
transdisciplinarity; (ii) gender and socioeconomic equity; (iii)
engaging in a participatory process; (iv) recognition of complexity;
and (v) sustainability (Lebel, 2003).
Vietnam
cites
more
than
seven
major
ministries/directorates involved in food safety for example
(ASEAN, 2006) while the Government of China reports
ten (Government of PR China, 2011). Within each, there
are again several agencies responsible for various tasks
and duties related to food safety. This was the basis for a
common observation and main complaint of participants;
communication and knowledge sharing within and across
institutions is difficult, sometimes seemingly impossible.
Major reasons for this include: (i) lack of knowledge of
338
J. Public Health Epidemiol.
Table 1. Government agencies in six Asian countries with significant roles in food safety legislation and inspection.
Country
Agency
Ministry or Directorate
Department of Public Health, Department of Animal Health and
Protection
Ministry of Health, Ministry of Agriculture,
Forestry, and Fisheries
Cambodia
Institute of Food Safety Control and Inspection, State Food and
Drug Administration of China Veterinary Bureau, Bureau for
Agricultural Food Quality and Safety
Ministry of Health, State Council of PR China,
Ministry of Agriculture, Ministry of Agriculture
PR China
National Agency of Drug And Food Control, Directorate of
Veterinary Public Health, Directorate of Animal Health
Food and Drug Department, Department of Livestock and
Fisheries, Lab of X
Ministry of Health, Ministry of Agriculture,
Ministry of Agriculture
Ministry of Health, Ministry of Agriculture &
Forestry
Indonesia
Lao PDR*
Food and Drug Administration, National Bureau of Agriculture
Commodities and Food Standards, Department of Livestock
Development
Ministry of Public Health, Ministry of
Agriculture and Cooperatives, Ministry of
Agriculture and Cooperatives
Ministry of Health, Ministry of Agriculture and
Rural Development
Thailand
Vietnam
Food Administration, Department of Animal Health
*Not a WTO member, thus not signatory to the WTO SPS agreement, but developing a framework (April 27, 2011).
institutional structure; (ii) weak access to other agencies;
(iii) the chain of authority hampers communication; and
(iv) cultural barriers (for example, low respect for other
disciplines) constrain willingness to communicate.
Health initiatives; at the recent 1st International One
Health Conference, Melbourne, February 2011, there
were more than 600 delegates, many of whom were
attending a One Health or ecohealth related meeting for
the first time. From a Southeast Asian perspective, One
Health University Network in Southeast Asia has been
initiated by USAID in May, 2011 and committed by 16
faculties of public health, medicine and veterinary
medicine in four countries Indonesia, Malaysia, Thailand
and Vietnam.
Part of the difficulty is unwillingness to admit a lack of
knowledge, revealed during problem solving when one
requests the assistance of an alternate discipline. But of
course it is quite unreasonable to expect, for example,
that a veterinarian would be expert in all matters related
to toxicology, just as a physician cannot be expected to
understand all the socio-economic reasons behind
willingness to change behaviour. Food safety issues are
no less complex than other ecohealth problems and
require transdisciplinary approaches. This leads to the
first recommendation of this paper in developing an
ecohealth approach to food safety: food safety experts
need to promote and accept transdisciplinary approaches
to understanding the complexity of zoonotic diseases that
compromise food safety. There are good examples
where this is already happening to a degree, but there is
still much work ahead to forge transdisciplinary working
relationships.
When the BECA project leaders consulted participants
who represented academic or related Asian institutions
involved in training health professionals, they learned that
none were teaching
a
formal course in which
understanding of ecohealth or One Health was part of the
curriculum. Differences of opinion may exist on how this
should be addressed, but if ecohealth is to be applied to
food safety, there must be training beyond the
introductory level. This would include extended field
exercises, graduate education, training of field
practitioners, research activities, and engagement with
industry, government, and communities in solving real life
problems. The response from participants as well as
persons outside the project has been enthusiastic in
terms of developing course and programme options for
ecohealth courses (academic, industry training, research
institutions, etc.) but of course the reality of bringing this
to fruition is dependent on funding, leadership approval,
and teaching capacity. One of the proposals that came
out from different regional discussions was to gradually
integrate ecohealth or One Health concepts and practices
in the existing teaching modules that could be more
easily accommodated, such as environmental health,
epidemiology, nutrition, and food safety. This is the basis
Increased training and knowledge in ecohealth
A second major point (an expression of interest rather
than a concern) was for increased knowledge and
training in ecohealth and related topics. For each of the
BECA workshops, there were up to four times the
number of formal requests to participate than could be
accommodated.
Other ecohealth initiatives are
experiencing a similar high level of interest in training in
ecohealth. This is also the case with the many One
Hall et al.
339
for the second recommendation of this report: for
ecohealth to contribute to improvements in food safety in
Asia there needs to be increased teaching and
application of ecohealth in medical sciences and other
subjects relevant to food safety.
embrace a wide number of disciplines, are founded and
applied by those with sound competence (knowledge,
attitudes, skills, and awareness), and incorporate
ecohealth in the policy process to support their
effectiveness.
These
are
broad-sweeping
recommendations. They will require examination of the
requirements and resources needed for change as well
as the distribution of benefits, from the level of village
communities up to international trading partners.
Incorporating ecohealth in the policy process
A third area of high need and concern relative to food
safety in Asia is that of policy. From discussions with
numerous stakeholders including BECA workshop
participants, agency and ministry representatives,
persons working in food industries, and academics,
several general observations can be drawn. There is a
false impression among many stakeholders that the
process of policy formulation rests solely in the domain of
government. When asked who is responsible for policy,
most stakeholders will indicate some branch or agent of
government, from local to national and regional levels. In
fact, all stakeholders have a role to play in the policy
process, from identification and agenda setting, to
formulation and adoption, and implementation and
evaluation. This is particularly true of engaging in
dialogue with those who are executors or legislators of
policy; they may not be government representatives, but
they probably do hold some authority in governance
(from community to provincial to national levels).
Of these proposed changes, the third may be the most
neglected. The latter is important because of the strong
influence preferences and choices (including willingness
to examine and change their rankings) have on behaviour
change. This is just as true for behaviour affecting food
safety as it is for any other health issue in which policy
can have an influence. For these recommendations to be
considered regarding the role of ecohealth in improving
food safety programmes in Asia, we must consider the
constraints. It is not difficult to understand the value of
transdisciplinarity, for example, but genuine engagement
requires institutional investment and cultural change that
may
be
constrained
by
rigid
organizational
communication policies, agency ideology, or simply
mistaken perceptions of the value of the opinions of
others.
With respect to applying these recommendations for
the role of ecohealth in improving food safety in Asia,
probably the most important constraint is limited
acceptance for application of ecohealth to the many
opportunities that exist. Following BECA workshop
attendance, some participants have noted that while their
community, supervisor, or institution may support
ecohealth in concept, supervisors or directors are
constrained from making this decision by the complicated
and time consuming process of approval required from
high levels of authority. Where it has been successful in
application, transdisciplinarity has either benefitted from a
starting point of previously existing good relations and
communications between individuals across disciplines or
agencies (for example, the Government of Vietnam-UN
Joint Programme to Fight HPAI), or it has been the
product of a long and carefully cultured relationship for
the benefit of all stakeholders, such as the collaborative
work in food safety between Thai ministries, industry, and
producers (for a recent example of this collaboration see
Bangkok Post, 2011).
To encourage transdisciplinarity, it may be helpful to
start simply. For example, sharing knowledge with
colleagues in other disciplines through programme briefs,
including leaders or supervisors in post-training
information sessions, or inviting ecohealth practitioners
outside one’s area of expertise to meetings to share
experiences or approaches to food safety. The
importance of including producers and industry in such
activities should be emphasized. Discussions with
Comments
from
participants,
questionnaire
respondents, and results of semi-structured interviews
indicate that even for those stakeholders who have better
understanding of the policy process, there is a feeling
that community members are somehow too far removed
from the policy process to have opportunities for
engagement. For an ecohealth approach to food safety to
be of value, it is essential that stakeholders recognize the
importance of engaging with the policy process, at all
stages, at all opportunities, and with wide representation
from community members (that is, usually the persons
who ultimately are affected by policy).
The third recommendation of this paper is to bring
ecohealth and One Health approaches into health policy
discussions, particularly where these discussions have
influence on the policy formulation stage of the process.
Food safety policy formulation should be based on sound
science-based decision making, but for this to have
relevance input from members of the non-scientist
community is equally important, particularly as it relates
to preferences and choices.
DISCUSSION
The complexity of the issues surrounding food safety in
Asia demands systems of prevention and control that
340
J. Public Health Epidemiol.
academic leaders indicate that main constraints to
incorporating ecohealth education into a health science
curriculum are usually based on funding or availability of
knowledgeable instructors. Interest in ecohealth
instruction is high and administrators seem willing to
consider such changes, but unless the identified
constraints are addressed this is unlikely to change soon.
For this reason, workshops and related training programs
may be of high value until regular programmes are
established.
(AusAID). The grant holder and implementing agency is
Veterinarians without Borders/Vétérinaires Sans
Frontières–Canada. Project focal points who contributed
to workshop activities include Ly Khunbun Narann
(Cambodia), Boualam Khamlone (Lao PDR), and Fang
Jing (PR China). Contributions during meetings from
workshop participants are gratefully acknowledged.
REFERENCES
To increase engagement in the policy process, there
must be existence and awareness of opportunity. For
example, preparation and promotion of gatherings to
discuss food safety related topics (for example, village
discussions, town hall meetings) that will influence policy
decisions complete with a plan for dissemination of
meeting conclusions. Finally, ecohealth and One Health
are now on the interest lists of donors and implementing
agencies. It is timely to pressure donors to fund
collaboration, transdisciplinary approaches to food safety,
training in ecohealth, and dialogue with individuals and
institutions influential in policy formulation.
ASEAN (2006). ASEAN Australia Project, Strengthening ASEAN Risk
Assessment Capability to Support Food Safety Measures: VietNam
Country Food Safety Framework. ASEAN, Jakarta, Indonesia.
Bangkok Post (2011). Tainted fowl meat traced to chicken sales outlets,
viewed
June
14,
2011.
traced-to-chicken-sales-outlets>
Charron DF (2012). Ecohealth Research In Practice. In: Charron (ed)
Ecohealth Research In Practice: Innovative Applications of an
Ecosystem Approach to Health, Springer, New York, pp. 255-271.
Government of PR China (2011). China Laws and Regulations of
Foods, Drugs, and Cosmetics. "Food – Departmental", viewed June
11, 2011, <http://www.chinafdc-law.com/laws/list_1-0_5-119_1.html>.
Hall D, Le QB, Waltner-Toews D, Davidson J (2011). Building Capacity
for Ecohealth Research in Asia. EcoHealth. 7:S81-S82.
Hertel TW, Ludena AG, Rae A (2007). ‘Food and agricultural trade and
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Summer Meeting, Beijing, 8-9 July 2007.
ACKNOWLEDGEMENT
Lebel
J (2003). HEALTH: An Ecosystem Approach. International
Development Research Centre. Ottawa, Canada.
The BECA project is funded by the Canadian
International Development Research Centre (IDRC) and
the Australian Agency for International Development
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