The Link Between Health and Biodiversity in Southeast Asia Through the Example of Infectious Diseases

Introduction

In Southeast Asia, the governments are increasingly aware of the importance of the biodiversity conservation for human development and ecosystems health, thus international documents are steadily translated into regional initiatives, engagements or legal instruments. This article aims to proceed backwards from the present to determine the main steps leading to the elaboration of the international instruments related to health and biodiversity and to present the ways they have been integrated and implemented. The point is to unravel the milestones of the international society involvement into issues regarding interrelations between health and biodiversity and highlight how these turning points are captured by international and regional governance.

1. The One Health Approach

The “One Health” (OH) approach, defined as “the integrative effort of multiple disciplines working locally, nationally, and globally to attain optimal health for people, animals, and the environment,” ¹ has been presented as a necessary “paradigm shift” ² in global health.

An inter-ministerial conference organized in Hanoi in 2010 by the European Union (EU) and the United States in partnership with the main international organizations has been decisive for the integration of the OH concept into the international governance. The Hanoi Declaration enjoined the participants to increase efforts to review pandemic preparedness plans and strengthen jointly human and animal public health systems. It did not mention how the environment is involved into the country strategies.

The link with the environmental side of the issue appears with the concern about wildlife health through the Tenth Conference of Parties of the Convention on Conservation of Migratory Species ³ which recognized the endorsement of OH approach by several international organizations and by the Scientific Task Force on Wildlife Disease.

The task force should elaborate on “evidence-based decision processes and tools that consider disease dynamics in the broader context of sustainable biodiversity/ecosystem management, agricultural production and food security, socio-economic development, environmental protection and conservation of migratory species, their habitats and migration routes.” ⁴

It aims to support the major conservation multilateral environment agreements (MEA) to encompass issues of livestock-wildlife-human-ecosystem health interface into their activities and resolutions through the promotion of the OH approach. ⁵

The resolutions regarding partnerships and synergies with MEAs are undoubtedly leading to strong influences between the different MEA mechanisms, movement fostered by the existence of the Liaison Group of Biodiversity-related Conventions. ⁶

OH is acknowledged by instruments of international environmental law but efforts should be focused on its integration within a coordinated framework where evidence-based research informs policy strategy. ⁷

In Southeast Asia, a number of conferences have highlighted the need of an integrated comprehension of the environment and health issues. The Association of Southeast Asian Nations (ASEAN) decided to target the issues linked with the animal-human-environment interface by creating the ASEAN Secretariat Working Group for One Health in charge of the coordination of diverse health-related initiatives. ASEAN is referring to an institutional coordination to maintain security in the case of pandemic but not to a comprehensive approach such as the one advocated by the OH.

2. Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES) and the Millennium Ecosystem Assessment (MA)

The complexity of the issues related to biodiversity and ecosystem services, their cross-sectoral and cross-scale nature, need to be addressed through strong scientific knowledge generated by the collaboration of different disciplines integrating best practices and knowledge of the civil society, communities, or beneficiaries of ecosystem services.

Decision makers mentioned the difficulty to access scientific results, the issues of reliability and independence of the scientific information or the improperness of data to decision making. Scientists, on their side, recognized their unfamiliarity with the needs and processes of policymaking and their will to produce relevant work. ⁸

An intergovernmental platform to strengthen decision making on biodiversity has been created to find appropriate responses to the deterioration of biodiversity. It accompanied a shift from a conservationist approach to a holistic vision comprehending conservation and sustainable use of biodiversity and ecosystem services. ⁹

The IPBES is intended to be an efficient science-policy interface mechanism able to improve policy-relevant information from all relevant sources about the state, trends, and outlooks of human-environment interactions. ¹⁰ Its four main functions ¹¹ are: knowledge generation; regular and timely assessments; support policy formulation and implementation; capacity building. It relies on an international group of renowned experts which should ensure the scientific credibility and independence of the IPBES work.

The experts identified the key features which might be included into the IPBES conceptual framework ¹² such as the need to integrate indigenous and local knowledge experts, policymakers, and relevant stakeholders. The existence of various temporal and geographical scales should be explicitly considered for a better understanding of the multi-scale impact of changes.

In 2013, an Asia-Pacific workshop on regional interpretation of the IPBES acknowledged that the region is expected to play an important role as it houses mega-biodiversity and large populations. ¹³ It proposed to create an IPBES Regional Hub to promote regional collaboration, the use of common methods, and to address assessments shortfalls. The purpose is to coordinate regional interventions to take into account trade-off dynamics, to address geographic imbalance, ¹⁴ and to ensure policy coherence.

The IPBES is resulting from the follow-up of the MA ¹⁵ presented in 2001 as “an international collaborative effort to map the health of our planet.” The MA assumes that a good environmental policy must be based on reliable scientific data and on comprehensive global assessment of the world's major ecosystems to deliver the appropriate responses regarding their conservation and their sustainable use. It provides a framework that allows understanding the dynamic interactions between people and other parts of the ecosystems, the drivers of change in ecosystems, and their effects on human well-being.

Ecosystem services are the benefits people obtain from ecosystems. The MA differentiates four categories of services: provisioning services; regulatory services; cultural services; supporting services.

The general results of the MA have shown that over the previous 50 years, humans have changed ecosystems more rapidly and extensively than in any comparable period of time and that almost 60% of the ecosystem services it examined were being degraded or used unsustainably.

The World Health Organization (WHO) report about MA (2006) was a “call to the health sector, not only to cure the diseases that result from environmental degradation but also to ensure that the benefits that the natural environment provides to human health and well-being are preserved for future generations” ¹⁶ in accordance with the principle of intergenerational equity which is a key element of sustainable development and a principle of international environmental law.

The report insists on the fundamental role of ecosystem services to the well-being and health of people everywhere and on the inherent needs of human biology for food, water, clean air, shelter, and relative climatic constancy. It recognizes the health sector responsibility for informing decision makers about the health effects of ecosystem changes and potential interventions. ¹⁷

3. New International Health Regulations (IHR) and Tools for Surveillance and Alert

The traditional approach to international disease spread changed with the acknowledgment that globalization of trade and increased international travel accelerated the risk of worldwide propagation of infectious diseases.

In 2003, the General Assembly of the United Nations recognising the need for greater international and regional cooperation to meet new challenges to public health and to control infectious diseases urged member states to give high priority to the revision of IHR. ¹⁸

The former IHR amended in 1973 covered only three diseases (yellow fever, plague, and cholera). The only obligations of the governments were to report those specific diseases to the WHO and to maintain the minimal public health capabilities at ports and borders.

The new IHR is an international legal instrument binding on all state members of the WHO giving a framework of global and integrated governance in order to achieve global health security. Its purpose is “to prevent, protect against, control and provide a public health response to the international spread of disease.” Its scope is now broadened to any extraordinary event that would constitute a public health emergency of international concern. ¹⁹ It takes into account the continued evolution of diseases and the factors determining their emergence and transmission. ²⁰ The WHO has now the possibility to get information from other sources than reports from the States.

Many MEAs, whether they relates to the ozone layer, climate change, or persistent pollutants, have health implications. Thus international environmental law plays an important role in the protection of health at the international level.

According to the IHR, the WHO shall cooperate and coordinate its activities with other competent intergovernmental organizations, ²¹ notably the Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (OIE). In that perspective, those organizations launched a Global Early Warning and Response System for Major Animal Diseases (GLEWS) in 2006: it builds on the added value of combining and coordinating their alert and response mechanisms for the international community, to assist in prediction, prevention, and control of animal disease threats. ²² They established a cross-sectoral mechanism (GLEWS+, 2013) for conducting joint risk assessments, aimed at formulating risk management options at the human-animal-ecosystems interface. It targets health events of potential international concern affecting domestic or wild animal populations, humans, or the food chain. ²³

At the regional level, different networks ²⁴ are supported by these organizations. Some networks ²⁵ participate in the improvement of cross-border infectious disease outbreak by sharing surveillance data and best practices in disease recognition and jointly responding to outbreaks.

4. Convention on Biodiversity Framework

Adopted in 1992, the Convention on Biodiversity (CBD) is considered as a landmark agreement in the environmental field. Its Preamble affirms that the conservation of biodiversity is a common concern of humankind. It is innovative in recognizing three levels of diversity and in being an all-encompassing agreement on conservation and sustainable use of biodiversity and natural resources.

It defines biodiversity as: “the variability among living organisms from all sources including, inter alia, terrestrial, marine and other aquatic ecosystems and the ecological complexes of which they are part; this includes diversity within species, between species and of ecosystems.” ²⁶

The convention sets out a framework for action with three main objectives: the conservation of biological diversity, the sustainable use of its components, and the fair and equitable sharing of the benefits arising out of the utilisation of genetic resources.

The CBD is a legally binding framework agreement requiring completion by additional international protocols. It establishes a body of flexible obligations that parties may apply through national laws and policies. ²⁷

The Secretary General of the United Nations stated the collective failure ²⁸ in achieving a significant reduction in the rate of biodiversity loss and underlined the higher priority to tackle biodiversity loss in all areas of decision making. ²⁹

In response, the parties decided to adopt ³⁰ the Strategic Plan for Biodiversity 2011–2020. This Plan includes five strategic goals subdivided into twenty targets with the commitment that “by 2050, biodiversity is valued, conserved, restored and wisely used, maintaining ecosystem services, sustaining a healthy planet and delivering benefits essential for all people.”

At the regional level, the ASEAN Centre for Biodiversity, an intergovernmental regional institution, facilitates cooperation and coordination among the ten ASEAN member states, on the conservation and sustainable use of biological diversity, and the fair and equitable sharing of benefits.

Nevertheless, the ASEAN biodiversity Outlook of 2010 confirmed that the region has been increasingly losing biodiversity and thus did not succeed in meeting its biodiversity targets.

The ASEAN Conference, “Biodiversity in Focus: 2010 and Beyond,” aimed to discuss the key biodiversity issues important to the region, including gaps and challenges. It notably insisted on the need to forge the inter-phase between policy and science, integrating different fields, such as social sciences, biology, and economics and transdisciplinary research to form the basis for decision-making support. ³¹

5. Global and Regional Strategies on Health and Environment

In 1992, the World Health Assembly requested the Director-General of the WHO to formulate a new global strategy for environmental health. ³² A year later the WHO presented its Global Strategy for Health and Environment in order to “bring to the forefront the health dimension of the environmental and development crisis.” ³³ Its main objectives are:

- achieving a sustainable basis for health for all;

The global strategy calls for broadened action for health and environment, a close cooperation with the other socio-economic development sectors, and puts health at the heart of the programs.

Meanwhile, a WHO interregional initiative has been launched to promote the involvement of the health sector in national planning for sustainable development and to prepare action plans for health and environment. ³⁴

In 1993, the WHO in South-East Asia Region (SEARO) adopted a regional strategic plan for health and environment which urged an important work on promoting national action plans in countries of the Southeast Asia region. ³⁵ The WHO SEARO insisted on the opportunity given to the ministries of health in preparing the World Summit (2002) to ensure that the place of health in sustainable development is fully appreciated by decision makers. In turn, it is assumed to enhance the place of health in regional and global developmental agendas. ³⁶

The WHO SEARO and Asia Pacific, the United Nations Environment Programme (UNEP), and the Asian Development Bank (ADB) decided to join in order to tackle the various problems related to health and the environment in the region and they finally establish the Regional Forum on Environment and Health. The general objective is to promote the implementation of integrated environmental health strategies and regulations both at national and regional level to address the need for policies which protect and enhance the environment and to improve the living conditions and quality of life “through enforceable legislation and other legal instruments.” ³⁷ It refers explicitly to the existing international environmental agreements and to international law principles such as the precautionary principle, the polluter-pays principle, and the norms of good governance. ³⁸

6. Sustainable Development: From the un Millennium Development Goals (MDGS) to Stockholm

The United Nations Millennium Declaration adopted unanimously in 2000 acknowledged collective responsibility of the member states to uphold the principles of human dignity, equality and equity at the global level. It called for a change in the current unsustainable patterns of production and consumption and prudence in the management of all living species and natural resources. ³⁹

The MDGs were set out to translate the key objectives contained in the Declaration into action. Many of those MDGs relate to health and one is concerning the need to ensure “environmental sustainability.” However, the linkage between health and environment is not endorsed by the MDGs even though it had previously been stated that the most critical health problems in the world would not be resolved without major improvement in environmental quality. ⁴⁰

The MDGs are now recognized “as the most successful global anti-poverty push in history” ⁴¹ as they guided concrete actions and improved coordination.

The MDGs target a “sustainable development” notion which started to be at the core of the international environmental policy with the Rio Conference of 1992 as the apparition of new global issues led the international community to adopt a cross-sectoral consideration of the environmental questions. ⁴²

The Rio Conference is considered as a major environmental legal landmark ⁴³ because of the CBD and the United Nations Framework Convention on Climate Change. It adopted the Forest Principles and the Agenda 21, an action program which contributed effectively to the promotion of health sector involvement in addressing health and environment issues. ⁴⁴ It led to the formulation or the reaffirmation of principles of particular importance for the development of international environmental law. ⁴⁵

Health is considered by the Rio Declaration in a very broad way illustrated by its first principle: “Human beings are…entitled to a healthy and productive life in harmony with nature.”

The link between environment and well-being has been affirmed in 1972 by the Stockholm Declaration which states: “Man has the fundamental right to freedom, equality and adequate conditions of life, in an environment of a quality that permits a life of dignity and well-being.” ⁴⁶ It led to the international recognition of the health dimension of environmental issues.

Considering the global extent of environmental problems and their impact on the international common realm, the Conference called for an increased cooperation among nations. ⁴⁷ The texts then adopted constitute the first comprehensive statements of international concern with environmental protection and one of the founding instruments of international environmental law.

The Stockholm Conference recommended the creation of the UNEP to promote international cooperation in the field of the environment. The UNEP finally played a larger role and has been the most active UN body in the development of MEAs and of international environmental law in general.

Conclusions

From the OH approach to the Stockholm Conference, we examined the main steps of the tendency to an integrative approach linking human and animal health within their ecosystems and the evolution of international governance in the areas of health and biodiversity.

International environmental law became a tool of global public health protection ⁴⁸ and advocates the integration of environmental protection as part of the development process. Since the Stockholm Declaration, the necessity of an integrated and coordinated approach to development compatible with the need to protect and improve the environment for the benefit of the population has been affirmed. More recently, the notion of well-being has been put at the core of the IPBES framework.

The IPBES is intended to follow a participatory, bottom-up approach, including the contribution of indigenous and local knowledge to the conservation and sustainable use of biodiversity and ecosystems. ⁴⁹ It should consider biodiversity and ecosystem services beyond their economic value and integrate the notions of co-viability, co-evolution, or resilience of socio-ecosystems.

Recalling that biodiversity is a common concern of humankind, the IPBES is hoped to be the appropriate framework to study the interlinkage between health and biodiversity to give shape to the notion of global environmental responsibility. It should provide findings encompassing the different dimensions of the well-being of the society in interaction with its environment which could ultimately help to address the issue of environmental justice.