Integrate Population, Health and Environment

            If we had unlimited resources we wouldn’t need to be concerned about human population. We live in a wonderful, rich world, but we need to share with such a large number of people and other living beings.

Some of the richest places on Earth have been called “biodiversity hotspots”. These 35 special areas are home to many endemic species—species that are unique to that one area. Although the hotspots make up only a small fraction of the Earth’s surface (about a 40th), they are home to such a variety of life that isn’t found anywhere else. The sad thing is that much of this wonderful diversity is already lost, and what is left is threatened with extinction.

Hotspots are also fertile spots. People are attracted to settle in them to exploit this productivity. Indeed, it is this humanity that threatens to destroy the fecundity. Fortunately a relatively new constellation of services offers help in a very humane way.

Population-Health-Environment (PHE) programs are the new way to slow damage to hotspots. Starting with the “E”, the first step is to help the local people be more aware of the value of the wonderful place where they live. The locals learn how they depend on ecosystem services, such as mangrove trees that serve as nurseries for fish. A clinic provides simple health care and health education, which are unusual in hotspots. Voluntary family planning is made available along with other health services. Often local women learn to be advocates for family planning and can administer certain modern contraceptive methods.

Many years ago we visited a PHE in Peru. It is the brainchild of an eccentric research scientist turned humanitarian, Eleanor Smithwick. Peru Amazon Conservation is based the small town of Atún Cocha. As Eleanor points out, the mestizo people there have lost their indigenous respect for nature. In the past they felled trees to sell for lumber, but didn’t replant; Eleanor taught them the value of raising saplings.

Eleanor recruited a local bilingual man, Clever Hoyos, to be the health educator. He taught about conservation as well as sanitation and nutrition. Together they set up a clinic that serves 14 villages and about 2500 people.

Their innovation was their family planning program. Most of the people live far from Atún Cocha along the river where the only means of transportation is a slow dugout canoe. On a certain Thursday every 3 months Clever would travel by boat to give DMPA (DepoProveraâ) injections. The women knew when to expect the boat and would be waiting at the dock. This was a very popular program, but unfortunately the cost of the medication rose so high that the program wasn’t sustainable.

A more recent and elaborate PHE program is half a world away in Madagascar. A British physician who loves to SCUBA dive became distressed by the destruction of the ocean life. Blue Ventures has an interesting combination of a nonprofit funded by a for-profit business. The for-profit arm features ecotourism and especially diving, but the nonprofit is more difficult to outline.

Blue Ventures not only conserves endangered species such as sea turtles and sharks, but engages the local children in conservation. They provide school scholarships to be certain that future generations are well educated. Because of the risk of overharvesting crops of fish, octopi and sea cucumbers, they have successfully instituted temporary fisheries closures, which have increased total yields—and the fishers’ incomes.

Health services focus on the basics—water and sanitation—as well as clinical services. They use many modalities to reach the people about health and conservation, including radio, interactive village presentations and school workshops using sports and theater.

Blue Ventures have trained 40 local women to provide voluntary reproductive health services to over 20,000 people in 50 communities. The contraceptive prevalence rate has gone from 10% to 55% in just 6 years. They calculate that voluntary family planning has averted more than 750 unintended pregnancies during this period. Most important, perhaps, is that the vast majority of people recognize the links between reproductive health, family size and food security. I wish that were true for more people in the USA!

To quote from the Blue Ventures’ website, “PHE programmes address the interconnected challenges of poor health, unmet family planning needs, environmental degradation, food insecurity, gender inequality and vulnerability to climate change in a holistic way.” They have great potential to keep biodiversity hotspots from being overrun by people. Just as important are the benefits to the people who live in these rich and beautiful areas.

© Richard Grossman MD, 2014

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Creative Commons Attribution 3.0 United States
This work is licensed under a Creative Commons Attribution 3.0 United States.