Dynamic Drivers of Disease in Africa: Ecosystems, livestock/wildlife, health and wellbeing

Health is a critical aspect of human wellbeing, interacting with material and social relations to contribute to people's freedoms and choices. Especially in Africa, clusters of health and disease problems disproportionately affect poor people. Healthy ecosystems and healthy people go together, yet the precise relationships between these remain poorly understood. The Dynamic Drivers of Disease in Africa Consortium will provide a new theoretical conceptualisation, integrated systems analysis and evidence base around ecosystem-health-wellbeing interactions, linked to predictive models and scenarios, tools and methods, pathways to impact and capacity-building activities geared to operationalising a 'One Health' agenda in African settings.

Ecosystems may improve human wellbeing through provisioning and disease regulating services; yet they can also generate ecosystem 'disservices' such as acting as a reservoir for new 'emerging' infectious disease from wildlife. Indeed 60% of emerging infectious diseases affecting humans originate from animals, both domestic and wild. These zoonoses have a huge potential impact on human societies across the world, affecting both current and future generations. Understanding the ecological, social and economic conditions for disease emergence and transmission represents one of the major challenges for humankind today.

We hypothesise that disease regulation as an ecosystem service is affected by changes in biodiversity, climate and land use, with differential impacts on people's health and wellbeing. The Consortium will investigate this hypothesis in relation to four diseases, each affected in different ways by ecosystem change, different dependencies on wildlife and livestock hosts, with diverse impacts on people, their health and their livelihoods. The cases are Lassa fever in Sierra Leone, henipaviruses in Ghana, Rift Valley Fever in Kenya and trypanosomiasis in Zambia and Zimbabwe. Through the cases we will examine comparatively the processes of disease regulation through ecosystem services in diverse settings across Africa.

The cases are located in a range of different Africa ecosystem types, from humid forest in Ghana through forest-savanna transition in Sierra Leone to wooded miombo savanna in Zambia and Zimbabwe and semi-arid savanna in Kenya. These cases enable a comparative exploration of a range of environmental change processes, due to contrasting ecosystem structure, function and dynamics, representative of some of the major ecosystem types in Africa. They also allow for a comparative investigation of key political-economic and social drivers of ecosystem change from agricultural expansion and commercialisation, wildlife conservation and use, settlement and urbanisation, mining and conflict, among others.

Understanding the interactions between ecosystem change, disease regulation and human wellbeing is necessarily an interdisciplinary challenge. The Consortium brings together leading natural and social scientific experts in the study of environmental change and ecosystem services; socio-economic, poverty and wellbeing issues, and health and disease. It will work through new partnerships between research and policy/implementing agencies, to build new kinds of capacity and ensure sustained pathways to impact.

In all five African countries, the teams involve environmental, social and health scientists, forged as a partnership between university-based researchers and government implementing/policy agencies. Supporting a series of cross-cutting themes, linked to integrated case study work, the Consortium also brings together the University of Edinburgh, the Cambridge Infectious Diseases Consortium and Institute of Zoology (supporting work on disease dynamics and drivers of change); ILRI (ecosystem, health and wellbeing contexts); the STEPS Centre, University of Sussex (politics and values), and the Stockholm Resilience Centre (institutions, policy and future scenarios).

Many major policy studies - from UK Foresight to the UN - have identified the global dangers of disease emergence, especially from areas where understandings of disease dynamics, detection and response is poor. A recent report in PNAS (Chan et al., 2010) looking at all disease outbreaks globally showed how detection of infectious diseases and warning of emerging epidemics was extremely poor in Africa, yet the continent is the origin of half the world's outbreaks.

A 'One Health' approach, integrating human, animal and ecological health in a holistic framework, has been suggested as a response. But what should a 'One Health' approach look like, and how would it work in African settings? The DDDAC will gear its outputs towards producing the answers to these questions, ones being posed by policymakers across the globe. Through its detailed case study work, focused on four important, but often neglected, diseases in five locations across Africa, combined with broader modelling and scenarios work, looking at disease drivers and future impacts, the Consortium will build a 'One Health' toolbox for use by practitioners and policymakers in Africa. It will provide cost-effective methodological tools for developing an effective 'One Health' approach for the African setting.

Through its novel approach to interdisciplinary analysis of ecosystems, health, poverty and wellbeing, and particularly its focus on integration across scales, disciplines and sectors, DDDAC will contribute to the growth of the new cross-disciplinary fields of eco-health and socio-ecological systems, providing new concepts, frameworks and methodologies for a growing research and practitioner community.

Engaging potential users of DDDAC research will happen from the very beginning. Key users will cut across sectors - from environmental management to wildlife conservation to veterinary and health systems, as well as broader rural development actors. Research users will involve diverse government departments, non-government agencies, the private sector and local communities, and will stretch from the local to national to international levels. All country project teams involve a partnership between government officials in key departments (usually the DDDAC host) and university researchers. This allows the Consortium an important opportunity to link research directly with national policy, gaining access to high-level national policy discussions from the outset.

In order to establish a Consortium-wide approach to research communications and policy engagement, we will use an adapted Participatory Impact Pathways Assessment (PIPA) approach which has been used successfully within the STEPS Centre. This articulates well with the ESPA impact framework, and provides a practical methodology for implementing it. Early stakeholder dialogues in all project sites will allow DDDAC to engage with users in refining research design, map potential impact pathways and define an impact and engagement plan.

This plan will operate across scales from particular field sites, involving community actors, local officials and development projects, to national level debates cutting across environment, health and agriculture/rural development sectors to the international level, where UN agencies such as the WHO and FAO, as well as major environmental and development NGOs, are eager to engage with the Consortium to define a practical 'One Health' approach, grounded in solid, field-based evidence.