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INNOVATION IN LOCAL AND GLOBAL LEARNING SYSTEMS FOR SUSTAINABILITY
ENSURE HEALTHY
LIVES AND
PROMOTE
WELL-BEING
FOR ALL
Experiences of Community
Health, Hygiene, Sanitation
and Nutrition
LEARNING CONTRIBUTIONS
OF REGIONAL CENTRES OF
EXPERTISE ON EDUCATION FOR
SUSTAINABLE DEVELOPMENT
Editors:
Unnikrishnan Payyappallimana
Zinaida Fadeeva
www.rcenetwork.org
CONTENTS
Contents
Foreword by UNU-IAS 2
Foreword by UNU-IIGH 3
List of Abbreviations 4
About RCEs 6
Editorial 8
COMMUNITY HEALTH
1. RCE Grand Rapids 20
2. RCE Central Semenanjung 28
3. RCE Borderlands México-USA 38
4. RCE Greater Dhaka 48
5. RCE Yogyakarta 56
6. RCE Srinagar 62
WATER, SANITATION, HYGIENE
7. RCE Central Semenanjung 72
8. RCE Kunming 82
This document should be cited as:
Innovation in Local and Global Learning Systems for Sustainability 9. RCE Bangalore 90
Ensure Healthy Lives and Promote Well-being for All
Experiences of Community Health, Hygiene, Sanitation and Nutrition 10. RCE Goa 98
Learning Contributions of the Regional Centres of Expertise on Education for Sustainable Development,
UNU-IAS, Tokyo, Japan, 2018 11. RCE Srinagar 104
Editing:
Unnikrishnan Payyappallimana NUTRITION
Zinaida Fadeeva
12. RCE CREIAS-Oeste 112
Technical Editors:
Hanna Stahlberg 13. RCE Munich 122
Kiran Chhokar
14. RCE Mindanao 136
Coordination:
Hanna Stahlberg
Nancy Pham Way Forward 142
Design and layout:
Fraser Biscomb Acknowledgements 147
© The United Nations University 2018
Contacts 148
Published by:
United Nations University, Institute for the Advanced Study of Sustainability (UNU-IAS)
5-53-70, Jingumae, Shibuya
Tokyo 150-8925, Japan
Email: rceservicecentre@unu.edu
Web: www.rcenetwork.org/portal
The designations employed and the presentation of material throughout the publication do not imply
the expression of any opinion whatsoever on the part of UNU-IAS concerning the legal status of any
country, territory, city or area or of its authorities, or concerning its frontiers or boundaries.
The contributing authors are responsible for the choice and presentation of the facts contained in this
document and for the opinions expressed therein, which are not necessarily those of UNU or UNU-IAS
and do not commit either the University or the Institute.
Print ISBN: 978-92-808-4581-5
e-ISBN: 978-92-808-4576-1
1
FOREWORD BY UNU-IAS FOREWORD BY UNU-IIGH
Leaving No One Behind
‘Leaving no one behind’ is the global aspiration of the The Regional Centres of Expertise (RCE) network has grown The Preamble to the Constitution of the World Health This book offers fresh insights from 14 case studies by
Sustainable Development Goals (SDGs). The goals are over the last decade to 158 in number. The network has Organization (WHO) that entered into force on 7 April the Regional Centres of Expertise Network on ESD from
articulated recognising that progress in different sectors demonstrated, through multi-stakeholder partnerships 1948 defined health in holistic terms as “a state of complete different regions. The richness of its diversity, the breadth
are mutually dependent, and hence an integrated, yet and contextually relevant learning, that communities physical, mental and social well-being and not merely of its inter-disciplinarity, and the depth of its analyses are
targeted approach is required to achieve a global vision. can effectively deal with local sustainability challenges. the absence of disease or infirmity.” Since then, efforts bound to open new vistas in the discourse and policy
There is a critical need for linking such learning of local have been made to place health at the centre of socio- debates on health and sustainability.
We are now into the second year of implementing the implementations with sustainable policy initiatives economic development. In 1978, the WHO-UNICEF Alma
2030 Agenda for Sustainable Development. The current through systematic inquiry. Ata Declaration on Primary Health Care strongly reaffirmed Obijiofor Aginam PhD
progress report, released in July 2017, notes that the the centrality of health in socio-economic development, Deputy Director
implementation must be accelerated by the member This book is an expression of the deep commitment stating that “the attainment of the highest possible level of United Nations University – International Institute for
states involving key stakeholders. Although progress of the RCE network partners on ESD, health and well- health is a most important world-wide social goal whose Global Health (UNU-IIGH);
has been made on many fronts in health, the report says being towards the global sustainability agenda and a realization requires the action of many other social and Adjunct Research Professor of Law and Legal Studies,
malnutrition, maternal and under-five mortality remain key sustainable future for all. I take this opportunity to thank economic sectors in addition to the health sector”. Carleton University, Ottawa, Canada, and Visiting Professor,
challenges to date. By showing that the progress has been and congratulate every member who has actively engaged Integrated Research System for Sustainability Science
uneven, the report specifically calls for harnessing the with the communities in the respective regions, and Primary Health Care, as endorsed by the Alma Ata (IR3S), University of Tokyo
power of data to effectively track the progress of the SDGs. shared their experiences through this publication. Declaration, recognises individuals and the community
Having accessible, reliable, timely and disaggregated data as full participants and beneficiaries. Very important
has been a major challenge in international and national Kazuhiko Takemoto trajectories in international human rights norms,
systems of reporting. Director environmental principles, Millennium Development Goals
United Nations University – Institute for the Advanced (MDGs), and the recent Sustainable Development Goals
UNU-IAS, as a research think tank, has made a significant Study of Sustainability (UNU-IAS) (SDGs), to name a few, have evolved to shape policy
commitment to contribute towards evidence-based multi- debates locally, nationally, and globally on the inexorable
lateral policy processes through transdisciplinary research November 2017 linkages between human health and sustainability. These
and capacity building. In this context, the 2030 Agenda is linkages were the core of Our Common Future, the famed
an important focus area for the institute. report of the Brundtland Commission in 1987 that served
as a precursor to the United Nations Conference on
Health is a sustainability subject with diverse intersectoral Environment and Development in 1992.
linkages across several SDGs. The scope of SDG 3 – Ensure
healthy lives and promote well-being for all at all ages – is The Sustainable Development Goals are anchored on
broad and ambitious. As highlighted through these case the principles of “Leaving no one behind” and “To ensure
studies, sustainability education and participatory, multi- healthy lives and promote well-being for all at all ages”
stakeholder learning and action have significant impact (SDG 3). Health policies must strive to bring marginalised
in improving health, sanitation and hygiene, nutrition individuals, groups and communities from the peripheries
as well as overall well-being. Health promotion through to the core of sustainability.
increased health literacy is an important contribution
that the education for sustainable development (ESD)
community can offer for the effective implementation of
the 2030 Agenda and the Global Action Programme (GAP)
on Education.
2 3
LIST OF ABBREVIATIONS LIST OF ABBREVIATIONS
LIST OF ABBREVIATIONS
ABC Alliance of Border Collaboratives ESP Education Sector Plan ISAAA International Service for the Acquisition of Agri-biotech Applications SCI Spinal Cord Injury
ACA Affordable Care Act ESTM Escola Superior de Turismo e Tecnologia do Mar ISDD Innovative Solutions for Disadvantage and Disability SCP Sustainable Consumption and Production
ACPE American College of Emergency Physicians FAO Food and Agricultural Organization IUBAT International University of Business, Agriculture and Technology SDM Shared Decision-making
AF ALBA Farmers FCT-UNL Faculdade de Ciências e Tecnologia-Universidade Nova de Lisboa JMB Joint Management Body SDMC School Development Management Committee
AIAC Américas Immigrant Advocacy Centre Forestry Environment Plantation Crop and Permaculture Consultancy JMP Joint Monitoring Programme SFS Sustainable Food Systems
FEPPCAR
and Research
AIDS Acquired Immune Deficiency Syndrome LCA Life Cycle Assessment SFSP Sustainable Food Systems Programme
FGSMP Flagship Globally Significant Medicinal Plants
ANC Ante Natal Care LL/CDT Living Lab/Centro de Diálogo y Transformación Inc. SMPB State Medicinal Plant Board
Food Nutrition and Research Institute – Department of Science and
APAS Associação de Produtores Agrícolas da Sobrena FNRI-DOST LoC Line of Control STARs Sustainability Tracking, Action and Reporting in Schools
Technology
ASER Assessment Survey Evaluation Research FP Family Planning MAPs Medicinal and Aromatic Plants SUN Scaling Up Nutrition
ASR Academic Social Responsibility FRESH Focusing Resources on Effective School Health MASIA Malaysia Spinal Injury Association SUST Shahjalal University of Science and Technology
ATRDS Agriculture Training, Research and Development Station FRLHT Foundation for Revitalization of Local Health Traditions MDGs Millennium Development Goals SDGs Sustainable Development Goals
AYUSH Ayurveda Yoga Unani Siddha Homeopathy GAP Global Action Programme MDM Mid-day Meal SWOT Strengths, Weaknesses, Opportunities, Threats
BCHC Browning Claytor Health Centre GACP Good Agriculture and Collection Practices MEA Millennium Ecosystem Assessment TBH Teddy Bear Hospital
BMC Biodiversity Management Committee GCED Global Citizenship Education MGNRES Mahatma Gandhi National Rural Employment Guarantee Scheme TDU Transdisciplinary University
BMI Body Mass Index GDAP Global Disability Action Plan MIMPA Malaysian Integrated Medical Professionals Associations TERI The Energy and Resources Institute
BMU Borderlands México-USA GDP Gross Domestic Product MLD Million Litres per Day TLE Technology and Livelihood Education
CAP Centre for Aromatic Plants GEF Global Environment Facility MM Million ToT Training of Trainers
CBO Community Based Organisation GHG Green House Gas MOH Ministry of Health UGM Universitas Gadjah Mada
CDH Conservation, Development and Harvesting GMO Genetically Modified Organism MPCA Medicinal Plant Conservation Area UM University of Malaya
CE Community Engagement GoI Government of India MPDA Medicinal Plant Development Area UMMC University Malaya Medical Centre
CEE Centre for Environment Education GSMP Globally Significant Medicinal Plants MPI Movimento Pró-Informação para a Cidadania e Ambiente UNCED UN Conference on Environment and Development
CEET Centre for Environmental Education Training GVSU Grand Valley State University NBA Nirmal Bharat Abhiyan UNCRPD United Nations Convention on the Rights of Persons with Disabilities
CGEC Centre for Global Environmental Culture HAPPRC High Altitude Plant Physiology Research Centre NCD Non Communicable Diseases UNDP United Nations Development Programme
CIMAP Central Institute of Medicinal and Aromatic Plants HEI Higher Education Institution NEWT Nanotechnology-Enabled Water Treatment UNEP United Nations Environment Programme
Convention on International Trade in Endangered Species of Wild Fauna HIV Human Immunodeficiency Virus NGO Nongovernmental Organisation UNESCO United Nations Educational, Scientific and Cultural Organization
CITES
and Flora
HRDI Herbal Research Development Institute NP Nyaya Panchayat UNICEF United Nations Children's Fund
CLTS Community Led Total Sanitation
HVWSHE Human Values-based Water, Sanitation and Hygiene Education NRDWP National Rural Drinking Water Programme UNPD United Nations Population Division
CM Casa del Migrante
HWSN Health and Well-being Support Network NTFP Non Timber Forest Produce UNSCN United Nations Standing Committee on Nutrition
COMBI Communication for Behavioural Impact
ICT Information Communication Technology OCH Opportunity Centre for the Homeless USMBHC United States-México Border Health Commission
COTHN Centro Operativo e Tecnológico Hortofrutícola Nacional
IEC Information Education Communication OD Open Defecation USTC University of Science and Technology Chittagong
CPR Centre for Policy Research
IFAD International Fund for Agricultural Development ODF Open Defecation Free UTEP University of Texas at El Paso
CRC Cluster Resource Coordinator
IHR Indian Himalayan Region OVC Online-Video-Course VFC Village Forest Council
CRPD Convention on the Rights of Persons with Disabilities
iM4U I Malaysia for Youth PAA Priority Action Area VGtS Vegetables Go to School
CSIR Council of Scientific and Industrial Research
IMAM Islamic Medical Association of Malaysia PAHO Pan American Health Organization WASH Water, Sanitation and Hygiene
D1SC Dengue 1 Stop Centre
IMHERE Indonesia- Managing Higher Education for Relevance and Efficiency PHC Primary Health Care WEHAB Water, Energy, Health, Agriculture and Biodiversity
DET Disability Equality Training
IMPCL Indian Medicines Pharmaceutical Corporation Limited PHM People’s Health Movement WFP World Food Programme
DISE District Information System for Education
INE Instituto Nacional de Estatística PIAT Pusat Inovasi AgroTeknologi WHA World Health Assembly
DP Dorothy's Place
IPC Interprofessional Collaboration PSDM Pre-School Dengue Module WHO World Health Organizaton
EE Environmental Education
IPCC Intergovernmental Panel on Climate Change PSG-SCI Peer-Support Group for Persons with SCI WHR World Health Report
EEA Environmental Education and Awareness
IPL Politécnico de Leiria PTF Plataforma Transgénicos Fora WRD World Report on Disability
EFA Education For All
IPMA Instituto Português do Mar e da Atmosfera PWDs Programme for Persons with Disabilities WWF World Wide Fund
EFSA European Food Safety Authority
IPR Intellectual Property Rights RCE Regional Centre of Expertise on Education for Sustainable Development WWOOF World Wide Opportunities on Organic Farms
ER Emergency Room
IPSCI International Perspectives on Spinal Cord Injury SASS Safe Ag, Safe Schools 10 Year Framework of Programmes on Sustainable Consumption and
ESCO Escola de Serviços e Comércio do Oeste 10YFP
Production Patterns
SBM Swachh Bharat Mission
ESD Education for Sustainable Development
4 5
ABOUT RCES ABOUT RCES
GLOBAL MAP OF RCES
The ESD Programme at UNU-IAS has created a global network of more than 150
Regional Centres of Expertise on Education for Sustainable Development (RCE)
worldwide. The RCEs provide a framework for strategic thinking and action on
sustainability by creating diverse partnerships among educators, researchers,
policymakers, scientists, youth, leaders within indigenous communities and
throughout the public, private and non-governmental sectors.
Because of each RCE’s diverse network of partners and their wealth of local knowledge
and resources, they have the potential to transform the way we approach health,
sanitation, nutrition, and hygiene issues. As these topics are critically linked across
different sectors, RCEs are best equipped to tackle these issues. Globally, RCEs have
launched a number of ground-breaking ESD initiatives that address some of the
greatest health-related challenges we face today.
AFRICA & Greater Sudbury, Canada Srinagar, India
Mauricie/Centre-du-Quebec, Thiruvananthapuram, India
MIDDLE EAST Canada Tirupati, India
Buea, Cameroon Montreal, Canada Bogor, Indonesia
Cairo, Egypt Peterborough-Kawartha- East Kalimantan, Indonesia
Ghana Haliburton, Canada Yogyakarta, Indonesia
Jordan Saskatchewan, Canada Kitakyushu, Japan
Central Kenya, Kenya Tantramar, Canada Yokohama, Japan
Greater Nairobi, Kenya Toronto, Canada Chubu, Japan
Greater Pwani, Kenya Bogota, Colombia Greater Sendai, Japan
Kakamega-Western Kenya, Kenya Guatemala Hokkaido Central, Japan
Mau Ecosystem Complex, Kenya Borderlands México-USA, México Hyogo-Kobe, Japan
Mount Kenya, Kenya Western Jalisco, México Okayama, Japan
North Rift, Kenya Lima-Callao, Peru Kyrgyzstan
Nyanza, Kenya Georgetown, USA Central Semenanjung, Malaysia
South Rift, Kenya Grand Rapids, USA Iskandar, Malaysia
Lesotho Greater Burlington, USA Penang, Malaysia
Zomba, Malawi Greater Portland, USA Waikato, New Zealand
Maputo, Mozambique Shenandoah Valley, USA Bohol, Philippines Nuremberg, Germany
Khomas-Erongo, Namibia Cebu, Philippines
Kano, Nigeria Oldenburger Münsterland, Germany
ASIA-PACIFIC Ilocos, Philippines Ruhr, Germany
Lagos, Nigeria
Gippsland, Australia Northern Mindanao, Philippines Stettiner Haff, Germany
Minna, Nigeria
Greater Western Sydney, Australia Pacific Island Countries, Regional Central Macedonia, Greece
Port Harcourt, Nigeria
Murray-Darling, Australia Changwon, Republic of Korea Crete, Greece
Zaria, Nigeria
Tasmania, Australia Incheon, Republic of Korea Dublin, Ireland
Senegal
Western Australia, Australia Inje, Republic of Korea Euroregion Tyrol, Italy
Gauteng, South Africa
Greater Dhaka, Bangladesh Tongyeong, Republic of Korea Vilnius, Lithuania
KwaZulu Natal, South Africa
Greater Phnom Penh, Cambodia Ulju, Republic of Korea Açores, Portugal
Makana and Rural Eastern Cape,
Anji, China Cha-am, Thailand CREIAS-Oeste, Portugal
South Africa
Beijing, China Maha Sarakham, Thailand Porto Metropolitan Area, Portugal
Swaziland
Greater Shangri-la, China Trang, Thailand Rhine-Meuse Region, Regional
Dar es Salaam, Tanzania
Hohhot, China Southern Vietnam Nizhny Novgorod, Russia
Greater Eastern Uganda, Uganda
Greater Kampala, Uganda Kunming, China Samara, Russia
Greater Masaka, Uganda Tianjin, China EUROPE Vojvodina, Serbia
Greater Mbarara, Uganda Bangalore, India Middle Albania, Albania Barcelona, Spain
Lusaka, Zambia Chandigarh, India Graz-Styria, Austria North Sweden, Sweden
Harare, Zimbabwe Chennai, India Vienna, Austria Skane, Sweden
Mutare, Zimbabwe Delhi, India Belarus, Belarus Uppsala-Gotland, Sweden
East Arunachal Pradesh, India Czechia, Czech Republic West Sweden, Sweden
Goa, India Denmark East Midlands, UK
THE AMERICAS Guwahati, India Espoo, Finland Greater Manchester, UK
Chaco, Argentina London, UK
Jammu, India Bordeaux Aquitaine, France
Cuenca del Plata, Argentina North East, UK
Kodagu, India Brittany, France
Curitiba-Parana, Brazil Scotland, UK
Kozhikode, India Paris Seine, France
Rio de Janeiro, Brazil Severn, UK
Lucknow, India Black Forest, Germany
Sao Paulo, Brazil Wales, UK
Mumbai, India Hamburg, Germany List of RCEs as of November 2017
British Columbia, Canada Yorkshire & Humberside, UK
Pune, India Munich, Germany
6 7
EDITORIAL EDITORIAL
ENSURE HEALTHY LIVES AND PROMOTE WELL-BEING FOR ALL – mentioned in the framing “Ensure healthy lives and
promote well-being for all at all ages”. In the 2030 Agenda,
On water and sanitation, around 12% of the world
population does not have access to safe drinking water,
LEARNING FOR SUSTAINABILITY goals 1 to 6 (poverty, hunger and food security, health, and water scarcity affects 40% of the global population.
education, gender equality, and water and sanitation) A study by WHO and UNICEF shows at least 1.8 billion
Unnikrishnan Payyappallimana, Zinaida Fadeeva. directly address health and its immediate drivers and people globally use a source of drinking water with faecal
determinants. At the same time, nearly every goal is contamination (Eid, 2015). Mortality, due to preventable
closely linked with health (figure below). ‘Leaving no one water and sanitation-related diarrhoeal diseases is 1,000
behind’ is the global ambition of the SDGs, based on the children per day. According to Bartram and Cairncross
perspective that progress in different sectors is mutually (2010), this major disease burden occurs through lack of
dependent, requiring a more integrated approach. hygiene, sanitation and water access leading to diarrhoeal
1. Health and Well-being as part of the While there has been considerable progress, the MDG deaths (53%), malnutrition-related consequences (29%)
2030 Agenda, Intersectoral Linkages and approach has had its challenges such as “limited As we progress into the second year of implementation and protein energy malnutrition (7%). All these are
Challenges focus, resulting in verticalization of health and disease of the SDGs, much is desired in terms of the basic needs preventable through awareness and access to simple,
programmes in countries, a lack of attention to of health, hygiene, sanitation, and nutrition especially cost effective interventions. Apart from these, simple
The Millennium Development Goals (MDGs) brought in strengthening health systems, the emphasis on a ‘one-
fresh, targeted perspectives in addressing sustainable in low and middle-income countries. According to the sanitation and hygiene measures can prevent key public
size-fits-all’ development planning approach, and a focus SDG baseline data on child health, more than 5.9 million health problems like intestinal helminthiases, giardiasis,
development globally. Substantial progress has been on aggregate targets rather than equity” (WHO, 2015a).
made in the key target areas of the MDGs in terms of children died in 2015 before the age of five (UNDESA, schistosomiasis, trachoma, and numerous other globally
This has prompted the move to a more comprehensive, 2017), nearly 80% of child mortality occurs in sub-Saharan critical infections (Bartram and Cairncross, 2010).
reducing poverty, improving education and improving integrated approach through the Sustainable
access to safe drinking water. Progress has also been Africa and Southern Asia, owing to challenges such as
Development Goals (SDGs), thereby focusing more broadly poverty and lack of basic education (UNICEF, 2016). In Health-related challenges are not just of health indices or
made in terms of controlling HIV, Tuberculosis and on people, planet, prosperity, peace and partnerships
Malaria epidemics as well as in reducing child and maternal health, while recognising improvements in terms infirmities, but clearly include health system governance
(WHO, 2012a). The scope of health-related goals has of reproductive care, there exists major disparity among and service delivery at the community level. Ideally health
maternal mortality (WHO, 2015a) . also become wider and more ambitious, as explicitly regions – maternal mortality continues to be 14 times services should deliver quality assured, safe, effective,
higher in low and middle-income regions as compared appropriate and equitable health interventions, and
to economically developed countries. There is also the timely and reliable information for the communities.
continuing challenges of HIV/AIDS, Malaria and neglected Such a system should have an adequate workforce that is
diseases and newly emerging infections. The health responsive, competent and efficient with an appropriate
sector is also faced with the added burden of lifestyle distribution system in place to deliver quality services and
diseases, accidents and injuries, microbial resistance, a create awareness. A health system must be supported by
rise in behavioural risk factors such as smoking, alcohol adequate resources, be used efficiently, have appropriate
consumption, and sedentary lifestyle, new pandemics financial protection and should be led and governed
and emerging infections, and other morbidities related to by strategic policy and regulatory frameworks with a
climate change (Jamison et al., 2013). participatory, systemic approach and accountability (WHO,
2007). However, inadequate institutional arrangements,
In the area of nutrition, agriculture continues to be lack of universal access, irrational use of drugs, increasing
providing livelihoods for 40% of the global population expenditure on account of health and burden of out of
and is a major source of jobs and income for poor pocket spending among others remain major concerns
households. Yet paradoxically approximately 12.9% of the (WHO, 2010).
population in developing countries is undernourished.
Poor nutrition causes nearly 50% of under-five mortality
or leads to stunting in a major section of the population.
It is estimated that 75% of the crop diversity has been lost
in the last two decades in farms. Localising agricultural
development through small holder farming, improving
access to resources for women, increasing energy access
and enhancing crop diversity are considered important
ways forward for food security, improving nutrition,
livelihoods and resilient farming systems among the poor1.
Health in the SDG Era (WHO, 2016a).
1
Goal 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture http://www.un.org/sustainabledevelopment/hunger/
8 9
EDITORIAL EDITORIAL
2. Intersectoral, Participatory Health long health education, facilitated through formal and non- for effective outcomes as affirmed at the 8th Global money and resources, and putting in a mechanism for
Action – Historical Trajectory and formal means (Ottawa Health Charter on Health Promotion, Conference on Health Promotion held in Helsinki in 2013 monitoring and impact assessment (WHO, 2008a). There
1986). (WHO, 2014). At the local level, engagement of state and was also an increased understanding of the societal factors
Developments non-state actors and multi-stakeholder partnerships and principles such as structural determinants, freedom,
The WHO Constitution in 1946 envisioned a The World Health Report (WHO, 1999) – 'Making a have become an important mechanism for identifying capabilities, plurality, equity, access, rights, social security,
comprehensive view of health (which is well reflected Difference', released by the then WHO Director General challenges, interests and synergies as well as advocating and related policy and regulatory frameworks and their
in a frequently quoted definition) – “Health is a state of Gro Harlem Brundtland, highlighted that income and relevant policy changes and effective implementation. impact on health and well-being.
complete physical, mental and social well-being and not education were the key determinants behind health
merely the absence of disease or infirmity”. It was in Alma improvements in low and middle-income countries As evident in the two milestone multi-lateral In recent years there has been a growing realisation that
Ata (1978), that the need for urgent action in primary between 1960 and 1990. The Report also highlighted proclamations (Alma Ata on PHC and Ottawa Charter human health is also inherently linked to more complex
healthcare through a participatory approach to achieve the importance of poor nutrition, sanitation and other on health promotion), environmental, socio-economic scenarios of environment and development such as
‘Health for All’ was called for. It stressed the need for not connected factors to poor health, yet it called for focusing determinants of health and their interlinkages, as well ecosystem changes (Millennium Ecosystem Assessment,
just curative and institutionally delivered healthcare, but on the health sector than other sectors. as community participation and empowerment, have 2005), unequitable and unsustainable production and
preventive, promotive and rehabilitative services, and remained key priorities of the sustainable development consumption practices, and climate change among others
comprehensive and coordinated efforts across sectors The World Health Report 2008 ‘Primary Health Care – Now deliberations from the early years. At the Earth Summit (UN (WHO, 2012b). Several novel intersectoral perspectives
and communities. The declaration said “(health) involves, More than Ever’, reiterated the need for a focus on primary Conference on Environment and Development) held in Rio are emerging today on environmental determinants
in addition to the health sector, all related sectors and healthcare and community participation. “At the core of de Janeiro, in 1992, Agenda 21, the social and economic and health. This is driven by emerging new infectious
aspects of national and community development, in policy dialogue is the participation of the key stakeholders. dimensions section was directed towards combating diseases, rapid increases of non-communicable diseases,
particular agriculture, animal husbandry, food, industry, As countries modernise, their citizens attribute more value poverty, addressing consumption patterns, promoting rising morbidity due to ecosystem and climatic changes,
education, housing, public works, communications and to social accountability and participation. Throughout the health, and achieving a more sustainable population. increased awareness of challenges of chemical use in
other sectors; and demands the coordinated efforts of all world, increasing prosperity, intellectual skills and social human and livestock farming like antibiotics, fertilisers,
those sectors”. More importantly, “education concerning connectivity are associated with people’s rising aspiration The UN Millennium Summit in 2000 lead to the Millennium and pesticides in agro-ecological systems and so on (WHO,
prevailing health problems and the methods of preventing to have more say in what happens at their workplaces Development Goals (MDGs), with a fifteen-year action 2012b). One health, eco-social health, planetary health,
and controlling them; promotion of food supply and and in their communities − hence the importance of agenda, and a targeted action plan. All MDGs were global health, conservation health, biodiversity and health,
proper nutrition; an adequate supply of safe water and people-centredness and community participation − and critically linked to health either directly (eradicating and health pluralism are some of the terms that encourage
basic sanitation; maternal and child healthcare, including in important government decisions that affect their lives − poverty and hunger, reducing child mortality, combating links with these broader frameworks. The Lancet
family planning; immunisation against the major infectious hence the importance of involving civil society in the social HIV/AIDS, Malaria and other diseases, improving maternal Commission on planetary health (Whitme et al., 2015) well
diseases; prevention and control of locally endemic debate on health policies” (WHO, 2008b). health) or as indirect drivers (achieving universal primary highlights the integrated nature of human and planetary
diseases; appropriate treatment of common diseases education, promoting gender equality and empowerment health. The impact of climate change on health with its loss
and injuries; and provision of essential drugs” were Around the same time the Pan American Health of women, ensuring environmental sustainability and of biodiversity and subsequent ecosystem changes, plus
also highlighted as key strategies. Yet another unique Organisation publicised ‘Renewing Primary Health Care in global partnership for development). In a parallel the impacts of disasters, malnutrition, and the challenges
feature of the Alma Ata declaration is the inclusion of the Americas: A Position Paper of the Pan American Health development, in 2002, the World Summit on Sustainable of unsustainable production and consumption on health
self-reliance both at the individual and at the community Organization/World Health Organization’ (PAHO/WHO, Development (also known as the Earth Summit) set up have all been highlighted. Other new paradigms have also
level; participatory engagement in all aspects including 2007) which emphasised equity, solidarity, responsiveness several comprehensive frameworks and programmes broadened the mandate of health today, including human
planning, organisation of primary healthcare; utilisation to people’s health needs, quality orientation, government towards sustainable development, including the Decade happiness, well-being, ecosystem transition, preparedness,
of maximum local and national available resources; and accountability, social justice, sustainability, participation on Education for Sustainable Development (DESD). It prevention, alternative development indices, planetary
effective capacity building of communities to participate in and appropriate governance and intersectorality for was in Johannesburg, where an inclusive framework boundaries, risk society, commons, and coevolution,
planning and implementation. achieving the highest attainable level of health. It also for addressing certain basic needs such as food, water, to name but a few key words that help describe these
underlined the need for disease prevention and promotion shelter, sanitation, energy, health services and economic perspectives. Though the 13 SDG health-related targets
Keeping the Alma Ata spirit alive, the Ottawa Charter of health and active mechanisms to maximise individual security were discussed. This called for a distinct multi- do not reflect this breadth or complexity (WHO, 2015a),
(1986) at the first international conference on health and collective participation in health. By referring to stakeholder process, involving state and non-state actors, the framing of Goal 3 as ‘To Ensure healthy lives and
promotion organised in Canada, highlighted fundamental the People’s Health Movement Charter (2000)2 (which and resulted in a framework called WEHAB (Water, Energy, to promote well-being for all at all ages’ embodies this
prerequisites and resources for ensuring health viz. is the most widely endorsed people’s and civil society’s Health, Agriculture (food, nutrition) and Biodiversity and comprehensiveness and ambition.
peace, income, shelter, stable ecosystem, education, commitment to primary healthcare following Alma Ata), Ecosystems. Health, sanitation, and nutrition continued to
resource sustainability, food and nutrition, social justice PAHO reaffirmed the human rights aspect of health not be high on the agenda. A number of targeted multi-lateral participatory initiatives
and equity. The Ottawa Charter also focused on critical just in principle but action (PHM, 2000). have also been implemented on water, sanitation, hygiene
factors such as the need for self-help, social support, public Whereas the impact of socio-economic conditions of and nutrition, led by WHO and other multi-lateral agencies.
participation for achieving good health and the vital need Understanding the implications of health across policies societies and related policies on health and well-being Joint Monitoring Programme on Water and Sanitation of
for information sharing and capacity building through life and integrating health in all policies at multi-levels of is well established, this has also evolved and broadened UNICEF and WHO has been active on monitoring water
governance have been suggested as important strategies over the years into more systemic, transdisciplinary and sanitation targets of the MDGs. It also specifically
and strategic approaches. The Commission on Social has been collecting data on open defecation in different
Determinants of Health by WHO in 2008 was yet another regions since the UN International Year of Sanitation in
2
The People's Charter for Health is a statement of the shared vision, goals, principles and calls for action that unite all the members of the PHM coalition.
It is the most widely endorsed consensus document on health since the Alma Ata Declaration available in 40 languages. The People's Health Charter was milestone in broadening these perspectives on health. 2008. This gave impetus for WASH (Water, Sanitation and
formulated and endorsed by the participants of the First People's Health Assembly held at Dhaka, Bangladesh in December 2000. By building on ‘people It conducted a detailed assessment and came out with Hygiene) in a major way and in 2015, WHO announced a
whose voices have rarely been heard before’ and asserting that inequality, poverty, exploitation, violence and injustice as root causes of ill health of the targeted action areas such as improving daily living global plan to integrate WASH in its efforts to tackle 17
poor, PHM encourages people to explore self-reliant solutions for health, while also holding institutional governance structures both local and national
accountable for good service delivery. http://www.phmovement.org/en/resources/charters/peopleshealth conditions, tackling the inequitable distribution of power, neglected tropical diseases (WHO, 2015b). Other agencies
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EDITORIAL EDITORIAL
like UNESCO along with UNICEF, WHO and the World 3. SDGs Implementation – Strengthening Box 1 – The Global Action Programme (GAP) on
3.1 Health and Education – Reinforcing Issues
Bank have been focusing on FRESH (Focusing Resources Bottom up Multi-stakeholder Engagement “Health literacy empowers individual citizens and
on Effective School Health), initiated during the World education for sustainable development (ESD) aims at
for Health Promotion through Education two critical aspects in the attempt to contribute to “a enables their engagement in collective health
Education Forum in Dakar (2000) which culminated in the promotion action. A high health literacy of decision-
Dakar Framework for Action for Education for All (EFA) “…knowledge and understanding remain powerful world where everybody has the opportunity to benefit
tools in health promotion. Improving health literacy in from education and learn the values, behaviour and makers and investors supports their commitment to
and was further endorsed by World Education Forum in health impact, co-benefits and effective action on the
2015 (Sarr et al., 2017). As a joint programme of UNESCO, populations provides the foundation on which citizens lifestyles required for a sustainable future and for
are enabled to play an active role in improving their positive societal transformation”. The two ambitions determinants of health. Health literacy is founded on
UNICEF, World Bank and the WHO, by focusing on school inclusive and equitable access to quality education and
health and nutrition through simple education sector plan own health, engage successfully with community of GAP – transforming educational systems through
action for health, and push governments to meet their incorporating sustainability into educational processes life-long learning. It must be an integral part of the skills,
(ESP) intervention, this has been a cost-effective approach and competencies developed over a lifetime, first and
to community health as well as education sector goals. responsibilities in addressing health and health equity” and systems and to put education as a key strategy
(WHO and UNDP, 2016). to make development processes more sustainable – foremost through the school curriculum.”
UNESCO, through the Global Education First Initiative, Shanghai Declaration on Health Promotion, 2016.
focuses on health as one of the critical outcomes of quality provide further argument for engagement between
education and affirms the strategy “all children and young This passage, pointing at the individual and collective the learning institutions and other stakeholders
responsibility for developing sustainable health systems, for development. Such engagement is at the core The links between education and learning are well-
people have access to safe, inclusive, health-promoting recognised and positively acknowledged by a large body
learning environments” and quality education “develops allows us to call upon developing perspectives on health of the regional centres of expertise on ESD (RCEs).
and health education vis-à-vis individual and collective Priority Action Area 5 of GAP recognised the critical of knowledge. To appreciate the importance as well as
the skills, values and attitudes that enable citizens to lead complexity of this relationship, let us consider the issues of
healthy and fulfilled lives, make informed decisions, and and, consequently, to position health education in the importance of engagement at the local level for
realm of other significant factors impacting on healthy accelerating sustainability solutions. literacy, education and health education.
respond to local and global challenges” (UNESCO, 2016).
Other agencies like UN-HABITAT have been promoting lifestyles. The Ottawa Charter on health promotion in 1986
amply highlighted such inter-sectoral multi-stakeholder System thinking, anticipatory ability, normative, Levels of literacy are often correlated with other
unique programmes like the Human Value based Water components constituting human well-being as they
Sanitation Hygiene Education (HVWSHE) across Africa and participatory action, especially through educational strategic, collaborative, critical thinking, integrated
interventions, which were further endorsed by the problem-solving competencies and self-awareness affect a person’s ability to be employed and connected
Asia (UN-HABITAT, 2006). to effective engagement in community life. The most
succeeding Jakarta (1997), Bangkok (2005), Helsinki (2013) are some of the key competencies in sustainability
health promotion declarations and even as recently as the learning. UNESCO, in its recent publication (2016) convincing data come from the area of women’s education
Nutrition has also been well recognised as a multi- where the literacy rate, measured by years spent at school,
sectoral development issue. Scaling up nutrition was Shanghai Declaration (2016). on Education for Sustainable Development Goals
mentions key cross cutting competencies for is linked, together with other top ten indicators, to the
launched in 2010 to strengthen such multi-sectoral action well-being of women. The education of women positively
towards achieving nutrition goals. This was also further This approach to proactive action also resonated in the sustainability and learning outcomes relevant to all
UN Decade on Education for Sustainable Development. SDGs. Specific goal-related learning, cognitive, socio- correlates with a reduction in child mortality and fertility
strengthened through an interagency programme, rate, while, at the same time, contributing to the capacity
supported by FAO3, IFAD4, UNICEF, WFP5 and WHO in 2013 The post decade sustainable development agenda on emotional and behavioural learning objectives for
education, Global Action Programme (GAP) continues the learners and learning approaches and methods to learn (Feinstein et al., 2016). While the ‘case’ for literacy
as the UN System Network for Scaling Up Nutrition (SUN). is celebrated, literacy within education is often narrowly
It is well recognised that key drivers like health system to highlight local action as a critical area – accelerating are indicated. While these may sound quite academic,
sustainable solutions at the local level. GAP 5 reasserts it is important to integrate such capacity building understood and might not be enough to realise the dream
strengthening, functioning education systems, social of a healthy population. This brings us to the discussion of
protection, eradication of poverty and reducing inequality, the need for improving local partnerships and creating approaches in multi-stakeholder initiatives.
dialogue and learning spaces through upscaling and health education.
through a human rights based approach are basic
premises for nutritional improvement under the UN Global improving quality through formal, non-formal and As the SDGs reaffirm the need for a broadened focus,
informal education7. GAP calls for integration of Education a diversity of intersectoral development approaches The examples of some countries with high rates of
Nutrition Agenda. education show that general education (or education
for Sustainable Development (ESD) programmes and ESD and integrated action in health, it also calls for strong
perspectives into policies and planning across sectors participatory supportive action through multi-stakeholder alone) did not prevent the spread of communicable
The UN Standing Committee on Nutrition is a platform of diseases. While health education might contribute to
UN agencies to develop global strategies and initiatives (Box 1). This should include public authorities, academic partnerships at subnational, and local levels for health
institutions, schools, private enterprises, civil society system strengthening. The advantages of such an addressing this challenge, other factors such as power
on nutrition. The UN Decade of Action on Nutrition spans relations, gender, and social structures play decisive roles.
2016-2025. WHO along with UNICEF and USAID has also organisations, community based organisations, and other approach through social learning and participatory
informal education institutions in health. action is clearly on the one hand to conduct evaluation of For example, in Zimbabwe and South Africa, despite
focused on studying evidence of improved nutrition having the highest rates of literacy among African
achieved by improving WASH and how both programmes institutional services, but at the same time complementing
them with appropriate contextually relevant intersectoral countries, their HIV infection rates remain among the
can be integrated in the implementation (WHO, 2015c). highest in the world, especially among women (Kickbusch,
Recently, the 10-year Framework of Programmes on community engagement towards disease prevention and
health promotion. This could be through health sector 2001). In addition, the high rate of infection and mortality
Sustainable Consumption and Production Patterns was have been persisting among school teachers, once again
launched for Sustainable Food Systems (SFS), as a multi- actions or through ecosystem approaches in nutrition and
food security; through clean air and fresh water; or social highlighting the deviation from the degree of education-
stakeholder initiative, working on diverse aspects such as health correlation, but also criticality of other social and
food value chains, sustainable diets, food waste, raising of and cultural support and rehabilitation systems; as well
as improving local livelihoods. Whatever perspective is economic factors as well.
awareness, capacity development, and networking6.
chosen, a learning element, through posing appropriate
questions, critical review of the practices, documenting This assumingly has prompted UNESCO to create two
3
FAO – Food and Agricultural Organization of the United Nations
learning and innovations, and paying attention to the new strategic priorities “ensuring that all children and
4
IFAD – International Fund for Agricultural Development young people benefit from good quality, comprehensive
5
WFP – World Food Programme underlying assumption and values would have to be
6
Sustainable Food Systems Programme http://www.unep.org/10yfp/programmes/sustainable-food-systems-programme brought into participatory processes. sexuality education that includes HIV education, and
7
Accelerating Sustainable Solutions at the Local Level http://en.unesco.org/gap/priority-action-areas/local-level
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EDITORIAL EDITORIAL
ensuring that all children and young people have access to 3.3 Strengthening Alternative Worldviews on Health 4. Regional Centres of Expertise 4.1. Community Health
safe, inclusive, health-promoting learning environments” and Well-being Network on Education for Sustainable In this section, six interventions of community health have
(UNESCO, 2016). Development been covered, specifically health promotion programmes,
In the recent discussions on sustainability, there has been
fresh thinking on alternative worldviews and perspectives This publication shares the experiences of the multi- or improvement or advocacy for existing institutional
Taken from a broader perspective, education provides health services.
provided by diverse knowledge systems on health and stakeholder networking and learning approach of the
opportunities to find a better job, to choose a better living
well-being. The idea of holistic health traditions has existed Regional Centres of Expertise Network (RCEs), a unique
environment, to practice a healthier lifestyle, to gain access RCE Grand Rapids – By bringing together areas of healthy
for a long time, but recently there have been some new and innovative platform created during the UN Decade
to better health coverage and services, and potentially lifestyle and medicine, preventive strategies towards
frames of reference that allow mainstreaming of more on Education for Sustainable Development (UNDESD)
to better be able to adapt to changing circumstances. In health have been successfully practised by RCE Grand
holistic approaches. ‘To be established in one’s self or own to explore the challenge of local solutions for local
short, it can provide all the conditions that help secure Rapids. The Health and Wellness Programme of the RCE
natural state’ is optimal health according to some health sustainability challenges. After twelve years of existence,
the health of individuals and communities. The state of aims at proactive neighbourhood health, wellness, and
cultures (Payyappallimana, 2013). To achieve this, one RCEs have grown to 158 local and regional networks
health, including the existence of disabilities, impacts nutrition so that all residents’ well-being is increased and
must have a balance of physical, mental, spiritual, social across different continents. Each of the RCEs represents
on the ability to achieve the desired level of education use of medical emergency services is minimised. Such
and ecological dimensions of existence. This balance is diverse stakeholders, including educators, policy makers,
by affecting learners’ concentration and attendance. a strategy is based on engagement across sectors with
achieved through optimal equilibrium between a ‘being’ researchers, communicators, youth, community leaders,
Social factors, including family situations, community a goal to empower communities to take care of their
and their external surroundings. Based on this philosophy, representing public, private and nongovernmental
practices and traditions, and social and economic policies health, to be able to understand and interpret holistic and
there are distinct epistemological principles and practices organisations (Fadeeva et al., 2014).
all mediate the complex relations between health and specific health-related information, while providing the
for prevention and promotion of healthcare in local health
education. decision makers with reliable data for devising strategies
cultures. The idea of RCEs came about to tackle education for
sustainable development at all levels but with a strong to continuously improve people’s health and healthcare.
3.2 What Type of Education Are We Looking For? Importantly, the range of health providing facilities has
Similarly, the biopsychosocial model of health, a local focus. The basic tenet of the RCE is the creation of
Health professionals, development specialists, educational framework developed by Engel (1977), brings the whole a local knowledge base and governance structure for increased from emergency rooms to primary holistic
practitioners and many others who deal with the challenge concept of health from a purely biological realm into, as collective action, applied to locally relevant and culturally healthcare centres, including referrals of patients to Mercy
of advancing human well-being and ecological health, the name suggests, the psychological and social factors appropriate development. Most RCEs are hosted or Health, dental clinics, immunisations, and preventive
all agree that a simplistic or narrow understanding of of health. The concept has gained popularity with health actively facilitated by a higher education institution, where healthcare screening services, bringing a more coherent
literacy and education that is limited to reading, writing, professionals, making them consider the broader factors scientifically sound sustainability ideas and transformative approach to wellness and healthcare. Cross sectoral
and calculation does not serve individuals or society. In impacting on the health and well-being of individuals and education are being promoted. The multi-stakeholder planning is well articulated in this case study.
the context of the SDGs, health literacy is seen beyond communities, indicating that healthcare alone does not network has an inclusive approach in terms of bringing in
the ability to organise a health appointment or to follow provide health. Similarly the concept of ‘salutogenesis’ the maximum number of ‘actors’ as possible, and covers RCE Central Semenanjung – The community health
health advice. It puts an emphasis on a person’s ability coined by Aaron Antonovsky (1979), depicts an approach different forms and levels of education, including lifelong project on spinal cord injury (SCI) demonstrated a
to act on information for the benefit of themselves, their that focusses on the drivers of health and well-being learning. Diverse thematic areas have evolved within the way of establishing a system that facilitates patient
families and their communities. The reference to Education rather than focusing on morbidities or pathogenesis. networks over the years, with health and well-being a empowerment, self-care, and patient engagement in
for Sustainable Development (ESD) that specifies Booske et al., (2010) based on a Country Health Ranking strong area of engagement and interest. treatment decision-making. To achieve the objective, an
competences (Box 2) requires a change in the way of study highlights that medical care alone is responsible adequate understanding of the challenges and skills for
thinking on education towards transformation. for less than 20% of determinants of health, while socio- This publication is a collection of diverse experiences and care and self-care of the patients, and the communities
economic, environmental, and public health factors had reflections of the Regional Centres of Expertise across the was needed. In the field of health literacy, the ability to
Box 2 – Competences for sustainable development a much bigger role in achieving good health. While the world. The multi-stakeholder action in the RCE networks access and to interpret information is critical, yet not well
(Wiek et al., 2011) contribution of different factors will vary from region to is not a uniform or standardised approach. Diversity in established. Moreover, a paternalistic attitude towards
region, the need for attention to the social, economic, local networking, multiple views and methodologies rehabilitation by the doctors is still common. A three-
• Systems-thinking competence – ability to analyse political, and environmental factors is undisputed. These are nurtured within the network, thus there may not be pronged approach was offered to facilitate quality of life
different domains and scales of complex systems to clearly point to the possibility that such alternative models uniformity or shared standards across local experiences or for the SCI patients: 1) provision of a multidisciplinary
define relevant issues and develop problem-solving and frameworks can complement the current public in their descriptions. Broadly the case studies have been health education programme or SCI information package
frameworks health approach (Becker et al., 2010) and the need for the grouped under three areas – Community Health, Water, leading to a better understanding of health information
• Anticipatory competence – ability to analyse and development of fresh theories on health and well-being. Sanitation, and Hygiene (WASH), and Nutrition. Though and its use; 2) peer mentoring leading to quicker
evaluate the complex picture of the future in relation The two questions remain, what are the possible strategies they have been grouped in this way, most case studies integration into the community, guided by those who have
to sustainability issues for addressing how these factors are linked and what is the portray cross-sectoral linkages and actions. experience of this path; and 3) shared decision making
• Normative competence – ability to define and new role of education and learning in achieving this goal? about treatment options. While carrying the processes
reconcile sustainability values and goals through the meetings, critical learning of the challenges
• Strategic competence – ability to design and of the processes occurred. It appeared that the scope
implement actions toward sustainability of mentoring ranged from setting boundaries in giving
• Interpersonal competence – ability to engage with medical advice, to sharing sensitive information, and
sustainability actions; to collaborate as ‘a prerequisite finally to the financial practicalities supporting the process.
for all other competencies’. The project has demonstrated the critical need to build
learning communities for rehabilitation and healthcare
that will contribute to the social health of the society.
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