Surfaces: an interdisciplinary approach to enhancing health in a vulnerable rainforest setting

Overview

Sustainable development requires supporting good health (SDG 3) and protecting life on land (SDG 15). Papua New Guinea (PNG) has the third largest tropical rainforest on Earth, harbouring c.8% of global biodiversity. However, one quarter of the forests of PNG (New Guinea's eastern half) have been cleared or degraded, nearly half by commercial loggers servicing global commodity demands.

As clans own or claim 97% of PNG as communal property, they can be a major force for conservation. Yet to some remote communities with low levels of health provision, SDGs on health and biodiversity can seem in conflict. Without alternative options for development many communities take inducements from extractive industries, even when aware of the effects this will have on ecosystem services. At the same time, PNG is ranked 155 of 188 countries by SDG health indicator scores, only two countries outside sub-Saharan Africa scoring worse. The four most prevalent causes of health problems have remained unchanged for fifteen years, the third being skin disease, of which scabies is the most important.

Logging companies' offer of roads and income can decrease remoteness from health services, making desire for health a driver for forest destruction and erosion of health related ecosystem services. Conservation success in PNG thus requires synergies be developed with delivery of other SDGs, particularly those pertaining to health.

We mapped and piloted biological, anthropological, and medical methods to address SDGs on health and biodiversity, focusing first on scabies and fungal diseases.

Stage 1

  • Combined clinical and rapid anthropological assessments of medical needs in our partner communities, alongside primary care treatments as needed
  • Systematic mapping of evidence on integrated conservation and health programmes worldwide
  • A study of how the Wanang conservation agreement developed, based on interviews with those involved.
  • A survey of skin disease

Stage 2

  • Mobile health interventions
  • Skin disease Mass Drug Administration
  • Expansion of protected areas
  • Research on health impacts of PNG logging/conservation.

Based on this research, a follow-on project on 'Improving food security and protecting rainforest biodiversity and carbon stocks in indigenous communities recovering from COVID-19 in Papua New Guinea' was financed by the Higher Education Innovation Fund (HEIF) and co-sponsored by SSRP in 2021/2022.

In 2022/2023 a further small-grants fund building was granted to the team to continue this stream of work with a follow-on project on 'Supporting integration of conservation and public health in the upland forests of Bougainville and the lowlands forests of Sepu, Papua New Guinea'.

Timeline and funding

Timeline

April 2017-January 2020
Funding

SSRP funding (£99,973)

Methods

Since 2001, Sussex has built a collaboration through the Binatang Research Center (BRC) with a rainforest community (Wanang, Fig 1) who have established multi-stakeholder agreements to preserve their forest in the face of financial incentives from logging companies. Our SSRP-funded SURFACES project has:

  • Conducted a community health needs assessment
  • Mapped evidence on the efficacy of integrated conservation and health programmes worldwide
  • Recorded the history of developing the multi-stakeholder conservation agreement and research-rich environment at Wanang.

Findings

A medical needs assessment of the Wanang community (Fig 2) was carried out in July 2018 by Gavin Colthart and Jo Middleton, together with two Papua New Guinean BRC staff with expertise in local cultural norms and language, botany, social science research and conservation biology. They:

  1. Collected the medical history and clinically examined 132 of 189 village residents
  2. Treated most of those examined, the commonest conditions requiring treatments or referrals being: malaria, tokelua (fungal skin disease), tropical skin ulcers, yaws (skin condition), TB, plus assorted other infections, including one acute life threatening case
  3. Conducted four focus groups (6-12 individuals amongst: young men; older men; young women; older women) to establish perceptions of health problems and needs. The groups produced radically different lists of the top five health problems affecting the community:

    i) Older men: malaria, cancer, tokelua, lack of reproductive health services, respiratory problems/asthma.
    ii)Younger women: paediatric malaria, respiratory problems/asthma, maternal health, snake bites and generalised pain.

  4. Carried out semi-structured interviews with local leaders (clan leader and traditional healer; two teachers; regional councillor; conservation chairman) to establish attitudes and aspirations in relation to health and conservation.

One important emergent issue is how lessons learnt from local studies can be scaled up to inform practices at a larger scale. With this in mind, we will be conducting a similar exercise in a different context: eight communities evenly spaced along an altitudinal transect on Mt Wilhelm (PNG’s highest mountain) from 200m to 3700m above sea level.

As a direct result of this SSRP project, we have secured £355K from the Darwin Initiative (DEFRA) for a 3-year project to:

  • Incentivise and expand indigenous rainforest conservation by providing health services, specifically a nurse-staffed aid post at Wanang
  • Evaluate the integration of health services into tropical forest conservation in PNG and worldwide
  • Determine relationships between forest integrity and health in PNG, contrasting conservation and logging communities
  • Train students and staff in biodiversity surveys and conservation.

Conclusion

Remote forest-dwelling communities in PNG have challenging unmet medical needs. Provision of health services can incentivise such communities to protect their forests in preference to taking financial inducements from extractive industries.

Useful links

The team

Where we worked

  • Wanang Conservation Area, Papua New Guinea
  • Mount Wilhelm Conservation and Research Area, Papa New Guinea.

Follow-on project

Improving food security and protecting rainforest biodiversity and carbon stocks in indigenous communities recovering from COVID-19 in Papua New Guinea

Over the past 20 years, slash-and-burn agriculture has accounted for nearly 50% of New Guinea's forest loss, with the recent increased town to rural migration triggered by Covid-19 related economic retraction exacerbating the situation further. Bringing together Sussex, IDS and in-country partner expertise in biodiversity conservation, sustainable food systems, and health, the team will carry out integrated intervention research in Papua New Guinea (PNG) with the aims of improving food security, reviving the local food economy after COVID-19 and reducing pressure on rainforests that harbour high carbon stocks and biodiversity in three indigenous rainforest communities in PNG.

    • Project description

      The COVID-19 pandemic is causing economic slow-down in Papua New Guinea (PNG), and a resultant increase in land clearance for (primarily) subsistence agriculture as communities seek to consolidate traditional forms of resilience in the face of economic uncertainty in the formal money economy. This project brings together Sussex and IDS expertise in biodiversity conservation (Prof Alan Stewart and Richard Hazell, Life Sciences), sustainable food systems (Dr Domonic Glover, IDS), and health (Jo Middleton, BSMS). We will work with in-country partners to carry out integrated intervention research in PNG to improve agricultural practices in indigenous communities (SDG 1 No Poverty and SDG 2 Zero Hunger) with implications for nutrition and health (SDG 3 Good Health and Wellbeing), which will in turn help reduce subsistence-based clearance of highly biodiverse rainforests (SDG 15 Life on Land) in the Mount Wilhelm Conservation and Research Area which are significant carbon stocks (SDG 13 Climate Action). It is a stand-alone project to be funded by HEIF and contributions from our long-term local lead partner New Guinea Binatang Research Centre (BRC), with the active collaboration of indigenous partner communities who collectively manage the Mount Wilhelm Research and Conservation Area.

      PNG is an underdeveloped country with exceptionally high forest cover among tropical countries, hosting high biodiversity and large carbon stocks. New Guinea's rainforests are the third largest in the tropics, and it is the world's floristically richest island, hosting 5% of earth’s biodiversity. The traditional land rights of indigenous clans are recognised by the country's legal system, making these communities true stewards of the rainforests. These communities rely on shifting cultivation to sustain their livelihoods. This practice is putting increasing pressure on the rainforests as the growing population requires larger and larger areas to grow crops, while unimproved traditional farming methods yield little. Over the past 20 years, slash-and-burn agriculture has accounted for nearly 50% of the country's forest loss, with the recent increased town to rural migration triggered by Covid-19 related economic retraction exacerbating the situation further.

      Activities

      Mt. Wilhelm (4,509 m asl.) is the highest mountain in the country, with exceptional diversity of rainforests from lowlands to the timberline at 3,700 m a.s.l., followed by an alpine zone. It is home to half of all New Guinea bird species and belongs among the six floristically richest areas in the world. The experiment will focus on affordable and locally available methods to improve sweet potato yields. The project will conduct agricultural experiments with local farmers in villages at three altitudes: 700, 1700, and 2200 m asl to test methods for improving yields of sweet potatoes, the main staple food in these communities. Experiments will have a replicated random block design, with 5x5m plots including control and treatments with NPK industrial fertilizer, compost, and coffee pulp (organic waste from processing locally grown coffee) as fertilizer. Plots will be replicated ten times at each elevation and yields of sweet potato evaluated. The field trial will be conducted by local farmers and field assistants (who live in the partner communities that make up the Mount Wilhelm Research and Conservation Area) working with PNG nationals Shen Sui and Dr Francesca Dem (based at lead partner BRC). Supervisory support will be provided by Sussex staff, who have prior and ongoing other work at Mount Wilhelm. Hazell will primarily provide support to the in-country team via Zoom, whilst Middleton will already be based at BRC during part of this period on other health related research and will provide some in-country supervisory support as well as input into nutritional implications of the work (particularly as regards anaemia and malaria resistance).

      On completion of fieldwork Shen Sui will travel to University of Sussex in July for a three-week visit (paid by other funding). Whilst here he will (1) with Hazell (Life Sciences) carry out the data analysis, (2) receive capacity building training in additional research methodologies from Hazell (Life Sciences), Prof Stewart (Life Science), and Middleton (BSMS), (2) from Dr Glover (IDS) receive advice and guidance on the write-up of the work for publication and how it fits into the wider politics of food, and similar work elsewhere that aims to support indigenous sustainable agricultural practices, (3) present the work at Sussex and online as part of a wider University of Sussex Papua New Guinea Research Symposium, (4) work together along with the Sussex-IDS team to develop a Sussex led funding application for a large programme of follow-on work.

      Expected outcomes and impacts

      The project aims to (1) improve food security, (2) revive the local food economy after COVID-19, and (3) reduce pressure on rainforests that harbour high carbon stocks and biodiversity in three indigenous rainforest communities in PNG. The recommended agricultural practices resulting from the experiments will be described in a simple illustrated manual, 300 copies of which will be printed and distributed to farmers (approximately 1,500 local people impacted). The project will also contribute to capacity building in agricultural research in PNG by training and developing the expertise of an indigenous researcher (Shen Sui).

      Moreover, the research will contribute to economic recovery while making communities more self-sufficient and less dependent on future disturbances. It is expected that increased production will have positive outcomes for local food security and result in additional income as sweet potatoes can be sold locally and imported to the lowlands. Both these outcomes are especially important in the context of economic recovery from Covid-19 as (1) local communities have been increased by town-to-rural migration as a result of the pandemic and (2) tourism, an important pre-Covid income stream around PNG’s highest mountain which supported local jobs (porters, guides, lodging, housing, etc.) but has almost totally closed down. Although the latter it is likely to recover slowly in the next several years, the Covid-19 pandemic has demonstrated the longer-term need for food and income security independent of such disruptive events.

      In terms of SDG 13 climate action, indigenous communities in the focal area practice swidden agriculture in large rainforest areas of global importance for carbon sequestration (PNG forests sequester c3% of global forest carbon). Culturally sensitive improvement of traditional swidden agriculture will contribute to a reduction in deforestation and conserve not only the exceptional biodiversity in local forests, but also their carbon stocks, which are significantly higher than on agricultural land. Prior work by Sussex (including Hazell and Prof Stewart) across 43 nested plots in the same province of PNG estimated a similar area size of forest as that in the Mt. Wilhelm Research and Conservation Area stored 1,479,194 tonnes of carbon (Peck et al., 'Estimating carbon stock in lowland Papua New Guinean forest: Low density of large trees results in lower than global average carbon stock', 2017).

      Building on 22 years of collaboration between Sussex and BRC, this research project will create new opportunities to expand work into agriculture, and importantly brings into the collaboration for the first-time expertise in sustainable food systems at IDS (Dr Dominic Glover). The project has the potential to impact positively the livelihoods of indigenous communities in five other conservation areas elsewhere in PNG that the team already works with on biodiversity conservation.

    • Sustainable Development Goals

      This project examined the following SDGs:

      SDG 1 – No Poverty
      SDG 2 – Zero Hunger
      SDG 3 Good Health and Wellbeing
      SDG 13 Climate Action
      SDG 15 Life on Land 

      Find out more about the UN Sustainable Development Goals.

    • The team

      Principal Investigator

      Co-investigator

      Project Partners

    • Timeline and funding
      Timeline

      March 2022-July 2022
      Funding

      HEIF fund co-sponsored by SSRP (£34,479)
    • Where we worked

      Mount Wilhelm Conservation and Research Area, Papa New Guinea.

Follow-on project

Supporting integration of conservation and public health in the upland forests of Bougainville and the lowlands forests of Sepu, Papua New Guinea

    • Project description

      Building upon a fruitful 22-year collaboration on tropical forest conservation between the PI and the partner institute in Papua New Guinea (PNG) as well as on the previous successful SSRP-funded project (SURFACES), the research team will lay the foundations for the integration of health and conservation initiatives at two more sites in Melanesia: Bougainville Island’s upland forests and the lowland forests of Sepu, Papua New Guinea (PNG). This cross-school project will provide baseline data on indigenous health and biodiversity, needed for a ~ £5 million application to a UK Darwin Initiative. Additionally, medical treatment of urgent cases will be provided alongside data collection as in SURFACES. 

      PNG has the third worst combined health SDG metrics of any country outside Africa. During data collection the project team will provide much-needed clinical diagnoses, referrals, and urgent treatments to pro-conservation communities on Bougainville which have little access to healthcare services, with the intention of generating evidence of need sufficient to aquire funding for health service introduction (as sucesfully done at Wanang Conservation Area). In addition, the needs assessment results will also be given to the local health authority to support wider service planning.

      New Guinea contains the third largest remaining rainforest on Earth which is threatened by commercial logging driven by global commodity demands. Similarly, the East Melanesian Biodiversity Hotspot (which includes Bougainville) is under growing pressure from logging and extractive industries. As evidenced by the SSRP-funded SURFACES project at Wanang and the SSRP SURFACES mapping of similar interventions worldwide, integration of health services with indigenous-led conservation can lead to positive results for biodiversity, such as expansion of conservation areas. The baseline biodiversity data collected in this project will be key to the planned scale up of this approach via the application to Darwin Extra, while the process of collecting it will consolidate links between the project team and pro-conservation communities on Bougainville.

      This project will therefore support scale up of integrated action on good health and wellbeing (SDG 3) and conservation of life on land (SDG 15) in the threatened rainforests of Melanesia.

      Activities

      A health needs assessment as part of the SSRP-funded SURFACES project enabled Sussex to win £350,000 from the DEFRA Darwin Initiative to build and staff a clinic and expand the Wanang Conservation Area (Middleton et al. 2020. Sustain Sci), producing real-world impact (REF2021 Impact Case Study). In line with the SSRP Planetary Health Theme strategy, the team plans to scale up this successful approach by applying for a DEFRA Darwin Initiative Extra grant of c5 million GBP in October 2023, to set up similar synergistic projects across Melanesia. 

      Three PNG research technicians and a nurse from the New Guinea Binatang Research Centre will collect health and biodiversity data using protocols developed during SURFACES (inc. Middleton et al. 2020. BMJ Open), while Sussex researchers will analyse the data and prepare the overall application for Darwin Extra. As then, urgent cases will be treated alongside data collection given absence of existing medical care. Biodiversity surveys will include vegetation plots, bird point counts, line transects for butterflies, light traps for moths. The main output will be the Darwin application, but the team will also write two academic publications on the baseline data, and provide treatments to a medically neglected community. 

      Expected outcomes and impacts 

      The project is designed to provide baseline data on a new site to support an application in October 2023 for the Darwin Initiative Extra grant to expand the scope of integrated health and conservation initiatives across the wider Melanesian region. The impact will be both immediate (provision of much-needed medical supplies to remote communities and short-term employment for research assistants) as well as long-term, leading to a major grant proposal. 

      The team will support scientific capacity building through continued development of PNG paraecologist staff from New Guinea Binatang Reserch Centre during biodiversity surveys and publication write-up, resulting in two peer reviewed publications:

      • Community health service needs on Mt. Balbi and the Kunua Plains, Bougainville: a clinical assessment with parallel treatment of urgent cases. Target: The Lancet Regional Health Western Pacific (IF 8·559)
      • Ecological assessment of two primary forest sites in lowland and upland Papua New Guinea. Target: PeerJ (IF 3.061)

      The project team will treat urgent cases in medically neglected clans in the Mt Balbi and Kunua Plains area on the island of Bougainville. A summary of the health needs assessment results will, in addition to providing baseline data for the Darwin Extra application, be provided to the local health authority to support wider service planning.

      Moreover, as rural PNG society is extremely culturally diverse, having over 800 languages, healthcare support to communities from whom medical care is remote indirectly helps to maintain the integrity of linguistic and cultural diversity by fostering continued community cohesion and reducing internal migration to towns. 

      Finally, this project will continue to foster the long-standing partnership with New Guinea Binatang Research Centre and the interdisciplinary relationship between researchers across the University of Sussex (School of Life Sciences, Brighton and Sussex Medical School, and the School of Global Studies).

    • Sustainable Development Goals

      This project examined the following SDGs:

      SDG 3 Good Health and Wellbeing
      SDG 13 Climate Action
      SDG 15 Life on Land 

      Find out more about the UN Sustainable Development Goals.

    • The team

      Principal Investigator

      Co-investigators

      Project Partners

    • Timeline and funding
      Timeline

      May 2023-July 2022
      Funding

      SSRP funding (£19,948)
    • Where we worked

      Bougainville Island’s upland forests and lowland forests of Sepu, Papa New Guinea.