A decade of One Health and Ecohealth in Southeast Asia: Inventory and perspectives

South East Asia (SEA) is a hot spot for diseases emergence as demonstrated for HPAI and SARS. To address challenges on disease emergence in livestock and human such as urbanisation, agriculture intensification, land use changes and others new integrated approaches have been increasingly introduced to the region to facilitated collaboration across disciplines, groups and stakeholders. Those approaches include the ‘ecohealth’ (EH) and ‘onehealth’ (OH) concept, both focusing on integrated research but having a different history and characteristics. The EH approach was pioneered over the last decades by the International Development Research Centre, Canada (IDRC). The OH concept builds up on Schwabe’s One Medicine and is currently institutionalised by the World Organisation for Animal Health (OIE) and FAO. To promote EH in the region, ILRI implemented an EH capacity building project (EcoZD) funded by IDRC between 2008 and 2013. The project targeted six Southeast Asian countries. In each country an across-disciplines research team was formed and implemented an EH case study aligned with capacity building on transdisciplinary research. In a subsequent step, ‘onehealth-ecohealth’ resource centres were established in three universities/institutions in Thailand, Vietnam and Indonesia. For this paper we also screened selected other OH/EH initiatives implemented since 2004 in SEA for their focus and impact. Most initiatives emphasised on capacity building others mainly on research or both. Challenges are various and complex, such as ‘loose’ or overlapping defi- nitions of OH/EH, cultural barriers, silo thinking, lack of qualitative research skills. While the use of integrated research has been successfully demonstrated in case studies (e.g. for Brucellosis in Yunnan) donor dependency, limited impact assessments of the added value of used integrated approaches and coordination gaps among the various initiatives remain a challenges and need more attention in the future

Cancer risk in socially marginalised women: An exploratory study

Background: Cancer is a leading cause of premature death in women worldwide, and is associated with socio-economic disadvantage. Yet many interventions designed to reduce risk and improve health fail to reach the most marginalised with the greatest needs. Our study focused on socially marginalised women at two women's centres that provide support and training to women in the judicial system or who have experienced domestic abuse. Methods: This qualitative study was framed within a sociological rather than behavioural perspective involving thirty participants in individual interviews and focus groups. It sought to understand perceptions of, and vulnerability to, cancer; decision making (including screening); cancer symptom awareness and views on health promoting activities within the context of the women's social circumstances. Findings: Women's experiences of social adversity profoundly shaped their practices, aspirations and attitudes towards risk, health and healthcare. We found that behaviours, such as unhealthy eating and smoking need to be understood in the context of inherently risky lives. They were a coping mechanism whilst living in extreme adverse circumstances, navigating complex everyday lives and structural failings. Long term experiences of neglect, harm and violence, often by people they should be able to trust, led to low self-esteem and influenced their perceptions of risk and self-care. This was reinforced by negative experiences of navigating state services and a lack of control and agency over their own lives. Conclusion: Women in this study were at high risk of cancer, but it would be better to understand these risk factors as markers of distress and duress. Without appreciating the wider determinants of health and systemic disadvantage of marginalised groups, and addressing these with a structural rather than an individual response, we risk increasing cancer inequities by failing those who are in the greatest nee