Health in Harmony: a planetary health approach in the making

By Sarah Sax

When people think of what drives tropical deforestation, they think of what are referred to as “the big five”: cattle, soy, palm oil, timber and pulp, and cacao. And for sure, these industries are responsible for a large part of tropical deforestation. But what if someone told you: lack of access to healthcare, or high maternal mortality rates could also be considered a driver? And what if providing high-quality healthcare to rural populations effectively reduces not only deforestation, but also things like maternal and infant mortality?

The idea of planetary health – that the health of our planet and the health of humans are connected – is gaining in importance. However, models that embrace this connection are still lacking. Health in Harmony, an international non-profit aiming to reverse tropical deforestation through improved health access is at the forefront of developing exactly that model. One that recognizes the intricate connections between healthcare access and deforestation, and positions local communities as experts, rather than recipients. It’s these kind of models that will be key to building a future where both human health and planetary health can thrive.

The founder of Health in Harmony, Dr. Kinari Webb, didn’t set out to develop this kind of model – in fact, she wasn’t even interested originally in healthcare. She went to Indonesia to study orangutans when she was an undergrad. She was awestruck by the immense beauty and biodiversity of the forest, but also devastated by the destruction of it going on around her. She saw that a lot of local communities were illegally logging the very forests they depended on and was confused by that paradox. So she asked them why. “One of the reasons that people are often forced to log even when they don’t want to, is actually access to health care,” she told Yarrow Global in an interview. For many rural, often isolated communities, logging was one of the only ways they could access enough funds to cover the fees for healthcare and other costs like lodging and transport. 

So in 2007, she founded Harmony in Health.  Together with a local Indonesian partner organization Alam Sehat Lestari (ASRI), Harmony in Health developed a model that focuses on the nexus between healthcare and the protection of natural resources. “I founded Harmony in Health on the principle that local communities are the experts,” she said. “And the solutions in the communities are often going to be intersectional. It’s like lots of pieces all going together at the same time.” The model relies on flipping the usual script of development. Instead of outside experts coming in, Health and Harmony uses a Radical Listening approach that emphasizes local and collective community knowledge as a keystone for developing and implementing community-designed solutions. In the case of Indonesia, when they asked the communities what they needed to stop deforestation, they said they needed access to healthcare, and training in alternatives, like organic farming.

In 2008, Health in Harmony set up a “forest-for-healthcare” initiative at a clinic run by ASRI where community members were able to pay for their healthcare with non-cash payment options – anything from seedlings or manure to labor. Clinic discounts were given to villages based on community-wide reductions in illegal logging and community members could request conservation programs, educational programs, and alternative livelihood trainings, which were facilitated in partnership with government entities.

“It was wildly successful,” she said. A study in 2020 by researchers from Stanford showed that over ten years Health in Harmony’s approach stabilized primary forest loss, decreased illegal household logging by 90%, and protected ecosystems worth $65 million in carbon. But the benefits weren’t just felt in the forest. The intervention provided health care access to more than 28,400 unique patients and led to a 67% drop in infant mortality.

Since then, Health in Harmony has expanded.

Health In Harmony Brazil Program Coordinator Érika Pellegrino, MD, provides healthcare to rainforest communities in the Brazilian Amazon. Courtesy of Health in Harmony/Marcelo Salazar/ISA

Health in Harmony has started a similar initiative near the Manombo Rainforest in Madagascar, a rapidly shrinking biodiversity hotspot that is being chipped away through slash-and-burn agriculture and uncontrolled human-driven wildfires, rooted in the nutritional and economic poverty of local community members – a situation that climate change will only magnify. Since October 2020, Health in Harmony has trained over 2,000 community members in organic farming and rice cultivation techniques, built 9 seedling nurseries to hold over 45,000 seedlings, hired 62 Forest Guardians from the communities to monitor forest degradation, and conducted over 8,000 mobile clinic consultations, among other things. In 2021 the World Health Organization recognized Health in Harmony as a model to address climate change and health.

Last year,  Health in Harmony alongside other local and national organizations helped vaccinate remote, largely indigenous communities in Brazil. It was an initiative, representatives from HIH say, that shows that public health interventions can directly address the climate crisis and environmental injustice.“Health care and access to health care have been deliberately weaponized in forest communities where it’s just inaccessible,” HIH program director Ashley Emerson told Grist in an interview last year. “And in Brazil, there is a direct tie between lack of access to health care and deforestation, so by helping to uplift community health we can also combat environmental injustice.”

In a world where public health and environmental crises are inseparable, Health for Harmony’s model seems like a promising way forward. The fact that it is a women-led organization focused on intersectional issues is important  “Our program is founded by women, led by women,” said Webb. And the impacts are rippling out. One of the community health workers in Indonesia just became the first female village chief, said Webb. And Dr. Monica Nirmala, ASRI’s former executive director, is helping to bring a planetary health framework into Indonesia’s Ministry of Health.

Check out https://radicallistening.org/ for upcoming webinars and trainings on Health in Harmony’s radical listening model

Read more about Health in Harmony’s journey in Webb’s book, recently published.

Feature Image: Health In Harmony Brazil Program Coordinator Érika Pellegrino, MD, provides healthcare to rainforest communities in the Brazilian Amazon/ Courtesy of Health in Harmony.

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