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Easier said than done: applying the Ecohealth principles to a study of heavy metals exposure among indigenous communities of the Peruvian Amazon
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).ORCID iD: 0000-0003-1975-9060
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0001-7234-3510
2013 (English)In: BMC Public Health, ISSN 1471-2458, Vol. 13, no 437Article in journal (Refereed) Published
Abstract [en]


The renewed interest in community participation in health research is linked to its potential for bridging gaps between research and practice. Its main attributes are the generation of knowledge that can lead to socially robust, long-lasting solutions and the creation of a colearner relationship between researchers and research users. Following this philosophy, Ecohealth has evolved into a specialized framework for participatory research on the impact of pollution on ecosystems and human health. However, its principles pose considerable challenges. Its outcomes are strongly influenced by contextual factors that are impossible to control for ahead of time.

This paper describes how the Ecohealth principles were applied to an epidemiological study of heavy metals exposure among indigenous communities of the Peruvian Amazon. It illustrates how knowledge generated from participatory research does not necessarily imply solving a public health problem. This study aimed to contribute to the understanding of the benefits and barriers of following the basic principles of the Ecohealth approach, and assist researchers working in similar contexts.

Research process

Based upon their personal experience as participant observers, the authors describe the research process; then, they discuss the most important challenges faced, their implications, and the attempted strategies for resolution.


Challenges were grouped into four themes: (1) building trust; (2) one partnership, many stakeholders, multiple agendas; (3) being a researcher; and (4) communicating complex and unexpected findings.


Integrating the principles of transdisciplinarity and participation posed a series of challenges to the research process that were difficult, and sometimes impossible to overcome. However, positive outcomes from this experience were the lessons learned by the different actors. Despite the lack of immediate action, it is expected that useful interventions to prevent and control lead exposure in the Corrientes population will be implemented in the medium term.

Place, publisher, year, edition, pages
2013. Vol. 13, no 437
Keyword [sv]
Ecohealth, Heavy metals exposure, Indigenous, Amazon, Peru, Participatory research
National Category
Public Health, Global Health, Social Medicine and Epidemiology
URN: urn:nbn:se:umu:diva-61253DOI: 10.1186/1471-2458-13-437OAI: diva2:565311
FAS, Swedish Council for Working Life and Social Research, 20061512

Funding for the epidemiological study described in this paper came from the Comprehensive Health Care Plan for the Corrientes Native Communities (PEPISCO) and a grant from FAS, the Swedish Council for Working Life and Social Research (grant 2006–1512).

Available from: 2012-11-07 Created: 2012-11-07 Last updated: 2015-04-29Bibliographically approved
In thesis
1. Lead exposure in indigenous children of the Peruvian Amazon: seeking the hidden source,venturing into participatory research
Open this publication in new window or tab >>Lead exposure in indigenous children of the Peruvian Amazon: seeking the hidden source,venturing into participatory research
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction. In 2006, a Peruvian environmental agency reported the presence of elevated blood lead levels (BLLs) in indigenous communities of the Corrientes river basin. This is a territory in the Peruvian Amazon where oil activity has been associated with serious environmental effects, with impact on an ongoing social conflict. This PhD project aimed to determine the lead sources, risk factors and pathways in children of these communities and to suggest control and prevention strategies. Given the arguments attributing the lead source to the oil activity pollution, the second objective was to clarify any potential connection between the two. This project was conducted by a collaborative research partnership with the regional health authorities and the community-based organization. The third objective was to characterize the challenges, facilitating factors and the lessons learned from the research process.

Methods. Two epidemiological studies were conducted. Study I (2009) was carried out in three communities and study II (2010) in six communities with different levels of exposure to oil activity. The participants were children 0–17 years old. Data collection included: determination of BLLs, hemoglobin levels and anthropometric indicators, a risk factor questionnaire, an environmental assessment and a risk map. Data analysis included univariate, bivariate and multivariate logistic regression. Data for the third objective came from field notes, documents, interviews and a process of collective reflection.

Results. Study I (n= 221) found no significant difference in the geometric mean(GM) BLLs between the communities exposed and not exposed to oil activity. Older age and being a boy were found as risk factors for BLLs ≥ 10 μg/dL. In study II (n= 346), age stratified logistic regression models indicated that children 0–3 years whose mothers had BLLs ≥ 10 μg/dL, children 0–6 years who played with pieces of lead and children 7–17 years who fished 3 times or more per weekor chewed pieces of lead to manufacture fishing sinkers had a significant increased risk of having BLLs ≥ 10 μg/dL. Children who lived in communities near oil battery facilities also had a significant increased risk of having BLLs ≥ 10 μg/dL. In both studies, environmental samples showed lead concentrations below reference levels. The challenges and facilitating factors identified focused on five interrelated themes: i) mutual trust, ii) multiple agendas, iii) equal participation, iv) competing research paradigms and v) complex and unexpected findings.

Conclusions. Metal lead appeared to be the main source of exposure. Playing with pieces of lead and chewing pieces of lead to construct fishing sinkers appeared to be pathways of exposure for children aged 0–6 years and 7–17 years, respectively. Mothers’ BLLs > 10 μg/dL was a risk factor for BLLs > 10 μg/dL in children aged 0–3 years. Living in a community with high exposure to oil activity was a risk factor for BLLs > 10 μg/dL. The identified connection with oil activity was the proximity of communities to oil battery facilities and thus greater access to lead from cables and other industrial waste. Despite the numerous challenges, participatory research appears to be the most appropriate approach for this type of context. The study findings led us to recommend:i) a comprehensive community-based lead control and prevention plan,ii) the introduction of substitute non-harmful material(s) for fishing sinkers and iii) secure containment of the oil company’s waste deposits.

Abstract [es]

Introducción. En el 2006, una agencia ambiental del Perú informó de la presenciade niveles elevados de plomo sanguíneo en las comunidades indígenas dela cuenca del río Corrientes. Este es un territorio en la Amazonía peruana, dondela actividad petrolera ha sido asociada con graves efectos ambientales, originandoun continuo conflicto social.Este proyecto de tesis doctoral tuvo como objetivo determinar las fuentes, factoresde riesgo y vías de exposición de plomo en niños de estas comunidades paraproponer estrategias de control y prevención. Teniendo en cuenta previos argumentosque relacionaban la exposición de plomo con la contaminación por laactividad petrolera, el segundo objetivo fue esclarecer cualquier conexión entreambos. Este proyecto se condujo con la participación de miembros de la DirecciónRegional de Salud de Loreto (DIRESA Loreto) y de la organización indígenaFECONACO. El tercer objetivo fue caracterizar los desafíos, las oportunidades ylos aprendizajes del proceso participativo.Métodos. Se condujeron dos estudios epidemiológicos. El estudio I (2009) sedesarrolló en tres comunidades y el estudio II (2010) en seis comunidades condiferentes niveles de exposición a la actividad petrolera. Los participantesfueron niños de 0–17 años. La recolección de datos incluyó: determinación deplomo sanguíneo, de niveles de hemoglobina y de indicadores antropométricos,un cuestionario de factores de riesgo, una evaluación ambiental y un mapa deriesgo. El análisis de datos incluyó análisis univariado, bivariado y multivariadode regresión logística. Para el tercer objetivo, los datos provinieron de notas decampo, documentos oficiales, entrevistas informales y un proceso de reflexióncolectiva.Resultados. En el estudio I (n = 221) no se encontró diferencia estadísticamentesignificativa entre las medias geométricas de los niveles de plomo sanguíneo delas comunidades expuestas y no expuestas a la actividad petrolera. Los niños degénero masculino y los del grupo etario de mayor edad tuvieron un riesgo significativamentemayor a presentar niveles de plomo sanguíneo > 10 μg/dL. Enel estudio II (n = 346), los modelos estratificados por edad indicaron que losniños de 0–3 años cuyas madres tenían niveles de plomo > 10 μg/dL, los niñosde 0–6 años que jugaban con piezas de plomo y los niños de 7–17 años que pescaban3 veces o más por semana o masticaban piezas de plomo para fabricarpesas de pescar tenían un riesgo significativamente mayor de presentar nivelesde plomo sanguíneo > 10 μg/dL. Los niños que vivían en comunidades cercanasa las baterías de petróleo también tuvieron un riesgo significativamente mayora presentar plomo sanguíneo > 10 μg/dL. Las muestras ambientales en ambosestudios mostraron concentraciones de plomo por debajo de los niveles de referencia.En cuanto al proceso de investigación, los desafíos y oportunidades másimportantes se centraron en cinco temas interrelacionados: i) la confianza mutua,ii) múltiples agendas, iii) participación equitativa, iv) competencia de paradigmasen la investigación y v) diseminación de resultados complejos e inesperados.Conclusiones. La fuente de exposición principal sería el plomo metálico. Jugarcon piezas de piezas de plomo y masticar piezas de plomo para la construcciónde pesas de pescar serían vías de exposición para los niños de 0–6 años y 7–17años, respectivamente. Niveles de plomo sanguíneo > 10 μg/dL en las madressería un factor de riesgo para presentar niveles de plomo sanguíneo > 10 μg/dLen niños de 0–3 años. Vivir en una comunidad con alta exposición a la actividadpetrolera sería también un factor de riesgo para presentar niveles de plomo sanguíneo> 10 μg/dL. La conexión con la actividad petrolera parece estar en laproximidad de las comunidades a las baterías del petróleo y por ende, el mayoracceso al plomo proveniente de cables y otros residuos industriales.A pesar de los varios desafíos, la investigación participativa parece ser el enfoquemás apropiado para este tipo de contextos. Los hallazgos nos llevaron a recomendar:i) un programa comunitario de control y prevención de plomo, ii) laintroducción de pesas de pescar de materiales seguros, alternativos al plomo yiii) el control de la disposición de residuos de la actividad petrolera.

Place, publisher, year, edition, pages
Umeå: Umeå university, 2012. 101 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1529
lead exposure, children, indigenous, Corrientes river, participatory research, Peruvian Amazon
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
urn:nbn:se:umu:diva-61254 (URN)978-91-7459-500-0 (ISBN)
Public defence
2012-11-30, Major Grove, Byggnad 6, Norrlands Universitetssjukhus, Umeå, 09:00 (English)
Available from: 2012-11-09 Created: 2012-11-07 Last updated: 2015-04-29Bibliographically approved

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