Developing Ecosystem Health Indicators in Centro Habana: A Community-based Approach

A set of interventions was undertaken between 1995 and 1999 to improve the quality of life and human health in Cayo Hueso, an inner city community in Central Havana. The municipality and community organizations contacted the agency responsible for public and environmental health in Cuba (INHEM) to evaluate whether these improvements were as effective and efficient as possible, so as to assist in planning further interventions in this and other communities. With the aid of international researchers, an effort was made to strengthen the community's capacity to apply an ecosystem health approach, adapting the analytical framework (DPSEEA: driving force–pressure–state–exposure–effects–action) developed for this purpose by the World Health Organization. A series of workshops and focus groups with community representatives and researchers was conducted in late 1999 and early 2000 to develop appropriate indicators for the analysis. Interventions were grouped into those relating to improved housing, the physical community infrastructure (e.g., water, sewage, street lights), and the socio-cultural environment (e.g., programs for youths and seniors). The DPSEEA framework was embraced by the community and used to define indicators at the individual, household, and neighborhood levels; the community-researcher team then collectively elaborated the methodology to obtain the needed information. Data collection is now underway with the process having triggered a series of new partnerships, including other communities (comparison groups) now eager to learn from the Cayo Hueso interventions. With the capacity to apply this approach strengthened, the community is preparing to use the results of the analyses to set new priorities and pursue longer-term ecosystem health interventions.