Building Capacity in Central Havana to Sustainably Manage Environmental Health Risk in an Urban Ecosystem

In the late 1990s, community officials in the inner city neighborhood of Central Havana consulted researchers at INHEM (National Institute of Hygiene, Epidemiology, and Microbiology) for assistance in evaluating the effectiveness of interventions that were being undertaken to improve the quality of life and human health amid the severe economic crisis that Cuba was experiencing. The ecosystem approach to human health framework was applied through a Cuban–Canadian collaboration to assess whether the measures taken to improve housing, municipal infrastructure, and social and cultural life were effective, and to strengthen local capacity to manage environmental health risks. Household surveys, interviews, and a series of workshops and meetings conducted between 1999 and 2001 indicated that the intervention had been effective and pointed to further needs. The greater capacity to understand and manage determinants of health led to the use of the Ecohealth framework being adopted to help respond to a serious outbreak of dengue fever in Havana in 2001–2002, as well as a follow-up project in 2003 to apply an integrated surveillance approach to more sustainably prevent and control future recurrences of dengue by extending established monitoring of clinical-epidemiological and entomological factors, linking this to more systematic monitoring and control of environmental conditions, and strengthening community participation. The experience in central Havana indicates that application of the Ecohealth framework can play a useful role in strengthening capacities for managing further challenges to a community.