Q&A: How providing health care can be an effective rainforest defense

Despite some headway toward slowing deforestation over a decade ago, the 2020s began with rising rates and a difficult year for forests and the people who live within them due to COVID-19. The pandemic was initially associated with an increase in illegal logging due to lockdowns preventing monitoring — while more than ever, the link between environmental degradation, animals, and the spread of diseases was made clear. One organization is using a multifaceted approach to trying to revive forests in Indonesia, Brazil, and Madagascar. International NGO Health In Harmony works to replant critical forests as well as stop illegal logging by providing incentives, from chainsaw buyback schemes to providing affordable health services so that people don’t turn to illegal logging to pay their medical bills. Mahardika Putra Purba, an assistant professor of forestry at the Agricultural Polytechnic of Kupang, ran the HIH program as director and then conservation manager in Borneo for four years and is now a conservation specialist and consultant, supporting the organization to take the model to Madagascar and Brazil. While his resume points to his specialist knowledge of trees and nature — with a master’s and doctorate in forest genetics — he says his career no longer works in silos and instead is inspired by the link between human and environmental health. “We need to understand that implementing co-beneficial solutions can improve human health while protecting natural ecosystems,” says Purba of the model his team has sought to implement. “It can go both ways, you don't really have to choose human well-being — but then discard the nature and the natural environment around you — you can actually work on both.” The Indonesia-based part of the program became known as Alam Sehat Lestari, or ASRI, now a partner organization to HIH. It was co-founded in 2007 by American physician Kinari Webb who now runs HIH from the Bay Area. It has since created a medical center accessible to over 120,000 people and supported over 200 former loggers to sell their chainsaws and start new businesses, the nonprofit says. Purba sat down to talk to Devex about how healthy forests are vital to humans, how to forge viable alternatives to logging, and why the whole world needs to protect Indigenous rights. This conversation has been edited for length and clarity. How do you encourage people to stop earning a living from illegal logging? We listen to communities and implement their solutions. We call this process “radical listening.” From listening to what people said they wanted, we identified a lack of access to health care as one of major drivers of deforestation and worked to establish a clinic in Indonesia, where local medical professionals provide quality, affordable health care, including maternal and infant care, dentistry, and optometric services. To ensure that the care is accessible to those without cash, patients can pay with seedlings, handicrafts, [and] organic manure, or they can pay with cash. Patients also receive discounts to their medical care if they or their community commit to stop logging and to taking care of the environment. In addition to medical services, ASRI and Health In Harmony provides organic agricultural training, as a way to create an alternative livelihood to support the local community. In terms of what people transition to working in — it includes opening shops, fish farming, [and] chicken farming, and we provide financial management training to help. We also run education and youth enrichment programs for teens and children. Logging comes with risks of being caught and going to jail. It’s also very bad for health too — we’ve seen former loggers damage their spines, lose their hearing, have accidents, or they can get dust in their eyes causing blindness over time too. “They [Indigenous groups] have done a lot — they are big allies in protecting biodiversity and forests and deserve a lot more respect.” --— Mahardika Putra Purba, ecosystem restoration specialist, Health In Harmony Since Health in Harmony and ASRI have found this proof of concept, it has been replicated to nearby sites in West Kalimantan, including Bukit Baka Bukit Raya National Park. And now we are also expanding this concept to the Manombo rainforest in Madagascar [from 2019], and also to Terra do Meio region in the Amazon rainforest in Brazil. The model now works with around 135,000 community members to protect more than a million hectares of climate-critical tropical rainforest. How does your work apply the concept of “planetary health”? Before I joined, I often thought about everything in silos. But then, when I started to learn about planetary health — recognizing that human and environmental well-being cannot be seen as separate from one another. We also need to understand that implementing co-beneficial solutions can improve human health while protecting natural ecosystems. It can go both ways, you don't really have to choose human well-being — but then discard the nature and the natural environment around you, you can actually work on both side by side. At ASRI and Health In Harmony, the planetary health interventions that we implemented mean integrating medical care, as well as reforestation and sustainable livelihoods training, which has had positive benefits for humans and the surrounding ecosystems. How does deforestation more broadly cause health issues for humans? A report published in 2021 from [the] Harvard Global Health Institute found that land use change is the primary culprit for diseases transmitted from animals to humans — or zoonotic diseases. Displaced animals in forested regions may be infected with pathogenic viruses, bacteria, or fungi — and when they seek shelter or food in human habitats, pathogens can spill over, leading to human infections. Another report from Ecohealth Alliance identified that 31% of outbreaks of new and emerging diseases are linked to deforestation. Climate change [exacerbated by deforestation] is leading to changes in the transmission patterns of infectious diseases, potentially accelerating outbreaks of [diseases such as] malaria and dengue fever. Right now in Indonesia, the cases of dengue are soaring. Finally, healthy forests lead to healthy air to breathe, not only because the forests convert carbon dioxide to oxygen, but [also] because deforestation can lead to fires due to increased dryness. During the 2019 forest fires in Indonesia, I was in Kalimantan and it was like doing a barbecue constantly 24 hours a day for a week and breathing in that smoke. Those fires caused around 900,000 people to report having respiratory illnesses. Deforestation and the resulting fires often occur in or near Indigenous territories. So they end up destroying crops, depleting the areas they live in, [and] their plants and wildlife used for food and medicine, leading to people being displaced [and] struggling to survive. Deforestation is still taking place at a worrying scale, do you have any hope progress will be made? I think there are a lot of people that are taking this more seriously — but still not enough. And I think we need more collective voice and collective action as well. Especially from our governments who are making policies and are on the front lines. There needs to be more listening to Indigenous peoples and local communities because they have an important role to play. They [Indigenous groups] have done a lot — they are big allies in protecting biodiversity and forests and deserve a lot more respect and gratitude. We need to support Indigenous rights and responsible land use, so restoring land rights to Indigenous people will be necessary. We need to invest more in the restoration of nature as well because the key to delivering on biodiversity is not just about the designation of protected areas, but effective management. And this is where most administrations may not deliver as there is little political appetite to provide funds and expertise as well. Tackling wildlife crime is also needed. One of the main reasons a lot of species are facing extinction is the continued illegal hunting and trading of protected animals which is a cross-border issue meriting further attention. Finally, biodiversity should be mainstream, it should be an integral consideration when it comes to building infrastructure, farming, forestry, or fisheries policies. Failure to do so will mean that biodiversity of living organisms on our planet will continue to decline. Editor’s note, Feb. 7: The text has been updated to reflect that Bukit Baka Bukit Raya National Park is in West Kalimantan. Visit the Planet Health series for more in-depth reporting on the current impact of the climate crisis on human health around the world. Join the conversation by using the hashtag #PlanetHealth.