| Sumario: | We developed a conceptual framework for improving health and environmental sanitation using an approach that combines health, ecological, and socio-economic assessments. The framework has three main components: health status, physical environment,
and socio-economic environment. Information on each of these three components can
be obtained using standard disciplinary methods and an innovative combination of these
methods. Analyses based on this framework lead to extended characterisation of health,
ecological, and social risks, while enabling comprehensive identification of critical control points.
Interventions based on comprehensive analysis take account of biomedical, engineering,
and social-science perspectives or a combination of them. Moreover, such interventions
encompass not only technical solutions but also behavioural and social changes which
are derived from the resilience patterns identified during the analysis. The framework
was conceptualised and validated for the context of urban and peri-urban settings in
developing countries, focusing on different types of waste such as excreta, wastewater,
and solid waste, as well as their influence on food quality and their related pathogens,
nutrients, and chemical pollutants.
We tested the framework in a case study in northern Vietnam, where we conducted a
combined assessment of the impacts of human excreta and wastewater reuse in agriculture on health, the environment, and society. The aim was to propose sustainable
and adapted interventions for improving health and environmental sanitation. Impact
on health was assessed based on epidemiological and microbial risk analyses. Environmental impact was assessed for both sanitation and agriculture systems, with a focus on
nutrient flows. Perceptions and behaviour regarding health risks were evaluated, along
with people’s ability to prevent health risks. Our contribution will present results from
this case study and insights regarding interventions proposed.
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