Hesperian Health Guides

Hesperian Health Guides

Mobilizing for Environmental Health

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HealthWiki > A Community Guide to Environmental Health > Chapter 2: Understanding and Mobilizing for Community Health > Mobilizing for Environmental Health


After many years of poverty and isolation, the people living on those muddy hills on the coast of Ecuador were discouraged. They did not know how to improve their lives. Everyday life was so hard, it was difficult to believe in or plan for a better future.

By working to solve the immediate health problem — cholera — Gloria and the health workers of Salud para el Pueblo saved many lives. The success of the health promoters, local organizations, and the villagers in working together to stop the epidemic motivated and prepared them to overcome other problems as well. When the big storm destroyed much of their work, they were able to organize and recover from the storm's damage. Then they were able to move on to solve other problems. Their work to make communities healthier continues, as they improve present-day conditions and build for the future.

Work to understand root causes

 Man and women asking and answering questions.

Why did so many people get sick with cholera?
Because there were germs in the water.
This is a physical cause of illness.
But why were there germs in the water?
Because we do not have toilets that keep germs out.
This is an environmental cause of illness.
But why don’t we have good toilets?
Because we have no money to build them.
This is an economic cause of illness.

Health problems may be caused by many things: germs, toxic chemicals, accidents, hunger, exposure to extreme cold or heat, and so on. These are examples of immediate causes of illness. Illnesses have many immediate causes, but they also have root causes.

Identifying root causes can help us to identify what we may need to do to solve the problem in the long term. You can see how using the "But why…?" activity, as Gloria did, can help people understand how a single problem may have several different root causes.

Change takes time

Improving environmental health does not happen quickly. In Manglaralto, the health workers first treated cholera by giving rehydration drink and also worked to prevent it by making the water clean. Then they organized the community to build new water systems and pit toilets to prevent cholera in the future. But it was only after the big storm came and washed away all of these improvements that they understood the problems of erosion and flooding caused by deforestation (the loss of trees). They needed this understanding of root causes to be able to make lasting changes.

 woman speaking
Improvements in environmental health happen step by step. Have patience. Sometimes change that happens quickly wears away just as quickly.

Sometimes, we must struggle and fail several times before we succeed. Often, it is only by seeing what does not work that we learn what does — and why. Improving environmental health takes time because it often requires 4 different kinds of changes:

  • changes to improve water systems, housing, or other things we build for ourselves (infrastructure).
  • changes in what we buy, such as refusing to buy junk food, toxic cleaning products, or products wrapped in plastic (consumption).
  • changes in our habits, such as regular hand washing, separating trash so more can be recycled, or growing crops in new ways (behavior).
  • changes in how much power local people, corporations, central governments, and others have in making decisions that affect the environment (political).

All of these changes take time and affect each other.

 "We must be the change we wish to see in the world"

Work with young people

One way to make sure change lasts is to work with young people, because they will take what they learn into the future. Each of us, no matter what age we are, can adopt the attitude of a young person — to always be willing to learn and try new things.


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