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Improving rural health care reduces illegal logging and conserves carbon in a tropical forest
Edited by Thomas E. Lovejoy, George Mason University, Fairfax, VA, and accepted by Editorial Board Member Carl Folke September 16, 2020 (received for review May 8, 2020)

Significance
Here, we show how a conservation–health care exchange in rural Borneo preserved globally important forest carbon and simultaneously improved human health and well-being, in a region of historically intense environmental destruction, widespread poverty, and unmet health needs. To evaluate this long-term conservation and health intervention, we analyzed earth observation data, clinic health records, and socioeconomic surveys to quantify conservation, health, and sustainable development outcomes simultaneously. Results demonstrate an actionable framework for aligning cross-sectoral goals and objectively quantifying intervention outcomes across both conservation and human health targets.
Abstract
Tropical forest loss currently exceeds forest gain, leading to a net greenhouse gas emission that exacerbates global climate change. This has sparked scientific debate on how to achieve natural climate solutions. Central to this debate is whether sustainably managing forests and protected areas will deliver global climate mitigation benefits, while ensuring local peoples’ health and well-being. Here, we evaluate the 10-y impact of a human-centered solution to achieve natural climate mitigation through reductions in illegal logging in rural Borneo: an intervention aimed at expanding health care access and use for communities living near a national park, with clinic discounts offsetting costs historically met through illegal logging. Conservation, education, and alternative livelihood programs were also offered. We hypothesized that this would lead to improved health and well-being, while also alleviating illegal logging activity within the protected forest. We estimated that 27.4 km2 of deforestation was averted in the national park over a decade (∼70% reduction in deforestation compared to a synthetic control, permuted P = 0.038). Concurrently, the intervention provided health care access to more than 28,400 unique patients, with clinic usage and patient visitation frequency highest in communities participating in the intervention. Finally, we observed a dose–response in forest change rate to intervention engagement (person-contacts with intervention activities) across communities bordering the park: The greatest logging reductions were adjacent to the most highly engaged villages. Results suggest that this community-derived solution simultaneously improved health care access for local and indigenous communities and sustainably conserved carbon stocks in a protected tropical forest.
Footnotes
- ↵1To whom correspondence may be addressed. Email: isajones{at}stanford.edu or ssokolow{at}stanford.edu.
Author contributions: I.J.J., A.J.M., S.R.H., A.J.L., Z.Y.-C.L., A.E., J.J., L.G., M.B., D.L.-C., K.W., G.A.D.L., and S.H.S. designed research; M.N., A.G.B., A.E., J.J., L.G., M.B., D.L.-C., K.W., G.A.D.L., and S.H.S. performed conceptual framing of the work; I.J.J., A.J.M., S.R.H., A.J.L., Z.Y.-C.L., N.I.F., M.P.P., K.F., K.W., and S.H.S. performed research; N.I.F., M.P.P., and A.J.C. handled acquisition of data; I.J.J., A.J.M., S.R.H., A.J.L., Z.Y.-C.L., K.F., A.J.C., and S.H.S. analyzed data; and I.J.J. and S.H.S. wrote the paper.
Competing interest statement: N.I.F., M.P.P., M.N., A.G.B., A.E., J.J., and K.W. are currently or recently employed with the nonprofit organization that contributed to intervention design, implementation, and data collection.
This article is a PNAS Direct Submission. T.E.L. is a guest editor invited by the Editorial Board.
This article contains supporting information online at https://www.pnas.org/lookup/suppl/doi:10.1073/pnas.2009240117/-/DCSupplemental.
Data and Code Availability.
Data and code have been deposited in Github (https://github.com/deleo-lab/Papers/tree/main/Jones_etal_PNAS_2020).
- Copyright © 2020 the Author(s). Published by PNAS.
This open access article is distributed under Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND).
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