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Research Article

Improving rural health care reduces illegal logging and conserves carbon in a tropical forest

View ORCID ProfileIsabel J. Jones, View ORCID ProfileAndrew J. MacDonald, View ORCID ProfileSkylar R. Hopkins, View ORCID ProfileAndrea J. Lund, Zac Yung-Chun Liu, View ORCID ProfileNurul Ihsan Fawzi, View ORCID ProfileMahardika Putra Purba, View ORCID ProfileKatie Fankhauser, View ORCID ProfileAndrew J. Chamberlin, Monica Nirmala, Arthur G. Blundell, Ashley Emerson, Jonathan Jennings, View ORCID ProfileLynne Gaffikin, Michele Barry, View ORCID ProfileDavid Lopez-Carr, Kinari Webb, View ORCID ProfileGiulio A. De Leo, and View ORCID ProfileSusanne H. Sokolow
PNAS November 10, 2020 117 (45) 28515-28524; first published October 26, 2020; https://doi.org/10.1073/pnas.2009240117
Isabel J. Jones
aHopkins Marine Station, Department of Biology, Stanford University, Pacific Grove, CA 93950;
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  • ORCID record for Isabel J. Jones
  • For correspondence: isajones@stanford.edu ssokolow@stanford.edu
Andrew J. MacDonald
bDepartment of Biology, Stanford University, Stanford, CA 94305;
cEarth Research Institute, University of California, Santa Barbara, CA 93106;
dBren School of Environmental Science and Management, University of California, Santa Barbara, CA 93106;
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  • ORCID record for Andrew J. MacDonald
Skylar R. Hopkins
eNational Center for Ecological Analysis and Synthesis, Santa Barbara, CA 93101;
fDepartment of Applied Ecology, North Carolina State University, Raleigh, NC 27607;
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  • ORCID record for Skylar R. Hopkins
Andrea J. Lund
gEmmett Interdisciplinary Program in Environment and Resources, Stanford University, Stanford, CA 94305;
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  • ORCID record for Andrea J. Lund
Zac Yung-Chun Liu
aHopkins Marine Station, Department of Biology, Stanford University, Pacific Grove, CA 93950;
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Nurul Ihsan Fawzi
hAlam Sehat Lestari, Sukadana, West Kalimantan 78852, Indonesia;
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  • ORCID record for Nurul Ihsan Fawzi
Mahardika Putra Purba
hAlam Sehat Lestari, Sukadana, West Kalimantan 78852, Indonesia;
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  • ORCID record for Mahardika Putra Purba
Katie Fankhauser
iOregon Health and Science University, School of Public Health, Portland, OR 97239;
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  • ORCID record for Katie Fankhauser
Andrew J. Chamberlin
aHopkins Marine Station, Department of Biology, Stanford University, Pacific Grove, CA 93950;
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  • ORCID record for Andrew J. Chamberlin
Monica Nirmala
hAlam Sehat Lestari, Sukadana, West Kalimantan 78852, Indonesia;
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Arthur G. Blundell
jNatural Capital Advisors, New Orleans, LA 70115;
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Ashley Emerson
kHealth In Harmony, Portland, OR 97214;
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Jonathan Jennings
kHealth In Harmony, Portland, OR 97214;
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Lynne Gaffikin
lDepartment of Obstetrics and Gynecology, Stanford University, Stanford, CA 94305;
mCenter for Innovation in Global Health, Stanford University, Stanford, CA 94305;
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Michele Barry
mCenter for Innovation in Global Health, Stanford University, Stanford, CA 94305;
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David Lopez-Carr
nDepartment of Geography, University of California, Santa Barbara, CA 93117;
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Kinari Webb
kHealth In Harmony, Portland, OR 97214;
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Giulio A. De Leo
aHopkins Marine Station, Department of Biology, Stanford University, Pacific Grove, CA 93950;
oWoods Institute for the Environment, Stanford University, Stanford, CA 94305;
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Susanne H. Sokolow
mCenter for Innovation in Global Health, Stanford University, Stanford, CA 94305;
oWoods Institute for the Environment, Stanford University, Stanford, CA 94305;
pMarine Science Institute, University of California, Santa Barbara, CA 93106
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  • ORCID record for Susanne H. Sokolow
  • For correspondence: isajones@stanford.edu ssokolow@stanford.edu
  1. 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)

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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.

  • planetary health
  • natural climate solutions
  • human health
  • tropical forests
  • conservation

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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Improving rural health care reduces illegal logging and conserves carbon in a tropical forest
Isabel J. Jones, Andrew J. MacDonald, Skylar R. Hopkins, Andrea J. Lund, Zac Yung-Chun Liu, Nurul Ihsan Fawzi, Mahardika Putra Purba, Katie Fankhauser, Andrew J. Chamberlin, Monica Nirmala, Arthur G. Blundell, Ashley Emerson, Jonathan Jennings, Lynne Gaffikin, Michele Barry, David Lopez-Carr, Kinari Webb, Giulio A. De Leo, Susanne H. Sokolow
Proceedings of the National Academy of Sciences Nov 2020, 117 (45) 28515-28524; DOI: 10.1073/pnas.2009240117

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Improving rural health care reduces illegal logging and conserves carbon in a tropical forest
Isabel J. Jones, Andrew J. MacDonald, Skylar R. Hopkins, Andrea J. Lund, Zac Yung-Chun Liu, Nurul Ihsan Fawzi, Mahardika Putra Purba, Katie Fankhauser, Andrew J. Chamberlin, Monica Nirmala, Arthur G. Blundell, Ashley Emerson, Jonathan Jennings, Lynne Gaffikin, Michele Barry, David Lopez-Carr, Kinari Webb, Giulio A. De Leo, Susanne H. Sokolow
Proceedings of the National Academy of Sciences Nov 2020, 117 (45) 28515-28524; DOI: 10.1073/pnas.2009240117
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