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Milestones in the advancement of public health have often been marked by trenchant observation (Edward Jenner), application of observationally derived knowledge (John Snow), experimentally derived principles of causation (Robert Koch), new technology (Louis Pasteur) or development of programmatic responses (e.g., smoking bylaws). More subtle milestones have addressed multifactorial and dynamic determinants of health. These developments are especially relevant to populations with broadly "acceptable" water to drink, air to breathe and food to eat, who face the new public health frontier of complex social, economic and environmental interactions, and demand research and action able to engage with real-life, real-time situations. While the separate study of health, economics, ecosystems and society has led to great advances in knowledge, and has also illuminated certain associations critical for population health (for example, poverty-obesity, obesity-diabetes, diabetes-vascular disease, etc.), persistent, interrelated public health challenges demand new approaches.The limits to what can be conceptually and practically achieved by attempting to disaggregate chains of causation between particular influences and the state of a population's health have been reenforced in recent decades. Frustrated by limited efforts to address complex issues such as environmental degradation, sustainability, poverty and chronic illness, scientists, practitioners and policymakers began to encourage integrative science through such mechanisms as the Canadian Tri-council environmental health and sustainability programs of the early 1990s. Subsequently, several lines of exploration have converged into an evolving field of research and practice called ecosystem approaches to health (also known as ecohealth). There is mounting evidence of the effectiveness of these approaches in addressing systemic challenges in population health, particularly among vulnerable populations. The development and application of ecosystem approaches to health has clear relevance to all twelve of the "Great Achievements" outlined by CPHA and warrants designation as a Population and Public Health Research Milestone. The MilestoneEcosystem approaches to health draw upon a variety of paradigms, including complex systems analysis, community engagement, and

This exploratory study aimed to examine the relationship between fish eating habits, human mercury levels, and mercury levels in fish in three communities of the Napo River Valley, Ecuadorian Andean Amazon, a region without gold mining but with significant deforestation and volcanic soils with naturally high mercury levels. By recognizing the politicoeconomic factors which cause deforestation, the cultural factors which influence diet, and the biogeochemical factors which contribute to mercury levels, this study employs an ecosystem approach. Interviews on diet were conducted, hair samples from 99 individuals were collected, and samples of commonly eaten fish were taken. Samples were analyzed using cold vapor atomic fluorescence spectrometry (CVAFS). Two rural communities were found to have higher fish consumption and hair mercury levels (8.71 lg/g and 5.32 lg/g) as compared to an urban community (1.87 lg/g). A sequential analysis of hair established mercury levels by month. No seasonal tendencies were noted. Piscivorous fish (0.36 lg/g) were found to be more contaminated in mercury than herbivorous fish (0.05 lg/g). The study shows that sociocultural factors are important in determining mercury exposure. The two village communities consume different species of fish with different frequencies, leading to differential exposure and mercury concentrations in hair samples. The levels of mercury in these two villages were similar to those found in Brazil where neurobehavioral tests showed a correlation between these relatively low levels of mercury and decreased psychomotor capacities. These findings are concerning and should be followed by further studies on the multiple factors that affect the health status of these exposed communities.

This forum paper proposes a reflection on the "field of ecohealth" and on how best to sustain a supportive environment that enables the evolution of diverse partnerships and forms of collaboration in the field. It is based on the results of a preconference workshop held in October 2012, in Kunming, China at the fourth biennial conference of the International Association for Ecology and Health. Attended by 105 persons from 38 countries, this workshop aimed to have a large-group and encompassing discussion about ecohealth as an emerging field, touching on subjects such as actors, processes, structures, standards, and resources. Notes taken were used to conduct a qualitative thematic analysis combined with a semantic network analysis. Commonalities highlighted by these discussions draw a portrait of a field in which human health, complex systems thinking, action, and ecosystem health are considered central issues. The need to reach outside of academia to government and the general public was identified as a shared goal. A disconnect between participants' main concerns and what they perceived as the main concerns of funding agencies emerged as a primary roadblock for the future.

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Elevated mercury (Hg) concentrations in fish from Amazonia have been associated with gold-mining, hydroelectric dams and deforestation but few studies consider the role of petroleum extraction. Hg levels were determined in fish samples collected in three river basins in Ecuador and Peru with contrasting petroleum exploitation and land-use characteristics. The non-migratory, piscivorous species, Hoplias malabaricus, was used as a bioindicator. The rate of Hg increase with body weight for this species was significantly higher on the Corrientes River, near the site of a recent oil spill, than on the other two rivers. In the absence of substantial deforestation and other anthropogenic sources in the Corrientes River basin, this finding suggests that oil contamination in Andean Amazonia may have a significant impact on Hg levels in fish.

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More contact with surface water and benthic fish may result in higher levels of 1-OHP in human urine among the study population. Reducing the amount of oil and wastes entering the waterways in Andean Amazonia would be one way to reduce exposure.