Case in point: A new study by UC Santa Barbara’s Andy MacDonald found that improving healthcare in rural Indonesia reduced incentives for illegal logging in a nearby national park, averting millions of dollars’ worth of atmospheric carbon emissions.

The analysis, published in the Proceedings of the National Academy of Sciences, finds that deforestation in the national park declined 70% in the 10 years after an affordable health clinic opened in the area. This equates to more than $65 million worth of avoided carbon emissions when translated to the European carbon market, the study reports.

“The results illustrate a strong link between human health and conservation in tropical forests in the developing world,” said MacDonald, an assistant researcher at the Earth Research Institute who coauthored the study with UC Santa Barbara’s David Lopez-Carr and colleagues at Stanford University, North Carolina State University Raleigh, Oregon Health and Science University, Natural Capital Advisors, and two NGOs involved in the intervention.

The Indonesian clinic accepts barter as payment and gives discounts to villages based on community-wide reductions in logging. Given its success, it could provide a blueprint for preserving the world’s biodiverse carbon sinks while reducing poverty and illness.

“This innovative model has clear global health implications,” said coauthor Michele Barry, senior associate dean of global health at Stanford and director of the Center for Innovation in Global Health. “Health and climate can and should be addressed in unison, and done in coordination with and respect for local communities.”

Every second, more than 100 trees disappear from tropical forests around the world. These forests, some of the world’s most important carbon reservoirs, are crucial to slowing climate change and mass extinction.

The current paradigm for conserving tropical forests — establishing protected areas — often excludes and disenfranchises local communities. This failure to address people’s needs can lead communities with few economic alternatives to illegally log and convert the land. Lack of access to high-quality, affordable healthcare can compound the problem by perpetuating cycles of poor health and expanding out-of-pocket costs.

With this in mind, the nonprofit organizations Alam Sehat Lestari and Health In Harmony in 2007 established a healthcare clinic adjacent to Gunung Palung National Park in West Kalimantan, Indonesia, with the support of the local government. The clinic was able to serve thousands of patients by accepting a range of alternative payments, such as tree seedlings, handicrafts and labor — an approach that was created in collaboration with the communities themselves.

Through agreements with most of the region’s district leaders, the clinic also provided discounts to villages that could show evidence of reductions in illegal logging. Between 1985 and 2001, this region had lost 60% of its forest to this activity. In addition to affordable health care, the intervention provided training in sustainable, organic agriculture and a chainsaw buyback program.

Researchers worked with the two non-profits to analyze more than 10 years of the clinic’s patient health records, coupled with satellite observations of forest cover over that time. “Private foundations funded the interventions, but it’s innovative new programs at Stanford and the University of California that are funding the research,” MacDonald said.

The medical care led to a significant decline in a range of diseases such as malaria, tuberculosis and diabetes. At the same time, satellite images of the national park showed a 70% reduction in deforestation, compared to forest loss at control sites, an amount equivalent to more than 6,770 acres of rainforest.

“We didn’t know what to expect when we started evaluating the program’s health and conservation impacts, but we were continually amazed that the data suggested such a strong link between improvements in healthcare access and tropical forest conservation,” said lead author Isabel Jones, who recently earned her doctorate in biology at Stanford. Looking more closely at community-level logging rates, the researchers found that the greatest drop-offs in logging occurred adjacent to villages with the highest rates of clinic usage.

A global blueprint

“This is a case study of how to design, implement and evaluate a planetary health intervention that addresses human health and the health of rainforests on which our health depends,” said coauthor Susanne Sokolow, a senior research scientist at Stanford.

Globally, about 35% of protected areas are traditionally owned, managed, used or occupied by Indigenous and local communities. Yet the perspective and guidance of Indigenous peoples and local communities are rarely considered in the design of conservation and climate mitigation programs. By contrast, the Indonesian clinic’s success grew out of the early and continued input of local communities who identified the mechanisms driving health and environmental problems as well as possible solutions.

Such holistic approaches can have greater long-term effects by preserving and restoring the ecosystem services that protect human health. These include natural filtering processes that reduce the risk of waterborne diseases and shade-providing forest canopies that reduce ground temperature and heat-related illnesses.

“The data support two important conclusions: human health is integral to the conservation of nature and vice versa, and we need to listen to the guidance of rainforest communities who know best how to live in balance with their forests,” said Monica Nirmala, the executive director of the clinic from 2014 to 2018 and current board member of Health In Harmony.

The clinic in West Kalimantan is still active, and the researchers are currently working on a follow-up project to see whether it and similar interventions in Indonesia have alleviated some of the shock from COVID-19 both on human health and deforestation.

“We would expect illegal logging activity to respond to changes in timber market prices or loss of income associated with COVID-19,” MacDonald said. “We want to know whether the interventions buffered communities against these effects, as well as whether they increased the communities’ resilience in terms of health and wellbeing.

“Health in Harmony is also expanding to Madagascar and Brazil,” he added, “and we want to be able to robustly evaluate the impacts of their interventions there.”

Floating gardens are essentially rafts built on a frame of plastic caging, wrapped in coconut husks, and filled in with native plantings. As plants grow, they extend their roots into the water, growing hydroponically. On Chicago’s North Branch of the Chicago River, non-profit Urban Rivers and partners are developing a mile-long, floating eco-park. Dubbed the Wild Mile, the re-development of this former industrial canal is Urban Rivers’ flagship project. As part of the park, floating gardens, attached to shore, are being installed.

The primary intent of the floating gardens is beautification. But the Illinois State team, from the University’s Department of Geology, Geography, and the Environment, saw an ideal setup for a controlled experiment. “We got involved because it’s the perfect opportunity to see if there’s an impact on water quality,” explains lead author Abigail Heath.

Heath will present the results of the study in an online talk on Tuesday during the Geological Society of America’s annual meeting.

The study is novel: previous studies have explored floating gardens’ impact on water quality over time, primarily in wastewater treatment ponds, but not over space, in moving water. The project also meshes well with Urban Rivers’ broader goals. “The city is interested in water quality,” says Phil Nicodemus, Urban Rivers Director of Research. “Happily, Illinois State got involved.”

Starting in spring 2018, Heath and co-authors have sampled water immediately upstream and downstream of a narrow 3 meter by 50 meter floating garden installed along the shoreline. Samples are collected weekly, at the surface and from 0.3 meters deep, the depth where roots reach from the garden’s base into the water. Although the garden is set at the edge of Chicago’s urban core, water quality is also impacted by upstream agriculture. Analyses are focused on nutrients including nitrate as nitrogen, chloride, sulfate, and phosphate.

Could this small slice of human-made paradise improve water quality? An average of data collected over the course of the study show modest but definitive improvement. For example, nitrate as nitrogen dropped from 4.69 milligrams per liter in surface water just upstream of the garden to 4.43 milligrams per liter just downstream, a drop of about 1 percent. Phosphate was also lower downstream of the garden.

“Despite how small this garden was there was measurable improvement in water quality from upstream to downstream, especially for nitrates,” notes Heath. She and colleagues see this as a scalable model for how larger floating gardens might help remediate water in similar settings. “Even this tiny garden makes a difference,” she says.

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“That’s because right now we can’t match the right combination of drugs to the right patients in a smart way,” said Trey Ideker, PhD, professor at University of California San Diego School of Medicine and Moores Cancer Center. “And especially for cancer, where we can’t always predict which drugs will work best given the unique, complex inner workings of a person’s tumor cells.”

In a paper published October 20, 2020 in Cancer Cell, Ideker and Brent Kuenzi, PhD, and Jisoo Park, PhD, postdoctoral researchers in his lab, describe DrugCell, a new artificial intelligence (AI) system they created that not only matches tumors to the best drug combinations, but does so in a way that makes sense to humans.

“Most AI systems are ‘black boxes’ — they can be very predictive, but we don’t actually know all that much about how they work,” said Ideker, who is also co-director of the Cancer Cell Map Initiative and the National Resource for Network Biology.

He gave the example of the way an internet image search for “cat” works. AI systems working behind the scenes are trained on existing cat images, but how they actually label a new image as “cat” and not “rat” or something else is unknown.

For AI to be useful in health care, Ideker said, we have to be able to see inside the black box to understand how the system comes to its conclusions. “We need to know why that decision is made, what pathways those recommended drugs are targeting and the reasons for a positive drug response or for its rejection.”

The team’s work on DrugCell began several years ago in yeast. In a previous study , they built an AI system called DCell using information about a yeast cell’s genes and mutations. DCell predicted cellular behaviors, such as growth, all outside the “black box.”

DrugCell, a next-generation version of DCell, was trained on more than 1,200 tumor cell lines and their responses to nearly 700 FDA-approved and experimental therapeutic drugs — a total of more than 500,000 cell line/drug pairings. The researchers also validated some of DrugCell’s conclusions in laboratory experiments.

With DrugCell, the team can input data about a tumor and the system returns the best known drug, the biological pathways that control response to that drug, and combinations of drugs to best treat the malignancy.

Precision cancer therapy is already available at Moores Cancer Center at UC San Diego Health, where patients may have a biopsy of their tumor sequenced for mutations and assessed by the Molecular Tumor Board, an interdisciplinary group of experts. The board recommends personalized therapies based on the patient’s unique genomic alterations and other information. A recent study showed these patients have better outcomes. In a way, DrugCell simulates the human Molecular Tumor Board.

“We were surprised by how well DrugCell was able to translate from laboratory cell lines, which is what we trained the model on, to tumors in mice and patients, as well as clinical trial data,” Kuenzi said.

The team’s ultimate goal is to get DrugCell into clinics for the benefit of patients, but the study authors caution there’s still a lot of work to do.

“While 1,200 cell lines is a good start, it’s of course not representative of the full heterogeneity of cancer,” Park said. “Our team is now adding more single-cell data and trying different drug structures. We also hope to partner with existing clinical studies to embed DrugCell as a diagnostic tool, testing it prospectively in the real world.”