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Harnessing the community capacity of small farmer organizations to reduce pesticide-related environmental.. Cabarcas, Fabio 2011-03-18

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     i  HARNESSING THE COMMUNITY CAPACITY OF SMALL FARMER ORGANIZATIONS TO REDUCE PESTICIDE-RELATED ENVIRONMENTAL HEALTH RISKS: A CASE STUDY IN AN INDIGENOUS COMMUNITY IN THE SOUTHERN RANGES OF ECUADOR, 2007-2008    by  Fabio Cabarcas  M.D., National University of Colombia, 1999 MPH, National University of Colombia, 2002     A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF     DOCTOR OF PHILOSOPHY    in   The Faculty of Graduate Studies (Interdisciplinary Studies)       THE UNIVERSITY OF BRITISH COLUMBIA  (Vancouver)   March 2011   ? Fabio Cabarcas, 2011       ii Abstract This work aims to better understand the capacity of small farmers, their organizations and other social players in the Ecuadorian indigenous communities of Quilloac and San Rafael to reduce pesticide-related environmental health risks. I used a multi-method approach that included Pierre Bourdieu?s field theory along with a 187-household survey, ethnographic methods, and participative approaches in 2007-2008. This study analyzed community capacity-building as social relationships co-determined by human agency and social structure in local and global contexts. By mapping community stakeholders? differential access to cultural, social and economic capital, this study reveals connections between the degree of access to resources and health vulnerabilities. Four key findings emerged. First, in a context in which workers were forced to diversify their income through strategies such as emigration and urban employment, families had reduced time for their crops and increased reliance on pesticides. Members of households with fewer people applied pesticides more times. Elders from poor households were left to care for crops and experienced more problems with pesticide handling and symptoms.  Children experienced increases in accidental pesticide poisoning cases that coincided with a period of high farmer migration to find work. Second, despite numerous well-intended efforts by community leaders, farmers with the highest participation in agriculture had less contact with community organizations. Third, structural factors such as inequitable land distribution, unfavorable market policies, and limited state support for small farmers represent critical barriers for harnessing the capacity of small farmer organizations.  Fourth, community leaders tended to adopt peasantry-focused strategies that were likely to further marginalize some vulnerable families who combined non-agricultural activities with their farming, which was characterized by consumption crops with low workforce and high pesticide use.    iii My findings provide theoretical and practical contributions for understanding the causes of environmental health inequities. Results from this research informed the development of several community-based initiatives (workshops, a radio show). My approach described important contextual barriers that need to be addressed by national and international stakeholders in order to harness the capacity of local organizations. It also identified specific social mechanisms that could increase health inequities despite great efforts by community organizations.   iv  Preface  This study was approved by the Behavioural Research Ethical Board at the University of British Columbia in Vancouver, Canada (Id number: H07-00198).     v Table of contents   Abstract ..................................................................................................................................... ii Preface ....................................................................................................................................... iv Table of contents ......................................................................................................................... v List of tables ............................................................................................................................... x List of figures ............................................................................................................................xii Acknowledgements .................................................................................................................. xiv Dedication ................................................................................................................................. xv  Chapter 1: Introduction ............................................................................................................ 1 1.1 Pesticide use as a growing global environmental health concern ............................................ 2 1.2 Health equity dimensions of pesticide-related risk ................................................................. 7 1.2.1 Vulnerability of small farmers of indigenous background in Ecuador ...................... 8 1.3 Community capacity as an instrument for reduction of environmental health inequities ....... 12 1.4 Overview of the research ..................................................................................................... 16  Chapter 2: A review of key community capacity-building issues for working with marginalized communities ...................................................................................................... 24 2.1 The concept of community .................................................................................................. 25 2.2 Defining community capacity-building ................................................................................ 27 2.2.1 Focusing on human agency and focusing on structural challenges ......................... 32 2.2.2 Approaching local context with a global perspective ............................................. 38 2.2.3 Questioning community: power differences among diverse community and state stakeholders ................................................................................................................... 40 2.2.3.1 Approaching community capacity-building as a social relationship among heterogeneous groups with differential access to power ...................................... 41 2.2.3.2 Hierarchical power structures within institutions and projects: ?top-down? and ?bottom-up? approaches to community capacity ........................................... 44   vi 2.2.3.3 Understanding the role of civil society and the state stakeholders as social players ............................................................................................................... 46 2.3 An approach to community capacity-building ...................................................................... 48  Chapter 3: Review on pesticides use and health .................................................................... 62 3.1 Pesticides, human health and the environment ..................................................................... 62 3.2 Challenges for public health action at a community level ..................................................... 71 3.2.1 Education and training for farmers ........................................................................ 72 3.2.2 Transformation of agricultural practice ................................................................. 75  Chapter 4: Review on the challenges of small farmer organizations in the field of agriculture in the southern Ecuadorian ranges ..................................................................... 79 4.1 Challenges in the development of Ecuadorian agriculture .................................................... 80 4.1.1 Land reforms and land distribution in Ecuador ...................................................... 81 4.1.2 Market for rural products in Ecuador..................................................................... 88 4.1.3 The role of the state and other organizations in supporting small farmers .............. 93 4.1.3.1 Small farmers and the emergence of the indigenous movement in  Ecuador............................................................................................................ 100 4.1.4 Migration ............................................................................................................ 106 4.1.4.1 Migration in Ecuador ............................................................................ 107 4.1.4.2 Migration and capacity of farmer organizations for reducing pesticide-related harm ..................................................................................................... 111    vii Chapter 5: Objectives and methods ..................................................................................... 123 5.1 General objective .............................................................................................................. 123 5.2 Specific objectives............................................................................................................. 123 5.3 Conceptual framework ...................................................................................................... 124 5.4 Methods ............................................................................................................................ 133 5.4.1 Methodological components ............................................................................... 139 5.4.1.1 Household survey ................................................................................. 139 5.4.1.2 Ethnographic methods .......................................................................... 154 5.4.1.3 Participatory action research component ............................................... 166 5.4.1.4 Review of hospital discharge and medical records ................................ 170 5.5 Ethical considerations ........................................................................................................ 172  Chapter 6: Results on participation in agriculture, current pesticide use and problems with pesticide handling .................................................................................................................. 174 6.1 Crop production and pesticide use ..................................................................................... 175 6.2 Participation in agriculture by individuals and households and identification of the person who most frequently applied pesticides ................................................................................... 182 6.2.1 Individual participation in agriculture ................................................................. 182 6.2.2 Household characteristics and participation in agriculture ................................... 184 6.2.3 Who applied pesticides? ...................................................................................... 187  6.3 Practices of pesticide application ....................................................................................... 190 6.4 Health and problems with pesticide handling ..................................................................... 194 6.4.1 Symptoms and problems with pesticide handling ................................................ 195 6.4.2 Pesticide related cases in discharge records of the regional hospital: accidental poisoning in children ................................................................................................... 201   viii  Chapter 7: Results on challenges in the field of agriculture and the capacity of small farmer organizations to reduce pesticide risk ...................................................................... 206 7.1 Pesticide- harm reduction in the agenda of community organizations ................................ 208 7.2 Community organizations? capacity: challenges in the field ............................................... 210  7.2.1 Limited access to resources ................................................................................. 215 7.2.1.1 Financial resources ............................................................................... 215 7.2.1.2 Human resources .................................................................................. 218 7.2.2 Land distribution and smallholdings .................................................................... 222 7.2.3 Unfavourable market changes and competitiveness ............................................. 227 7.3 Interaction with organizations, access to social resources and trust .................................... 235 7.3.1 Contact between community members and organizations .................................... 236 7.3.2 Access to social resources ................................................................................... 237 7.3.3 Trust in organizations.......................................................................................... 242  Chapter 8: Results on household and organizational adaptation strategies affecting community capacity .............................................................................................................. 245 8.1 Perceptions, habitus and strategies by community organizations ........................................ 247 8.1.1Farmer organizations: between competition and cooperation ................................ 247 8.1.2 Farmer organizations: competing visions for projecting an agricultural tradition into the future ..................................................................................................................... 251 8.2 The construction of household survival strategies: multiple sources of income .................. 255 8.3 Contrasting strategies from households and community organizations regarding agricultural practices .................................................................................................................................. 262    ix Chapter 9: Discussion and conclusions ................................................................................ 271 9.1 Overview of main results by specific objective  ................................................................. 272 9.1.1 Specific objective 1: diverse patterns of human exposure to pesticides in agricultural practices, and problems with pesticide handling by inhabitants of Quilloac and San Rafael ............................................................................................................. 272 9.1.2 Specific objective 2: structural factors determining the capacity of small farmer organizations to reduce pesticide-related risks ............................................................. 277 9.1.3 Specific objective 3: individual and organizational adaptation strategies affecting the community?s capacity for reducing pesticide-related vulnerabilities ....................... 279 9.1.4 Specific objective 4: strategies for harnessing community capacity to reduce environmental and health risk associated with pesticide use in Quilloac and San Rafael282 9.2 Strengths and limitations of the research ............................................................................ 284 9.2.1 General limitations .............................................................................................. 284 9.2.2 Additional limitations of quantitative components............................................... 288 9.3 Considerations for future research ..................................................................................... 293 9.4 Conclusions ....................................................................................................................... 294  References.............................................................................................................................. 299  Appendix 1: Operationalization of variables for household survey .......................................... 338 Appendix 2: Survey of farmers (English translation) ............................................................... 345         x List of tables Table 1.1 Percentages of poor and extremely poor in population for different indicators according to region and area in Ecuador, 2006 ?????????????.??.??? .. 10 Table 2.1 Three different approaches to the definition of community ?????..?.??.... .. 26 Table 2.2 Some examples of successful ?community capacity-building? projects, their evaluation approach, and the key elements of their view of community capacity ??..?????....?. .. 31 Table 3.1 Summary of literature on known health effects of common pesticides used in Quilloac and San Rafael, 2007?????????????????????????..???. .. 66 Table 3.2 Summary of literature on the known environmental fate of common pesticides used in Quilloac and San Rafael, 2007 ?????????????????????..??.? .. 69 Table 4.1 Distribution of number of agriculturally productive units and hectares according to different unit size in different areas of Ecuador, 2000 ????????????..???. .. 84 Table 5.1. Characteristics  of  survey respondents compared with other members of  household 18 years old or older, in Quilloac and San Rafael, 2007 ???????????.?.. ?.. .. 142 Table 5.2 Grassroots farmer and indigenous organizations in Quilloac and San Rafael, 2007-2008 ?????????????????????????.?????????. .. 160 Table 5.3 Other relevant organizations for the communities of Quilloac and San Rafael , 2007-2008?????????????????????????????????..?. .. 161 Table 5.4 Details of collaborative activities promoted in Quilloac and San Rafael for reducing health risk related to pesticide use, 2007-2008. ??????????????????.. 169 Table 6.1. Age, gender, marital status, education level, main occupation and degree of participation in agriculture of the household leader, Quilloac and San Rafael, 2007 ???... . 176 Table 6.2. Socio-demographic characteristics of the households, Quilloac and San Rafael, 2007?????????????????????????????????.?... . 177 Table 6.3. Percentages of number of pesticide applications per harvest for different products, Quilloac and San Rafael, 2007 ????????????????????????.. . 178 Table 6.4. Frequency and percentage of households using particular types of pesticides on their crops ??????????????????????????????????.. . 180 Table 6.5. Household average of participation in agriculture by adults, Quilloac and San Rafael, 2007 ??????????????????????????????????.. .. 185 Table 6.6. Household adult participation in agriculture averaged by hectares of land owned and harvested by household, Quilloac and San Rafael, 2007????????????...?? . 186 Table 6.7. The person who most frequently applied pesticides by community, Quilloac and San Rafael, 2007 ???????????????????????????????... . 188   xi Table 6.8. Gender, marital status, education level and level of participation in agriculture of household leaders who applied pesticides more frequently vs. leaders who do not, Quilloac and San Rafael, 2007 ?????????????????????????????? . 189 Table 6.9. Frequency of use of protective equipment during the application of pesticides, Quilloac and San Rafael, 2007 ??????????????????????.?? .. 192 Table 6.10. Distribution of some acute symptoms according to having or not having applied pesticides in the seven days prior to the survey, Quilloac and San Rafael, 2007 ???..?..... 196 Table 6.11. Age, gender, marital status, education level, main occupation and degree of participation in agriculture of farmers according to whether or not they had applied pesticides in the seven days prior to the survey, Quilloac and San Rafael, 2007??. ??????.?? . 197 Table 6.12. Distribution of pesticide handling practices in farmers who had applied pesticides in the seven days prior to the survey, Quilloac and San Rafael, 2007 ???????..?........ . 198 Table 6.13. Odds Ratio estimates for a logistic regression model for feeling nauseated or vomiting in the seven days prior to the survey, having applied pesticides in the same period, gender, and having had a lesion in the past, Quilloac and San Rafael, 2007 ??????? . 199 Table 6.14. Odds Ratio estimates for a logistic regression model for having diarrhea in the seven days prior to the survey, having applied pesticides in the same period, and age, Quilloac and San Rafael, 2007 ???????????????????????????.????.. . 199 Table 7.1 Organizational structure, target population for services and main funding sources in some of the main farmer and indigenous organizations, Quilloac and San Rafael, 2007-2008  . 213 Table 7.2. Average of surface area of land units in fourteen communities according to the registry of the irrigation system, Association of Organizations, Ca?ar, 1997-2007 ?.?? ..... 225 Table 7.3. Frequency of contact of the interviewees with anyone from community organizations and institutions, Quilloac and San Rafael, 2007 ????????????????..?.. . 236 Table 7.4. Odds Ratio estimates for having at least some contact with Association of Organizations, the Financial Cooperative or the Association of Agronomists according to education level, household income and individual participation in agriculture, Quilloac and San Rafael, 2007 ??.. ................................................................................................................. 237 Table 7.5 Access to people who would be able to provide social services for free, Quilloac and San Rafael, 2007 ???????????????????????????..??. .. 238 Table 7.6 Odds Ratio estimates for having some trust in diverse organizations  to improve community?s  quality of life  according  to  having  some  contact, Quilloac and  San Rafael, 2007 ??????????????????????????????????... . 240 Table 8.1 Percentages of dependency on diverse sources of household income by community, Quilloac and San Rafael, 2007 ??????????????????????.?.... .. 256 Table 8.2 Profile of six household clusters according to their reliance on different sources of income, Quilloac and San Rafael, 2007 ??????????????????..??.. . 257   xii List of figures Figure 1.1 Quilloac and San Rafael in maps of Latin America and Ecuador ................................ 3 Figure 1.2  Cost of importations and exportations of pesticides in North, Central and South America from 1961 to 2006 ?????????????????????.??.??? .. 4 Figure 2.1 Schematic representation of field and habitus ??????????.?...??..... 51 Figure 2.2 Relationship between civil society and state???????????????.. .. 59 Figure 4.1 Area in hectares according to unit size in Ecuador, 1954, 1974 and 2000??? ...... 82 Figure 4.2 Relative contribution of different-sized productive units to the net agricultural production according to their final market, Ecuador, 2000???????????..??? . 89 Figure 4.3 Ratio of farmers receiving different types of credit by 1000 productive  units according to unit size, Ecuador, 2000 ?????????????????..????..... 96 Figure 4.4 Ratio of farmers receiving technical assistance by every 1000 productive units according to unit size, Ecuador, 2000 ????????????????????......... .. 98 Figure 4.5 Total legal migration of Ecuadorians from 1996 to 2006???????.??? . 111 Figure 4.6. Emigrants for work-related reasons from Ecuador according to poverty line, years 1995 to 2000 ???????????????????????????????.. . 120 Figure 5.1 Conceptual framework ????????????????????.??? . 125 Figure 6.1 Correspondence analysis of the use of protective equipment and getting wet during the application of pesticides, Quilloac and San Rafael, 2007 ????????????? 193 Figure 6.2 Correspondence analysis of symptoms felt in the 7 days prior to the survey, Quilloac and San Rafael, 2007 ????????????????????????????. . 200 Figure 6.3 Histogram of cases of acute pesticide poisoning by age group, Luis F. Martinez Hospital, Canar Municipality, 1998 to 2008 ............................................................................ 202 Figure 6.4. Number of cases of poisoning treated in the emergency room of Luis F Mart?nez Hospital, all ages, over 10 years old, and children 10 years old or younger, 1998-2008 ........... 203 Figure 7.1 Organizations related directly or indirectly to agricultural production, Quilloac and San Rafael, 2007 ..................................................................................................................... 207 Figure 7.2 Timeline of creation and consolidation of some of the organizations and institutions with influence in Quilloac and San Rafael, 1930-2008 ............................................................ 211    xiii Figure 7.3 Some  assets  owned by community organizations, Quilloac  and San Rafael, 2007-2008 ??????????????????????????????????... . 214 Figure 7.4. Structure of land tenure in households of Quilloac and San Rafael, 2007?.......... . 223  Figure 7.5 Summary of group discussion on economic development in a community planning workshop facilitated by the Association of Organizations and the Provincial Indigenous and Farmer Organizations as part of their strategic planning process, 2007 ????.??.......... . 229 Figure 7.6 Correspondence   analysis of   access to different   types of   social   resources, Quilloac and San Rafael, 2007  ???????????????..????.?...??.. .. 239 Figure 7.7 Correspondence analysis of trust in different organizations and institutions with influence, Quilloac and San Rafael, 2007 ????????.?????????..??.. . 243 Figure 8.1 Saint Anthony of Padua, a European Catholic saint as seen at the entrance of the Ca?ar Municipal Church, Ca?ar, Ecuador, 2007 ??????????..????.??? . 245 Figure 8.2 Types of services provided by the Association of Organizations, the Financial Cooperative, and the Association of Agronomists , Quilloac and San Rafael, 2007 ??. ........ 248 Figure 8.3 Graphic representations of two competing models of inter-organizational governance in Quilloac and San Rafael according to a community leader ????????????... 249 Figure 8.4 Clusters of household income according to their percentages of land tenure and monthly household income, Quilloac and San Rafael, 2007 ????????????? .. 259 Figure 8.5 Clusters   of   household   income  according to their percentages of  high  participation in agriculture and membership in community organizations,  Quilloac  and  San  Rafael, 2007 ?????????????????????????? ?????.. . 264 Figure 8.6 Clusters of household income according to membership in community organizations and education level of the interviewee, Quilloac and San Rafael, 2007...???..????... . 266   xiv  Acknowledgements The collaboration with my main community partner, Rafael Alulema, a friend and  indigenous leader who is now pursuing his doctoral studies,  was fundamental for this study.  Quilloac and San Rafael?s inhabitants and their organizations, whose brave struggle is the subject of this research, were active participants in the achievement of this research?s goals.  My supervisors Dr. Jerry Spiegel and Dr. Annalee Yassi have provided their constant guidance and support.   Dr. Pilar Riano, Dr. Bruce Baum and Dr. Richard Carpiano provided valuable advice and guidance well beyond their role as thesis committee members.  The team members of the CIDA-Tier 1 project on sustainable management for environmental health in Ecuador provided a rich academic network I could learn from. In particular, Dr. Jaime Breilh, one of the key partners of this project and a leader in public health studies in Latin America, provided valuable insights in early stages of my research.  German Cabarcas, faculty member at the School of Mathematics, National University of Colombia, offered valuable and timely advice on statistical procedures.  This research was funded by a Canadian Institutes of Health Doctoral Research Award (Public health priority) and an International Development Research Centre Doctoral Award (Ecosystem Health program).    xv Dedication        To Lauren and Samuel        1 Chapter 1: Introduction This work aims to better understand the capacity of small farmers,1 their organizations and other social players in the communities of Quilloac and San Rafael to reduce environmental and health risks associated with pesticide use in agriculture. Quilloac, with 396 households, and San Rafael, with 136 households, are two contiguous communities of indigenous background in the southern ranges of Ecuador (see Figure 1.1). The idea of assessing pesticide-related harm and the capacity of community organizations to promote action originates from long-held concerns of community leaders.2  This subject unites my interests in agriculture and health, and is one of the priority areas of study in our Global Health Program at the University of British Columbia. The indigenous peoples in the Ecuadorian Andean region are an appealing case to study because their social organizations have historically played key roles in addressing the vulnerabilities of their communities.   For these reasons, the efforts to reduce problems with pesticide handling in agriculture by farmers in Quilloac and San Rafael were of great interest for analysis. This paper seeks to explore the interconnections among the following three major concerns: 1) environmental and health problems associated with pesticide use in agriculture, 2) a growing awareness of health inequities as co-determined by global, regional and local social determinants of health of vulnerable groups such as indigenous peoples and small farmers, and 3) the extent to which local                                                1 Except when otherwise stated, in this paper small farmers refers to peasants with either small holdings (5 or less hectares) or small farmers (more than 5 hectares but less than 20). 2 The opportunity to develop this project resulted as a consequence of my work as a research assistant with the University of British Columbia in a Canadian International Development Agency-funded inter-institutional initiative to build community capacity in order to reduce environmental health risks in Ecuador. Rafael Alulema, an indigenous leader who later became my main partner in this project, was a student at an International Master?s Program in Ecosystem Health, and was a part of the initiative. When asked about potential subjects for his Master?s thesis, Rafael Alulema presented an idea for assessing the environmental impact of pesticide use in his community. This proposal caught my attention because Rafael and two other members of the community were able to present their initiative after only one day of discussion with community leaders. The proposal was an example of the   2 community capacity can play a role in overcoming environmental health problems such as the impacts of pesticide use in agriculture.  In this research, I apply Pierre Bourdieu?s (1980b; 1986) approach to the forms of capital to analyze the capacity of small farmers in Quilloac and San Rafael to reduce pesticide-related risks as a health equity concern co-determined by human agency and social structure, which are embedded in layers of local, regional, national and global context.   1.1. Pesticide use as a growing global environmental health concern The use of pesticides is increasing worldwide, a growing public health concern because of potential environmental contamination and toxicity to humans. The development of modern crop varieties from the 1950?s and 1960?s, known as the Green Revolution, has also been accompanied by an increase in use and development of pesticides and artificial fertilizers. This is exemplified by the fact that the world trade in pesticides grew roughly by a factor of 14 worldwide from 1972 to 2002  (Gaybor, Nieto, & Velastegu?, 2006).  This worldwide phenomenon has also been experienced by countries in Latin America, including Ecuador (Gaybor et al., 2006, p.47).3 Figure 1.2 shows the long-term trends in international trade of pesticides for different regions in America, illustrating a dramatic increase from 1961 to 2006. If the trend towards Green Revolution technologies continues, in the first 5 decades of the 21st century there will be close to a three-fold increase in the use of pesticides and fertilizers (Tilman et al., 2001).                                                                                                                                                         capacity of the organizations to promote a community-based agenda; Rafael was connecting with a long-held interest of community leaders. 3 In the Ecuadorian case, this increased use of pesticides is determined by 1) an expanding agriculture frontier, 2) the increase use of mono-crops, which use pesticides more intensely than combined crops (also, short cycle crops use   3 Figure 1.1 Quilloac and San Rafael in maps of Latin America and Ecuador    Notes: Despite its relatively small area and population (12.156.608 inhabitants), Ecuador has profound regional divisions that are expressed in several dimensions, including its agricultural activity. Ecuador is divided into 4 geophysical regions (the Coast to the west, the Andean Ranges from north to south in the centre, the Amazon to the east and the Galapagos Islands). However, most of its population is concentrated in the ranges (51.0%) and the coast (44.4%) (INEC, Several Years).  The agricultural production in the coast is traditionally linked to exportation (cocoa and bananas). By contrast, the Andean production tends to cover the Ecuadorian markets (Larrea, 2006). Oil extraction in the Amazon region is an important source of revenue.   Source:  (Darlet, 2007-2010a, 2007-2010b)-? free under terms of license.                                                                                                                                                           more pesticides, affecting mainly small farmers), finally, 3) the adoption of agricultural techniques that increasingly use more pesticides per hectare (Gaybor et al., 2006: 57-66).     Latin America (Ecuador in grey)  Ecuador    4 Figure 1.2. Cost of importations and exportations of pesticides in North, Central and South America from 1961 to 2006 050000010000001500000200000025000001961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006Year*US$1000North America Imports Central America  Imports South America  ImportsNorth America Exports Central America Exports South America ExportsSource: Based on data from FAOSTAT |  FAO Statistics Division 2010 | Retrieved on 09 July 2010 from http://faostat.fao.org/site/424/default.aspx#ancor   In general economic terms, the Green Revolution may have led to a reduction in prices and an increase in total production yields, but its gains in terms of profit margins by farmers are less clear (Evenson & Gollin, 2003). Despite this, farmers have needed to use pesticides to maintain their competitiveness in the market. However, the adverse environmental and health effects of pesticide use in agriculture remain an important area of concern for environmental and public health action. In effect, the increase in crop production and the use of fertilizers and pesticides have contributed to the disruption of biotic loops and biodiversity with serious environmental consequences (Matson, Parton, Power, & Swift, 1997). In terms of human health, pesticide use associated with the Green Revolution accounts for millions of poisonings and thousands of deaths a year, generating public health and environmental costs close to US$100 billion a year in the world, with detrimental effects on human health which particularly affect low and middle income countries (Pimentel, 1996).    5 Preventing environmental and health consequences of these growing trends in pesticide use requires urgent change at several levels towards safer alternatives, such as pesticide-free agriculture and a more rational use of existent technologies (Matson et al., 1997; Tilman et al., 2001).4 First, farmers can adopt safety practices such as the use of personal protective equipment and adequate handling of products, equipment and disposals. Second, some changes in agricultural practices such as crop-rotation, sowing multiple products simultaneously and early pest surveillance can reduce the total use of chemicals. Third, technologies such as integrated pest management (IPM) techniques, organic agriculture, or permaculture are alternatives to Green Revolution agricultural practices.5 Fourth, adequate policies are fundamental at the local, national and international levels  (Yassi, Kjellstrom, de KoK, & Guidotti, 2001b). For instance, a number of the most toxic chemicals have been banned in high income countries but not in some low and middle income countries (Konradsen et al., 2003).  Despite these possibilities, the growing trends toward pesticide use and its environmental health problems are indicative that more research is needed to better understand barriers and opportunities to adopt safer agricultural practices. For instance, despite efforts by farmers and other stakeholders, poor safety practices in the use of pesticides are commonly reported in multiple contexts worldwide  (Crissman, Yanggen, & Espinosa, 2003; Anna Karin Hurtig et al., 2003; Jors et al., 2006; Khan, Shabbir, Majid, Naqvi, & Khan, 2010; Ntow, Gijzen, Kelderman, & Drechsel, 2006; Palis, Flor, Warburton, & Hossain, 2006; Quandt et al., 2010; Recena, Pires, & Caldas, 2006; Singh & Gupta, 2009). Some research has identified behavioural barriers such                                                4 ?Safe agricultural practices? is an expression used in this text to make reference to an agricultural method of production that is healthier for humans and less contaminating and disruptive for natural environments.  5 While IPM, organic agriculture, and permaculture are intersecting practices, some general differences can be argued. Some practices of IPM may have a limited use for pesticides (e.g., in traps). By contrast, in organic agriculture and permaculture, the use of synthetic substances is mostly avoided. Permaculture tries to have a more radical imitation of the ecological niches than some of the organic agriculture practices.  In this paper, safer agricultural practices refer to all of these strategies in general, including a rational use of pesticides within the context of traditional crop technologies.    6 as farmers? belief systems that associate chemicals with medicine or low education levels (Palis et al., 2006). Other social structural barriers such as high equipment cost (Elmore & Arcury, 2001), low access to information (WHO/UNEP, 1990, pp.94-97), or lack of appropriate institutional or financial support have also been identified (Hong et al., 2009; Tracy, 2007, pp. 56-57; Wilson & Tisdell, 2001, pp. 455-459).    My research project studies the case of Quilloac and San Rafael to provide further information for the debate about concrete action to reduce pesticide-related environmental health risk.  Despite continued interest and multiple initiatives by community organizations, some Non-Governmental Organizations (NGOs) and state stakeholders, so far attempts to overcome the potential problems of pesticides in Quilloac and San Rafael have failed.  In analysing the change processes of these three groups, I focus on social structural factors and the perspectives and practices of individuals and groups embedded in these structures. Their case helps to inform the debate from a public health perspective, and will hopefully serve to reduce health inequities. As small farmers and indigenous peoples in a low and middle income country, peasants in Quilloac and San Rafael are vulnerable to many negative social determinants of health.  My hope is that my research will lead to more justice for them and others like them.      7 1.2. Health equity dimensions of pesticide-related risk In reducing environmental health impacts of pesticide use, the protection of the natural environment and the reduction of health inequities are interconnected. There has been, in recent years, a growing academic interest in social inequities and their connection to social determinants of health and environmental justice. The World Health Organization?s Commission on the Social Determinants of Health (Rother, Hall, & London, 2008) reported that social inequity within and across countries, rather than wealth, is more associated with different types of health outcomes such as child mortality. Consistent scientific evidence also shows that the most marginalized communities are the most vulnerable to ecological problems (Agyeman, Cole, Haluza-DeLay, & O'Riley, 2009; Masuda, Zupancic, Poland, & Cole, 2008; WHO & CSDH, 2008). This holds true in terms of pesticide-related harm. For instance, while less than 20% of pesticide use is concentrated in low and middle income countries, these countries account for more than 90% of deaths from pesticide poisoning (Kesavachandran et al., 2009). Lack of adequate regulations, insufficient control, poverty, and low credit and technical assistance may contribute to this unbalance (Kesavachandran et al., 2009; London, 2009).    While there is some consensus among scholars about the role of social determinants in health inequities, which particular strategies will reduce the health gap is still a matter of great debate (Muntaner, Sridharan, Solar, & Benach, 2009). The report by the World Health Organization Commission states that social inequities resulting in gaps in health status are determined by several socioeconomic and political factors that go beyond the scope of health care services. Consequently, the Commission suggests 1) improving the living conditions of people in extreme poverty, and 2) tackling inequities of power, money, resources, and the factors behind these inequities (WHO & CSDH, 2008, pp. 69-71).  Going beyond this general statement,   8 authors such as Carles Muntaner, Sanjeev Sridharan, Orielle Solar, and Joan Benach (2009) suggest that there is a need to move from general formulas to particular strategies and policies that adequately conceptualize the context in which they are embedded (local, regional, national and global) in order to reduce health inequities. Research should also refine methodological approaches to identify and target the most vulnerable.  In this proposal, I aim to contribute to the discussion about strategies to reduce pesticide-related harm with an emphasis on health equity. I focus on the communities of Quilloac and San Rafael and their placement in a local, regional, national and global context. In the next section, I will briefly introduce the position of small farmers in the indigenous communities of Quilloac and San Rafael as vulnerable groups in the Ecuadorian context.    1.2.1. Vulnerability of small farmers of indigenous background in Ecuador. Farmers in Quilloac and San Rafael are an extremely vulnerable population for reasons related to their country, their property, and their indigenous background. First, Ecuador is a relatively poor and highly inequitable country (as is true in many Latin American countries).  In 2000, 39.8% of Ecuadorians lived below the consumption poverty line, 6 (INEC, Several Years) and Ecuador?s GINI index was 53.6 for 2007 (WB, 2007a).7 In the late 1990?s and early 2000?s Ecuador experienced an economic crisis that worsened poverty and income inequities (Acosta, Lopez, & Villamar, 2006; Beckerman & Solinamo, 2002, pp. 7-12; Parandekar, Vos, & Winkler, 2002, p.128). In 1998 and 1999, the economic crisis reached such levels that the net growth of the                                                6 Consumption poverty is defined as the number of people with a purchasing power below the poverty line, which is understood as the amount of money needed for basic goods.  7 The GINI index is an indicator of income concentration according to which 0 is absolute equality and 100, absolute inequality. Despite the fact that data from different countries is not completely comparable due to divergence in the methodology, this index can provide a general idea of the international place of Ecuadorian income distribution: Canada 32.6, United States 40.8, Mexico 46.1, Costa Rica 49.8, Argentina 51.3, Peru 52, Colombia 58.6 (WB, 2007a).    9 Gross Domestic Product was negative.8-9 Dollarization, which was adopted in 2000 to stop high rates of inflation, triggered an increase in the consumer price index.10 Domestic prices grew almost 100% in 2000, but later became more stable in 2001 (Beckerman & Solinamo, 2002, pp.7-12).   While urban poverty has grown faster in recent years, rural areas are still poorer than urban areas in the three most populated regions of the country as shown in Table 1.1 (INEC & WB, Several Years).11 Furthermore, despite the fact that rural poverty on the coast is more widespread, the number of poor in the rural population of the Andes has grown faster. While rural consumption poverty in the coast was steady between 1990 and 2001, it grew 15% in the Andes (WB, 2004).   The province of Ca?ar, where Quilloac and San Rafael are located, has total increase in poverty percentages that are higher than the Andean region as a whole, but similar to the national average. This coincides with a trend in the whole of Latin America and the Caribbean where, excluding Brazil, rural poverty has been constant or rising, with higher numbers of poor rural inhabitants than poor urban dwellers (de Janvry & Sadoulet, 2000).12                                                 8 Amidst avid academic discussion, there is controversy about the determinants of the crisis. Some triggering factors can be mentioned: 1) a growing inequity in the country and difficulties reaching consensus about national policies, 2) the Ecuadorian fiscal structure and an economy that has always depended on export commodities that are currently subject to international crisis (e.g. oil), 3) the international debt crisis in the 1980's, 4) a marked debility of institutional capacity, 5) a banking crisis in 1998, which also showed problems in regulation, concentration of loans and vulnerability of portfolios to high interest (Beckerman & Solinamo, 2002). 9 In addition to the economic crisis, Ecuador also experienced a political crisis in the 1990?s and 2000?s. Some aspects of the political crisis, as well as the emergence of an indigenous movement in the country, will be described later in this document.  10 Dollarization is the change of currency from Ecuadorian Sucre to US Dollar, which is still the currency in use in Ecuador.  11 Despite being less prevalent than rural poverty, urban poverty has grown faster. In effect, in a process that has been called urbanization of poverty, urban poverty has grown at a higher rate since the 1980?s in Ecuador. This process is the combined result of 1) migration from rural to urban areas, 2) changes in employment in urban centres, and 3) the effects of the economic crisis of the 1990?s on the cities? middle class (WB, 2004). 12 In recent years, Brazil has implemented a series of state policies with the goal of reducing rural poverty. The effect of Brazil makes the average of the whole region look positive for rural poverty reduction. In addition, it should be noted that urban poverty is a fundamental concern for Latin America, with worse poverty indicators than the rural areas in many countries (de Janvry & Sadoulet, 2000).    10 Overall, the Ecuadorian economy has experienced a relative loss in the value of its crop and livestock production in the last several decades.13  Table 1.1 Percentages of poor and extremely poor in population for different indicators according to region and area in Ecuador, 2006  Ranges (%) Coast (%) Amazons (%) Country (%) Rur Urb Tot Rur Urb Tot Rur Urb Tot Rur Urb Tot Consumption poverty 58.8 16.0 33.7 62.1 31.4 40.1 73.3 21.8 59.5 61.5 24.8 38.2 Extreme consumption poverty  25.7 2.9 12.3 22.0 6.2 10.7 51.9 5.6 39.4 26.8 4.8 12.8 Unsatisfied basic needs  68.1 26.2 43.5 90.2 50.5 61.8 79.6 49.0 71.4 77.8 40.3 54.0 Notes: Rur = Rural, Urb= Urban, Tot= Total Consumption poverty is defined as the number of people with a purchasing power below the poverty line, which is understood as the amount of money needed for basic goods.  Extreme consumption poverty is defined as the number of people with a purchasing power below the extreme poverty line, which is understood as the amount of money needed to meet minimum nutritional needs. It represents the inability to satisfy minimum nutritional requirements.   Unsatisfied basic needs makes reference to the number of people unable to fulfill basic needs such as housing, health, education and employment. Data from INEC, & WB. (2006). Quality of Life Survey. Quito: National Institute of Censuses and Statistics- Instituto Nacional de Estadisticas y Censos-INEC, Ecuador; World Bank.  Farmers in Ecuador also face inequitable land distribution. Three major land reforms (in 1964, 1973 and 1994) have done little to reduce inequity in land distribution, despite favouring some communities.14 Sixty percent of agricultural land (60.4%) is still controlled by 6.4 % of persons (those owning more than 50 hectares). Conversely, more than sixty percent of persons (63.5%, those with fewer than 5 hectares) own only 6.3% of the agriculturally productive area. In the province of Ca?ar, 2% of those with 50 hectares or more control 53.5% of the land, leaving 77.8% of people (those with less than 5 hectares) with just 19.6% of the land (INEC-SICA, 2000).  In the Ecuadorian context, Manuel Chiriboga (1997) has suggested that people with 5 or fewer hectares have little chance for economic viability.  Moreover, the international political                                                13 In the early 1980?s the country shifted from having a majority rural population to having more of its inhabitants in urban centres (FAO, 2004). This trend is consistent with the evolution of the world?s population during the twentieth century (Cohen, 2003; Homer-Dixon, 2006). Similar to other countries in the region, the Ecuadorian agricultural sector, as a percentage of the Ecuadorian Gross Domestic Product, has decreased. 14 With Costa Rica, Honduras and Uruguay, Ecuador was one of the Latin American countries with the smallest area of land modified by the land reforms (ECLAC and FAO, 1986 as quoted by Kay, 1998).   11 agenda promoted in the last decades by the Washington Consensus, which entails, among other things, an export driven model for agriculture, the liberation of domestic markets for imports, and the decrease in direct support from state institutions, has particularly affected small farmers in developing countries (Mazoyer & Roudart, 1997).15   Marginalized as small farmers, the indigenous population is also the poorest ethnic group in Ecuador. According to the National Population and Household Census of 2001, self-identified Ecuadorian indigenous inhabitants make up 6.8% of the total population  (INEC, Several Years).16 Most of this population is concentrated in the Andean region.  For instance, in 2001, 71.7% of self-identified indigenous inhabitants lived in the ranges, and 19.6% lived in the Amazonian region (CEPAL, 2005; INEC, Several Years). According to the National Quality of Life Survey for 2006, the percentage of self-identified indigenous communities living below the consumption poverty line reached 69.8%. This was followed by Afro-Ecuadorians at 48.6%, mixed-race Ecuadorians at 34.5%, and Caucasian Ecuadorians at 33% (INEC & WB, Several Years).  Summarizing, most of the indigenous communities in Ecuador experience two of the key conditions for marginalization: being rural dwellers and indigenous.  In addition, as small                                                15 I am by no means suggesting that the burden of the solution to health and environmental problems posed by pesticides lies on the shoulders of small farmers. On the contrary, while small farming may offer important alternatives for overcoming the limitations of the Green Revolution, as stated before, large-scale farming is associated with great health and environmental problems. According to M. Altieri, small farmers are fundamental for several reasons. First, with just 34.5% of the total crop area in Latin America, small farmers produce 51% of the maize, 77% of the beans, and 61% of the potatoes for domestic use. Furthermore, they use more polycultures than large farms, which is important for biodiversity. Combinations of multiple crops can also have more yields if all the products are accounted for, while tending to be more sustainable in environmental terms (Altieri, 2008; Rosset, 2000).  In addition, small farming is an important source of employment since the creation of new jobs in small farming is cheaper than in other economic sectors (Rosset, 2000). 16 This estimate is contested. By using other criteria such as language and cultural patterns, other authors have calculated that the indigenous population in Ecuador ranges between 24 and 51%, second only to Bolivia and Peru in the Andean region (Escarzaga, 2004:105 quoting Matos-Mar & Wermus, 2002).  Self-identification may lead to underestimation due to the fact that some indigenous people may fear discrimination. It is also necessary to mention that the results have several political implications (Bartlett, Madariaga-Vignudo, O'Neil, & Kuhnlein, 2007). In this document, I use the estimates by the Ecuadorian Institute of Statistics and Censuses (INEC), based on self-  12 farmers in a middle and low income country, inhabitants of Quilloac and San Rafael are in a disadvantageous position to overcome global changes such as integration of global markets, reduction of state support, and competition from high intensity technological developments in agriculture. Their use of pesticide is embedded in this context. This proposal studies their efforts with a view toward health equity and reduction of vulnerability at local, regional, national and international levels. This paper wishes to understand the capacity of peasants in Quilloac and San Rafael to engage in transformative action.   1.3. Community capacity as an instrument for reduction of environmental health inequities Focused on the search for effective interventions for pesticide related harm, I intend to focus on the extent to which community capacity can play a decisive role in building healthy, environmentally safe and sustainable alternatives for small farmers. There is not consensus about the concept of community capacity, which is often overlapped with terms such as community participation, empowerment and social capital (Craig, 2007; Kwan, Frankish, Quantz, & Flores, 2003; Verity, 2007). In this research, I understand community capacity as a group?s potential to achieve change for promoting their health or improving their environment. This builds on public health scholars who, using the notion of empowerment to refer to increased control over life conditions, have defined community capacity as a social relationship (Labonte & Laverack, 2001a; Laverack, 2006; Laverack, 2007).  My interest in community capacity started with the considerable number of academic papers and public health agencies that have highlighted the need for community capacity-building for public health initiatives. Some of the commonly quoted potential benefits of community capacity-building are empowerment and involvement of                                                                                                                                                        identification. These estimates are also used in other official data such as poverty rates.  However, there is a need to   13 groups and individuals, facilitation of democratic decision making, greater accountability for policies and projects, provision of services adequate to community needs, better acceptance of projects and initiatives by community members, and increased mobilization of resources and enhanced support networks (Maclellan-Wright et al., 2007, p 229; Verity, 2007, p. 11). Of particular interest is the fact that, in the recent World Development Report 2008, Agriculture for Development, the World Bank includes the strengthening of social capital and civil society as one of its fundamental strategies for overcoming the limitations of the Green Revolution. It states:  Decentralized governance allows greater access to local information and use of local social capital in regulating externalities. Civil society has the capacity to provide technical assistance and help organize farmers and communities to meet the more stringent environmental standards. Community organizations and producer cooperatives were at the heart of the recent expansion of organic export production in East Africa. (WB, 2007b, pp.188-189).      Despite optimism about notions such as community capacity, engagement or social capital, the intense debate about the notion of social capital promoted by the World Bank (2000) is illustrative of some of the challenges of effectively implementing perspectives on community capacity to address inequities. The World Bank?s approach is mainly based on work by Robert Putnam (1993; 1995), who defines social capital as networks, norms and social trust that facilitate collective action for mutual benefit. Applications of this concept are common in public health research (Kawachi, Kim, Coutts, & Subramanian, 2004; Moore, Shiell, Hawe, & Haines, 2005; Whitley & McKenzie, 2005). However, some authors have raised concerns about the extent to which power and inequities are not central to this social capital notion and appear as an add-on with the potential of depoliticizing and deviating the discussion from the central social structures that generate inequalities (Fine, 2001, 2007; Morrissey, 2006). This is related to inadequate approaches to history and social context in mainstream social capital research (Farr,                                                                                                                                                        acknowledge that these statistics may lead to underestimation.   14 2004). Acknowledging this debate, Anthony Bebbington, Scott Guggenheim, Elizabeth Olson, and Michael Woolcock (2004) suggest that behind the discussion about social capital there has been a struggle between different groups within the World Bank to promote different political agendas about empowerment and community participation in development. Beyond this debate, a central issue requiring more development is the extent to which community engagement and empowerment can be central to the reduction of social inequities, and challenge their factors of origin (Bebbington et al., 2004).  In public health sciences, questions about the role of vulnerable people in overcoming their own health risks are very important given the high prevalence of works that overemphasize individual responsibility. Studying the case of pesticide intoxication in South African farmers, Leslie London (2003) describes the extent to which public health practice very often resorts to explaining the origin of the problems in the behaviour of workers. This approach tends to ?blame the victim? by overemphasizing their role without a proper assessment of the context and structural forces that co-determine the problems. Alternative approaches such as ?collective lifestyles? have emerged to overcome this issue by making the relationship between practices and social structure central to the development of action paths to health equity (Frohlich, Corin, & Potvin, 2001; Frohlich & Potvin, 2008b; Potvin, Gendron, Bilodeau, & Chabot, 2005). In terms of strategies to harness community capacity to reduce health inequities, human agency goes beyond personal responsibility to harness resources for overcoming structural disadvantages. Several scholars have used concepts such as empowerment to highlight the extent to which human agency and social structure should be approached together as co-determined and embedded in local, regional, national and international contexts (Labonte, 2004; Labonte & Laverack, 2001a; Raeburn, Akerman, Chuengsatiansup, Mejia, & Oladepo, 2006; Wallerstein, 2002). A fundamental concern is to better understand the extent to which promoting local   15 community capacity can effectively contribute to reduce health inequities, while simultaneously avoiding overburdening already marginalized populations with problems for which other groups are ultimately responsible. This requires a clear understanding of the links between human agency and social structure as mutually determined and embedded in multiple layers of social context.  My approach to health equity is based on the work by the French sociologist Pierre Bourdieu (1980b; 1986). Bourdieu?s work first offers a refined framework for approaching human agency and social structure simultaneously, and responds to questions of co-determination and embedment in social contexts. Second, Bourdieu places equity and power issues at the centre by utilizing a multidimensional approach to the distribution of cultural, economic and social resources. This is similar to discourses of empowerment, which, based on Foucauldian and feminist scholars, approach power as a multidimensional and dynamic process localized in social relationships (Labonte, 2004; Wallerstein, 2002). Finally, while other empowerment perspectives, such as Nina Wallerstein?s (2002), conceive of power as a limitless resource that can be harnessed by community organization and collaboration, the work by Bourdieu assumes cultural, social and capital resources as relatively limited assets, the objects of constant struggles to control by social groups in a particular context. By mapping community stakeholders? differential access to social resources, I aim to map differential barriers and opportunities by social players. The work by Bourdieu has been previously used for approaching issues of equity in health sciences and other disciplines (Buzzelli, 2007; Campbell, Cornish, & Mclean, 2004; Kim & Kim, 2009; Lynam & Cowley, 2007; Osborne, Baum, & Ziersch, 2009; Veenstra, 2007). Further details about my application of his work are provided below.    16 By applying Bourdieu?s work to analyzing the capacity of Quilloac and San Rafael?s farmers to reduce pesticide-related risks, I offer new insights about the role of vulnerable peoples in reducing environmental health inequities. In Latin America, the marginalization suffered by small farmers in recent decades has led to the rise of different types of farmer movements that clamour for better production conditions, including more environmentally friendly agriculture (McMichael, 2006).  Quilloac and San Rafael have been organizational centres for the Ca?ari indigenous peoples in the area and active participants in the wider Ecuadorian indigenous movement. Both communities contain a large number of community organizations within their borders.  These organizations have a long history of struggle for the betterment of their inhabitants. In the 1950?s and 1960?s, they fought for land. In the 1970?s and 1980?s they also fought to control water and conditions for their agricultural production. However, despite their struggle, farmers in Quilloac and San Rafael remain in a vulnerable social position; their use of pesticides is embedded in this context.   1.4. Overview of the research Building on this triple interest in the pesticide-related environmental health problems, health equity, and community capacity, this paper aims to better understand what role, if any, small farmers, their organizations and other community members can play in establishing healthier and environmentally friendlier agriculture in the communities of my study. The key questions are: What can small farmers do to change their conditions and build long-term solutions for problems with pesticide handling? and How can small farmers in the southern ranges of Ecuador mobilize their resources to affect social change? To answer these overriding questions,   17 I identified the following sub-questions, which then guided the articulation of specific objectives for investigation: 1: Is pesticide handling really a problem in the communities of study? Is there evidence to warrant the reduction of pesticide related risk as part of the agenda of community organizations? If so, who are the community members that are more likely to face health risks because of pesticide use?  ? Specific Objective 1: To better understand diverse patterns of human exposure to pesticides in agricultural practices, and to identify problems with pesticide handling by inhabitants of Quilloac and San Rafael. 2: What is the capacity of small farmer organizations to address the problems related to pesticide use? What are the main structural conditions determining the capacity of small farmer organizations to promote healthier and environmentally friendlier agriculture in the communities of my study?  ? Specific Objective 2: To better understand structural factors determining the capacity of small farmer organizations to promote healthier and environmentally friendlier agriculture in the communities of my study, Quilloac and San Rafael. 3: What are the main strategies adopted by farmers and farmer organizations to adapt to their conditions and survive? How do these strategies affect the capacity of small farmer organizations to develop sustainable and healthier agriculture alternatives in their communities?    18 ? Specific Objective 3: To better understand the extent to which individual and organizational adaptation strategies affect the community capacity for developing sustainable and healthier agriculture alternatives in the communities of study.  4: What strategies are needed for harnessing community capacity to reduce environmental and health risk associated with pesticide use in Quilloac and San Rafael?  ? Specific Objective 4: To identify strategies for harnessing community capacity to reduce environmental and health risk associated with pesticide use in Quilloac and San Rafael.  I do not aim to suggest that small farmers should bear the core of the responsibility for transforming structural conditions that are sometimes out of their control. On the contrary, I would like to contribute to the discussion to better understand the extent to which these farmers can act within their capabilities. This would also help to better understand the role of other stake-holders such as governmental institutions, universities and the chemical industry. In this thesis, I intend to provide possible answers to these questions by focusing on the case of small farming in the southern ranges of Ecuador. As most small farmers in the southern ranges of Ecuador are indigenous, I am also going to focus on these farmers being doubly marginalized: as small farmers and as indigenous people.  To answer these questions,  I have based my analysis on Bourdieu?s (1980b; 1986) approach to the forms of capital within a defined social field. To simplify, for Bourdieu, a field is a system of relationships constituted by social agents related to the production and promotion of a particular product. A field is constituted by two elements: the existence of a common capital and the struggle for its appropriation by different social actors  (Bourdieu, 1980b, 1986). Different social players compete for the acquisition of determinate forms of accumulated capital in a given   19 field.17 Any field is codetermined by a broader social structure that shapes its organization, even though its internal dynamics are partially autonomous. A field can change over time. For instance, the adoption of the Green Revolution in agriculture may have been favoured in rural settings by the change in the field of agriculture to favour more capitalist forms of production, with the need for greater profits for accumulation.  In the case of this work, the Ecuadorian rural setting linked to agriculture is understood as a field.18 Small-farmer organizations are one of many social actors competing for access to the forms of capital that allow them to survive.  19  Codetermined by the field, habitus is a social learning that constitutes the basis for perceptions that generate practices. It is learned according to a person?s position in society and also helps to reproduce society?s structure  (Bourdieu, 1980b, 1986). Focusing on community capacity building for public heath, I will provide more details on this approach in Chapter 2.   To achieve my objectives, I conducted a descriptive case study using a mixed-method design. My approach combined quantitative, qualitative, and participatory components. To address Objective 1, I conducted a cross-sectional study that aimed to identify patterns of exposure and perceived symptoms. A sample of 187 households was randomly selected out of the 532 families in the communities (71 households from San Rafael and 116 from Quilloac), and a survey was applied to adult family members that identified themselves as household                                                17 For Bourdieu, capital in general is accumulated labour, which can be expressed in objects. When appropriated by groups or individuals, capital can harness social energy for specific objectives. The forms of capital include other kinds of capital different from the economic type, which is the most commonly acknowledged. They include, for instance, social capital, defined as resources embedded in more or less institutionalized networks of mutual acquaintance and recognition. Social capital is used by groups or individuals according to their interests. Furthermore, cultural capital refers to forms of knowledge, including skills and education, which may provide benefits to a group or person according to their position in society. Habitus, socially constructed knowledge, is very important for cultural capital (Bourdieu, 1986).  18 Among other social spaces, the notion of field was applied by Bourdieu to rural settings linked to agricultural production in Algeria and France (Bourdieu, 2008; Grenfell, 2006). The sociology of Bourdieu has also been suggested as appropriate for rural studies in Ecuador  (Martinez, 2005a). 19 On the other hand, the role of small-farmer organizations is linked to the role of small farmers; however, they are not the same. While there are small-farmers that are not linked to such organizations, many organizations that group small-farmers are not just defined by their presence. The case of indigenous organizations will be discussed below.     20 leaders. Pentox?, a 10-minute screening survey under development by partners in Ecuador for problems with pesticide handling, was adapted and included. In addition to the household survey, I reviewed hospital discharge records from 1998 to 2008 at the local hospital to identify cases of pesticide poisoning. Data from in-depth interviews and an exploratory case-control study was used to better characterize cases of accidental poisoning in children.  For the second, third and fourth objectives, I combined three main approaches. First, ethnographic methods applying observation and in-depth interviews with key actors were used, together with an archival literature analysis. This helped to examine perceptions about the dynamics of different forms of capital and community capacity. Second, I included in the household survey a set of questions asking for perceptions about trust and unity and social capital (e.g. access to networks and social resources). Third, based on my findings, I developed and action research component to work with community leaders to promote a number of initiatives to reduce pesticide related harm in the communities. Some of the initiatives included an eight month radio show and a number of workshops with farmers and community leaders.  The progress in the development of the initiatives was the subject of collective analysis with community leaders. More details about my methodological approach are provided in Chapter 5. In addition to this introduction, the final report is organized into nine chapters as follows: Chapter 2 provides a brief summary of some key issues from the literature on community capacity building in health sciences. This chapter also develops my theoretical perspective on community capacity, which is based on Bourdieu?s (1980b; 1986)  approach to the forms of capital.   In Chapter 3, I summarize some of the potential health and environmental challenges of pesticide use. I focus on the pesticides most commonly used in each area. I also briefly describe   21 some alternatives to pesticide use that can reduce the environmental health risks associated with pesticide use, with particular attention to some challenges for training of farmers and for transforming agricultural practices at the local level.   In Chapter 4, I describe the main factors that determine the structure of the field of agriculture for small farmers in the southern ranges in Ecuador. I focus on inequitable land distribution, inadequate market access, and limited state support as fundamental challenges for the adoption of safer agricultural practices. In addition, I discuss international migration as a phenomenon affecting the capacity of small farmers to transform their agriculture.  Chapter 5 provides a detailed description of my methodological approach. It starts with a full description of my conceptual models and my operationalization of key concepts. It also contains a discussion of my main methodological approach and a detailed description of its main components: household survey, ethnographic methods, action participation research, and analysis of hospital discharge records. I present the results of my investigation in Chapters 6, 7 and 8. In Chapter 6, I show the results focused on gaining an understanding of the diverse patterns of human exposure to pesticides in agricultural practices, and to describing problems with pesticide handling by inhabitants of Quilloac and San Rafael (Specific Objective 1). I emphasize the fact that some of the most vulnerable members of the community are simultaneously the most likely to participate in agriculture (and use of pesticides): older and less educated community members, and households with less income and land. I also identify the extent to which pesticides were effectively a problem for the communities. Poor safety practices predominated. Furthermore, farmers who had recently applied pesticides were significantly more likely to have had symptoms such as diarrhoea and nausea. In addition, based on hospital discharge records, I   22 describe a peak of accidental poisoning in children from 2001 to 2004, which may have been associated with non-parental childcare in a period of economic hardship and high migration rates in the communities.  Chapter 7 shows data related to the development of Specific Objective 2: to better understand structural factors determining the capacity of small farmer organizations for promoting healthier and environmentally friendlier agriculture. I state that the communities had an important density of organizations with knowledge and technical capacity for transforming agricultural practices. However, the dimension of challenges such as smallholdings and lack of resources limit their capacity to develop sustainable action. This is reflected by the fact that the number of community members who had contact with the organizations was limited. Only a small number of farmers had access to a number of resources such as free credit and assistance for pesticide use. A limited number of farmers who had better than average household income and education level had more contact with organizations and more access to social resources. By contrast, the fact that community members with the highest levels of participation in agriculture had less contact with their main organizations was concerning. A large number of farmers had little trust in the capacity of their organizations to improve the quality of life in their communities.  Specific Objective 3, aiming to better understanding the extent to which individual and organizational adaptation strategies affect community capacity for developing healthier agriculture alternatives, is developed in Chapter 8.  I suggest that while leaders of farmer organizations tended to rely on an agriculture-centred vision of the community (either ancestral or modern), a substantial number of community members were simultaneously resorting to other survival strategies which did not necessarily centre in agriculture. I identified six different   23 clusters of households based on their sources of income. Among the clusters with less access to community organizations were some of the most vulnerable families. These were households which, having little land and low income, resorted to participation in agriculture combined with non-agricultural work.  The scarcity of manpower was central to limiting their access to community organizations and reducing their capacity to reduce pesticide use.  Finally, Chapter 9 contains the discussion of findings and conclusions.  While community organizations had managed to build a pool of services for farmers despite their scarcity or resources, an important sector of the community was left behind, with important implications for health equity. A cluster of community households had already moved away from agriculture, and had little contact with organizations. More relevant, some of the most marginalized farmers (elders with low levels of education and households with less land and income) were simultaneously among the most exposed to pesticide use (farmers with some of the highest levels of participation in agriculture) and among the groups with less contact with community organizations (households with multiple non-agricultural employment combined with subsistence agriculture).  While I celebrate the possibilities for building democratic solutions to the environmental health problems related to pesticide use, I argue that, to harness the capacity and dynamism of small farmers and their organizations towards effectively reducing health and environmental impacts of pesticide use, these farmers and organizations need to be provided with adequate resources, coherent state support, and favourable policies in order to access land, credit and financial support. Otherwise, small farming has little chance, not only to make the transition towards new forms of production, but also to survive. Without significant change, agriculture will be the sole domain of large producers who have better access to forms of capital in the field.    24 Chapter 2: A review of key community capacity-building issues for working with marginalized communities In order to better understand the potential role of small farmers and their community-level organizations in reducing their environmental health vulnerabilities to pesticide use, there is a need for a reinterpretation of the community capacity-building literature in public health at different levels. It starts by better understanding the notion of community as a setting for health action. In this discussion, I focus on three central issues. First, behavioral change in the use of pesticides needs to build on research efforts that approach the contextual limitations of peoples? actions to enable transformation, while avoiding traditional bio-medical perspectives that overemphasize individual responsibility and blame the victim. Second, within a social determinants of health approach, there is a need to move from general diagnostics to identifying context-relevant actions to tackle the structural foundations of health inequities.  Local action to reduce pesticide-related environmental health vulnerabilities needs to build on efforts to approach the international, national and regional forces that favour pesticide risks in the context of a increasingly global food production system. Third, local community capacity-building requires an understanding of the potential role of a diverse range of community and state stakeholders in supporting or challenging the local and global power dynamics that favour environmental health vulnerabilities to pesticides.  In this work, I build on approaches to community capacity-building as an instrument for health promotion, as a tool for the empowerment of vulnerable groups (Labonte, 2004; Wallerstein, 2002), and as the product of social relationships which are structured in particular contexts (Labonte & Laverack, 2001a, 2001b). These perspectives are informed by the work of Bourdieu (1986).   I believe that this theoretical perspective is appropriate for better understanding the extent to which marginalized groups can engage in developing sustainable   25 action for promoting their health, while identifying some contextual constraints that are the responsibility of other agents.  2.1. The concept of community  The use of the term community in the health literature is vague. Over the years, it has been used mainly regarding geographical, relational, or interest elements of a group of people (Phillips, 2007: 57). Table 2.1 summarizes some of the approaches to community, while identifying some of their advantages and disadvantages for academic work and public health action.  Describing a case study of community engagement for environmental and health protection, Meg Huby and Rupert Adams (2008) point out that the conceptual ambiguity of ?community? leads to different answers regarding community work and health interventions, as well as questions about whom to involve as stakeholders and how to engage community members in a particular project depending on the adopted approach. The scheme in Table 2.1, however, shows advantages and disadvantages for different approaches. Most of the literature on community capacity-building that is discussed below inherits the difficulties in defining community.     26  Table 2.1 Three different approaches to the definition of community Approach Some Advantages Some Disadvantages Geographical Group of people from a geographical area. ? It may reflect political and administrative areas, which better coincide to available data. ? It facilitates the focus of public health interventions and public policies.  ? It can include diversity. ? It may help to identify inequities across geographical areas.   ? People from a particular area do not necessarily share the same characteristics or interest (Craig, 2007: 337-338). ? Some communities that are not necessarily related to place are overlooked (such as migrants). ? It may hide inequities within geographical areas.  Interest Group of people sharing some elements such as common interest, values, identity, beliefs or activities (e.g., occupation, religion, culture, etc.). ? It can help to identify differences within a geographical area, while focusing on elements that may be of particular interest (e.g., small farmers).  ? It may provide more efficacy in public health interventions and public policies as it targets people with common traits.  ? It allows the opportunity for ?community members? to identify themselves according to their perspective (even though it can also give room to outsider?s labeling? see next column).   ? A commonality in one element such as identity does not reflect a commonality of other elements.  ? There is always a risk of externally labeling negative aspects of the community.20   ? Identity labels may favour control over marginalized groups. ? There may be a gap between perceived commonalities and real differences.  ? It may hide differences among the ?community members? regarding other aspects different from the ones identified.  Relational Group of people who are interconnected by means of relations of loyalty, affect or activities (Brint, 2001:8 according to Phillips, 2007) (e.g., workers of an agribusiness, who may not share the same values or interests).  ? It can help to identify differences within a geographical area.  ? The set of relationships and bonds can explain some components of social action that are not fully motivated by common interest.  ? Social relationships can help to maintain inequities in a particular group of people.   Notes: Elaborated by F. Cabarcas, based on (Craig, 2007;  Phillips, 2007; Verity, 2007)                                                  20 This problem is very common for development and health projects. For instance, defining a community because they are poor or vulnerable implies a negative image of the community members that can have unintended consequences. First, it can label community members as negative members of a particular society. Second, it can affect self-identity and foster paternalistic-dependant relationships. Some authors have suggested a more positive approach to community capacity-building. For instance, mapping different types of community assets (traditional and non-traditional) can help to achieve a more positive vision of the community (Kretzman & McKnight, 1993).    27  Depending on the particular object of interest, one possible alternative is to combine different perspectives when approaching a particular setting for research or action.  An awareness of the multiple levels may be beneficial for analysis. For example, in the case of small farmers in the southern ranges of Ecuador, I am mainly using an interest-type of community. This is the community of small farmers who use pesticides.  Most of them also happen to be indigenous in the particular communities of my interest. I believe that this focus can help to target public health action and better understand its circumstances.  However, I am also using other types of approaches to community when necessary. A relational type of community definition is going to be fundamental for my approach to community capacity. I will focus on the type of organizations that can affect agricultural practices, particularly on small farmer organizations.  Furthermore, a geographical type of community is used for some aspects such as some techniques for data collection and to better understand the context and history of the area.   2.2. Defining community capacity-building The term community capacity in health disciplines has been applied to a wide variety of concepts. In health literature,  Brenda Kwan, Jim Frankish, Darryl Quantz and Julieta Flores (2003) identified a total of 83 characteristics of community capacity used in the literature until 2003.21 Some terms that are usually associated to community capacity-building in the literature                                                21 The level and scope of the term ?community capacity? are also broad.  Summarizing their literature search and based on focus group discussions, Brenda Kwan et al. (2003) described a framework that covers three levels (individual, organization, and community) across four dimensions (context, resources, activities, and outcomes).  Fiona Verity (2007) identified six domains at the community level: physical (infrastructure),  institutional (policies, structures, and inter-system interaction), economic (resources, opportunities, and knowledge), social (networks, participation, and trust), and human (skills, motivation, etc.).  Glenn Laverack (2006) identifies nine domains in his notion of empowerment: participation, local leadership, problem assessment capacities, critical evaluation of goals and rationale, organizational structures, resource mobilization, internal community-program collaboration, external partnerships, and control over management.   28 are participation, community empowerment, community development and social capital (Kwan et al., 2003). According to Kwan et al (2003), most definitions of community capacity make reference to the potential of community change for improving health or quality of life, and this potential is usually referred to as a cyclical process for achieving particular goals.  Accordingly, in her literature review, Fiona Verity also found a great variety of definitions, grouped in three major types of work: conceptual literature, literature focused on practical applications and literature focused on critical analysis of the approaches to the term. Overall, the notion of community capacity also usually refers to community effort, resources or actions towards particular objectives of change.  Community participation is usually central to the notion of community capacity (Verity, 2007). In this section, I will summarize some challenges emerging from the imprecise use of the notion of community capacity in the literature. I will next focus on the development of community capacity as a source of power in health promotion as a central notion for addressing health vulnerabilities.  Despite the fact that particular approaches to community capacity may provide very important insights for achieving health goals in different settings, the imprecision of the term reduces its analytical power. In a report for Health Canada on the use of the term community capacity, Richard Crilly (2003) states that there are no universally accepted definitions of community capacity. He found that the term is often used inconsistently to the point of being mentioned in some projects where community engagement is not part of the activities (Crilly, 2003). This has also been highlighted by other authors (Chaskin, 2001; Kwan et al., 2003). The fact that the term community capacity is so broadly defined leads to the need to specify the debates and name the contradictions that can emerge.                                                                                                                                                            29  The need for proper conceptualization deeply related to measurement, particularly regarding the role of public policy in community capacity (Kwan et al., 2003).  Despite general agreement about the value of community capacity and some of its principles such as community participation, proper evaluation is still lacking. In addition to the lack of conceptual consensus, community capacity-building outcomes are usually expected in a time frame longer than the funding cycle of the projects (Crilly, 2003). Some authors have suggested that alternative evaluation methods such as action research and qualitative approaches are required (Boutilier, Rajkumar, Poland, Tobin, & Badgley, 2001). Evidence from some case studies has shown some positive health benefits of community engagement,  although academic consensus does not exist (Raeburn et al., 2006).   Table 2.2 shows some examples of successful community capacity-building cases, but also provides an illustration of the diversity of approaches and contexts in which the notion is used.  Overall, there is huge potential for community capacity-building and community participation to be better understood and evaluated. In evaluation, there has to be a clear answer to questions such as who participates, what participation is for, who defines the sectors of the community that participates, how decisions are made, and who is excluded from the decision-making process.  Otherwise, the use of imprecise models and assumptions can lead to frustrating results.   For instance, an analysis of the outcome of community participation in local councils in Uganda showed that the initial interest of community members declined with time due to fatigue and unwarranted assumptions about the role of the community in policy-making (Golooba-Mutebi, 2004).  Amidst this inconsistency, my discussion about the notion of community capacity-building is mostly informed by an approach to community capacity-building as empowerment, which has   30 been central to health promotion debates in the public health sciences (Labonte & Laverack, 2001a; Laverack, 2007). The notion of empowerment focuses on the ability of community groups to control the determinants of their health vulnerabilities (Labonte & Laverack, 2001a). Capacity-building is understood a dimension of power in social relationships which are embedded in a particular context (Labonte & Laverack, 2001a; Laverack, 2007). From this perspective, community capacity is fundamental for marginalized communities to gain control over their social determinants of health and the projects and initiatives that affect them (Labonte, 2004).   I will discuss three major concerns that are relevant to small farmers? efforts to reduce pesticide-related environmental harm in Quilloac and San Rafael. First, human behaviour and its contextual determinants need to be analyzed simultaneously to avoid placing an excessive emphasis on the responsibility of farmers and their organizations while addressing structural mechanisms supporting health inequities.  Second, as the use of pesticides in agriculture is a worldwide problem embedded in the terrain of a global food system, it is important to approach its driving forces across multiple layers of international, national, regional and local context. Third, my objective of understanding what role small farmer organizations can play in reducing environmental health risk in Quilloac and San Rafael speaks to a need to identify asymmetries in power distribution among a diversity of state and community stakeholders embedded in local, regional, national and international contexts. My emphasis on the latter is central to my use of Bourdieu?s work (1986) in approaching community capacity.    31  Table 2.2 Some examples of successful ?community capacity-building? projects, their evaluation approach, and the key elements of their view of community capacity Project General Description Evaluation Approach Key Elements of Community Capacity-Building  Promoting environmental justice through community-based participatory research (Minkler, Vasquez, Tajik, & Petersen, 2008). ? Evaluation of partnerships in the United States with focus on environmental health problems. ? The results are mostly focused on process evaluation, highlighting the importance of the following elements:  leadership, participation, skills, resources, ability to form and maintain social and organizational networks, and shared values. ? Also highlighted that although the projects had solid partnerships, differences between community members and institutional stakeholders may be a source of conflict.     A multiple case study of four community action research projects, following the approach suggested by Yin, 2003. In-depth interviews and focus groups were conducted.  It includes the mobilization of a community and the use of their power for environmental health organization. It also involves the leadership of researchers, health practitioners and their institutions for the same goal. Some domains are mentioned: leadership, participation, skills, resources, social and organizational networks, sense of community and of partnership identity, understanding of community history, community power (defined as the ability to act to make or resist change that affects the environment), shared values, critical reflection (defined as the ability to analyze successes and failures) (Goodman et al., 1998 and Freudenberg, 2004 according to Minkler et al., 2008).   Participation for perinatal health (Turan, Say, Gungor, Demarco, & Yazgan, 2003) ? Evaluation of a project to promote community participation in prenatal health projects in Istanbul, Turkey. ? The results show gains in health outcomes and community capacity.     Pre- and post-tests with program participants and interviews with participants. 1) Participation in decision-making. 2) Improved knowledge and skills of community members. 3) Continuity of participants and health program. 4) Initiation of new activities.  ? In addition, health indicators were used for outcome.  The implementation and evaluation of a healthy communities process (Smith, 2000) ? This article describes the evaluation of Healthy Community Initiatives in a health region in Alberta, Canada.  ? It concludes that the evaluation should include non-traditional outcomes. The process may result in enhanced demands on institutions and policies.  ? Community leadership ranged from being very strong to being weak.     ? Surveys and interviews of community participants and the facilitation team.  ? Other qualitative techniques such as monthly written stories were used. ? The region?s capacity to engage in community development was assessed. Structural and relational dimensions of capacity components included:  communication, participation, ongoing learning, a shared vision, sense of community, knowledge/skills/resources, and leadership.   32 Table 2.2 Some examples of successful ?community capacity-building? projects, their evaluation approach, and the key elements of their view of community capacity Project General Description Evaluation Approach Key Elements of Community Capacity-Building  Evaluating the effectiveness of a multi-component intervention to improve health (J. Spiegel et al., 2003; Yassi et al., 2003). ? These articles evaluate the effectiveness of a multi-component intervention to improve health, housing and lifestyles.  ? The overall plan was found to be highly successful in terms of housing and some lifestyle outcomes. ? Extensive community involvement, based on existing community-based organization, was found.  ? Ecological approach.  ? Qualitative study  ? Quantitative study with not randomized pre and post evaluation. ? Community workshop to choose indicators.   ? Inputs => outputs => outcomes => impact ? Inputs: materials, labour, administrative time, travel, community support (type of leadership, community involvement, etc.). ? Outputs: houses repaired, street repairs, lights, cultural activities, water supply connections, solid waste collected.  ? Outcome (needs reduced): Improved housing conditions; improved cultural live in community; improved safety and feeling of security; community integration. ? Impact: averted cost, improved health, improved satisfaction and quality of life.  2.2.1. Focusing on human agency and focusing on structural challenges. The inclusion by the World Health Organization (1986b) of public policies and community capacity-building as strategies in the Ottawa Charter for Health Promotion is one of the important milestones that marked the emergence during the second half of the twentieth century of several efforts in health sciences to overcome bio-medical perspectives that emphasized individual risk behaviours and health education for disease prevention. This emphasis, which is still highly prevalent in public health practice and research, tends to approach health risks as the product of peoples? beliefs and actions, and emphasizes education as the main tool for modifying lifestyles.22 One of the consequences is that the contextual limitations of behaviour are not properly assessed, which leads to placing responsibility for change on individuals and to ignoring the social structures that may be determining health outcomes in the first place.  This process has been referred to as ?blaming the victim? because vulnerable groups, who suffer from unjust distribution of social determinants of health, are labelled as ultimatly responsible for their health outcomes    33 (Bacigalupe, Esnaola, Martin, & Zuazagoitia, 2010).  The consequences of this viewpoint are facing renewed investigation as the growing awareness about the social determinants of health inequities become a priority for public health action (Bacigalupe et al., 2010; Spiegel, Labonte, Hatcher-Roberts, Girard, & Neufeld, 2003; WHO & CSDH, 2008).  The need to overcome approaches that blame the victim is central to efforts to reduce environmental health risks associated with pesticide use (London, 2003). Farmers are frequently encouraged to use protective equipment and to avoid hazardous use of pesticides. However, structural conditions in agricultural production, such as increased competition, the need to reduce economic risks generated by pests, the high price of some of safer chemical products and protective equipment, and inadequate access to safety information, also contribute to increase the farmers? potential to come to harm (see Chapter 3 for more details). Erika Rosenthal (2003) describes an illustrative example to support this point. In a rural town in Peru, the death by pesticide poisoning of 24 children was attributed by the chemical industry to accident and poor safety practices. However, Rosenthal discusses that the industry promoted highly toxic products, such as methyl parathion (classified as extremely hazardous by the World Health Organization), among farmers who did not speak the language in which the caution labels were printed and who had little access to protective equipment. Rosenthal is one of an increasing number of scholars who indicate that the most toxic pesticides should be banned in such a context (Kesavachandran et al., 2009; Konradsen et al., 2003; Rosenthal, 2003). The analysis of the social context in which environmental health risk associated with pesticide use occurs should be a part of the search for solutions (Sherwood, Cole, & Paredes, 2003).                                                                                                                                                         22 This is different from progressive efforts in popular education that try to approach social change by engaging community members in a participative learning process in which the social structures that generate injustices are the subject of study (Freire, [1970] ).    34 In terms of determinants of health problems, several scholarly efforts have offered alternative perspectives that aim to integrate the codetermination of human agency and social context, a notion that is central for the reduction of health inequities. The Latin American Social Medicine Movement has been, for instance, one of the pioneer perspectives in developing an approach to identify the social processes that determine health (Iriart, Waitzkin, Breilh, Estrada, & Merhy, 2002). Examples in Canada are the Settings Approach to health promotion (Dooris et al., 2007; Poland, Frohlich, & Cargo, 2009; Poland, Lehoux, Holmes, & Andrews, 2005) and the notion of Collective Lifestyles developed by Katherine Frohlich et al (2001). This later perspective is heavily informed by the work of Pierre Bourdieu (1980a; 1980b; 1993), Anthony Giddens (1984; 1993) and Amartya Sen (1988; 1992). Collective lifestyles are shared perceptions and actions embedded in a social environment (Frohlich et al., 2001b). This notion helps to overcome approaches that ?blame the victim? by overemphasizing individual behaviour, but instead focus on the extent to which lifestyles and context are co-determined (Frohlich et al., 2001). In addition, social determinants of health are not independent risk factors that directly affect health. Conversely, social determinants are dynamic factors embedded in a context (Frohlich et al., 2001; Potvin, Gendron, Bilodeau, & Chabot, 2005). Context is therefore dynamic and encompasses place and people?s actions and practices (Frohlich et al., 2001). The concept of collective lifestyles aims to make the relationship between practices and social structure central to the development of actions paths to health equity (Frohlich & Potvin, 2008).  The dominant bio-medical perspective that focuses primarily on individual responsibility has to be offset by a focus on structural challenges such as social determinants of health (Raphael, 2003).  Community action is also co-determined by people?s structural conditions in their social context. In effect, the emphasis on individual responsibilities is also prevalent in some approaches to community capacity-building. Glenn Laverack (2007, pp. 134-135) mentions the   35 example of government campaigns to promote awareness about ?informed consumer choice? (e.g., in terms of information about toxic substances). This type of initiative usually leaves social determinants of health untouched, while encouraging individual behavioural change to avoid risk (defined according to the government criteria). This emphasis can deepen inequities and increase the ?victim blaming? of already stigmatized communities. Marginalized people usually have fewer options to choose from and fewer ?resources? to mobilize than other community members. If adequate support is not provided, the expectation that under-resourced and marginalized people bear the main responsibility for transforming their position in society can become unrealistic (Phillips, 2007, p. 66). To overcome inequities in the absence of an exceptional instability of any society, marginalized groups need resources, assistance, and political will. Paradoxically, local community capacity-building projects often resort to voluntary work by community members. For instance, volunteerism has often been suggested as a central issue to promote environmental protection, in low and middle income countries, including those in Latin America (Danielsen et al., 2009).  This emphasis has to be accompanied by adequate support to overcome the structural limitations that create the vulnerabilities in the first place. If contextual and behavioural dimensions are articulated, the use of community resources, such as volunteers, can be an opportunity to promote change by articulating people?s action in terms of the structural causes of their vulnerabilities. This is central to community-capacity building approaches that emphasize building on strengths that had previously been overlooked by community stakeholders (Kretzman & McKnight, 1993).   Both community agency and social structure should be taken into account to adequately harness community capacity for positive change. In addition to people?s actions and perceptions, a society?s contextual aspects, such as class structure, economic trends and political landscape, need to be considered for adequate promotion of community capacity for marginalized groups.    36 In a five-case study of institutional community projects for health promotion in Canada, it was found that community engagement was influenced by determinants such as bureaucratic rules, resources and organizational structure (Boyce, 2001, 2002). In another example that evaluated participative strategies for tree planting and soil conservation in rural villages in the Philippines, it was found that the community?s specific history and existing socio-economic elements explained differences in people?s involvement (Walters, Cadelina, Cardano, & Visitacion, 1999).  Overall, inequity problems linked to both society?s structure and people?s behaviour need to be addressed for effectively channelling community capacity for health promotion. This is central to my approach to community capacity-building as the product of social relationship, which are embedded in a particular context. This is a central concern in the approach to empowerment that informs this notion (Labonte & Laverack, 2001a; Laverack & Labonte, 2000). As a part of, and building on, a tradition of approaches that promote social change through critical collective learning and action,23 Ronald Labonte and Glenn Laverack (2001a; 2000) have described empowerment as the increasing ability by community members to define, understand, evaluate and act to solve their health issues which are caused by social determinants in their particular context. The authors clearly express that empowerment should go beyond notions of ?psychological empowerment? to specifically address the material and political dimensions of the social determinants of health (Labonte & Laverack, 2008, pp. 182- 184). The central issue to be considered amidst the confusion of concepts and terminology in community capacity-building should be the socio-economic and political power structures that determine health inequities in the first place (Labonte, 2004; Wallerstein, 2002).                                                 23 See, for instance, Freire, 1970; Goodman et al., 1998; Jackson et al., 2003; Kretzman & McKnight, 1993; Kretzmann & Mcknight, 1993.   37 While building on the notion of empowerment to inform the central questions of my community capacity-building approach, I also use the work of Bourdieu (1980a; 1986) as stated earlier. From its inception, the notion of empowerment has received criticism for the lack of theoretical ground in its description of social relationships, human agency and social context (Rissel, 1994). In spite of the fact that scholars of empowerment in health promotion have built on the work by Michael Foucault (1972; 1982; 1988; 1995) and Steven Lukes (1974; 2004; 2005) to inform their approach to power (Labonte & Laverack, 2008, pp. 25-26; Wallerstein, 2002), most of the literature offers little discussion about the notion of social context and the extent to which it is related to human agency and power. I therefore turn to the sociological work of Bourdieu to focus on the interaction between human agency and structure and the power dynamics that emerge from this interaction. Details will be provided in the final section of this chapter.     38 2.2.2. Approaching local context with a global perspective. In order to better understand the potential role of small farmers and their organizations in reducing environmental health risks in the communities of Quilloac and San Rafael, there is a need to approach the contextual determinants of health across multiples layers of international, national, regional and local contexts. Chapter 1 describes the extent to which environmental health risk from pesticide use in agriculture is a worldwide problem. It also introduces the notion that the vulnerabilities associated with pesticide use are unevenly distributed between countries and across marginalized groups according to predictable patterns, which are codetermined by global and local contexts.  This is consistent with the growing interest in public health literature about the need to better understand the multiple connections between global forces and local action (Gilbert & Gilbert, 2004; Raeburn et al., 2006; Spiegel & Andruske, 2005). Laverack and Labonte (2008) argue that the emphasis on community and local action by many health promotion and empowerment initiatives should be complimented by an analysis of the extent to which many of the social determinants of health are driven by forces beyond community limits. This is consistent with other authors such as John Raeburn, Marco Akerman, Komatra Chuengsatiansup and Fanny Mejia (2006), who argue that community capacity-building action that will face emerging global challenges should simultaneously focus on collaboration for international, national and regional action to tackle macro-determinants of health, and local action to address the needs of the most vulnerable.  Public health literature has seen increased efforts to conceptualize the global scale of social determinants of health. Labonte (2008) identifies several competing frameworks for discussing the health dimensions of global changes: health as commodity, security, development, global public good, and/or human right. Amidst this debate, the concept of globalization has been used   39 to describe the process of closer interaction of activities across a range of spheres including economic, political, social and cultural, but whose effects are explicitly being considered at the community level (Bettcher & Lee, 2002; Spiegel, Labonte, & Ostry, 2004).  Labonte, Jerry Spiegel and Alex Ostry (2004) identify six characteristics of global changes in recent decades: 1) a higher importance of international institutions, 2) different axes of power with more truly global patterns of trade dominated by western Europe, east Asia and North America, 3) increased international capital flows, 4) a greater role of foreign investment in services, 5) neo-liberal policies promoted by the World Bank and the International Monetary Fund, and 6) changes in migration patterns with increased international emigration of high-skilled workers from low and middle income countries.  The extent to which global changes and local settings are codertermined in different contexts, and the consequences for community capacity-building, is also a subject of debate in the literature.  The notion of glocalization has been used to describe the extent to which global and local contexts are interconnected and codetermined (Kickbusch, 1999).  Global changes entail a set of processes that are reflected in local settings and people?s everyday lives (Spiegel & Andruske, 2005). Global trends are not homogenously expressed in particular contexts as local players adopt diverse strategies according to their specific circumstances (Giulianotti & Robertson, 2006; Kickbusch, 1999).  An example of glocalization is recent immigrants? health and their decreased capacity to respond to social change in new settings (Carballo & Mboup, 2005; Williams & Labonte, 2007). Another example is international organizations? policymaking practices reducing the capacity of local democratic institutions to control their environment (Alston, 2002; Cameron & Wise, 2004). Bourdieu (2002) points out that the extent to which local social movements, whose priorities lie in specific social issues such as housing, employment and health, are part of a global process of resistance to unjust policies (Bourdieu,   40 2002). An analysis of local community capacity-building efforts, as in the case of small farmers in Quilloac and San Rafael, requires an analysis of the local expression of international, national and regional dynamics. Understanding their potential role in the reduction of pesticide-related risk can assist understanding about the particular mechanisms that contribute to the regional, national and international dimensions of the problem.   2.2.3. Questioning community: power differences among diverse community and state stakeholders. A central purpose in understanding community capacity-building as social relationships is that it provides an analytical tool to avoid romantic or simplistic descriptions of local communities as unitary entities with positive properties. Discussing community setting approaches to health promotion, Blake Poland (2000) identifies that perspectives on capacity-building, social capital or empowerment that highlight positive aspects, such as engagement and participation, as properties of the entire population can contribute to perpetuating the conditions that reinforce social inequities within and beyond the community. Labonte and Laverack (2001a; 2008) promote the notion of community capacity-building as relationship in order to overcome a tendency to identify community properties (empowerment, social capital, capacity, etc.) as concrete and collective objects that can be assessed and modified to achieve particular objectives. These characteristics are not the attributable to all individuals as they vary across groups and are co-determined by social structures, state support and institutional support. In approaching community capacity-building, there has to be a clear answer to questions such as who participates, what the participation is for, who defines the sectors of the community that participate, how decisions are made, and who is excluded from the decision-making process.   In this section, I emphasize three dimensions of these questions: 1) power inequities among   41 community members, 2) hierarchical power structures within institutions and projects (top-down and bottom-up approaches), and 3) the interaction between state and civil society stakeholders as a social relationship.   2.2.3.1 Approaching community capacity-building as a social relationship among heterogeneous groups with differential access to power. The contrast between different approaches to the concept of social capital can be illustrative of the importance of understanding community capacity as a social relationship in which the role of diverse groups with differential access to power needs to be clearly identified.   The term ?social capital? has been commonly used in public health research to describe features such as networks, interpersonal trust, and norms of reciprocity (Kawachi, Kennedy, & Glass, 1999; Kawachi, Kennedy, Lochner, & Prothrow-Stith, 1997). This approach is mainly based on work by Robert Putnam (1993; 1995), who defines  social capital as networks, norms and social trust that facilitate collective action for mutual benefit. To Putnam, social capital tends to have a collective focus. Social capital is an asset of a collective. High levels of trust and social cohesion tend to benefit the entire community. This is a different use of the term from the use that Bourdieu (1986) gives to the notion of social capital, defined by him as resources embedded in more or less institutionalized networks of mutual acquaintance and recognition.  In effect, while according to Putnam, social capital is about collective values and societal integration, Bourdieu emphasizes actors engaged in struggles to achieve their interests (Siisi?inen, 2000). This difference has important implications for equity analysis. While Putman?s work has provided some interesting analysis on the cooperative social determinants of health, some authors ask for more attention to be paid to inequity and power (Sapag & Kawachi, 2007; Wakefield & Poland, 2005). A key question is the   42 extent to which power and inequities can be central to the analysis and not only ?confounding variables? (Fine, 2001).  Community capacity-building strategies that aim to engage community members can have a double effect: while they favour the engagement of some community members in institutional structures, they also have the potential to exclude the most marginalized sectors of society. Peter Coyte and Dave Holmes (2006) discuss the extent to which health policies and initiatives whose goal is to benefit the entire population can lead to exclusion of marginalized groups.   In one of their examples, an initiative promoted to increase engagement of community members in the decision-making process around health care could help to improve social welfare by integrating services to answer to needs of the community. However, patients who participate may also be the same patients that were initially more capable of adapting to institutional programs. Marginalized community members could be further excluded when their level of responsibility is increased by the terms institutional programs demand. They have more difficulties adapting. Coyte and Holmes suggest that this ambiguous result stresses the need for awareness about the effect that institutional policies may have on marginalized members of society in inequitable communities (Coyte & Holmes, 2006).  In some cases, community capacity-building initiatives can lead to increased inequities by favouring traditional elites. In Brazil, for example, a study about the impact of internationally funded non-govermental organizations (NGOs) on elections found that the NGOs played an ambiguous role. At a national level, NGOs opened some political channels by advocating about key issues affecting vulnerable communities. However, at a local level, local NGOs helped to strengthen existing elites who had higher access to the resources provided by the organizations (Brown, Brown, & Desposato, 2007).  In another example, the work of Bourdieu was used to   43 analyze the extent to which local elites in Hong Kong used the participative efforts by government institutions to legitimate their power in the community. The elite?s participation in the planning of local festivities provided an opportunity for their control of rituals and symbolic mechanisms that perpetuated their hegemony (Wong, 2007).   Furthermore, different segments of civil society may act in favour of or against marginalized community members (Santoro-Rocha, 2007). For instance, Labonte and Laverack (2008, p. 179) warn against xenophobic groups who can use community capacity-building efforts to further exclude newcomers and ethnic minorities. In the Indian state of Gujarat in 2002, efforts by right wing organizations to promote community development and political change, were used by community groups to justify the construction of physical fences that served as barriers preventing minorities from accessing their territory. The result was a polarized environment that led to violent confrontations  (Jha, 2009).  Community capacity-building initiatives that aim to close gaps in health inequities, as is true in the case of the reduction of pesticide-related harm to vulnerabile people in Quilloac and San Rafel, need utilize a critical approach, viewing community as a heterogeneous setting with power disbalances among different groups. This is central to better understanding the potential role that community organizations can play in reducing pesticide risks. In the final section of this chapter, I will describe Bourdieu?s work as a powerful analytical tool for this purpose.     44 3.2.3.2. Hierarchical power structures within institutions and projects: ?top-down? and ?bottom-up? approaches to community capacity. Labonte, Laverack, Georgia Bell Woodard, and Karen Chad (2002) have introduced the notion of ?parallel track? to highlight the extent to which community capacity-building needs to integrate ?top-down? and ?bottom-up? approaches to development and project management (see also Braunack-Mayer & Louise, 2008 for a similar argument). The phrases ?bottom-up? and ?top-down? refer to differential power hierarchies in community and institutional settings. ?Bottom-up? is used to describe initiatives that emerge and are controlled by community members at a grassroots level.  In contrast, ?top-down? approaches, traditional to some health prevention programs, aim to engage community members in goals and activities defined by institutions or professionals.  In practice, stakeholders in institutions, projects and programs are subjet to tensions between ?top-down? and ?bottom-up? approaches which have to be acknowledged and explicitly addressed in order to avoid problems in the implementation of initiatives. For example, according to Danny MacKinnon (2002), decentralized rural development projects led by the state in Scotland created limited empowerment of local communities. One of the main reasons for this was the limited decision-making capacity of grassroots initiatives because the institutions? direction and financial goals were previously defined by the neo-liberal policies of state agents (MacKinnon, 2002). Any possibility for synthesizing ?top-down? and ?bottom-up? approaches to health promotion requires not only an explicit framework of collaboration that identifies different interests but also a change in traditional perspectives of institutional engagement (Laverack & Labonte, 2000). In public health, state-driven activities are fundamental for health promotion and well-being (Raphael et al., 2001). However, there has to be a clear disclosure of institutional and stakeholders? interests. This disclosure, which is not easy to reach, must be accompanied by a clear assessment of political, social, and economic inequities and their driving forces.   45 The need to acknowledge ideological differences in community participation has been highlighted in the literature of health sciences and community development (Fraser, 2005). This issue becomes more important in inequitable societies, such as most countries in Latin America. Concerned with some uncritical health participation literature from the mid-1980?s, and triggered by progressive approaches to public health such as the Alma Ata declaration for Primary Health Care, Antonio Ugalde (1985) reviewed evidence from several decades of community development projects in rural areas in Latin America. His review showed that rural development projects had commonly adopted a participative approach that tended to see community member involvement in utilitarian terms. This meant that the community members were usually called on for activities such as volunteer work, excluding their engagement in the decision-making process and the control of resources. Nonetheless, these projects usually had very high expectations regarding the community?s role. This approach contributed to the failure of community participation initiatives in most cases. In more inequitable societies, community engagement usually started with enthusiasm but rapidly became inaction.  Moreover, the outcome often generated violence. When community members, empowered by the process, started to demand a reduction of inequities, projects and local elites retracted promises, generating violence among the groups (Ugalde, 1985). Ugalde (1985) argues that the symbolic use of community participation by international development agencies had the intention of legitimizing poor quality services and the authoritarian regimes that supported them.  According to Ugalde (1985), health institutions should not always encourage community participation. Community engagement should not be used by government or institutions to suit their interest. Its effectiveness is limited to some scenarios where equitable distribution of resources exists (Ugalde, 1985). This is a cautionary note to highlight the necessity of an awareness of hierarchical structures and mechanisms in programs, projects and institutions to   46 promote health. This understanding is fundamental for providing a critical basis to choose ?top-down? or ?bottom-up? as best favours particular goals for reducing health inequties (Braunack-Mayer & Louise, 2008; Laverack & Labonte, 2000).    2.2.3.3. Understanding the role of civil society and the state stakeholders as social players. The state?civil society conceptual division allows for insight into some relationships, but blurs other interactions. Claire Mercer (2002) points out that there is an important ideological tendency in the literature to emphasize the affirmative role of civil society and NGOs in democracy. This vision, which is based on a liberal perspective, assumes that 1) the democratic process is strengthened by civil society, 2) NGO?s and associations are part of civil society, and 3) NGOs strengthen civil society (Mercer, 2002). While this perspective has allowed for the recognition of the potential for change by societal elements different from the state,, it overlooks the existence of strategic alliances between state sectors and non-state sectors. In general, it oversimplifies the complexities of both the state and civil society. For instance, any state has different levels playing diverse roles for democracy. Some levels of the state may be used by different groups in civil society to defend their privileges. Overemphasizing the role of civil society in democracy (as opposed to the state) could lead to overlook power mechanisms that are a part of any society (Fine, 2001; Fontana, 2006). Civil society and state are both a political arena in which social groups struggle to gain control for advancing their particular interests. This is fundamental for granting some marginalized communities? rights. Discussing the case of indigenous and peasant movements in Latin America, Gerardo Otero challenges some scholars? argument that there has been, in recent decades, a loss of relevance of the nation-state as a setting for struggles in favour of subordinated   47 communities. Otero argues that despite the fact that the nation-state is fundamental for defending the interests of dominant sectors of society, vulnerable communities that are able to establish local political pressure are capable of influencing domestic public policies (Otero, 2004). Resistance to the adverse health effects of globalization may take place in both state and non-state scenarios (Spiegel & Andruske, 2005).   In summary, despite the great potential for positive change that has been acknowledged by some scholars and institutions, the notion of ?community capacity-building? is problematic. The lack of clarity about the definition makes it difficult to use the term for action, research, or evaluation. In this chapter, I have turned to scholars who have defined community capacity-building as a social relationship which is embedded in social context, in order to highlight some of the challenges to better understanding the role of small farmers and their organizations in reducing pesticide risks in Quilloac and San Rafael.  Central issues of importance when approaching pesticide-related risks from an environmental health equity perspective are 1) understanding human behaviour and agency as co-determined by social structure, 2) locating community capacity-building in multiple layers of interdependent international, national, regional and local contexts, and 3) developing a critical approach to power differences across different groups in a particular setting.  In general, community capacity-building approaches in research or action need to explicitly address these issues while understanding the limitations of any particular approach.     48 2.3. An approach to community capacity-building  No particular approach to community capacity-building addresses all of the challenges discussed above. Moreover, any particular study or project may require specific questions according to its goal and circumstances.  In my work, I focus on certain issues. First, small farmers in the communities of study are vulnerable to structural problems such as poverty, which affect their capacity for change (see Chapters 1 and 4). Second, a strong indigenous tradition of farmers in my area of study shapes their relationship with the environment, their organizations, and their interaction with other members of society. Thus, small farmers? practices and perceptions are fundamental for understanding their potential to reduce pesticide-related harm. Third, my area of study has an impressively high density of institutions and organizations interested in transformations in agricultural practices. Better understanding differential access to social resources among diverse community and state stakeholders may be important for overcoming the limitations of the Green Revolution in these communities.24 Fourth, the Ecuadorian indigenous movement has gained political visibility in the past two decades, and the national state is one of the political arenas in which they have fought to promote better conditions for their peoples (Otero, 2004). Hence, state-civil society relationships could be fundamental for harnessing community capacity for local change. Here, I am going to describe my attempt to approach the notion of community capacity so that some of these issues are addressed. In doing so, I will mainly draw upon Bourdieu?s (1980a; 1986) approach to the forms of capital. Bourdieu?s work has been used by several authors in health disciplines (Buzzelli, 2007; Carpiano, 2006; Veenstra, 2007; Ziersch, Baum, Macdougall, & Putland, 2005). I argue                                                24 The Green Revolution is a process of technical improvement of agricultural production that started in the 1950?s (see Chapter 1). The improvement was based on the use of genetic engineering, chemical substances such as pesticides and fertilizers, and other related technology. However, in spite of important benefits for increasing   49 that his sociology can help to better understand the extent to which community capacity can be harnessed to promote safer agricultural production among small farmers.  The work by Bourdieu (1980a; 1986) offers some advantages for my objectives. First, his work provides a refined framework for approaching human agency and social structure simultaneously. Second, Bourdieu places equity and power issues at the centre by utilizing a multidimensional approach to the distribution of cultural, economic and social resources. Bourdieu assumes cultural, social and economic capital as relatively limited assets, the objects of constant struggles to control by social groups in a particular context. By mapping community stakeholders? differential access to social resources, I aim to map differential barriers and opportunities by social players.  One of the most powerful advantages of applying Bourdieu?s work to community capacity-building is its potential to reconcile approaches based on human agency (?subjectivism?) and approaches focused on society?s structural conditions (?objectivism?) (Bourdieu, 1990, pp. 29-51).  An illustration of Bourdieu?s effort to bridge objectivism and subjectivism is in his perspective on the extent to which culture and ideology can help to reinforce social inequities. Groups of people who occupy a particular position in society can be culturally labelled, making their differences appear self-evident (Bourdieu, 1993, p. 159).  A minority group?s identity is part of both its objective and perceived differences. Discrimination is explained by a group?s position in a social structure, but reinforced by a shared perception of their place in society. Ideology and reality are co-determined. An example of this approach in health disciplines is provided by Judith Lynam and Sarah Cowley (2007). Following Bourdieu?s perspective, they studied the process of marginalization of first-generation immigrant daughters and their mothers                                                                                                                                                        agricultural production, the Green Revolution has had negative environmental results. Furthermore, its benefits for   50 in the United Kingdom and Canada, and the extent to which this marginalization constitutes a social determinant of health. Marginalization occurred at two levels: as an actual exclusion from access to resources and opportunities, and as a discourse that undervalued the immigrant women?s potential. This discourse had the capacity to justify and reinforce marginalization for the women. It also justified the perception of the person in power  (Lynam & Cowley, 2007).    The concepts of ?field? and ?habitus? are central to better understanding the interconnection between subjective and objective realities, and hence agency and structure. For Bourdieu (1980a; 1986), a field is a system of relationships constituted by social agents related to the production and promotion of a particular product (e.g., a social product such as education or agriculture). A field is constituted by two elements: the existence of a common capital and the struggle for its appropriation by different social players (Bourdieu, 1980a, 1986).25 Any field is co-determined by a broader social structure that shapes its organization, even though its internal dynamics are partially autonomous. Educational institutions are illustrative of a field that Bourdieu studied.  Knowledge is a form of capital that faculty members aim to control. It is relatively autonomous since scholars? internal discussions determine most of the knowledge production. However, there is also a connection to a broader social structure that determines, for example, the social class represented in the faculty (Bourdieu, 2003, p. 284). Figure 2.1 shows a very simplified and schematic representation in the field of agriculture.  Embedded in a broader social structure, and containing different types of capital, the arrows represent the competition between groups to control different forms of capital.                                                                                                                                                          improving the quality of life of farmers are not clear (Evenson & Gollin, 2003).  25 For Bourdieu (1986), there are different types of capital in a particular field. I will discuss this below.    51  Figure 2.1: Schematic representation of field and habitus        Notes: Embedded in a broader social structure, and containing different types of capital, the arrows represent the competency among different groups for different forms of capital. Black arrows represent strategic alliances, while red arrows represent conflicts among groups. The arrows are dynamic and vary in short periods of time.  The position in terms of the forms of capital is more stable over time. Also, the arrows simplify the complexity or explicit or implicit alliances among groups. For example, two groups may compete with each other in one aspect of their life, but they can be strategic allies in another. The concept of habitus is represented by eyes (view). Depending on their position in the social structure, different groups develop particular perspectives that co-determine their actions. However, there is not a complete correspondence between social position, as determined by the forms of capital, and habitus. For instance, when a field changes its structure, social players could maintain perspectives and behaviors. Elaborated by F. Cabarcas based on Gotschi et al. (2006).   Field of agriculture   Social structure                             Social                                                                                                    Capital                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Cultural                                                                                                                                     Economic Capital                                                                                                                                       Capital                 Notes: Embedded in a br ader social structure, a d containing different types of capital, the arrows represent the competency among different groups for different forms of capital. Black arrows represent strategic alliances, while red arrows represent conflicts among groups. The arrows are dynamic and vary over short periods of time.  The positions of the forms of capital are more stable over time. Also, the arrows simplify the complexity of explicit or implicit alliances among groups. For example, two groups may compete with each other in one aspect of their life, but they can be strategic allies in another. The concept of habitus is represented by eyes (view). Depending on their osition in the s cial structure, different groups develop particular perspectives that co-determine their actions. However, there is not a complete correspondence between social position, as determined by the forms of capital, and habitus. For instance, when a field changes its structure, social players can maintain perspectives and behaviours.  Elaborated by F. Cabarcas based on Gotschi et al. (2006).     52 Co-determined by the field, the dispositions adopted by individuals are called the habitus. To Bourdieu, ?The habitus is a set of dispositions, reflexes, and forms of behaviour that people acquire through acting in society? (Bourdieu, 1980a). Habitus is considered the basis of perceptions and principles that generate practices. It is learned according to people?s position in society.  It also helps to reproduce society?s structure (Bourdieu, 1980a, 1980b, 1986). In Figure 2.1, habitus is represented by the eye (perspective) that individuals and groups have according to their position in society. Consequently, it is usually similar within social classes or groups that share a position in the social structure. However, habitus is not the simple reflection of social structure. For instance, when a field changes its structure, social players could maintain their perspectives and behaviors. The habitus is highly related to the process of marginalization described above since it defines the limits of possibility, according to the individual?s perspective. Being the basis of social action (practice), habitus contributes to domination or resistance (Bourdieu, 1990, 1999). For instance, first nations? learned forms of resistance allowed their survival through very difficult situations.  The formation of the habitus is not a passive act. On the contrary, it is constituted by a constant struggle by individuals and groups to redefine their reality on their own terms. As Bourdieu says, ?The construction of social reality is carried out in and through the innumerable antagonistic acts of construction that agents perform, at every moment, in their individual or collective, spontaneous or organized struggles to impose the representation of the social world that best corresponds to their interest? (Bourdieu, 2008, pp. 193-194).  A study in rural France by Bourdieu (2008) is illustrative of the extent to which the concepts of field and habitus can contribute to overcoming the tension between objectivism and subjectivism.  The study describes a process of change during the 1960?s and 1970?s in a   53 traditional rural community. This process led to changes in marriage and migratory strategies. Traditionally, marriage was determined by the need to maintain the land property. The first-born sons of families with land had the right to inherit the land. As a consequence, they also had the best chances for marrying the best women (who had a dowry saved by their families to offer to the husband at marriage). In this scenario, a field of agricultural production was defined by elements such as the size of the farm (economic capital) and age (the cultural value associated to it) among other aspects. The traditional habitus defined survival strategies focused on agricultural production. Marriage was a practice centered on the protection of land as a resource.  Age and land tenure were categories of status.  Nonetheless, the structure of the field changed due to factors such as rapid urbanization, better roads and a transformation in rural production that challenged traditional agriculture in favour of modern techniques and more competitive markets. These types of changes generated a symbolic transformation within the field. The symbolic value of land and age decreased in favour of urban cultural elements. This also generated a change in perceptions and behaviours. Young women, for instance, started to marry urban bachelors and to emigrate. Factors such as land tenure and age that in the traditional field favoured a ?good? marriage were associated with celibacy and low status in the new field of unified urban-rural spaces. Many elder sons resisted changes in the field and defended the values associated to their traditions. However, changes in habitus also generated transformations of the social structure. Migrant women and men started to become an important source of income for rural families (Bourdieu, 2008). It is important to point out that this transformation of the field operated at both objective and subjective levels: ?The unification of the social field, of which the unification of the symbolic goods market, and therefore of the matrimonial market, is one aspect, takes place both in objectivity ? under the effect of a whole set of factors as different as the increased access to a form of secondary education, etc. ? and in representations. One would be tempted to say that it takes place in objectivity ? leading to phenomena of differential elimination, of   54 which the non-marriage of the heirs is the most significant example ? only because it takes place in and through the subjectivity of the agents who grant a recognition that is at once extorted and accepted to processes oriented towards their own submission? (Bourdieu, 2008, p. 173).  In addition to offering conceptual alternatives to reconciling objective and subjective approaches to community capacity, Bourdieu views social inequities as a central issue. I have already described some examples above about the extent to which his approach has been used to analyze marginalization as a social determinant of health (Lynam & Cowley, 2007). Equally important, adapting Bourdieu?s perspective on community capacity-building makes it possible to examine the distribution of capital in both objective and subjective terms.  Capital, in general, is accumulated labour, which can be expressed in objects. When appropriated by groups or individuals, capital can harness social energy for specific objectives. Individuals and groups are in constant competition to control sources of capital (Bourdieu, 1986). In Figure 2.1, the arrows represent conflict or strategic alliances among groups for either moving up or maintaining a position in the social structure.  Cultural capital refers to forms of knowledge, including skills and education. As another form of capital, it provides benefits to a group or person according to their position in society. Habitus, as a socially constructed knowledge, is very important for the reproduction of cultural capital. There are also different types of cultural capital: 1) embodied state, referring to people?s knowledge and skills, 2) cultural goods, which include material objects such as pieces of art with symbolic value, and 3) institutionalized capital, including credentials and recognized qualifications (Bourdieu, 1986). It is fundamental to understand that, as with economic capital, social groups can harness cultural capital as social energy for specific objectives. As such, in terms of community capacity-building, it can have positive or negative results. For instance, training of farmers can contribute to improving productivity and implementing safer forms of   55 production. However, particular groups of farmers can also monopolize cultural capital to achieve gains in the social structure represented in Chart 1. In this scenario, cultural capital has the potential to increase inequities, and prevent social change. In effect, cultural capital has been used as an instrument to identify health inequities. Gerry Veenstra (2007), for example, used a matrix combining economic and cultural capital to assess health inequities in the province of British Columbia, Canada. This study provided a more complete map of the social structure of the province with respect to health inequalities  (Veenstra, 2007).  Social capital is another distinctive form of capital. It is defined by Bourdieu (1986) as resources embedded in more or less institutionalized networks of mutual acquaintance and recognition. Because, in this perspective, social capital is used by groups or individuals according to their interests, its analysis is important to better understand the reproduction of social inequities.26 There are several reasons for this. First, social capital focuses on resources and their access by means of networks and groups. Second, as with other forms of capital, it represents a method of potential community transformation that can be used by groups to serve their particular interest. Therefore, it can lead to positive or negative results according to the distribution and use of available resources. Third, by assuming that groups protect their interest and use resources for making gains in social structure, the notion of social capital provides some elements to better understand power structures within a community (Carpiano, 2006; Siisi?inen, 2000; Ziersch et al., 2005). For example, in a study using Bourdieu?s approach, for assessing health implications of social capital in some Adelaide, Australia neighbourhoods,  Ziersch et al. (2005) found that some aspects of social capital, such as civil action, did not show any association with health status. In general, the authors determined that social capital had some                                                26 As discussed above, it is necessary to point out that this definition of social capital is different from the definition by Robert Putnam (1993; 1995), who defines social capital as networks, norms and social trust that facilitates collective action for mutual benefit..     56 positive effects for mental health. However, as a resource, it was unequally distributed among community members.  There are two characteristics of forms of capital that are necessary to point out. First, all forms of capital are symbolic. This means that social groups and individuals perceive their social relationships as justified according to their vision of a society?s structure. In addition, people do not have a complete perspective of the power networks in which they are embedded  (Bourdieu, 1986).  In Figuret 2.1, for instance, by mapping all three axes, we can obtain a more complete picture of social structures. However, the particular position of a group or individual is the product of social relationships in this particular society. Some of them are indicated by arrows. Second, all forms of capital can be transformed into other forms. For instance, education credentials or social status can favour the acquisition of economic capital (Bourdieu, 1993, pp. 166-178).  Applying Bourdieu?s concepts about forms of capital has some important implications for the tension between ?top-down? and ?bottom-up? approaches to community capacity-building. First of all, a community with homogenous distribution of resources and capacity would be very difficult to find. Even when community members or organizations promote action (bottom-up), there is a need to question society?s structure, marginalization, and distribution of forms of capital.  Hence, there is a need to consider a ?top-down? component to any intervention or research. This is important when there is institutional involvement since any organization is a field by itself or part of a field.  ?Top-down? approaches to community capacity-building are inevitable and always present. Furthermore, as part of an elite, leaders of organizations and external groups can have access to resources or perspectives that members of marginalized   57 communities do not have access to. This is due to their position in society.  However, there has to be a constant examination of their interests, resources, capital, and marginalization.  Regarding civil society and state, both are also part of a field. Civil society and state stakeholders have access to different types of resources and are instruments of power and marginalization. According to Martti Siisi?inen (2000), Bourdieu?s position regarding the concept of state is ambiguous. First, in some of his earlier works, the state is described as a super-force for symbolic violence and domination. Second, he acknowledges ambiguity (as has been mentioned above) because the state can be a guarantor of social rights and a promoter of change (Siisi?inen, 2000). I believe that both views of the state are true. Particular care needs to be taken in analyzing the potential for community capacity-building. In recent decades some of the resistance movement to neo-liberal policies led by different groups have turned to levels of the state as guarantors of rights (Otero, 2004; Rizvi, 2005; Spiegel & Andruske, 2005). Moreover, state regulation and direct support have been fundamental, when in existence, for promoting developmental projects for agricultural production, and welfare systems for marginalized communities.  While the state may be a particular type of player in the field of agriculture, its different layers and roles need to be studied. My preferred approach is shown in Figure 2.2. The divide between civil society and state in part of the literature on community capacity-building is a contested issue.  For example, based on the work by Antionio Gramsci, Benedetto Fontana (2006) mentions that civil society has the following characteristics: 1) it includes political and economical struggles (not harmonic or homogenous), 2) it exerts hegemony, which is a a process of domination in which some groups have intellectual and moral leadership other others   58 (Fontana, 2006),27 and 3) It forms part of the state. In effect, some authors such as Ben Fine (2001) and Claire Mercer (2002) have suggested that the whole notion of a separation between civil society and the state is misleading and only supported on the grounds of a liberal ideology. I agree that there is no sharp division between civil society and state institutions. For example, ?civil society? members can have connections and influence government decisions at different levels. The opposite is also plausible. There is an ample area of intersection between state and civil society. Some of the group alliances and competitions shown in Figure 2.1 are part of the intersection area shown in Figure 2.2, as represented by the dotted square. I also agree with the notion that the action of dominant groups in a particular society can occur either at state or civil society levels. Resistance also occurs at both levels (Santoro-Rocha, 2007).  As a result, state institutions, and groups within the state, also need to be analyzed in terms of their position in a particular field. However, contrary to the notion that civil society is contained in the state, I think that it is important to maintain the possibility of differentiating between these groups. Some state institutions can turn to resources and power mechanisms that may not be available for other sectors of society.  The possibility of a conceptual distinction between state and civil society may be important for countries where the state?s role has been weak, and where marginalized groups struggle for a more important role in the state regarding issues of social justice.                                                     27 Hegemony is a process of political, economic and cultural domination in which some groups have intellectual and moral leadership other others. The use of cultural and moral instruments reduces the need for coercion or physical violence to a minority of cases (Fontana, 2006).    59     Figure 2.2 Relationship between civil society and state              Notes: The dotted square represents the area of figure 2.1.  Elaborated by F. Cabarcas, based on Fontana (2006) and Mercer (2002)     State Civil Society Hegemony   60 In summary, I believe that using P. Bourdieu?s approach to the forms of capital can help to overcome some of the problematic issues that have been discussed in this document regarding the notion of ?community capacity-building?. Pierre Bourdieu?s approach can contribute to further develop efforts that define community capacity-building as a social relationship, which is embedded in social context (Labonte & Laverack, 2001a, 2001b; Labonte & Laverack, 2008).  The main reason for his positive contribution is that he offers a bridge between objectivist and subjectivist approaches to social sciences. The result is a powerful conceptual tool for mapping the complexity of social structures for a particular field in a given community, and the extent to which, influenced by their position in society, different players aim to control available resources, and therefore, empower. This is appropriate for better understanding the extent to which small farmers can play a role in developing sustainable action for reducing pesticide-related harm, while identifying some structural constraints that require other people?s main responsibility.  The emphasis is on different forms of capital and the extent to which different groups and individuals, based on their perceptions, build strategies for accessing resources. This focus makes P. Bourdieu?s view very suitable for understanding determinants of health inequities. For communities facing long-term inequities such as the farming communities of my interest, it is important to identify the social dynamics that reinforce inequities and the role different social players have had in reproducing them. Developing a sustainable alternative to reduce pesticide-related harm for small farmers, who are marginalized members of society, will require a mobilization of different types of resources and groups of people. Better understanding the extent to which different forms of capital can be accessed and used by different groups in scenarios such as the state, civil society, and their vast intersection, is fundamental for   61 developing a feasible alternative for harnessing community capacity for a healthier and environmentally friendly agriculture. Chapter 5 provides a description of my operationalization of this approach.        62 Chapter 3: Review of pesticide use and health In this chapter, I will summarize some of the health and environmental concerns related to pesticide use in agriculture (with focus on the most frequent substances in the communities of interest). I state that, while pesticides are a valuable resource for farmers, they pose important known risks for humans and the environment. Efforts should be made to reduce associated risk by a transition to less intensive pesticide agricultural practices or by promoting proper use of toxic substances.  I will describe some common practices for the reduction of pesticide-related harm in farming. My focus is on community level interventions and highlights some of the challenges for their development. While the objectives of this chapter are descriptive, the range of difficulties identified is suggestive of the need to accompany community level interventions with regional, national and international action. Some arguments will be developed in subsequent chapters.   3.1 Pesticides, human health and the environment  The term ?pesticide? is used to denominate a variety of substances and agents that are used in human activities, such as agriculture or animal production, to control undesirable biological agents, denominated ?pests? (fungi, plants, or insects) (Ecobichon, 2001). In this project, I focused on chemical substances and their toxicological effects. The vast rage of chemical types used in agriculture as pesticides makes it difficult to summarize their effects on human health.  For a general approach, the World Health Organization classifies pesticides into five classes according to their acute toxicity: Ia - Extremely Hazardous, Ib - Highly Hazardous, II -  63 Moderately Hazardous, III - Slightly Hazardous, and U - Unlikely to Present Acute Hazard (WHO, 2010). Although this classification is an initial point of reference, there are some critical considerations to be made. First, the classification is primarily based on acute toxicity (Lethal Dose 50- LD50). 28  Chronic effects may not be adequately reflected. This is particularly relevant since chronic pesticide health effects can differ from acute problems.  Pesticide doses that trigger acute health problems may also be different from the doses that originate chronic diseases. Chronic problems can appear after repeated low to moderate exposure for a long period of time, or long after a single high-level dose (Ecobichon, 2001: 767).   Second, an environmental degradation product or metabolite of some substances may be more toxic and stable than the original substance. A particularly relevant example is the pesticide mancozeb, frequently used as fungicide in the communities of study. mancozeb is classified as U (Unlikely to Present Acute Hazard). However, mancozeb is transformed in the environment and human body into ethylenethiourea (ETU), a highly toxic substance identified as a potential carcinogen to the thyroid gland (NTP, 2005).29  Third, the World Health Organization classification is based on expected regular use of the substances. Common events such as accidental poisoning, use with higher doses or inappropriate use with other substances can increase the potential risk of any pesticide. Improper use of pesticides is more frequent in developing countries (Kesavachandran et al., 2009).                                                  28 Lethal Dose (LD50) is an indicator of toxicity that estimates the dose in which fifty percent of subjects in a population (usually rats in laboratory) are killed in experimental conditions. Human doses are usually calculated based on theoretical safety algorithms. Lethal doses are gross indicators of toxicity that are frequently used, and are helpful for comparing pesticides. However, this measure also has a number of limitations. First, health problems may appear well bellow the LD50. In this case, other indicators such as the NOAEL (no-observable-adverse-effect-level) or the LOAEL (lowest-observed-adverse-effect-level) are more appropriate as they identify the lowest doses for non-lethal effects of pesticides. 29 Details on both substances are included in Table 3.1.    64 Health effects from pesticides can be underestimated for several reasons. First, many symptoms, such as headache and dizziness, are unspecific and can be attributed to other causes such as seasonal flu or alcohol consumption. Second, some of the potential effects of chronic exposure appear decades later. This makes it difficult to establish a clear association between health outcomes and the chemical hazard (WHO/UNEP, 2006). Third, experimental analyses are usually conducted in animals to avoid harm to human subjects. The susceptibility of different species can vary. Fourth, human exposure in real life conditions is difficult to assess. Assessment of occupational exposure usually entails the analysis of all activities (e.g., purchase and transport, storage, preparation, application, post-application activities, use of protective equipment, hygiene practices, etc.). An adequate assessment should also consider all paths of exposure (dermal, oral, and respiratory) (Arcury et al., 2006; McCauley et al., 2006).  Table 3.1 shows details on acute and chronic health effects for the most common substances used in the communities of study. The risk of pesticide-related effects on health is a function of the toxicity of the pesticide and the dose (or exposure).  Common routes of human exposure are oral intake, dermal contact and inhalation. Table 3.1 also shows lethal doses of oral and dermal intake for acute pesticide poisoning. Dermal contact is the most frequent occupational route to pesticide exposure. Forearms and hands are the most common areas of contact (Ecobichon, 2001: 767-768; O'Malley, 2007).  Further, Table 3.1 shows vapour pressure as one of the indicators of the volatility of a substance, which partially determines the likelihood of human inhalation.  In addition to health outcomes listed in Table 3.1, other potential effects have been identified by numerous studies. For instance, organophosphate compounds30 have been consistently reported                                                30 Current insecticides usually act by affecting the neurological system of pests. For instance, organophosphates (such as methamidophos and profenofos in Table 3.1) and carbamate compounds (carbofuran in Table 3.1) inhibit   65 to produce chronic problems in the nervous system, such as alterations of peripheral sensibility, and loss of memory, coordination and concentration (Costa, 2006; London, 2009; Lucchini & Zimmerman, 2009). Another example is the growing attention to potential mental health effects that organophosphate pesticides can generate. Organophosphate compounds have also been associated with higher rates of depression, a mental health problem that is usually underreported (Beseler & Stallones, 2003; Beseler et al., 2008; Genuis, 2008; Stallones, 2006; Stallones & Beseler, 2002).  Some populations are more susceptible to pesticide harm than average. In particular, pesticides are more dangerous to children for several reasons. First, they are exposed to a higher dose per kilogram of toxic substances. Second, childrens? skin absorption can be higher than in adults. Third, some of their internal organs do not metabolize toxic substances as efficiently as they will in adulthood. Fourth, children have more chances of accidental intoxication due to their play activities (OCFP, 2004: 167-171).                                                                                                                                                         the acetil-cholinesterase, a important enzyme in the human peripheral and central system and blood (Ecobichon, 2001).       66 Table 3.1 Summary of literature on known health effects of common pesticides used in Quilloac and San Rafael, 2007 Pesticide /  Chemical Type (Use) WHO Class* LD50 (mg/kg) ?  and Vapour Pressure  (mPa) Acute Health Effects Chronic Health Effects Mancozeb  / Ethylene-bis-dithiocarbamate (Fungicide)   Production of ethylenethiourea (ETU) (Panganiban et al., 2004; Steenland et al., 1997) U     ? LD50 Oral: >8000  (WHO, 2010)  ? LD50 Dermal:  > 10000 (EXTOXNET, 1996) ? Vapour Pressure: 1.33  (Xu, 2000b)  ? LD50 Oral ETU: 1832 (CCOHS, 2004; DHHS, 1993)  ? Irritant to skin (EXTOXNET, 1996; WHO, 2010)  ? ETU: Irritatant to skin and/or eyes (OSHA & EPA)  ? Potential thyroidal dysfunction (EXTOXNET, 1996; Panganiban et al., 2004; Steenland et al., 1997) ? ETU: Carcinogenic for thyroids (proven in animals- anticipated to be carcinogenic in humans) (IARC, 2001; NTP, 2005)  Profenofos / Organophosphorus compound  (Insecticide)    II ? LD50 Oral:358 (WHO, 2010)  ? LD50 Dermal: 1610  (CCOHS, 2004) ? Vapour Pressure:  2.53  (AERU, 2010e)  ? Cholinesterase inhibition in blood and brain (EPA, 2000) ? Potential symptoms: skin irritation, increased secretions, broncho-constriction, miosis, gastrointestinal cramps, diarrhea, urination, bradycardia, causing tachycardia, hypertension, muscle fasciculation, tremors, muscle weakness,  emotional changes, ataxia, mental confusion, loss of memory, generalized weakness, convulsion, cyanosis, coma and death in high doses (AERU, 2010d; Ecobichon, 2001; EPA, 2000) ? Neurotoxicant (AERU, 2010d) ? Potential of persistent neurological symptoms after single very high dose or repeated high doses (O'Malley, 2007)   Carbofuran / Carbamate  (insecticide)  Ib ? LD50 Oral:8 (WHO, 2010)  ? LD50 Dermal: 120  (CCOHS, 2004) ? Vapour Pressure: 1.11 (low) (Evert, 2002)   ? Cholinesterase inhibition in blood and brain (AERU, 2010a; EXTOXNET, 1996)   ? Potential symptoms: nausea, vomiting, abdominal cramps, sweating, diarrhea, excessive salivation, weakness, imbalance, blurring of vision, breathing difficulty, increased blood pressure, and incontinence (AERU, 2010a; EXTOXNET, 1996)   ? Death though oral, dermal and respiratory pathways  (AERU, 2010a) , potential nervous system malfunction (AERU, 2010a; EXTOXNET, 1996)  and respiratory failure (EXTOXNET, 1996) ? Potential  testicular degeneration (AERU, 2010a) ? Potential of persistent neurological symptoms after single very high dose or repeated high doses (O'Malley, 2007: 543-544)        67 Table 3.1 Summary of literature on known health effects of common pesticides used in Quilloac and San Rafael, 2007 Pesticide /  Chemical Type (Use) WHO Class* LD50 (mg/kg) ?  and Vapour Pressure  (mPa) Acute Health Effects Chronic Health Effects ?- Cyhalothrin / Pyrethroid  (Insecticide) II ? LD50 Oral: 56-144 (variable) (CCOHS, 2004; WHO, 2010) ? LD50 Dermal: 632   (CCOHS, 2004) ? Vapour Pressure:    0.0002 (AERU, 2010b)   ? Irritatant to skin, tingling, prickling and burning sensations (face in particular) (EPA & OSU, 2001) ? Dizziness, headache, nausea, anorexia, and fatigue, seizures and coma may occur (EPA & OSU, 2001) ? Respiratory track irritatant (AERU, 2010b) ? Affects nervous system by disrupting sodium channels (EPA & OSU, 2001) ? Not likely to be  carcinogenic (EPA & OSU, 2001) Sulfluramid / Sulfonamide (Insecticide- inhibitor of insect energy production) (AERU, 2010g)  II  ? LD50 Oral: 543 (WHO, 2010)  ? LD50 Dermal: > 2000 in rabbits (AERU, 2010g; EPA, 1989) ? Vapour Pressure:    0.057  (AERU, 2010g) ? Low acute toxicity (EPA, 2001) ? Not known (AERU, 2010g)  ? Not longer approved for pesticide use in the United States for health concerns: otential reproductive and developmental effects (EPA, 2008b) ? Potential of bioaccumulation of toxic metabolites (perfluorooctanesulfonate) in humans and animals (EPA, 2001, 2008b) Terbuthylazine / Triazine derivative  (Herbicide- inhibitor of photosynthesis.)  III ? LD50 Oral: 2160 (WHO, 2010)  ? LD50 Dermal: > 2000 (AERU, 2010h) ? Vapour Pressure:    0.15   (AERU, 2010h) ? Potential symptoms: sedation, dyspnoea, diarrhea, and tremors (WHO, 2003) ? Eye and respiratory tract irritant (AERU, 2010h) ? Transitory reduced blood cell production in some animal studies (WHO, 2003) ? Potentially lethal if inhaled (AERU, 2010h) ? Potential for decreasing body weight (CCOHS, 2004; EPA, 1995) Methamidophos / Organophosphorus compound  (Insecticide) Ib ? LD50 Oral: 30 (WHO, 2010)  ? LD50 Dermal: 69 in rabbits (AERU, 2010c) ? Vapour Pressure:    2.3  (AERU, 2010c; FAO & WHO, 2003)    ? Acetyl-cholinesterase (AChE) inhibitor (EPA, 2006) ? Potential symptoms: skin irritation, increased secretions, bronchoconstriction, miosis, gastrointestinal cramps, diarrhea, urination, bradycardia, causing tachycardia, hypertension, muscle fasciculation, tremors, muscle weakness,  emotional changes, ataxia, mental confusion, loss of memory, generalized weakness, convulsion, cyanosis, coma (Ecobichon, 2001)    ? Toxic to neurological system (AERU, 2010c)  ? Delayed peripheral neuropathy in humans (EPA, 2006 :13)   ? Potential of persistent neurological symptoms after single very high dose or repeated high doses (O'Malley, 2007)      68 Table 3.1 Summary of literature on known health effects of common pesticides used in Quilloac and San Rafael, 2007 Pesticide /  Chemical Type (Use) WHO Class* LD50 (mg/kg) ?  and Vapour Pressure  (mPa) Acute Health Effects Chronic Health Effects Propineb / Dithiocarbamate (Herbicide) U ? LD50 Oral: 8500 (WHO, 2010)  ? LD50 Dermal: > 5000 (AERU, 2010f) ? Vapour Pressure:  0.16 (AERU, 2010f) ? May damage lungs or cause muscular problems (AERU, 2010f) ? Primarily distributes via the thyroid gland without known carcinogenic effects (AERU, 2010f) Notes: Pesticides are listed according to their frequency of use in the communities of Quilloac and San Rafael, according to the Household Survey (see Chapter 6). The list is consistent with data from the census of vendors conducted by Rafael Alulema (2008).  Warehouses were asked for their five most common products. The results showed that mancozeb was reported by 85% of the vendors, profenofos by 60%, carbofuran by 45%, propineb by 40% and cyhalothrin by 35% (Alulema, 2008). *Toxicity classification:  Ia - Extremely Hazardous, Ib - Highly Hazardous, II - Moderately Hazardous, III - Slightly Hazardous, and U - Unlikely Hazardous (WHO, 2010). ? LD50 (Lethal Dose 50) Unless otherwise noted, the data are based on experimental models with rats.      Table 3.2 shows a summary of the environmental fate of the most common pesticides used in Quilloac and San Rafael.31 The search for scientific evidence about the environmental fate of pesticides is challenging due to the great number of substances and the variability of environments in which they are used.  In most cases, dissipation of the original substance can occur.  Depending on the chemical properties, a substance or its derivates can distribute in water, soil or air (e.g., see volatility in Table 3.2).  In other cases, there may be concentrations of residue in organisms or other environmental compartments (bioaccumulation).  In addition to the affinity to environmental compartments (water, soil, air or biota), the stability of a substance or its derivates can affect the time it lasts in the environment. An indicator of this persistence is the half-life, which is the time in which half of the substance is degraded in a particular media. Inadequate disposal of containers can lead to potentially longer persistence of pesticide residue                                                31 A more detailed discussion of the environmental fate of pesticides can be found in the Master?s thesis of my community partner, Rafael Alulema (Alulema, 2008).      69 than otherwise anticipated. Furthermore, some species may be particularly susceptible to some substances (Seiber, 2002). A particular example is the susceptibility of birds to the pesticide DDT (Carson, 1962).    Table 3.2 Summary of literature on the known environmental fate of common pesticides used in Quilloac and San Rafael, 2007 Pesticide / Chemical Type (Use) Water Solubility Fate in Soil  Environmental Concerns  Mancozeb  / Ethylene-bis-dithiocarbamate (Fungicide)  Ethylenethiourea (ETU) ? Low Solubility: 6mg/L (EXTOXNET, 1996; Xu, 2000b)  ? ETU= High Solubility  20g/L (IARC, 2001) ? Half-Life (pH7): 1 to 2 days (EXTOXNET, 1996; Xu, 2000b)  ? Half-Life ETU: 1-4 days (Xu, 2000a)   ? Weak Absorption  (Mancozeb and/or ETU)(Xu, 2000b)  ? Low Soil Persistence: Half-life: 1-8 days (EXTOXNET, 1996; Xu, 2000b)  ? ETU: 1-7 days in field conditions (Xu, 2000a) ? Medium to high toxicity to aquatic species (EXTOXNET, 1996)  Profenofos / Organophosphorus compound  (Insecticide)  ? Low to Moderate Solubility: 28 mg/L at pH 6.9 (AERU, 2010e; FAO & WHO, 2008 quoting J?kel, 1987)  ? Very Persistent -Half-Life (pH7): 14.6 days (AERU, 2010e) ? Low Soil Persistence: Half-life: 7 days (AERU, 2010e) ? Can be lethal for fish (EPA, 2000) ? High toxicity for birds, honeybees and fish (AERU, 2010d)  Carbofuran / Carbamate  (Insecticide)  ? Moderate to High Solubility: 322 -351 mg/L (at 25?C), potential to contaminate (AERU, 2010a; Evert, 2002; Iesce et al., 2006)  ? Half-Life (pH7): 27.7 days (Evert, 2002) ? Low Soil Persistence: Half-life: 14-29 days (AERU, 2010a) ? Lethal for birds, in particular the granular products that can be confused for seeds - banned in United States (Evert, 2002) ? Honeybees are extremely sensitive (Evert, 2002).  ? Potential microbial degradation in soils (Evert, 2002) ? Potential to contaminate water sources (AERU, 2010a; Evert, 2002; Iesce et al., 2006) ?- Cyhalothrin / Pyrethroid  (Insecticide) ? Low Solubility: 0.005 mg/L (AERU, 2010b; EPA & OSU, 2001)  ? Half-Life (pH9): 7 days  (EPA & OSU, 2001) ? High Binding Affinity - Non-Persistent. Half-life: 25-30 days (AERU, 2010b; EPA & OSU, 2001) ? Toxic to aquatic animals  and honeybees  (EPA & OSU, 2001) ? potential to bio-concentrate in fish and mammals (high octanol /water partition coefficient  Log P:  6.9)    (AERU, 2010b)     70 Table 3.2 Summary of literature on the known environmental fate of common pesticides used in Quilloac and San Rafael, 2007 Pesticide / Chemical Type (Use) Water Solubility Fate in Soil  Environmental Concerns  Sulfluramid / Sulfonamide (Insecticide) (AERU, 2010g)  ? Low Solubility:  0.01 mg/L  (AERU, 2010g)  ? Not available ? Moderately toxic for aquatic organisms(AERU, 2010g) ? Potential risk to birds and small mammals (EPA, 2008b) ? Potential for bio-concentration (AERU, 2010g)  ? Potential of metamolite perfluorooctylsulfonate (PFOS ) to contaminate ground water (EPA, 2008b)  Terbuthylazine / Triazine derivative (inhibitor of photosynthesis.) (Herbicide) ? Low Solubility: 6.6 mg/L ? low (AERU, 2010h)  ? Half-Life (pH7) (High persistency): >200 days (EPA, 1995; WHO, 2003) ? Moderately Persistent: Half-life: 19.4-75.1 days   (AERU, 2010h)   ? Moderately toxic to fish and aquatic invertebrates (AERU, 2010h; EPA, 1995) ? Highly toxic to aquatic plants (EPA, 1995) Methamidophos / Organophosphorus compound  (Insecticide) ? High Solubility: 200000 mg/L  (AERU, 2010c)  ? Half-Life (pH7): 30 days (FAO & WHO, 2003) ? Non-Persistent: Half-life: 3.5-4 days (AERU, 2010c) ? Highly toxic for mammals, birds, and honeybees (AERU, 2010c; EPA, 2008a) ? Highly toxic to aquatic invertebrates (EPA, 2008a)  Propineb / Dithiocarbamate (Herbicide) ? Low Solubility: 10 mg/L  (AERU, 2010f)  ? Half-Life (pH7): 1.5 days (AERU, 2010f) ? Non-Persistent: Half-life: 3 days (AERU, 2010f) ? Moderately toxic for algae, fish and honeybees (AERU, 2010f)  Summarizing, the use of pesticides in agriculture can lead to human and environmental health problems of great concern. Tables 3.1 and 3.2 summarize some well-known health consequences. Other potential effects are currently under research. Furthermore, some human groups are more susceptible to adverse health effects by pesticides. Of particular concern are children who can be exposed in occupational use or by accidental poisoning.         71 3.2. Challenges for public health action at a community level In order to reduce human risk derived from pesticides, action at several levels is required. First, the use of personal protective equipment such as gloves, boots and proper pumps is necessary and possible. Second, human risk from pesticides may be reduced by means of good agricultural practices such as the rotation of crops, the use of proper doses of chemicals, and the proper use and storage of equipment and chemicals. Early surveillance systems for pests and diseases are also desirable. In addition, integrated pest management (IPM) techniques are also an option. IPM involves the application of several varied approaches towards pest control, ultimately reducing the need for pesticides. Methods used in IPM may include strategies for early detection of diseases, better use of chemicals to reduce doses of pesticides, continuous surveillance of crops to assure more specific control, and alternatives to the control of pests  (Yassi et al., 2001b). Organic production and permaculture (agriculture within the natural feedbacks of an environmental niche) are also alternatives that have gained acceptance in recent decades.32   In addition to changes in agricultural practices, advocacy and political action are required at the local, national and international levels so that favourable economic policies can be adopted.   Appropriate reduction of pesticide-related harm depends on a combination of action at different levels (WHO/UNEP, 1990). In this section, I will focus on community level interventions, the subject of this study.33  In particular, I will briefly discuss two dimensions of these changes:  1) implications for training of farmers, and 2) implications for a broader                                                32 While IPM, organic agriculture and permaculture are intersecting practices, some general differences can be argued. Some practices of IPM may have a limited use of pesticides (e.g., in traps). By contrast, in organic agriculture and permaculture, the use of synthetic substances is mostly avoided. Permaculture tries to have a more radical imitation of the ecological niches than some of the organic agricultural practices.  In this paper, safer agricultural practices refer to all of these strategies in general, including a rational use of pesticides within the context of traditional crop technologies.  33 Regional and national environmental and agricultural policies are powerful tools for public health action. In fact, my focus on community level interventions aims to develop the hypothesis that community level intervention and actions do not suffice in offering feasible alternatives for a transition to safer forms of agriculture.       72 transformation of agricultural practices. Chapters 4, 6, 7 and 8 will further explore some of these implications in the context of small farming in the Ecuadorian Andes.  Overall, any of these strategies require the availability of different types of community resources, such as technical knowledge and financial assistance.   3.2.1. Education and training for farmers. A considerable volume of the literature on local level action for pesticide harm prevention has focused on farmer training. In a context with a prevalence of small family units, training has great potential for the adoption of protective practices by peasants. If adopted properly, these practices are powerful tools for preventing pesticide-related harm. For instance, the use of adequate gloves can reduce pesticide exposure by more than a third (Ecobichon, 2001: 769).34  WorkSafeBC (2009) recommends the use of waterproof clothing, gloves, headgear, eye protection, footwear, respirators and hearing protection depending on circumstances. In addition, protective practices also include the regulation of times for re-entry into crops after application, storage and preparation care, and final disposal of receptacles and residue.  Farmer education also has the potential of going beyond the use of protective equipment and towards training on integrated pest management approaches for crops. For example, traps for potato pests to reduce the use of carbofuran have been successfully implemented in Charchi, Ecuador, in potato crop production (Crissman et al., 2003).   However, despite numerous experiences in training, the use of protective equipment and the adoption of alternative pest management techniques remain relatively low for small farming in                                                34 In large scale farming, these practices can be systematically enforced. However, in small farming, the dispersion of production and variability of productive units makes systematic supervision and enforcement difficult.      73 low and middle income countries (Das & Dey, 2005; Delgado & Paumgartten, 2004; A. K. Hurtig et al., 2003; Moreira et al., 2002; Rendon von Osten, Epomex, Tinoco-Ojanguren, Soares, & Guilhermino, 2004). The farmers? belief systems (which are usually difficult to change) can offer additional barriers for the adoption of some practices (Palis et al., 2006). In addition to knowledge and attitudes, conditions such as discomfort, heat, and access to (or cost of) protective equipment have also been identified as potential determinants of poor safety practices (Elmore & Arcury, 2001).  Training of small farmers in low and middle income countries is a challenging task that requires adequate support and monitoring. The label of the product, which contains color coded indications of toxicity and adequate use, should be a timely and reliable source of information about adequate pesticide use. However, farmers who use pesticides may have low levels of formal education to interpret the (sometimes complex) labels.  Under these conditions, the warehouse vendor is usually the main source of information (WHO/UNEP, 1990: 94-97). However, chemical producers usually have more influence on vendors than government agencies or community organizations.  The challenges of training for change in agricultural practices have forced the search of appropriate risk communication strategies. A relevant example, given its application in the Ecuadorian context, is the use of Farmer Field Schools. Farmer Field Schools are based on participatory adult education approaches. In Farmer Field Schools, facilitators accompany farmers in practical applications of new technology or practices in their own crops. The experience is facilitated in small groups of farmers that meet on a weekly or bi-weekly basis to implement new practices in real crops.  This approach has been implemented with some success in Ecuador by government agencies, non-governmental organizations and international     74 collaboration projects.  However, a study of some of these experiences showed that Field Schools had good potential, but the results varied according to the context and the way the new practices were implemented. Conflicting objectives that opposed economic viability and environmental health expectations undermined the results from some of these experiences (Tracy, 2007). Farmer Field Schools require a great deal of investment from the promoting organizations. Some other reasons cited for the potential failure of Farmer Field Schools are 1) low farmer participation, 2) predominance of top-down training and low-quality facilitators, 3) lack of planning, 4) failure to adapt to local contexts, 5) lack of institutional support, 6) lack of coordination among promoters, and 7) high cost of implementation (Tracy, 2007: 56-57). In Asia, some successful experiences have had strong state support (ILEIA, 2003).      75 3.2.2. Transformation of agricultural practices. In addition to adequate knowledge, there are other important challenges for the adoption of safer agricultural practices (e.g., the rotation of crops, the use of proper doses of chemicals, and the proper use and storage of equipment and chemicals). Based on a case study in Sri Lanka,  Clevo Wilson and Clem Tisdell (2001) argue that the continued use of pesticides in developing countries is not cost-effective in the long-term since it entails higher costs and reduced capacity of ecosystems (with consequences for the sustainability of the production). These externalities affect farmers? overall return. However, the authors also indicate that in the short-term, market conditions in low and middle income countries usually favour a higher short-term return for pesticide users. This forces all producers in the market to adopt technologies with pesticide use in order to maintain production. With time, the cost of producing with pesticides increases. However, the costs of transforming the production are also high, forcing farmers to keep a pesticide-based production. Other potential reasons for continued use of pesticides are as follows. First, farmers have limited information about other techniques and the real risks and costs of pesticides. When information is available, chemical producers usually have more resources than other stakeholders and can control information about their products. Second, access to credit is sometimes easier for the purchase of chemicals than for the initial adoption of other approaches (despite long-term compensation).  Third, there are great difficulties in associating pesticide use and health problems (related to the lack of quality health care). Fourth, subsistence farming, practiced by many small farmers, has limited capital and skills. These conditions make a potential transformation to safe agricultural practices difficult. Fifth, the institutional capacity necessary for supporting a transformation of agricultural practices is limited in some countries (Wilson & Tisdell, 2001: 455-459).      76 Some of these constraints can be illustrated by examining efforts to promote organic agriculture, which have been discussed with some detail. Small farmers willing to transform to organic agriculture need substantial support in order to be successful in terms of their profit margins and the crop yields. Evaluation of experiences in Brazil and China were consistent to show that, to be successful, farmers required marketing support, production assistance and help with formal certification processes. Credit and financial assistance were also necessary.  In Brazil, state support was fundamental for a successful transition (Oelofse et al., 2010). In the European Union, many organic producers were dependant on direct payments from the state for their economic stability (Offermann, Nieberg, & Zander, 2009). In Scandinavia, state subsidies were associated with technological improvements in organic farms and a decreased likelihood of losing market shares (Sauer & Park, 2009).   An additional challenge for scaling up organic farming is the need for a more intensive use of human resources than in traditional farming. Labour was one of the challenges identified in the Netherlands when increasing organic farming. The reason was that organic farming required more manual control of weeds (de Jong & Van Zoest, 2001 and Leferink &Adriaans, 1998 according to Goewie, 2003). The need for more intensive labour to take care of the crops has also been described as a challenge for organic coffee growers in Nicaragua (Valkila, 2009).  Dependency on market constraints is also a significant challenge for organic farmers. For small coffee farmers in Nicaragua, the potential advantages of organic farming are dependant on the comparative prices between organic coffee and coffee from mainstream markets. When the prices of regular coffee were low, small organic farmers had a chance at some profit. When regular coffee prices went up, organic farmers were in a disadvantageous situation. However, in any scenario, the uncertainty of the market and the associated challenges made organic     77 production a relatively poor option to alleviate poverty (Valkila, 2009). This dependency is concerning because the markets for organic crops are still very limited even in richer countries. In 2000, Denmark had one of the highest shares of organic produce in the food market. However, the percentage did not reach 3% of the country?s total food market. The combined share of organic product of the United Kingdom, Germany, France, the Netherlands, Belgium, Austria, Switzerland, Denmark, Sweden, the United States, and Japan was only close to 1% of the total food market (Liu, Boto, Kortbech-Olesen, Vrolijk, & Pilkauskas, 2001).   The challenges of transforming the productive process can generate further inequities between small and large producers. A comparison of small and large organic agriculture units in Mexico showed that the requirements for certification of organic produce favoured large-scale agribusinesses. The resources and technical capacity required for obtaining international certification of organic produce offered a burden that many small farmers could not bear. Large producers, on the contrary, had a wealth of resources that could be invested to obtain the sometimes onerous certification. The potential for increase in the gap between large and small producers is substantial (G?mez Tovar, Martin, G?mez Cruz, & Mutersbaugh, 2005).  Standards for organic certification, which are required for adding value to the production, are usually defined in international settings with little input from small farmers. Thus, small farmers have the potential to be further alienated by the process of transformation to organic production (Gonz?lez & Nigh, 2005).  To sum up, the adoption of initiatives for reducing pesticide-related risks offers a number of important challenges for community level interventions.  The cases of training programs for farmers and initiatives for transforming practices of pesticide use in agriculture are illustrative of some of the difficulties. Local stakeholders need to have the capacity to control a number of     78 factors such as coordination with other stakeholders, market access, financial assistance, technical support, lack of adequate and sufficient human resources, and cultural barriers. Having adequate answers to many of these questions would require other levels of intervention. The case of state, national and international policies is worth mentioning. For instance, Flemming Konradsen et al (2003) have pointed out that national policies restricting the use of the most toxic pesticides is fundamental for the reduction of cases of poisoning in developing countries. Sustainable agriculture needs to be supported by national and international policies (Pretty, 2008). While international, national and regional support and policies are required, some initiatives have focused on local policymaking. For instance, the provinces of Quebec and Ontario in Canada have banned the cosmetic use of some pesticides. However, promoting such initiatives also asks much of local stakeholders. Some of these challenges will be discussed in more detail in Chapter 4 when analysing the Ecuadorian context.       79 Chapter 4: Review on the challenges of small farmer organizations in the field of agriculture in the southern Ecuadorian ranges  In this chapter, I identify trends in the field of agriculture that contribute to the vulnerabilities of small farmers in the southern ranges of Ecuador and pose challenges for their organizations in transitioning from the Green Revolution to a truly green chain production. While describing some elements of agricultural activity in Ecuador, I will highlight four main aspects. First, I will discuss land distribution and market policies, important issues for Ecuadorian agriculture that affect small farmers and their organizations by reducing their access to capital. Second, I will discuss state policies for promoting agriculture and the extent to which they have led to challenges for small farmer organizations. Third, I will discuss some aspects of the emergence of the indigenous movement in Ecuador, which has led part of the struggle in favour of small farmers in recent decades. Fourth, I will explore the issue of emigration and the extent to which it can offer challenges and opportunities for farmer organizations and profound transformations in the field of agriculture. I will argue that, if an emphasis on capacity building for small farmer organizations is not accompanied by profound change in the field of agriculture by means of strategies such as public policies providing more support, small farming in the southern Ecuadorian ranges has little chance of transitioning towards new forms of production.  Social determinants such as inequitable land distribution, unfavourable market changes, limited state support and political capacity, and the overwhelming social changes of mass international migration are embedded in regional, national and international layers of context, but expressed locally in a reduced capacity to adopt safer agricultural practices.       80 4.1. Challenges in the development of Ecuadorian agriculture  Agricultural productivity in Ecuador, defined as the agricultural GDP by the Economically Active Population in agriculture, has grown 196.5% from 1980 (productivity of 1,839 Tons/Has.) to 2003 (productivity 3,614 Tons/Has.) (FAO, 2004). 35 However, this increased production occurs with less manpower. The trend is indicative of a more intensive use of technology in agricultural production in order to reduce the required human resources while increasing productivity36 . In many cases, this transformation has occurred by resorting to genetically modified crops and pesticides, such as in the case of floriculture and bananas. This is a significant change for Ecuadorian farming, farming that is, not only heterogeneous, but also highly inequitable. In fact, small family farms do not usually have access to resources or technological support for improving productivity. In such circumstances, small farmer organizations are facing an overwhelming challenge. In this section, I will briefly discuss some of the determinants of productivity problems faced by small farmers and the extent to which they may affect their organizations. I will initially discuss land reform, leaving market problems for a later section. After briefly describing the process of land reform in Ecuador, I will argue that this process has had two major effects in terms of the capacity of farmer organizations in the Andean ranges in Ecuador. First, the land reform helped to consolidate and empower nascent farmer organizations, mainly in indigenous communities, by dismantling the traditional elites. Second, the process has also perpetuated an excessive fragmentation of land in some areas, entailing further difficulties for agricultural production and the coordination capacity of farmer organizations.                                                 35 This has not been constant, with decrease points in 1983, 1998 and 2000. This type of trend is common for other countries in Latin America and the Caribbean (FAO, 2004).  36 However, while technology use has increased over time, the technological gap between rich and poor countries has also increased, making it more difficult for poor countries to compete. This widening technological gap has been described for Andean countries including Ecuador (Pfeiffer, 2003).     81 4.1.1. Land reforms and land distribution in Ecuador. In the twentieth century, Ecuador had three major land reforms: in 1964, 1973 and 1994.  The two initial reforms, politically promoted by a populist military dictatorship, helped to dismantle pre-capitalist forms of production and large landholdings such as the hacienda.37  They were part of a group of similar reforms in other Latin American countries, such as Chile, Peru and Colombia, aiming to transform the country to pre-capitalist forms of rural production (Kay, 1998).38 The reform in 1964 established a ceiling of 2,500 hectares per farm in the coastal region and 1,000 hectares in the Andes. It also continued with a previously set policy of promoting colonization of new lands, mainly in the Amazon. In addition, it attempted to distribute fallow lands and effectively created the Ecuadorian Institute of Land Reform for providing assistance. More importantly, it promoted the abandonment of pre-capitalist forms of labour exchange, such as non-remunerated work and vassalage, and provided some alternatives for credit and technical assistance to farmers.  In effect, one of the mandates of state institutions was to support the adoption of pesticides to promote agricultural production (Viteri-D?az, 2007). Within the same wave of reforms in Latin America, the Land Law of 1973 attempted to provide more assistance to boost agricultural production. In addition to further developing some of the initiatives of its predecessor, this law created zones for coordination of rural production policies and established productivity as one of the criteria for land expropriation (Viteri-D?az, 2007).  In addition, with a different ideological framework, in the 1990?s another reform was carried out. In effect, the 1994 land reform was                                                37 Common to other Latin American countries, the Ecuadorian hacienda was a productive system usually associated with debt peonage in large ranches. In the 1950?s the haciendas were mostly located in the Ecuadorian ranges, owned by mixed-race elites, and mostly populated by indigenous farmers. I will discuss the details of this later.  38 Except for some countries such as Argentina and, to some extent, Brazil, agrarian reforms were adopted in most countries in Latin America. Several reasons may be mentioned as driving forces for the policies of agrarian reform: 1) the governments? fear of left-wing revolutions in the region after the experience of the Cuban revolution (agrarian reforms were part of the Alliance for Progress initiative by the United States government), 2) the pressures from farmers? uprisings in some regions (conflicts favouring deeper changes arose even in some regions where top-down reforms where implemented), and 3) the attempt by some reformist governments to promote a higher yields in agricultural production by strengthening capitalist forms of production (Kay, 1998).     82 executed in the framework of structural adjustment policies and the Washington Consensus.39 This policy proceeded in an agenda of reinforced market-led strategies, such as the freedom to divide and trade communal lands, limitation of state expropriation, and requirement of payment for accessing new land (Nieto, 2004). The reform favoured an export-oriented agriculture and favored market control of other productive resources, mainly water.40  Figure 4.1 Area in hectares according to unit size in Ecuador, 1954, 1974 and 2000.432,200 538,700774,225565,800935,3001,706,7941,138,7002,664,7004,614,4363,863,0003,810,8005,260,37502,000,0004,000,0006,000,0008,000,00010,000,00012,000,00014,000,0001954 1974 2000YearHectares>100 Has.20 to 1005 to 20<5  Despite having some positive effects for particular communities, land reforms have contributed very little to improving land distribution in Ecuador.41 Despite some gains for some sectors of farmers, the reforms did not help to significantly change the country?s indicators of                                                39 This type of marked-led reforms was also carried out in other countries in the world. It was promoted by international institutions as an alternative for improving agricultural production. However, there is evidence to suggest that this policy is prejudicial against small and poor farmers, favouring dominance by large landowners (Borras Jr., Carranza, & Franco, 2007; Gauster & Isakson, 2007; Lahiff, Borras, & Kay, 2007). 40 Different from the reforms in 1964 and 1973, this law had opposition from indigenous organizations and some farmer organizations. First, while the uprisings of the 1960?s and 1970?s promoted further application of the reforms, the indigenous organizations in 1994 led a coordinated national uprising to oppose the reform because they perceived it as damaging from the perspective of small farmers (Novillo-Rameix, Hern?ndez-Enr?quez, & D?valos, 1999). 41 With Costa Rica, Honduras and Uruguay, Ecuador was one of the Latin American countries with the lowest area of land modified by the land reforms (ECLAC and FAO, 1986 as quoted by Kay, 1998). By F. Cabarcas according to data of the National Agricultural Censuses of 1954, 1974 and 2000 as shown by F. Garcia, F. (2006). El sector agrario del Ecuador: incertidumbre (riesgos) ante la globalizaci?n. ICONOS(24), 71-88.     83 land concentration. Figure 4.1 shows that there is a relative increase in area of units between 5 and 100 hectares and a relative reduction of importance of large landholdings as a percentage of the total agricultural area in Ecuador. The net increase in total crop area is behind part of the improvement in land distribution indicators.42 In addition, in Ecuadorian agriculture from 1980 to 2005 there was further consolidation of social and territorial inequities that came from previous years (Garcia, 2006).  Inequity is still a structural part of land distribution in Ecuador. Similar to other Latin American countries, Ecuador?s land distribution is very unequal (Deininger & Olinto, 2000, pp. 23-24). The evolution of Land GINI went from 0.86 in 1954 to 0.85 in 1974.43  There seems to have been a small improvement with the 0.80 Land GINI for 2000 (Le?n, Amores, Izquierdo, Lucio, & Ponce, 2003b; Ot??ez, 2000). However, as shown in Table 4.1, 60.4% of the agricultural land is controlled by the 6.4 % of units that have more than 50 hectares. On the other hand, the 63.5% of units with less than 5 hectares own only 6.3% of the agriculturally productive area. In the province of Ca?ar, the 2% of units with 50 hectares or more controls 53.5% of the land, leaving the 77.8% of units with less than 5 hectares with just 19.6% of the land (INEC-SICA, 2000).                                                  42 Garcia suggests that part of the gain is explained by the settlement of new lands in the Amazon rather than distribution of previously exploited properties. In fact, from 1990 to 2004, the increase in land designated for agriculture and livestock was only 3%, while it had been 101% from 1960 to 1990. For agriculture alone, according to the FAO, there were 2,986,000 hectares. While close to 72.3% of this was gained for agriculture from 1960 to 1990, the increment was only 2.1% of hectares from 1990 to 2004. This data also suggests that the growth of the agricultural frontier has reached a limit (Garcia, 2006).  43 The Land GINI is an indicator of concentration of land distribution. It ranges from 0 to 1. A value of 1 is the worst-case scenario in which one person has all the land. The global Land GINI for 1990 was 0.65 (Deininger & Olinto, 2000).     84   Table 4.1 Distribution of number of agriculturally productive units and hectares according to different unit size in different areas of Ecuador, 2000  Unit Size (Has.) Province of Ca?ar Andean Region (Ranges) Coastal  Region Total Country No % No % No % No % Area in Hectares 0 to <1 4664 1.8% 83106 1.7% 12112 0.3% 95834 0.8% 1 to <5 29050 11.2% 475745 10.0% 190575 4.0% 678391 5.5% 5 to <10 21557 8.3% 394197 8.3% 264860 5.5% 688987 5.6% 10 to <20 24911 9.6% 517098 10.9% 416516 8.7% 1017807 8.2% 20 to <50 39856 15.4% 873843 18.3% 907362 19.0% 2372027 19.2% 50 to <100 22165 8.6% 632866 13.3% 733745 15.4% 2242409 18.1% ?100 Has. 116029 44.9% 1785476 37.5% 2253691 47.2% 5260375 42.6% TOTAL 258232 100.0% 4762331 100.0% 4778859 100.0% 12355831 100.0% Number of Productive Units 0 to <1 11996.5 37.3% 216999.1 38.2% 29090.9 13.2% 248397.7 29.5% 1 to <5 13028.3 40.5% 208803.4 36.8% 73267.5 33.3% 286911.2 34.0% 5 to <10 3268.7 10.2% 58417.6 10.3% 38162.2 17.4% 101065.9 12.0% 10 to <20 1899.5 5.9% 38744.1 6.8% 30581.2 13.9% 75660.5 9.0% 20 to <50 1338 4.2% 29375 5.2% 29679.8 13.5% 76792.4 9.1% 50 to <100 333.8 1.0% 9612.8 1.7% 10902.6 5.0% 34497.8 4.1% ?100 Has. 308.7 1.0% 5669.4 1.0% 8125.2 3.7% 19556.5 2.3% TOTAL 32173.5 100.0% 567621.4 100.0% 219809.4 100.0% 842882 100.0% Notes: The data from the whole country also includes the regions of Amazons and Galapagos Islands, not detailed in this table. However, the majority of agriculturally productive units are in the ranges and on the coast.  By F. Cabarcas according to data taken from INEC-SICA. (2000). III Censo Nacional Agropecuario [III National Census of Agriculture and Livestock Production]. Quito, Ecuador Despite modest gains in land distribution, the agrarian reforms of 1964 and 1973 focused efforts on the rupture of the traditional hierarchies of the hacienda system, especially those hierarchies linked to indigenous communities.  Perhaps the most important organizational change in the first half of the twentieth century in the hacienda system was the Law of Communes in 1937, promoting the creation of community assemblies in indigenous and non-indigenous rural communities. This law helped to create a sense of protection and belonging regarding a territory and reinforced a long-term process of protection of indigenous communities from colonial practices. The Law of Communes may have also have reinforced a previous process in indigenous communities as these communities adopted this structure in greater proportion than non-indigenous ones. However, they were not exempt from conflict, or from contradictory pulls between land protection and land abandonment (Ibarra, 2004).  Although it     85 was one of the provinces in the Andes with more communes, the percentage of rural inhabitants in communes in Ca?ar in 1947 was just 20% (Tamayo Rubio, 1947 and CONADE-UNFPA, 1987 as quoted by Ibarra, 2004, p. 1300). Describing a case study in the northern Andes in Ecuador, Marc. Becker (1999)  describes the extent to which some previously well-organized indigenous communities initially rejected the communes since 1) the communes maintained dependence on the state and traditional elites and therefore did not provide more autonomy, 2) the communes favoured the co-optation of social movements, and 3) the communes did not address issues of land or economic self-sufficiency.  Basically, until the land reform of 1964, most of the rural Andes kept the social system of the hacienda, which gave the landowner monopoly of the land, the production and the workforce.44 The huasipungos were farmers (and their families) who had the right to cultivate in exchange for labour. Other farmers (not huasipungos) who did not live on the hacienda also had the possibility of working for it in exchange for payment in-kind (Commander & Peek, 1986). In addition, the Catholic Church, which was also a land owner, was very important in maintaining a complex structure of authority and reciprocity among landowners and farmers (Lyons, 2006).  The agrarian reform helped to increase the mobility of farmers, to break the social structures of the hacienda, and to make it easier for the transition to capitalist forms of agriculture. The number of landowners with huasipungos reduced from more than 100,000 in 1950 to close to 2,600 in 1974 (MAG/ORSTON, 1978 as quoted by Commander & Peek, 1986).  The break down of the traditional elite of landowners and Church facilitated the consolidation of some indigenous organizations, such as land cooperatives, which were actively promoted by the land reform of 1964. In effect, the period beginning with the first agrarian reform in 1964 was marked by an increasing density and the creation of local farmer organizations (Korovkin, 1997). In                                                44 On the coast, large landholdings adopted capitalist forms of labour earlier than in the ranges.      86 effect, even before the land reform, the pressure of a growing demand for food from the internal market and growing urban centers forced some haciendas to modify their labour structure in favour of capitalist and more flexible engagement by farmers (Commander & Peek, 1986). Furthermore, the land reform of 1964 promoted the creation of farmer cooperatives. The state also provided support for peasant organizations that started to control part of the productive process to some degree, further strengthening their capacity (Viteri-D?az, 2007). Moreover, in some areas of the ranges, the struggle and mobilization of some communities helped to strengthen farmer organizations. Further, the resistance to the reform by a sector of the hacienda elites forced indigenous peoples and farmers to strengthen their organizations in order to gain control of the land (Korovkin, 1997).   In spite of favouring farmer organization?s capacity, the agrarian reform perpetuated the problem of smallholdings in the Andes.45 In general, the relative location of smallholdings with less than 5 hectares in the rural ranges in Ecuador has changed little as shown in Figure 4.1. However, the absolute number of productive units with less than 5 hectares has increased (Ot??ez, 2000 based on data from National Agriculture Censuses of 1954, 1974 and 2000). Moreover, small farming is highly concentrated in the Andean ranges, including in the province of Ca?ar, as shown in Table 4.1.  The 87.4% of productive units with less than 1 hectare and the 72.8% of units with between 1 and less than 5 hectares are located in the ranges (Calculation based on data from INEC-SICA, 2000).  Despite the small improvement in the Land GINI described above, some forces threaten to worsen the problem of smallholdings. For instance, the 1994 reform freed communal lands, allowing their fragmentation. In addition to land markets, inheritance practices that divide the land in equal parts among all children have contributed to an                                                45 LNAME. Martinez categorizes the land reform of 1994 as a counter reform since it stopped state-led efforts for land distribution and freed some protected communal lands for the market (Mart?nez, 2004).      87 increase in the number of smallholdings (Mart?nez, 2004). Small farmers in Ecuador are mostly smallholders. The fact that small farmers in the Ecuadorian Andes are mostly smallholders represents a challenge for farmer organizations trying to develop environmentally friendly production. Productive units with fewer than 5 hectares have poor chances of having economic viability in Ecuador (Chiriboga, 1997). This strikingly reduced probability for 63.5% of Ecuadorian productive units suggests that more demanding transaction costs and technical assistance are needed to develop these farms. Moreover, training for proper use of pesticides or development of alternative pest management requires a standardization of practices and training, which is more difficult with small and heterogeneous units.  For instance, at its outset organic farming created an important role for small farmers worldwide who sought to improve in their situation. However, international standardization and bureaucratic barriers are deterring small producers (Vogl, Kilcher, & Schmidt, 2005). Complex certification processes and the need for access to research have become a burden, particularly for small farmers in developing countries (Kilcher, 2007, p. 90). In addition, as small producers can afford very little economic risk, they require important types of support over the initial years in order to achieve suitable organic production (Crucefix, 1998). In cases studies of organic farming in Brazil, Ecuador and Guatemala, the number of small producers that engaged in the projects was determined by two main factors: 1) the support of government and 2) the liaison under contract of small farmers with larger agro-industrial companies (Damiani, 2000). Farmer organizations alone will have little chance to coordinate the efforts deemed necessary for building environmentally friendly and economically viable alternatives for small farmers.      88 Summarizing, the decline in traditional rural structures favoured by land distribution weakens the small family farm that characterizes an important part of the Ecuadorian ranges.  Small farms, which are very important for generating employment, face important limitations to survive and adapt their productive system to the challenges imposed. This makes it more difficult to replace technology brought on by the Green Revolution.         4.1.2. Market for rural products in Ecuador. The Ecuadorian domestic market has been fundamental for the survival of small farmers. As shown in Figure 4.2, internal markets are supplied by small farmers, whereas export-oriented production is dominated by larger productive units. This two modal system also reflects differences in the type of product and region. Bananas and flowers, the main export-oriented agricultural products, account for 38.9% and 18.2%, respectively, of the net agricultural production in Ecuador.  On the other hand, products such as rice, sugar cane, corn and potatoes, which are destined mainly for the internal market, account for 36.3% of total production. Traditionally, while most export products have been farmed in the coastal region, the ranges have mostly been focused on the internal market (Le?n, Amores, Izquierdo, Lucio, & Ponce, 2003c). In recent years, policies favouring export-oriented agriculture have been adverse for the domestic market, and subsequently, for the small farmer-based agriculture of the ranges.  In this section, I am first going to describe some market characteristics of agricultural products in Ecuador. I will focus on domestic markets, as they are more important for small farmers.  Second, I am going to argue that market policies in Ecuador are deleterious for small farmers and for any attempt by their organizations to promote environmentally friendly practices.       89 During most of the twentieth century, the demand for agricultural products in Ecuador grew, forcing the transformation of the productive system and the adoption of Green Revolution technologies. The growth in population and the production boom in bananas and oil, combined with the growth of the urban population in Ecuador, generated an increased internal demand for agricultural products from the first half of the twentieth century. In effect, during their final years, some of the haciendas modified their productive systems by promoting mono-crops, changing labour relations, and implementing Green Revolution technology to supply the demand (Commander & Peek, 1986, p. 81).   The expanding rural markets had inefficiencies that were subsidized during the export substitution policy that predominated until the mid-1980?s. As in other countries of Latin America, during the 1960?s and 1970?s, a policy of import substitution that was tied to earlier efforts for promoting industrial development predominated. Customs barriers and taxes blocked the importation of some products that were considered fundamental for the development of national industry and food security (Bielschowsky, 1998).  However, according to M. Chiriboga, local rural markets in Latin America, usually consisting of traditional market squares, were also Figure 4.2 Relative contribution of different-sized productive units to the  net agricultural production according to their final market, Ecuador, 2000 25.0%  65.8% 65.3% 68.8% 65.8% 80.8% 67.2% 47.1% 31.6% 31.6% 27.8% 30.7% 14.4% 7.8% 4.2% 2.6% 3.0% 3.4% 3.5% 0% 20% 40% 60% 80% 100% 0-1 1 to 5 5 to10 10 to 20 20 to 50 50 to 100 >100 Has. Size of Productive Unit % of net production production Not Classified Internal Market Export- Oriented  By Fabio Cabarcas according to data of the 2000 National Agriculture and Livestock Census as show by Leon et all, 2003:INEC-SIICA, SIISE     90 described as inefficient due to high information costs and high transaction and transport costs. This implies that small farmers did not have the means to access information in order to ask for a better price or the means to reach more favourable markets elsewhere. Traditional markets were controlled by a few people who forced small farmers to reduce prices. During the import substitution period, the state-led policy subsidized traditional market inefficiencies by assuming some costs and direct trade. However, the state assumed a role that did not allow the markets to correct some of the problems. It did not help to reduce transport costs, to provide better flow of information, or to strengthen farmer organizations to a point that counterbalanced the traditional monopolies (Chiriboga, 1997, 2004).  The systematic institutional structural adjustment policies that started in Ecuador in the 1980?s left small farmers in poor competitive conditions vis-?-vis the inefficiencies of the market. While the initial reforms to liberalize the Ecuadorian economy took place from 1988 to 1992, the core of the reforms happened from 1992 to 1996 during the government of Duran Ballen (Lefeber, 2003).46 As in other Latin American countries, the Ecuadorian state support in terms of subsidies, direct services, and technical assistance was essentially dismantled without building adequate assistance in order to support small producers and farmer organizations in building capacity to deal with the inefficiencies. The result was that the competitive conditions of small producers deteriorated (Chiriboga, 1997). In addition, free trade agreements and the reduction of import taxes in Ecuador introduced products at a lower production cost, reducing even more the profit margins of small producers. Figure 4.3 shows the relative increase of cost of crops and livestock as a percentage of total imports in Ecuador. This increase is indicative of higher volumes of food imports that compete in traditional markets.                                                 46 The economic crisis starting in 1982 implied one of the reasons for these changes, following a reduction in the oil revenues and an increase in the interest rates of international loans (Hey & Klak, 1999; Lucero, 2001).       91  In addition, small farmers have little control over or access to the internal market, with emerging factors, such as supermarkets, gaining control of the trade distribution. First, despite the market-led policies established since the 1980?s, the internal market in Ecuador is still inefficient. For 2000, the percentage of farmers that sold to intermediaries was 50.5% in the province of Ca?ar, 59.4% in the ranges and 64.8% in the country, as compared to direct sales to the consumer, sales to the exporter or sales to a processing centre for generating added value (INEC-SICA, 2000). Supermarkets have quickly replaced the traditional markets of small farmers. Supermarkets represent a risk of market monopoly since it is estimated that in Asia, Africa and Latin America, three or four chains are able to control 50% or more of the supermarket sector (Reardon, Timmer, Barrett, & Berdegue, 2003).  In Ecuador, chains of supermarkets have almost doubled their number from 1998 to 2004 (Zamora, 2005). The volume of supply required and the technical specifications that supermarkets ask for represent a challenge for small farmers. In order to take advantage of the supermarket opportunity, small farmers will require technical assistance to meet the increased market standards demanded for their products, coordination to provide the volume required by large distributors, and financial support to make these changes (Reardon et al., 2003; Zamora, 2005).  Market problems are one of the determinants that explain the fact that the trends in economic growth in agriculture have especially affected small farmers. From 1980 to 2005, the productivity by hectare increased, but the price of exported products decreased. There was also a marked increase in imports. This increase in imports was accompanied by a reduction of costs, again reducing profit margins (Garcia, 2006). In effect, taking the values for 1995 as reference (=100), the unit value of exported crops in Ecuador, defined as the price of one unit when sold for exportation, has decreased from 124 in 1980 to 92 in 2003 (FAO, 2004 table 146). The growth in production that was promoted by export agriculture is represented by products such as     92 flowers, bananas and processed foods. These types of export products require a greater investment and control of the market than the ones small farmers are easily able to produce. Traditional rural production has suffered because it has had a low generation of surplus in comparison to the new alternatives, accompanied by increasing competition from national and international non-traditional production.  The agricultural model seems to favour more production of cheaper products, with very little support for small producers (Garcia, 2006). In addition to the difficulties that markets present for small farmers, they provide very limited incentive for pesticide-free or organic production. Worldwide, despite the rapid growth of markets for organic products, mainly in developed countries, market share remains relatively small. For instance, in the year 2000, the share of organic foods in the markets of the United States, Japan and Europe was only close to 1%. The market with the highest percentage of organic products was Denmark, where organics made up just close to 3% of the total food trade (Liu et al., 2001). Moreover, markets for organic produce in developing countries are even smaller. In the case of bananas, for instance, it has been acknowledged that while there is some demand for organic products in developed countries, internal demand in developing countries is very small (Holderness, Sharrock, Frison, & Kairo, 1999).  Under such conditions, small farmers and their organizations have little chance of accessing markets without proper assistance.  While domestic markets are fundamental for small farmers in Ecuador, the internal market?s long term inefficiencies are worsened by the fact that customs policies have favoured competition from products from abroad, some of which are artificially low due to subsidies. Moreover, domestic markets offer little incentive for pesticide-free or ecologically-oriented products. Organizations of small farmers would require not only marketing expertise but also high technological and credit support to overcome these challenges.  They     93 would also require an ample network of contacts and clients. Thus, market challenges are added to the difficulties in distribution of resources, such as land, which make it very difficult for small farmer organizations to facilitate viable alternatives to pesticide use.   4.1.3. The role of the state and other organizations in supporting small farmers. From the mid 1980?s, there was a worldwide shift to allocate funds to Non-Governmental Organization (NGO) led programs. This was heightened in the mid 1990?s by a change in emphasis on neo-liberal policies (second generation reforms). Institutional reform, decentralization and promoting social capital were part of the policy package (North, 2003; North & Cameron, 2003).47  This process was accompanied by a reduction in state-level investment. Manuel Chiriboga (1997) describes the extent to which the adjustment policies for rural Ecuador have involved 1) the reduction in investment on public services and infrastructure, 2) the dismantling of sector-specific policies and the organizations in charge of carrying them out, and 3) the emergence of groups and organizations that provide project-based assistance (Chiriboga, 1997). This process may have been deleterious for the capacity of organizations to face the challenges of a changing rural scenario. However, the social situation for small farmers remains problematic. Several factors may contribute to this. First, while some indigenous and farmer organizations have gained some capabilities, their capacity is not enough to replace the need for effective state-led initiatives and policies. Second, the increased number of local organizations has meant an inefficient use of resources. External actors and sectors also compete for the same resources. In this section, I will focus on the above-mentioned factors to discuss the extent to which neo-liberal policies may affect the capacity of indigenous organization at the local level.                                                 47 Despite this emphasis on institutions, the second generation reforms still prioritized economic policies (North, 2003; North & Cameron, 2003).     94 Support by the Ecuadorian state for development of agriculture, and particularly small farmers, has never been strong. Some important development initiatives in the rural areas were led by NGOs, showing the weakness of state intervention. For instance, in the 1960?s and early 1970?s, Andean Mission, an NGO linked to some sectors of the church, helped to trigger the creation of infrastructure such as roads and schools in the rural areas. In addition, it provided technical assistance that introduced the technological package of the Green Revolution (Breton, 2001, pp.  39-41). Other actors, such as agrochemical distributors, also helped to provide technical support to consolidate the use of pesticides. Despite the weakness of the Ecuadorian state, its support helped to develop an environment in which some farmer organizations grew, and development projects were consolidated through state policies.  For instance, the role of the state in subsidizing and protecting the inefficient rural markets was described above. Moreover, helped by oil revenues during the 1970?s, the state led some infrastructure projects such as road construction, irrigation programs and technical assistance. For instance, the budget for rural and urban planning and housing was higher than 1% of the GDP from 1972 until 1992, when it fell below this percentage (BCE).  Regardless of the inefficiencies of the policies, the reduction of this already small role by the state left a vacuum that could not be filled by a myriad of lower scale programs led by small organizations. With a fiscal crisis in the early eighties, there was a diminution in the direct presence of the state followed by a proliferation of organizations and NGOs harnessing funds from international agencies through small programs targeted for special interest groups. The illustration in Figure 4.3 shows that the relative amount of money that NGOs and other organizations offer on credit to farmers of any productive unit size is small. Also small is the relative amount of money that both the National Development Bank and the private banks offer,     95 and these offers are highly skewed towards larger producers. To access credit, small farmers have few options. They are left with either the assistance of financial cooperatives, usually of small size, and moneylenders, who usually offer high interest rates. It is important, therefore, to highlight the larger significance that family loans have for small farmers.      96 Total0-11 to55to1010to2020to5050to100>100Has.Other 3.8 3.0 4.3 5.0 2.5 3.4 3.6 6.4NGOS and Organizations 4.4 2.3 5.9 6.4 3.9 3.7 3.0 4.4Family 7.0 6.6 8.6 8.2 6.7 4.5 2.2 1.7Intermediary 4.8 0.9 5.9 9.5 8.2 5.3 2.0 2.4Moneylender 18.4 7.1 24.7 34.3 25.1 12.9 6.4 4.2Processing Company 3.1 0.9 4.0 6.5 3.7 2.8 2.5 2.7Agricultural Supplies Provider 1.7 0.3 1.2 3.0 3.4 3.7 2.6 4.2Financial Cooperatives 12.1 11.8 13.4 13.3 12.2 9.9 8.1 6.8National Development Bank 11.6 1.7 5.6 13.7 21.9 27.8 44.9 51.5Private Bank 6.7 3.5 3.9 5.7 9.7 12.9 16.0 41.10.020.040.060.080.0100.0120.0140.0(# Farmers who received credit/ number of units)*1000Unit SizeFigure 4.3 Ratio of farmers receiving different types of credit by 1000 productive units according to unit size, Ecuador, 2000 OtherNGOS and OrganizationsFamilyIntermediaryMoneylenderProcessing CompanyAgricultural SuppliesProviderFinancial CooperativesNational DevelopmentBankPrivate BankIndex calculated by F. Cabarcas according to data from INEC-SICA. (2000). III Censo Nacional Agropecuario [III National Census of Agriculture and Livestock Production]. Quito, Ecuador      97 Another important illustration, shown in Figure 4.4, is the role that NGOs play in providing technical assistance to small farmers. Despite being relatively important to farmers with five or fewer hectares, the contribution of NGOs is insufficient to overcome the technical assistance gap between small farmers and large landholders. Again, the role of state institutions such as the Ministry of Agriculture is relatively small and heavily skewed to providing technical assistance to farmers in the largest productive units. Without proper credit or technical assistance, small farmers have little chance to engage in a process of environmentally friendly, sustainable and healthy agriculture.  The withdrawal of an already weak state also left different types of small organizations without resources such as technical assistance and financial and institutional support.  As an example, traditional organizations may be fragile. In the case of the Zhuar Federation in the Ecuadorian Amazon, the rise of indigenous organizations had brought political and economic power to this group. However, the federation failed to adopt strategies for self-financing, while depending on external funding. In addition, indigenous organizations also lacked adequate internal control and accountability mechanisms, allowing leaders to push their own agendas.  These internal problems were also exacerbated by national political and economic problems such as the macroeconomic public policy for the Amazonian region (Bebbington et al., 1993). In another case, Diane Bates (2007) identifies the combined effect of the disappearance of state subsidies and environmental degradation in worsening the agricultural crisis and favouring the migration of the labour force.       98 Figure 4.4 Ratio of farmers receiving technical assistance by every 1000 productive units according to unit size, Ecuador, 20000.050.0100.0150.0200.0250.0TOTAL 0-1 1 to 5 5 to10 10 to 20 20 to 50 50 to 100 >100Has.Unit Size(# Farmers who received assistance/ number of units)*1000Other Private InstitutionOther Public EntityMinistry of AgricultureNGOS and OrganizationsAn individualUniversityWarehouseAgricultural CooperativesNational DevelopmentBank   Index calculated by F. Cabarcas according to data from INEC-SICA. (2000). III Censo Nacional Agropecuario [III National Census of Agriculture and Livestock Production]. Quito, Ecuador     99 In addition to the void left by the state, the increasing number of organizations has caused a fragmentation of approaches and a lack of coordination, generating competition among different groups. Basically, the need for accessing limited resources that are distributed in market-like conditions generates competition. This competition is increased by the fact that a high number of organizations tend to concentrate in some areas.  In the Ecuadorian ranges, as more NGOs are working in a determinate area, more indigenous organizations are locating in the same area. This higher density of organizations is triggered by the requirements of development agencies. NGOs usually have to promote local organizations for accessing funding, generating exaggerated density in some particular regions that are of interest to donors. The diversity of organizations grouped in this complex structure lends itself to multiple sources of conflict and rivalry among different groups (Breton, 2001, pp. 39-50, 125-153).  The multiplicity of micro-projects seen in neo-liberal policies can also mask important structural inequities (Petras & Veltmeyer, 2006).  To sum up, small farmers have traditionally had little support for developing sustainable production with lower use of pesticides. Even technical assistance, required for training in adequate use of pesticides, is reduced for small farmers. Even though some organizations may have gained ground in generating alternatives for small farmers, their scope is not wide enough to replace the void left by a state system that is not only small, but also skewed in favour of larger producers. Furthermore, the need to compete for resources and the diversity of agricultural settings generate overlap and potential conflicts among well-intended organizations.       100 4.1.3.1. Small farmers and the emergence of the indigenous movement in Ecuador. Taking into account that small farming in Ecuador is highly concentrated in the ranges, which is the area with the highest indigenous population, it is logical that in the past two decades, the demands for protection of small farmers in Ecuador have been made mostly by indigenous organizations. In the 1990?s, the Ecuadorian indigenous movement gained worldwide attention due to several uprisings that partially contributed to the instability of several governments in the following years.48 These events have been described by several authors as indicative of the indigenous movement?s strength, at least at the national level (Macas, Belote, & Belote, 2003). Indigenous groups have made important ethnic demands, such as the search for acknowledgement of multiple cultural identities in Ecuadorian laws. However, they have also focused on socio-economic class and peasantry issues such as requests for better land distribution, adequate productive support and more favourable market policies (Otero & Jugenitz, 2003).The movement has been clearly opposed to neo-liberal policies, and demands better conditions for agrarian production while rejecting international trade agreements.49  In this section, I am going to briefly describe the emergence of the indigenous movement in Ecuador as a very important defender of small farmers? interests within the context of the indigenous struggle in Ecuador. Several factors contributed to the emergence of the majority of indigenous o