Looking beyond the traditional focus on disease agents toward broader environmental issues

Reducing the environmental contribution to ill health will require addressing the links among environment, development, and health at the outset. Infectious diseases are a case in point. Clearly, governments should continue to offer incentives to pharmaceutical companies to develop and market at reasonable prices new drugs and vaccines for diseases such as malaria, dengue fever, and cholera. Steps to improve monitoring and surveillance systems to track newly emerging or reemerging infectious diseases are also critical (9) (10). But these initiatives alone will not alleviate the infectious disease burden because they do not address the myriad factors that contribute to emerging infections (11). For instance, despite these efforts, land use changes resulting from development – including deforestation, dam building, and irrigation schemes – will continue to lead to shifts in disease vectors as well as bring workers into areas where they may encounter infectious agents for which they lack immunity. Uncontrolled pollution of water resources from domestic, agricultural, and industrial wastes will continue to challenge the health of marine ecosystems and increase risks of cholera and/or shellfish poisoning. Unwise chemical use may alter the delicate balance between predators and insects as well as foster chemical resistance. Even rising energy use, which seems far removed from a case of malaria, could influence disease transmission through its effect on global climate.

The advantage of looking beyond the traditional focus on disease agents toward broader environmental issues is that doing so illuminates new places to initiate preventive actions and policy reforms. Specifically, this chapter focuses on environmental strategies to prevent disease and improve public health; it does not address the important reforms needed within the health sector. First, the chapter explores the longstanding environmental health problems related to poverty and lack of development. It examines a range of interventions and technologies, many of which can be applied at the household or community level, and some of which require broad government reforms. Next, the chapter explores those problems that emerge as countries begin to develop – as they begin to industrialize, intensify their agriculture, and consume more fossil fuels. As described in Linking Environment and Health many countries face both types of problems, traditional and modern, simultaneously; they are separated here simply for ease of discussion. Solutions to these problems typically require policy actions at the national or international level. Because it is impossible to describe these policies in great detail within one chapter, the discussion that follows makes the case more broadly for ensuring that health and environment concerns receive greater prominence in policy decisions facing industrialized and developing countries alike. This discussion is by no means exhaustive but outlines the variety of possible interventions, as well as the different actors who will be critical to finding solutions.