Academic journal article Environmental Health Perspectives

Using Human Disease Outbreaks as a Guide to Multilevel Ecosystem Interventions

Academic journal article Environmental Health Perspectives

Using Human Disease Outbreaks as a Guide to Multilevel Ecosystem Interventions

Article excerpt

Human health often depends on environmental variables and is generally subject to widespread and comprehensive surveillance. Compared with other available measures of ecosystem health, human disease incidence may be one of the most useful and practical bioindicators for the often elusive gauge of ecologic well-being, We argue that many subtle ecosystem disruptions are often identified only as a result of detailed epidemiologic investigations after an anomalous increase in human disease incidence detected by routine surveillance mechanisms. Incidence rates for vector-mediated diseases (e.g., arboviral illnesses) and direct zoonoses (e.g., hantaviruses) are particularly appropriate as bioindicators to identify underlying ecosystem disturbances. Outbreak data not only have the potential to act as a pivotal warning system for ecosystem disruption, but may also be used to identify interventions for the preservation of ecologic health. With this approach, appropriate ecologically based strategies for remediation can be introduced at an earlier stage than would be possible based solely on environmental monitoring, thereby reducing the level of "ecosystem distress" as well as resultant disease burden in humans. This concept is discussed using local, regional, and global examples, thereby introducing the concept of multilevel ecosystem interventions. Key words: bioindicators, disease control, disease outbreaks, ecologic management, ecosystem health, surveillance. Environ Health Perspect 112:1143-1146 (2004). doi:10.1289/ehp.7122 available via[Online 27 May 2004]


During the construction of the Panama Canal in the 1880s, continuous outbreaks of yellow fever killed > 5,500 workers, or > 6% of the workforce. The most immediate cause of those outbreaks was, then as now, obvious and was captured in the records of artist-to-be Paul Gauguin, who was then a digger with the French Canal Company: "At night I am devoured by mosquitoes" (Harrison 1978). The ultimate cause of these outbreaks was more complex, however, involving disruptions to both environment and society, mediated by a range of political and economic drivers.

Models have been developed to describe the way in which such interacting disruptions influence health (Parkes and Weinstein 2004), but from a biophysical perspective one of the more constructive lines of analysis is directed toward the disruption of the immediate ecosystem. During the Panama Canal construction, it is obvious (with the wisdom of ecologic hindsight) that replacing a rainforest environment with an urban/industrial environment offers the opportunity for container-breeding vector mosquitoes to proliferate and to transmit disease at a scale never before encountered in an affected area. By today's standards, this disease outbreak and the associated ecosystem disturbance might seem to have followed a relatively obvious path. Nevertheless, despite a greater contemporary understanding of microbiologic and ecologic dynamics, insults to the environment occurring even in modern times are often discovered only as a result of detailed outbreak investigation.

Measurable bioindicators of ecosystem health were first described in detail by Rapport et al. (1985). These include changes in nutrient cycling, decreased species diversity as a result of decreasing habitat diversity, retrogression (a reversal of the normal process of species succession as the ecologic community is simplified), and increased fluctuations in population size. Presence of disease also explicitly formed one of the bioindicators, and it was suggested that increased disease incidence among plant, animal, and human populations would manifest as the fabric of the ecosystem begins to deteriorate and natural buffering and protective mechanisms break down.

The intrinsic link between ecosystem health and human disease (especially vector-mediated disease) has been discussed in a number of previous publications (Cassis 1998; Chivian 2001; Epstein 1995; Forget and Lebel 2001; Haines et al. …

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