Bridges to sustainable tropical health

Abstract

Ensuring sustainable health in the tropics will require bridge building between communities that currently have a limited track record of interaction. It will also require new organizational innovation if much of the negative health consequences of large-scale economic development projects are to be equitably mitigated, if not prevented. We focus attention on three specific contexts: (i) forging linkages between the engineering and health communities to implement clean water and sanitation on a broad scale to prevent reworming, after the current deworming-only programs, of people by diverse intestinal parasites; (ii) building integrated human and animal disease surveillance infrastructure and technical capacity in tropical countries on the reporting and scientific evidence requirements of the sanitary and phytosanitary agreement under the World Trade Organization; and (iii) developing an independent and equitable organizational structure for health impact assessments as well as monitoring and mitigation of health consequences of economic development projects. Effective global disease surveillance and timely early warning of new outbreaks will require a far closer integration of veterinary and human medicine than heretofore. Many of the necessary surveillance components exist within separate animal-and human-oriented organizations. The challenge is to build the necessary bridges between them.global surveillance ͉ health impact assessment ͉ sustainable health ͉ water and sanitation

Research core and framework of sustainability science

“…Renewed interventions in 1992 followed by sustained, supervised, community-based vector control largely suppressed reestablishment of the disease. Singer and de Castro (2007) concisely proposed three routes for sustainable health. One is bridging the engineering and health communities, for example by implementing clean water and sanitation on a broad scale to prevent reworming.…”

Untapped potential of health impact assessment

“…31,32 Impact mitigation strategies should thus form an integral part of project developments in tropical and subtropical zones. 33 The Nam Theun 2 hydroelectric project in the Lao People's Democratic Republic is an important example of mitigation strategies implemented over time and with ongoing surveillance.…”

Cost-effectiveness of a community-based intervention for reducing the transmission ofSchistosoma haematobiumand HIV in Africa

“…Current control of schistosomiasis focuses on reducing schistosomiasis-induced morbidity by implementing large-scale preventive chemotherapy programs through administration of praziquantel to school-aged children (23). Although praziquantel has an appreciable immediate reduction on schistosomiasis morbidity (24), the high frequency of posttreatment reinfection, especially in endemic areas (14,15), means that praziquantel treatment alone may have a limited impact on the long-term control of schistosomiasis (16,25). To ensure sustainability of schistosomiasis control, it is essential to integrate praziquantel administration with provision of WSH, which is necessary for reducing schistosomiasis transmission (16,26).…”

“…Additionally, morbidity arising from posttransmission schistosomiasis often persists as clinical symptoms even for many years after transmission has been interrupted (13). Praziquantel must be repeatedly administered to prevent schistosomiasis reinfection, a common problem in areas endemic for schistosomiasis (14,15). Therefore, complementary community control measures are simultaneously needed to curtail schistosomiasis sustainably (15,16).…”

“…Therefore, complementary community control measures are simultaneously needed to curtail schistosomiasis sustainably (15,16). Specifically, reducing the contact rate of a community with schistosomeinfested water may be achieved through provision of clean water, sanitation, and health education (WSH) (14,(16)(17)(18).…”