Foreword
Introduction: How to Use This Book
Part I
Part II
Part III
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FOREWORD
Ecosystem Change and Public Health: A Global Perspective, edited
by Joan Aron and Jonathan Patz, is one of those books that has long been
due. It will quickly find a place on the shelves and tables of students,
teachers, and professionals working in a broad range of disciplines.
Because the theme "the interface between ecosystem change and public
health" is so extraordinarily complex, relevant literature and information
sources are spread throughout a multitude of different disciplines, from
biology, chemistry, and physics all the way to the social, economic, and
behavioral sciences. As a consequence, students, faculty, and researchers
interested in this area have lacked a primary source of inspiration and
reference for their work.
This is no longer the case. A carefully selected list of contributors
provides the reader with the navigation tools needed for successful exploration
of this interface. Embracing the principle that less is more, the book
avoids the temptation to become a source of encyclopedic reference for
every discipline. It uses instead modern pedagogical approaches to encourage
active learning "where discovery is more important than passive absorption
of text" and acts as a platform from which to begin investigating the effects
of global ecosystem changes on public health. This innovative approach
is undoubtedly good news.
This first textbook on research methods in this area also stresses the
combination of investigations into health outcomes with integrated assessment
for policy development, which generates insights into the uses and limitations
of projections into the future. This is accomplished by structuring the
book into three parts, the different chapters of which, being cross-referenced,
can be read in any order: (1) approaches to the complex topics of the effects
of global change on human health, (2) environmental changes, and (3) case
studies, which link facts about the effects of global change with the methods
needed to understand and remedy them. There is a great need for further
research in this area and for innovative approaches in tackling the complex,
multivariate dependent phenomena that are observed¾as illustrated,
for example, by the ongoing debate on the influence of global climate change
on the continuing spread of malaria.
As we enter the twenty-first century, the health implications of a destabilized
global ecosystem are an increasing challenge to scientists, physicians,
governments, and the general public. This innovative textbook will undoubtedly
become a major source of inspiration for those working and researching
in this area of such need.
Carlos Morel
Director
Special Programme for Research Training
in Tropical Diseases, UNDP/World Bank/ WHO, Geneva
Introduction: How to Use This Book
Purpose
The purpose of this textbook is twofold: (1) to raise awareness of changes
in human health related to global ecosystem change and (2) to expand the
scope of the traditional curriculum in environmental health to include
the interactions of major environmental forces and public health on a global
scale. In support of these broad purposes, this textbook incorporates modern
pedagogical approaches to encourage active learning and reduce dependence
on the lecture format, taking advantage of electronic information accessible
on the World Wide Web.
The themes of ecosystem, environment, and ecology appear throughout
this book in the context of concerns about planet Earth that developed
throughout the twentieth century and will continue to emerge in the twenty-first
century. Each of these terms has many meanings in the literature, sometimes
generating confusion as these terms are often loosely used as synonyms.
The title of the book uses ecosystem instead of environment
or ecology because ecosystem is a comprehensive term that
refers to a system of interacting biotic and abiotic elements applicable
to the study of the human population and planet Earth. Ecosystem
conveys a stronger sense of interactions than does environment,
which often emphasizes the world external to the human population, such
as toxic agents in air, food, or water. Ecosystem also conveys a
stronger sense of the importance of abiotic elements than does ecology,
which usually emphasizes the biological world. Admittedly, the distinctions
between these terms are not rigid, as usage has evolved in different ways
in different groups; the important message is that this textbook emphasizes
interactions from a variety of perspectives: biological, chemical, physical,
and social.
A global perspective on ecosystem change and public health covers
an extraordinarily large and complex array of information. Global ecosystem
change refers to changes in the earth's ecosystem that are global in
extent, including changes in local ecosystems caused by pressures of population
and consumption on local resources, which are becoming more wide spread.
Global changes arise from the interaction of natural and anthropogenic
dynamics, involving a variety of factors such as climate and atmosphere,
water and land, and the growth and movement of the human population. The
scope of investigation is rather extensive and can fill volumes and volumes
in print and electronic media. A Global understanding of how people are
injured, become ill, develop a disability, and die; the core questions
in the science of public health; is also a vast subject.
This textbook embraces the principle that "less is more" and avoids
any attempt to be an encyclopedic reference for every discipline. As a
place to begin investigations of how public health is and may be affected
by global ecosystem change, the book focuses on the interface between studies
of global ecosystem change and studies of public health. Case studies,
overviews of relevant material from many fields, and pointers to additional
information help the reader to explore sources on information, develop
inquiries, and identify techniques that need to be learned. The methodological
aim is to enable to the student and researcher to arrive at the intricate
picture of interactions among global change and public health by discovery
rather than by the absorption of text. This textbook integrates the contributions
from multiple authors into a handbook that aids interdisciplinary research
and study design (see Appendix A).
The Target Audience
The primary target audience is a master's-level student in public health,
especially one with a strong interest in environment and health. This book
should be helpful for students in public health seeking to integrate studies
of infectious and noninfectious disease. The scope of the book includes
but is not restricted to infectious diseases, which are commonly taught
separately from environmental health issues that focus on the toxicity
of chemical and physical agents. Another target audience is master's-level
students and upper-level undergraduate students in a variety of disciplines¾environmental
science, climatology, ecology, geography, and social science. This book
will foster the development of interdisciplinary courses that bring together
students with diverse backgrounds,. Guidance on integrating multiple disciplinary
perspectives avoids excessive technical jargon and technical notation comprehensible
only to specialists within a narrow field. This book can be used as a primary
or supplementary text for a course, as well as for independent study. The
common element must be a desire to learn more about the study of global
change and public health.
Multiple Ways to Use the Chapters
In this book Part I develops approaches for research, Part II describes
environmental changes, and Part III provides case studies linking ecosystem
change and public health. Although all three parts are interdependent and
cross-reference each other, one strategy for using the book is to focus
on one part at time.
Part I: Approaches. Chapters 1-5 present a diverse selection
of perspectives and research strategies for approaching complex topics
on the effects of global change on human health. Examples illustrate successful
applications of various methods, thereby assisting the new researcher in
selecting appropriate approaches to research problems.
Part II: Environmental Changes. Chapters 6-10 present a selection
of vital issues of today's global change with special emphasis on atmospheric
changes and the hydrological cycle. Applying the principle of "less is
more," this part of the book does not intend to be complete; rather, it
provides selected specific topics on changes in the planet's environment
and ecosystems.
Part III: Case Studies. Chapters 11-14 are case studies that
emphasize the influences of global change on human health. The examples
chosen represent different environmentally related health effects in different
geographic areas. Within the context of real-life situations, the case
studies link factual knowledge of the effects of global change and methods
that are needed to understand and remedy the situation.
An alternative view of the chapters sets them in a web of interconnections.
Each successive chapter does not require a thorough comprehension of all
preceding chapters, and so the chapters do not have to be read in a linear
sequence. All of the chapters cross-reference each other, and different
parts of the book may serve as starting points for a course or for independent
reading. One option is to start with an overview of the human dimension
of global change (Chapter 6) in Part II before using Part I to develop
specific approaches for research. Another option is to start with a specific
disease, such as the case study on malaria (Chapter 12) in Part III, and
then examine linkages with the changes described in Part II; Chapter 12
refers to every chapter in Part II. Yet another option is to start with
the case study on global climate change and air pollution (Chapter 13)
in Part III and then examine how the issue of global climate change appears
in other chapters; Chapter 13 refers to Chapters 6,7,9,10,11,12, and 14
in an overview of the potential pathways of the effects of global climate
change on public health. A course with a primary interest in water issues
may focus in depth on water resources management (Chapter 9) and on water-related
health problems (Chapter 14); references in these chapters lead to information
in Chapters 2,4,5,8,10, and 11. Readers with a background in research on
global change may want to learn about study designs in epidemiology (Chaper
2), whereas trained epidemiologists may want to concentrate on applying
techniques for remote sensing to global change (Chapter 3); both of these
chapters refer to Chapter 1 for an overview of information on global change.
Another group may want to focus on approaches for linking scientific data
to the development of public policy affecting environment and public health
(Chapters 4 and 5). And so on.
Electronic References and Information Literacy
Electronic references are references to uniform resource locators (URLs)
on the World Wide Web. Although each chapter includes the traditional format
of references to published books and articles, most chapters also refer
to some URLs. The references to URLs are used like any citation but are
set in a different typeface. For example, the notation (Environmental Protection
Agency 2000) points to a traditional list of references at the end of the
chapter, but the notation (Environmental Protection Agency 2000)
points to a separate list of electronic references at the end of the chapter.
These URLs provide links to reference material that would add considerably
to the size of the printed book, including some color images that would
be relatively expensive to put in print. Since the information at URLs
can be updated regularly, references to URLs help the book to maintain
currency. Of course, the addresses of URLs can and do change, but each
electronic reference includes details about the owner of the website and
the title of the page, which should make it possible to search for new
links.
Besides the URLs in individual chapters, Appendix B provides annotation
of major websites and a list of online directories and libraries that may
serve as gateways into new sources of information. Online libraries may
contain copies of traditional print publications, as either abstracts or
full-text documents; it is also useful to consult the website of the organization
that produces a publication of interest. Another feature of Appendix B
is a list of topically arranged websites that are smaller than the annotated
websites and have a stronger focus on a particular theme or regional and
local concerns. These topically arranged websites are samples o the diverse
sources of information available on the World Wide Web that may be of use
in interdisciplinary research.
With a plethora of information directly accessible via electronic means,
investigators need to develop and apply skills in information literacy.
Appendix A contains general guidelines for information literacy in the
world of the Internet. Chapter 1 suggests how to search for information
about issues of global change, with explicit recognition of information
from multiple disciplines. For every theme, Chapter 1 refers to chapters
in this book and selected URLs as starting points for inquiry.
The Format of Suggested Study Projects
Each of Chapters 2-14 suggests three study projects that invite the
reader to reflect upon the material in the chapter and to extend inquiry
beyond the chapter and the book. All chapters explicitly cross-reference
other chapters, thereby helping the reader to make full use of the book.
The study projects may lead to a variety of written, oral, and multimedia
presentations that could be completed by individuals or teams; various
combinations may be used to enhance interactivity and communication among
course participants (see Appendix A). Since suggested study projects may
involve rather extensive research, they should be viewed as options rather
than as a set of exercises to be completed to demonstrate knowledge of
details in the chapter. The objectives listed for the suggested study projects
are useful aids to navigation and help an instructor make use of the chapter
in a formal course. However, the list of projects is not comprehensive.
Instructors and independent readers may be motivated to design other projects
tailored to specific needs.
Conclusion
The problems of global ecosystem change and their effects on public
health constitute a growing challenge to scientists, physicians, governments,
and the general public. This textbook provides an innovative structure
that permits a diversity of approaches to a complex and important subject.
The hope is that this book will motivate more and better studies of global
change and public health.
Part I
Approaches
Part I develops approaches for interdisciplinary research on global
ecosystem change and public health, beginning with an examination of information
on global change from the perspective of multiple disciplines (Chapter
1). A sample site on the World Wide Web is part of the information on each
of the major forces of natural and anthropogenic dynamics. The next step
is to focus on establishing links with public health through epidemiological
analysis that builds on basic concepts of study design--ecological, cross-sectional,
case-control, and cohort (Chapter 2). The methodological examples also
serve to illustrate a variety of health hazards (e.g., filariasis in Egypt,
trachoma in Tanzania, air pollution in China, radiation-induced illness
from the Chernobyl nuclear accident, and mortality in refugees from Iraq
and Rwanda). More sophisticated tools for the analysis of geographic information
can be incorporated into epidemiological studies, taking advantage of relatively
new forms of global information from Earth-observing satellites (Chapter
3). The discussion addresses sources of information available on the World
Wide Web, including criteria for the evaluation of the quality of datasets.
Empirical studies become part of a process of assessing risks
to human health and developing policies to protect the environment and
human health. The experience of air pollution in the United States demonstrates
four essential concepts of risk assessment--hazard identification, dose-response
assessment, exposure assessment, and risk characterization (Chapter 4).
Traditional risk assessment is expanded into integrated assessment, which
is a broader examination of social, economic, and environmental factors
that provides insights into decisions (Chapter 5). The aim is to encourage
interdisciplinary research that combines mathematical models of the consequences
of different policies with a perspective on integrated assessment as a
participatory process.
A multifaceted strategy for research emerges from Part I. Its
scope ranges from empirical observations of what has already occurred and
what is occurring to the process of integrated assessment that requires
anticipation and analysis of possible events in the future. The rationale
for this organization is to encourage more and better research in empirical
studies, in the analysis of decisions about complex ecosystems, and in
the development of better connections between these two areas.
See Part II for background on environmental
changes on a global scale. See Part III for case studies
on global ecosystem change and public health.
Part II
Environmental Changes
Part II presents a selection of vital issues on global change,
with special emphasis on atmospheric changes and the hydrological cycle.
Part II begins with a chapter that explores the relationship between human
populations and the environment (Chapter 6). This chapter has three sections:
a broad overview of historical relationships between demographic, technological,
and economic changes and human health; a survey of contemporary changes,
such as urbanization, migration, population growth, and aging, that are
likely to affect human health in the future; and an analysis of recent
attempts to reach international agreement on issues of environmental degradation
on a global scale, especially stratospheric ozone depletion and global
climate change. The next chapter describes four main types of large-scale
atmospheric degradation--stratospheric ozone depletion, acid rain, urban
smog (ozone), and enhanced global warming due to anthropogenic emissions
of greenhouse gases (Chapter 7). The perspective of a chemist elucidates
both the sources and consequences of these atmospheric changes. The chapter
that follows provides an ecological perspective on health through an explanation
of the interdependence of cycles of energy, water, and carbon and how they
shape the earth on which we live (Chapter 8). Of particular note is the
use of the climatic fluctuations of El Ni¤o as an example of interactions
in the earth's dynamics with direct implications for public health. A chapter
on water resources provides an overview of the use of water during the
twentieth century and the growing importance of management of this most
precious resource in sustainable development (Chapter 9). Topics include
the quantity and quality of water as well as the effects of agriculture,
forestry, population growth, and urbanization and their potential interactions
with global climate change. A chapter on ecology and infectious disease
lays out cycles of transmission of infectious agents and how they are affected
by specific environmental changes (Chapter 10). This foundation provides
a framework for the study of emerging infectious diseases that examines
the contribution of humans, animals, and abiotic factors in the spread
of disease.
See Part I for approaches to research. See
Part
III for case studies on global ecosystem change and public health.
Part III
Case Studies
In Part III, the purpose is to present examples of public health
issues that demonstrate interactions among the various themes of the book.
The first case study is on cholera, one of the few bacterial diseases that
continue to cause pandemics (Chapter 11). Recent research on the aquatic
environment has shown that the causative agent of cholera multiplies in
association with plankton independently of humans. A series of studies
suggests that changes in the environment, rather than simply human migration
and the fecal-oral route of transmission of the disease, may be a primary
factor in the rapid pandemic spread of cholera. The case study on malaria
also focuses on the relationship between an infectious disease and global
ecosystem change (Chapter 12). Global changes in the growth and movement
of populations, patterns of economic development, and climate are changing
the risk of exposure of human populations to malaria. Examples from Zimbabwe,
Gambia, Niger, Sri Lanka, Brazil, and the United States demonstrate complex
interconnections between these global changes and the local situations.
Another case study examines interactions among atmospheric changes and
their implications for human health (Chapter 13). Traditional forms of
air pollution and greenhouse gases interact in several ways: the use of
fossil fuels serves as a common source, the concentrations of some air
pollutants are expected to increase under projections of enhanced global
warming due to anthropogenic emissions of greenhouse gases, and the effects
of air pollutants and projected changes in heat stress due to enhanced
global warming may possibly exhibit synergy. The primary focus on air pollutants
is augmented by a discussion of other possible pathways of the effect of
global climate change on threats to public health. The last case study
examines the importance of water resources through four examples that illustrate
the diverse ways in which too little or too much water can adversely affect
human health (Chapter 14). Cholera in a refugee camp in Africa due to a
shortage of clean drinking water contrasts with the serious health effects
of flooding in Brazil. The consequences of diversions of water for agricultural
or municipal use are shown in terms of massive ecological deterioration
in the Aral Sea basin and, on a smaller scale, an increase in dusty air
in California.
See Part I for approaches to research. See
Part
II for background on environmental changes on a global scale.
copyright 2001 The Johns Hopkins University Press
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