Worldwatch Paper #129: Infecting Ourselves: How Environmental and Social Disruptions Trigger Disease
Anne E. Platt
Rates of infectious disease have risen rapidly in many countries during the past decade, according to a new study released by the Worldwatch Institute. Illness and death from tuberculosis, malaria, dengue fever, and AIDS are up sharply; infectious diseases killed 16.5 million people in 1993, one-third of all deaths worldwide, and slightly more than cancer and heart disease combined.
The resurgence of diseases once thought to have been conquered stems from a deadly mix of exploding populations, rampant poverty, inadequate health care, misuse of antibiotics, and severe environmental degradation, says the new report, Infecting Ourselves: How Environmental and Social Disruptions Trigger Disease. Infectious diseases take their greatest toll in developing countries, where cases of malaria and tuberculosis are soaring, but even in the United States, infectious disease deaths rose 58 percent between 1980 and 1992.
Research Associate Anne Platt, author of the report, says, "Infectious diseases are a basic barometer of the environmental sustainability of human activity. Recent outbreaks result from a sharp imbalance between a human population growing by 88 million each year and a natural resource base that is under increasing stress."
"Water pollution, shrinking forests, and rising temperatures are driving the upward surge in infections in many countries," the report says. "Only by adopting a more sustainable path to economic development can we control them."
"Beyond the number of people who die, the social and economic cost of infectious diseases is hard to overestimate," Platt says. "It can be a crushing burden for families, communities, and governments. Some 400 million people suffer from debilitating malaria, about 200 million have schistosomiasis, and nine million have tuberculosis."
By the year 2000, AIDS will cost Asian countries over $50 billion a year just in lost productivity. "Such suffering and economic loss is doubly tragic," says Platt, "because the cost of these diseases is astronomical, yet preventing them is not only simple, but inexpensive."
The author notes, "The dramatic resurgence of infectious diseases is telling us that we are approaching disease and medicine, as well as economic development, in the wrong way. Governments focus narrowly on individual cures and not on mass prevention; and we fail to understand that lifestyle can promote infectious disease just as it can contribute to heart disease. It is imperative that we bring health considerations into the equation when we plan for international development, global trade, and population increases, to prevent disease from spreading and further undermining economic development."
The report notes that this global resurgence of infectious disease involves old, familiar diseases like tuberculosis and the plague as well as new ones like Ebola and Lyme disease. Yet all show the often tragic consequences of human actions:
Population increases, leading to human crowding, poverty, and the growth of mega-cities, are prompting dramatic increases in dengue fever, tuberculosis, and HIV/AIDS. Lack of clean water is spreading diseases like cholera, typhoid, and dysentery. Eighty percent of all disease in developing countries is related to unsafe drinking water and poor sanitation. Poorly planned development disrupts ecosystems and provides breeding grounds for mosquitoes, rodents, and snails that spread debilitating diseases. Inadequate vaccinations have led to resurgences in measles and diphtheria. Misuse of antibiotics has created drug-resistant strains of pneumonia and malaria. Vastly increased human mobility from air travel can move infectious agents between continents in hours. The report shows that the methods of preventing and treating most infectious diseases are well known. But the growing pressures of budget cuts and population growth are overwhelming efforts in many countries to control epidemics. As a result, many nations lack the money, personnel, and resources to provide adequate prevention and treatment. Platt agrees with World Health Organization officials who say that poverty is the deadliest disease. It is the main reason that babies are not vaccinated, clean water is not provided, and effective drugs are not available. For example, government-owned water utilities may provide services only to landowners or homeowners, leaving large squatter populations, typical of many Third World cities, outside the scope of the service.
Even the United States often fails in the most obvious ways to prevent infectious diseases. Only 58 percent of Americans are immunized, far below the rates in many developing countries, including India, Mexico, Thailand, and Uganda. An estimated 3 million American children are not immunized against traditional childhood infections. And although water quality has improved in the U.S., waterborne infectious diseases such as giardiasis cost the nation nearly 20 billion dollars each year.
The report recommends a four part plan, to control the spread of infectious diseases.
Slow population growth and stabilize the world's climate. The world needs to implement the World Population Plan of Action, as adopted at the 1994 International Conference on Population and Development in Cairo, and to allocate more money for family planning and reproductive health programs, as well as the prevention of sexually transmitted diseases. Effective implementation of the International Climate Convention is crucial to address the increasing global emissions of carbon dioxide and other greenhouse gases. Improve social and environmental conditions. A combination of measures to reduce poverty, prevent pollution, and improve living conditions, particularly in poor urban and rural areas, are needed to address the underlying causes of infectious disease. More than one-fifth of humanity lacks regular access to safe drinking water and sanitation. Environmental protection efforts must be invigorated in developing and developed countries alike to restore air and water quality, and to preserve biological diversity and the integrity of ecosystems, which keep many infectious organisms in check. Expand coverage of basic public health measures, including vaccines, antibiotics, and medicines. Supplies of clean syringes, rubber gloves, and other basic health equipment are sorely needed in developing countries. Funding for ongoing public health programs, including outreach, education, and research should be a top priority at local, national, and international levels of government. Nations also need to expand access to basic health care and medical services, especially for women and children, and to raise public awareness. Establish a global health monitoring system. In 1995, the World Health Organization General Assembly passed a resolution urging member states to strengthen surveillance; improve rapid diagnosis, communication, and response; and conduct routine testing for drug resistance. Policymakers would do well to integrate environmental, climate, population, and land use data and information to detect conditions conducive to disease outbreaks, to provide early warning to health officials, and to create an efficient response network. Today, disease control is crisis driven, with public health agencies and governments reacting to epidemics, not preventing them; paying larger sums for treatment of disease rather than pennies a day for preventive measures. In the long run, prevention is our most effective weapon against infectious disease: public health measures that improve the health of individuals and populations, as well as sustainable economic and environmental policies that control the emergence and spread of infectious diseases and maintain the natural checks and balances will go a long way toward promoting a healthier world. The price of failing to understand these links is clear: rising health care costs and a world in which, even now, more than half the people live in fear of plagues.