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AGRICULTURE AND HUMAN HEALTH PowerPoint PPT Presentation

AGRICULTURE AND HUMAN HEALTH. AGRICULTURE AN D HUMAN HEALTH Water- associated vector-borne diseases. OVERVIEW. Water-associated vector-borne diseases Nature Magnitude Agricultural driving forces Environmental Social Health status and agricultural production

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AGRICULTURE AND HUMAN HEALTH

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AGRICULTURE AND HUMAN HEALTH


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AGRICULTURE AND HUMAN HEALTH

Water-

associated

vector-borne

diseases


Overview

OVERVIEW

Water-associated vector-borne diseases

  • Nature

  • Magnitude

    Agricultural driving forces

  • Environmental

  • Social

  • Health status and agricultural production

    Activities in UN context and beyond

  • Historical review

  • Current activities

  • Issues and conclusions


What are vector borne diseases

What are vector-borne diseases ?

  • Malaria

  • Schistosomiasis

  • Lymphatic filariasis

  • Japanese encephalitis


What are vector borne diseases1

What are vector-borne diseases ?

  • Malariaover 2 billion people at risk

  • Schistosomiasis779 million people at risk

  • Lymphatic filariasisover 1 billion people at risk

  • Japanese encephalitis1.9 billion people at risk


What are vector borne diseases2

What are vector-borne diseases ?

  • Malaria300-500 episodes every year

  • Schistosomiasis207 million people infected

  • Lymphatic filariasis120 million people infect

  • Japanese encephalitis50,000 clinical cases reported every year


What are vector borne diseases3

What are vector-borne diseases ?

  • Malaria> 1 million deaths a year

  • Schistosomiasisannually 15,000-100,000 deaths

  • Lymphatic filariasisno immediate deaths

  • Japanese encephalitis15,000 deaths in 2001, fluctuates from year to year


What are vector borne diseases4

What are vector-borne diseases ?

In 2002:

  • Malaria46.4 million DALYs lost

  • Schistosomiasis1.7 million DALYs lost

  • Lymphatic filariasis5.8 million DALYs lost

  • Japanese encephalitis709,000 DALYs lost

    World Health Report 2004


What are vector borne diseases5

What are vector-borne diseases ?

Other relevant vector-borne diseases include

  • African trypanosomiasis – sleeping sickness, tsetseflies

  • Chagas disease (American trypanosomiasis) – triatomine bugs

  • Onchocerciasis – river blindness, blackflies

  • Leishmaniasis – visceral/cutaneous – sandflies

  • Plague, scrub typhus, (dengue), tick-borne encephalitis, (yellow fever)


What is the fraction of the burden attributable to irrigation

What is the fraction of the burden attributable to irrigation ?


What is the fraction of the burden attributable to irrigation1

What is the fraction of the burden attributable to irrigation ?

In 2002:

  • Malaria46.4 million DALYs lost

  • Schistosomiasis1.7 million DALYs lost

  • Lymphatic filariasis5.8 million DALYs lost

  • Japanese encephalitis709,000 DALYs lost

    2003: work initiated with the Swiss Tropical Institute in Basel to carry out systematic and comprehensive literature reviews of the nature and magnitude of the links to water of four vector-borne diseases. The method combines the development of a causal web linking exposures and outcomes combined with Comparative Risk Assessment (CRA). A strengthened and expanded evidence base will help clarify the health impacts (in terms of Burden of Disease BOD and expressed in Disability Adjusted Life Years DALYs) of water resources that have been developed and are managed without due consideration of adverse health effects and health opportunities.


What is the fraction of the burden attributable to irrigation2

What is the fraction of the burden attributable to irrigation ?

In 2002:

  • Malaria46.4 million DALYs lost

  • Schistosomiasis1.7 million DALYs lost

  • Lymphatic filariasis5.8 million DALYs lost

  • Japanese encephalitis709,000 DALYs lost

    It will also provide a solid foundation for the assessment of the cost-effectiveness of water-driven health interventions, including alternative design and construction options for water resources development projects, and improved water management practices. This will allow a comparison not only between different options for “water interventions”, but also between this type of interventions and other medical and public health interventions. It will help elucidate trade-offs, synergies and antagonisms whenever combinations of interventions are considered. It will also highlight situations where options with only a marginal benefit to the production output of other sectors become highly desirable because of their added health benefits. An example of this would be the case where investment in irrigation infrastructure results in marginal benefits for agricultural production, but has a substantial impact on the transmission reduction of

    malaria.


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Water resource development and management

Large dams, artificial lakesHydropower

Large dams, river modificationsFlood control

Small dams, irrigation schemes Agriculture

Small dams, pondsAquaculture

Pumps, drains Water supply & sanitation

Pools, artificial lakesRecreation

New breeding sites (e.g. reservoir, surface irrigation)

Chang in atmospheric system (e.g. humidity)

Change in ecosystemChange in hydrological system (e.g. water flow, chemistry)

Creation and influence of larval/adult mosquito habitats

Host 1:

Domestic animals

Plasmodium development, Plasmodium/Anopheles survival rate, Anopheles longevity,increase in Anopheles density

Improve household living conditions, community resources, local economy, health infrastructure

Vector control

Water management

Personal protection,chemoprophylaxis,

vaccination

Customs, culture

Host 2:Local population, labour, migrants

Susceptibility, immunity

Legend:

Anaemia, undernutrition, low birth weight, increased susceptibility to general infection

Positive impact

Clinical disease

Infected human population

Sequelae

Negative impact

Severe clinical complication

Death

Causal web


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Populations at risk from irrigation sites


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Populations at risk from large dam sites


What is the fraction of the burden attributable to irrigation3

What is the fraction of the burden attributable to irrigation ?

Malaria

  • In Africa South of the Sahara – irrigation introduction in areas of stable transmission no change or a reduction in transmission ("paddies paradox") – for a number of speculated reasons.

    (Mali, Burkina Faso, Sénégal)

  • In areas of unstable transmission: irrigation introduction causes a shift from seasonal to perennial transmission and places a heavy burden on non-immune populations.

    (Burundi, Ethiopia)


What is the fraction of the burden attributable to irrigation4

What is the fraction of the burden attributable to irrigation ?

Malaria

  • In South and Southeast Asia: significant increases in malaria transmission (up to 5-fold increases)

    (Pakistan, Iran, India, Sri Lanka)

  • Coastal areas of South and Southeast Asia: malaria transmission linked to shrimp and fish farming

    (Viet Nam, Indonesia)


What is the fraction of the burden attributable to irrigation5

What is the fraction of the burden attributable to irrigation ?

Lymphatic filariasis

  • Complex picture because of many contextual determinants at the local level and a dearth of datasets

  • Long incubation period, the entire disease burden stems from disability

  • An estimated 213 million people in endemic countries at risk in irrigated areas


What is the fraction of the burden attributable to irrigation6

What is the fraction of the burden attributable to irrigation ?

Japanese encephalitis

  • Limited distribution

  • 1.9 billion people at risk

  • Critical contextual determinants: surface irrigation for rice production; pigs; ardeid birds; poor access

  • Several options for "agricultural type" interventions: improved irrigation water management (AWDI), biological control, IPM and IVM, economic (des)-incentives to reduce pig rearing.


What is the fraction of the burden attributable to irrigation7

What is the fraction of the burden attributable to irrigation ?

Schistosomiasis

  • 779 million people at risk

  • In West Africa: pronounced impact on intestinal schistosomiasis, Sénégal from 0% to 71.8% prevalence rate following the construction of the Diama barrage

  • In Central Africa: a marked impact of irrigation development on the prevalence of urinary schistosomiasis (3-4 fold)

  • In East Africa: the irrigation development related spread of S. mansoni

  • In southern Africa: no conclusive evidence for a lack of solid datasets

  • (Iran: the resilience of environmental engineering measures)


Agricultural driving forces and determinants

Agricultural driving forces and determinants


Agricultural driving forces and determinants1

Agricultural driving forces and determinants

Health and environment cause-and-effect framework

Driving forcePopulationEconomicTechnology

growthdevelopment

PressureProductionConsumptionWaste release

StateNatural hazardsResource Pollution levels

availability

ExposureExternal exposureAbsorbed doseTarget organ dose

Vector densityVector longevityHuman-vector contact

frequency

EffectWell-beingMorbidityMortality

ActionImpact assessmentRisk managementHealth sector response


Agricultural driving forces and determinants2

Agricultural driving forces and determinants

Environmental determinants

Hydrological changesintroduction of irrigation

intensification of irrigation

impoundments, reservoirs, night storage

water for livestock (small dams)

fish ponds

coastal areas

(mangroves shrimp ponds)


Agricultural driving forces and determinants3

Agricultural driving forces and determinants

Environmental determinants

Changesin land use patternsplot size

cropping intensity and patterns

settlement siting vis-à-vis

agricultural lands

livestock distribution

chemical inputs (pesticides,

fertilizers)


Agricultural driving forces and determinants4

Agricultural driving forces and determinants

Social determinants

Changesin social structureincome levels and distribution

and processconsumption patterns

gender roles

nutritional status

migration (seasonal,

re-settlement)

subsistence vs cash crops

mechanization


The impact of ill health on agriculture

The impact of ill-health on agriculture

Undermining the human resource base

  • loss of production capacity

  • school absentee-ism

  • pressure on gender roles

  • opportunity costs


The impact of ill health on agriculture1

The impact of ill-health on agriculture

Poverty induced vicious circle

  • insufficient economic foundation to meet basic needs

    (including under-nutrition)

  • environmental degradation depleting the agricultural resource base

  • no resources to purchase essential agricultural inputs

    or upgrade production process

  • no access to health services


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A combination of Burden of Disease estimates and cost-effectiveness analyses can differentiate those water interventions that give poor largest incremental health gains for least possible costs.

Recent WHO analyses to attribute a disease burden to water, sanitation and hygiene risk factors show they account for:

  • 2.1 million deaths each year (3.9% of total)

  • 76 million DALYs lost each year (5.3% of total)


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A combination of Burden of Disease estimates and cost-effectiveness analyses can differentiate those water interventions that give the poor largest incremental health gains for least possible costs.

Maximum health gains in absolute terms:

  • provide the most basic water supply services to those who have no access at all

  • provide water supply and sewage connection to individual households

    Most cost-effective interventions:

  • Disinfection at point-of-use through chlorine treatment and safe storage vessels combined with limited hygiene education

  • Targeting key behavioural change (hand washing)


Annual funding per intervention world wide billions of us

Annual funding per intervention world-wide (billions of US$)


Costs of interventions versus healthy life years gained

Costs of interventions versus healthy life years gained


Who links and action

WHO links and action

Current focus of the WHO Water Sanitation and Health programme with respect to irrigation and dams:

Water Resources Development and Management

  • Assisting countries in IWRM policy development to ensure human health considerations are incorporated

  • National capacity building for Health Impact Assessment and Health Risk Management of water resources projects

  • Backstopping Member States with HIA Terms of Reference and Appraisals of specific water projects

  • Promoting research on water management measures for health protection and promotion


Who links and action1

WHO links and action

The WHO/FAO/UNEP Panel of Experts on Environmental Management for Vector Control (1981-1996):

Objective: to establish an effective inter-agency and intersectoral framework for the promotion of environmental management for vector control in the context of agriculture, health and nature conservation programmes


Who links and action2

WHO links and action

The WHO/FAO/UNEP Panel of Experts on Environmental Management for Vector Control (1981-1996):

  • Technical reviews through annual Panel meetings

  • Guidelines development and promotion

  • Setting multidisciplinary research agendas and promoting research on EMVC

  • Capacity building, in particular skill development on intersectoral decision making

    Some key products:

    Strengthened knowledge base on the links between rice production systems and malaria/schisto in W-Africa (the WARDA/PEEM/IDRC project 1993-1998)

    A comprehensive Health Impact Assessment capacity building package, tested in five countries and currently being implemented in the Mekong area


Who links and action3

WHO links and action

Current collaboration with UNEP: Health and Environment Linkages Initiative (HELI)

  • Encourages developing country policy makers to support action on environmental

    threats to health

  • Sponsored by the Canadian Government, implemented by WHO and UNEP

  • Range of case studies at countries level (incl. Uganda, Thailand and Brazil) including health issues in agricultural settings

  • Priority areas: vector-borne diseases, the urban environment, indoor air pollution

    and household energy, water-health-ecosystems, climate change and toxic

    substances

    Collaboration with FAO in this area has declined, but continues in other areas such as food safety, Codex alimentarius, veterinary public health (bird flu) and water legislation


Who links and action4

WHO links and action

Links with the CGIAR system:

IRRI1987 workshop

1988-1992 proposal development, collapsed for

lack of donor interest

Work on pesticides and their impact on the health

of rice farmers, links between IPM and IVM


Who links and action5

WHO links and action

Links with the CGIAR system:

IWMI1985 workshop in Digana Village (irrigation and

malaria)

Establishment of the Health and Environment department

Creation of SIMA

Dialogue on Water for Food and the Environment

Research on malaria, JE and irrigation in Asia;

malaria and urban agriculture in Ghana; health aspects

of waste water use


Who links and action6

WHO links and action

Links with the CGIAR system:

WARDA1992-1998 Consortium Research project on the

Association between Irrigated Rice Production Systems

and Malaria/Schistosomiasis in West Africa

Nine papers published in the biomedical literature

Supported by IDRC, Govnmts of Denmark and Norway


Who links and action7

WHO links and action

Links with the CGIAR system:

ISNARReview of irrigation related malaria in the Causasian

countries

Work on alternatives to POPs pesticides for public

health purposes


Issues for discussion

ISSUES FOR DISCUSSION

How to expand our knowledge base on the

(cost-) effectiveness on water management, environmental management and similar interventions in specific contexts in an efficient way ?


Issues for discussion1

ISSUES FOR DISCUSSION

How to mainstream the outcomes of case studies and intervention studies into the international and national agricultural policy frameworks ?


Issues for discussion2

ISSUES FOR DISCUSSION

The need to clarify the economics of agriculture/health linkages and of intersectoral interventions for health protection and promotion in the setting of agricultural production systems.


Issues for discussion3

ISSUES FOR DISCUSSION

Optimizing the delivery of health messages to farmers with a focus on improved environmental management and best practice in irrigation and other agricultural activities: technical content, intersectoral mechanisms, the credibility issue


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THANK YOU FOR YOUR ATTENTION


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