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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

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 ?
  • Malaria over 2 billion people at risk
  • Schistosomiasis 779 million people at risk
  • Lymphatic filariasis over 1 billion people at risk
  • Japanese encephalitis 1.9 billion people at risk
what are vector borne diseases2
What are vector-borne diseases ?
  • Malaria 300-500 episodes every year
  • Schistosomiasis 207 million people infected
  • Lymphatic filariasis 120 million people infect
  • Japanese encephalitis 50,000 clinical cases reported every year
what are vector borne diseases3
What are vector-borne diseases ?
  • Malaria > 1 million deaths a year
  • Schistosomiasis annually 15,000-100,000 deaths
  • Lymphatic filariasis no immediate deaths
  • Japanese encephalitis 15,000 deaths in 2001, fluctuates from year to year
what are vector borne diseases4
What are vector-borne diseases ?

In 2002:

  • Malaria 46.4 million DALYs lost
  • Schistosomiasis 1.7 million DALYs lost
  • Lymphatic filariasis 5.8 million DALYs lost
  • Japanese encephalitis 709,000 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 irrigation1
What is the fraction of the burden attributable to irrigation ?

In 2002:

  • Malaria 46.4 million DALYs lost
  • Schistosomiasis 1.7 million DALYs lost
  • Lymphatic filariasis 5.8 million DALYs lost
  • Japanese encephalitis 709,000 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:

  • Malaria 46.4 million DALYs lost
  • Schistosomiasis 1.7 million DALYs lost
  • Lymphatic filariasis 5.8 million DALYs lost
  • Japanese encephalitis 709,000 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.

slide14

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

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 determinants1
Agricultural driving forces and determinants

Health and environment cause-and-effect framework

Driving force Population Economic Technology

growth development

Pressure Production Consumption Waste release

State Natural hazards Resource Pollution levels

availability

Exposure External exposure Absorbed dose Target organ dose

Vector density Vector longevity Human-vector contact

frequency

Effect Well-being Morbidity Mortality

Action Impact assessment Risk management Health sector response

agricultural driving forces and determinants2
Agricultural driving forces and determinants

Environmental determinants

Hydrological changes introduction 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

Changes in land use patterns plot 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

Changes in social structure income levels and distribution

and process consumption 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
slide29

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)
slide30

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)
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:

IRRI 1987 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:

IWMI 1985 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:

WARDA 1992-1998 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:

ISNAR Review 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