Tony McMichael

Synanthropy of wild mammals as a determinant of emerging infectious diseases in the Asian-Australasian region.

Humans create ecologically simplified landscapes that favour some wildlife species, but not others. Here, we explore the possibility that those species that tolerate or do well in human-modified environments, or ‘synanthropic’ species, are predominantly the hosts of zoonotic emerging and re-emerging infectious diseases (EIDs). We do this using global wildlife conservation data and wildlife host information extracted from systematically reviewed emerging infectious disease literature. The evidence for this relationship is examined with special emphasis on the Australasian, South East Asian and East Asian regions. We find that synanthropic wildlife hosts are approximately 15 times more likely than other wildlife in this region to be the source of emerging infectious diseases, and this association is essentially independent of the taxonomy of the species. A significant positive association with EIDs is also evident for those wildlife species of low conservation risk. Since the increase and spread of native and introduced species able to adapt to human-induced landscape change is at the expense of those species most vulnerable to habitat loss, our findings suggest a mechanism linking land conversion, global decline in biodiversity and a rise in EIDs of wildlife origin.

Action on climate change: the health risks of procrastinating

Objective: The worlds climate will continue to change because of human influence. This is expected to affect health, mostly adversely. We need to compare the projected health effects in Australia arising from differing climate change scenarios to inform greenhouse gas emission (mitigation) policy.

Comparative assessment of transport risks: how it can contribute to health impact assessment of transport policies

Health impact assessment (HIA) and comparative risk assessment (CRA) are important tools with which governments and communities can compare and integrate different sources of information about various health impacts into a single framework for policy-makers and planners. Both tools have strengths that may be combined usefully when conducting comprehensive assessments of decisions that affect complex health issues, such as the health risks and impacts of transport policy and planning activities. As yet, however, HIA and CRA have not been applied widely to the area of transport. We draw on the limited experience of the application of these tools in the context of road transport to explore how comparative assessment of transport risks can contribute to HIA of transport policies.

Global health equity and climate stabilisation ? need for a common agenda

While health has improved for many, the extent of health inequities between and within countries is growing. Meanwhile, humankind is disrupting the global climate and other life-supporting environmental systems, thereby posing serious risks to health and well-being, especially in vulnerable populations but ultimately for all. The underlying determinants of health inequity and of environmental change overlap substantially. They reflect, in particular, an economic system predicated on asymmetric growth and competition, shaped by market forces that mostly disregard health and environmental consequences and limits rather than by values of fairness and support. A shift is required in priorities in economic development, healthy forms of urbanisation, more efficient and renewable energy modes and a sustainable and fairer food system. Addressing the social determinants of health will not only improve global health, but advances will also be made in poverty eradication and social equity such that people, communities and nations will be able to resist current climate change and avert further damage to the global environment and climate. This paper will explore in particular the issues of economic development, urbanisation and food systems in the context of global health equity and climate stabilisation

Primary Mother Care and Population

![][1] Eds Glen Mola, Jim Thornton, Michael Breen, Colin Bullough, John Guillebaud, Frank Addo Published privately by Maurice King, pp 416 ISBN pp 416 ISBN 0 9544212 0 5. For information about price and ordering, email sales@spiegl.co.uk or telephone + 44 (0)1780 762550 www.leeds.ac.uk/demographic.disentrapment/ Rating: ![Graphic][2] ![Graphic][3] ![Graphic][4] ![Graphic][5] for importance and novelty;![Graphic][6] ![Graphic][7] ![Graphic][8] for content, layout, and usability A remarkable thing about Maurice King is his ingenuity in getting his controversial ideas into print. Motivated by public health and humanitarian concerns, he has long pursued a well researched, passionate, somewhat eccentric, and tireless campaign to avert demographic and environmental disaster in an increasingly overpeopled, overconsuming world. Now entering the fourth quarter of his first century, after several decades of engagement and leadership in primary health care in developing countries, King has reinvented himself as “knowledge engineer,” a sort of literary puppeteer. The editors of this book, all colleagues from his years of work and travel, have contributed ideas and critiques. King, however, has done much of the writing and design. The … [1]: /embed/graphic-1.gif [2]: /embed/inline-graphic-1.gif [3]: /embed/inline-graphic-2.gif [4]: /embed/inline-graphic-3.gif [5]: /embed/inline-graphic-4.gif [6]: /embed/inline-graphic-5.gif [7]: /embed/inline-graphic-6.gif [8]: /embed/inline-graphic-7.gif

Global Change and Health — The Good, The Bad and The Evidence

Debates over the merits and demerits of globalisation for health are increasingly polarised. Conclusions range from globalisation being essentially positive for health, albeit with a need to smooth out some rough edges, to one of utter condemnation, with adverse effects on the majority of the worlds population. Anyone wading into this debate is immediately confronted by seemingly irreconcilable differences in ideology, opinion and interests. Both camps agree that global changes are occurring, and with them many of the determinants of population health status. While some skepticism persists about whether “globalisation” has value beyond being a fashionable buzzword, most agree that we need better understanding of these changes. Two difficult questions arise: (i) What are the health impacts of these changes; and (ii) how can we respond more effectively to them? To move beyond the stand-offs that have already formed within the health community, this paper reviews the main empirical evidence that currently exists, summarises key points of debate that remain, and suggests some ways forward for the research and policy communities. In particular, there is need for an informed and inclusive debate about the positive and negative health consequences of globalisation.

Reported changes in dietary behavior following a first clinical diagnosis of central nervous system demyelination

Background/objectives Although the current evidence is insufficient to recommend a special diet for people with multiple sclerosis (MS), dietary advice for people with MS is prolific online and in the media. This study aimed to describe dietary changes made in the year following a first clinical diagnosis of central nervous system demyelination (FCD), a common precursor to MS. Subjects/methods We used follow-up data from the Ausimmune Study, a multicentre matched case-control study examining the environmental risk factors for a FCD. A total of 244 cases (60 male, 184 female) completed a 1-year follow-up interview, which included a question about dietary changes. We described the number and proportion (%) of participants who reported making dietary changes and the type of change made. We investigated independent predictors of making a dietary change using a multivariable logistic regression model. Results A total of 38% (n = 92) of participants at the 1-year follow-up reported making at least one dietary change over the last year. There were no statistically significant independent associations between any participant characteristic and odds of making a dietary change. Of those who made at least one dietary change, the most common changes were increasing fruit and/or vegetable intake (27%, n = 25) and following a low-fat diet (25%, n = 23). Conclusion A considerable proportion of the study population reported making at least one dietary change in the year following a FCD, with the majority of changes being toward a healthier diet. Further research is warranted to investigate the reasons behind any dietary changes adopted by people with a FCD or with MS, and whether making a dietary change has benefits for the progression of demyelinating diseases, e.g., to a diagnosis of MS, as well as for general health and well-being.

Living with infection

270 Barnes has digested a voluminous scientific literature and gives an orderly, well-written and comprehensive account of the topic. For a succession of types of infectious disease, she discusses origins and sources, genetic adaptations (of both microbe and human), microbial biology, population-health impacts, clinical features and, in some cases, control policies. The 23 chapters are approximately chronological, encompassing the parasites that first travelled with post-australopithecine hunter-gatherers, the revolution in human–microbial relations ushered in by farming and the consequent rise of various human-adapted infections (malaria, schistosomiasis, trypanosomiasis, tuberculosis, leprosy). Then there’s the amplification of infectious diseases by urbanization and, in recent centuries, their spread by seafaring empires. Dramatic epidemics have occurred along the way — Europe, for example, has suffered from the bubonic plague (especially the fourteenth-century Black Death) and syphilis. In the crowded squalor of early industrialization, whole populations, and especially the urban poor, were ravaged by smallpox, cholera, tuberculosis, measles and other infectious diseases. In today’s world, influenza is going global; many new infectious diseases are emerging, including HIV/AIDS and severe acute respiratory syndrome (SARS); and surprises have arisen such as Britain’s mad cow disease and its human version, variant Creutzfeldt–Jakob disease. The word ‘disease’ in the book title is somewhat misleading. Barnes accords little space to non-infectious diseases and, even then, the brief discussions of asthma and other immune disorders, heart disease, diabetes and various cancers tend to highlight the possible contributions of infectious agents. Indeed, the writing here is less enthusiastic and engaged than it is in the author’s favoured microbial heartland. Certainly, until early last century the great bulk of (non-violent) deaths everywhere were due to infections and starvation. But today well over half the world’s deaths are due to noninfectious diseases. And there is an expanding literature on how the biological legacy of human evolution predisposes us to many of those non-infectious diseases, especially as the living conditions in today’s societies deviate ever further from the formative conditions of pre-agrarian life. Maybe there is another book to be written, to round out the story. The author invokes the discomfiting military idiom that permeates much of the writing about this topic: chapter 2 is titled ‘The war between microbes and men’. This language was adopted early in the basic public-health models of infectious disease — in which researchers estimate ‘attack rates’ and talk about targets, microbial enemies and defence mechanisms. Modern molecular biology has embellished the idiom with notions of molecular missiles, antigenic camouflage and so on. However, this ‘us against them’ perspective can distort our understanding of the evolutionary basis and ecological complexity of infectiousdisease transmission and virulence. In the rapidly changing world we live in today, we need a greater understanding if we are to lessen, proactively, the risks of new infectious diseases arising. Defensive reactivity — Living with infection