Sustainable Control of Water-Related Infectious Diseases: A Review and Proposal for Interdisciplinary Health-Based Systems Research

Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan 48109, USA.
Environmental Health Perspectives (Impact Factor: 7.98). 08/2009; 117(7):1023-32. DOI: 10.1289/ehp.0800423
Source: PubMed


Even when initially successful, many interventions aimed at reducing the toll of water-related infectious disease have not been sustainable over longer periods of time. Here we review historical practices in water-related infectious disease research and propose an interdisciplinary public health oriented systems approach to research and intervention design.
On the basis of the literature and the authors' experiences, we summarize contributions from key disciplines and identify common problems and trends. Practices in developing countries, where the disease burden is the most severe, are emphasized.
We define waterborne and water-associated vectorborne diseases and identify disciplinary themes and conceptual needs by drawing from ecologic, anthropologic, engineering, political/economic, and public health fields. A case study examines one of the classes of water-related infectious disease.
The limited success in designing sustainable interventions is attributable to factors that include the complexity and interactions among the social, ecologic, engineering, political/economic, and public health domains; incomplete data; a lack of relevant indicators; and most important, an inadequate understanding of the proximal and distal factors that cause water-related infectious disease. Fundamental change is needed for research on water-related infectious diseases, and we advocate a systems approach framework using an ongoing evidence-based health outcomes focus with an extended time horizon. The examples and case study in the review show many opportunities for interdisciplinary collaborations, data fusion techniques, and other advances.
The proposed framework will facilitate research by addressing the complexity and divergent scales of problems and by engaging scientists in the disciplines needed to tackle these difficult problems. Such research can enhance the prevention and control of water-related infectious diseases in a manner that is sustainable and focused on public health outcomes.

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    • "We evaluate our process as successful using a variety of metrics recently developed for ID research. This success supports the findings of prior research into successful ID scientific teamwork (Batie 2008; Batterman et al. 2009; Falkenmark and Rockström 2004; Freeman 2000; Jury and Vaux 2005; Lach et al. 2005; Nowak et al. 2006). Our team demonstrated a unique approach to facilitating international ID team success through specific leadership techniques, intensive workshops, and group exercises. "
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    ABSTRACT: Bringing together and successfully managing a highly interdisciplinary (ID) research team of socioeconomic, biophysical, and engineering scientists is highly challenging, particularly when that team includes 20 scientists and students across six countries. This paper reports on the results of evaluating the success of such a team as it studies the socioecological impacts of bioenergy development across the Americas. We find that the team has succeeded according to several different metrics. We demonstrate that the literature on accelerated sustainability transitions and small group team creation, development, and management holds valuable lessons for the success of ID teams.
    Full-text · Article · Oct 2015
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    • "Risk models are advantageous because they can inform early warning systems which attempt to predict outbreaks, but generally focus on a limited range of variables [28]. Researchers have argued for an expanded transdisciplinary approach to combat water-associated disease, as a large number of factors such as climate patterns, land use and socioeconomic determinants are often examined separately and with limited successes [10], [29]–[31]. For instance, using only the Aedes mosquito index based on larval surveys has been ineffective in predicting dengue incidence in many regions including Malaysia, Taiwan and Trinidad [24], [32], [33]. "
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    ABSTRACT: The Water-associated Disease Index (WADI) was developed to identify and visualize vulnerability to different water-associated diseases by integrating a range of social and biophysical determinants in map format. In this study vulnerability is used to encompass conditions of exposure, susceptibility, and differential coping capacity to a water-associated health hazard. By assessing these conditions, the tool is designed to provide stakeholders with an integrated and long-term understanding of subnational vulnerabilities to water-associated disease and contribute to intervention strategies to reduce the burden of illness. The objective of this paper is to describe and validate the WADI tool by applying it to dengue. A systemic ecohealth framework that considers links between people, the environment and health was applied to identify secondary datasets, populating the index with components including climate conditions, land cover, education status and water use practices. Data were aggregated to create composite indicators of exposure and of susceptibility in a Geographic Information System (GIS). These indicators were weighted by their contribution to dengue vulnerability, and the output consisted of an overall index visualized in map format. The WADI was validated in this Malaysia case study, demonstrating a significant association with dengue rates at a sub-national level, and illustrating a range of factors that drive vulnerability to the disease within the country. The index output indicated high vulnerability to dengue in urban areas, especially in the capital Kuala Lumpur and surrounding region. However, in other regions, vulnerability to dengue varied throughout the year due to the influence of seasonal climate conditions, such as monsoon patterns. The WADI tool complements early warning models for water-associated disease by providing upstream information for planning prevention and control approaches, which increasingly require a comprehensive and geographically broad understanding of vulnerability for implementation.
    Full-text · Article · May 2013 · PLoS ONE
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    • "Isolating excreta to a consolidated area is a positive step but is minimally effective in lowering water-related disease rates (Bolaane & Ikgopoleng, 2011). Batterman et al. (2009) notes that isolated pit latrines in Africa, which technically indicate " access to sanitation, " often serve over 200 people and frequently overflow during rainy season. Integrated sanitation infrastructure is the most promising hope for sustainable waste management. "

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