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      An ecosystem approach to health and its applications to tropical and emerging diseases Translated title: Uma abordagem ecossistêmica à saúde e suas aplicações às doenças tropicais e emergentes


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          Disease and health outcomes occur within a complex socio-ecological context characterized by feedback loops across space and time, self-organization, holarchies, and sudden changes in organization when thresholds are reached. Disease control programs, even if they are successful, may undermine health; conversely, programs in agriculture and economic development designed to improve health may simply alter disease patterns. A research and development strategy to promote sustainable health must therefore incorporate multiple scales, multiple perspectives, and high degrees of uncertainty. The ecosystem approach developed by researchers in the Great Lakes Basin meets these criteria. This has implications for community involvement in research, development policies, and for understanding and controlling tropical and emerging diseases. Even if unsuccessful in achieving specific outcome targets, however, the requirements of this approach for open and democratic communication, negotiation, and ecological awareness make its implementation worthwhile.

          Translated abstract

          As manifestações de doença e de saúde ocorrem em contexto socioecológico complexo, caracterizado tanto por circuitos de retroalimentação, que atravessam o espaço e o tempo, quanto pela auto-organização, holarquias e mudanças bruscas ao nível da organização ao atingir-se certos limiares. Mesmo programas de controle de doenças bem sucedidos podem prejudicar a saúde; inversamente, programas agrícolas e de desenvolvimento econômico projetados para melhorar a saúde podem alterar os perfis das doenças. Assim, uma estratégia de pesquisa e desenvolvimento voltada à promoção sustentável da saúde deve incorporar múltiplas escalas e perspectivas e elevados graus de incerteza. A abordagem ecossistêmica desenvolvida por pesquisadores na Bacia dos Grandes Lagos satisfaz tais critérios, com implicações importantes para a participação comunitária em pesquisa e políticas de desenvolvimento, bem como para a compreensão e controle de doenças tropicais e emergentes. Ainda quando a abordagem ecossistêmica não obtém êxito quanto a metas específicas, exigências de comunicação aberta e democrática, negociação e consciência ecológica justificam sua implementação.

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          Most cited references 61

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          Thresholds and breakpoints in ecosystems with a multiplicity of stable states

           Robert M. May (1977)
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            Social inequalities and emerging infectious diseases.

             P S Farmer (1996)
            Although many who study emerging infections subscribe to social-production-of-disease theories, few have examined the contribution of social inequalities to disease emergence. Yet such inequalities have powerfully sculpted not only the distribution of infectious diseases, but also the course of disease in those affected. Outbreaks of Ebola, AIDS, and tuberculosis suggest that models of disease emergence need to be dynamic, systemic, and critical. Such models--which strive to incorporate change and complexity, and are global yet alive to local variation--are critical of facile claims of causality, particularly those that scant the pathogenic roles of social inequalities. Critical perspectives on emerging infections ask how large-scale social forces influence unequally positioned individuals in increasingly interconnected populations; a critical epistemology of emerging infectious diseases asks what features of disease emergence are obscured by dominant analytic frameworks. Research questions stemming from such a reexamination of disease emergence would demand close collaboration between basic scientists, clinicians, and the social scientists and epidemiologists who adopt such perspectives.
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              Human Development Report


                Author and article information

                Cadernos de Saúde Pública
                Cad. Saúde Pública
                Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz (Rio de Janeiro, RJ, Brazil )
                : 17
                : suppl
                : S07-S36
                [01] Guelph orgnameUniversity of Guelph orgdiv1Department of Population Medicine and Network for Ecosystem Sustainability and Health Canada
                S0102-311X2001000700002 S0102-311X(01)01700002

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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