and landscapes—is such that multiple, interacting ecosystem services are stressed simultaneously. Second, the worldwide cumulative effect of these stressors promises to alter the earth system with human health consequences (e.g., climate change and movement toward the poles and high elevation for tropical diseases). Third, the features of ecosystems that are believed to be relevant to health are much broader than previously thought and are likely to affect not only infectious diseases but also the most common chronic diseases. For example, ecosystem services that are directly related to human health include food production, water supply and quality, air quality, as well as other aspects of the human-environment interface related to the ways in which human settlements are built, organized, and linked to their natural environments.

The challenge is to understand the overall impact of ecosystems on infectious and chronic diseases broadly defined, as well as the consequences of changes in ecosystems—not only on overall rates of morbidity, but also on health inequalities by place and person.

Key Questions

•  What are the relevant aspects of human health that would be important to measure?

•  What kinds of features of ecosystems are likely to be most important to human health over the next few decades?

•  What are the key outstanding questions in understanding the links between ecosystems and chronic and infectious diseases?

•  What kinds of methodologic approaches (measures, studies, and analytical approaches) are necessary to understand and predict ecosystems effects on chronic and infectious diseases?

•  Can measure be developed to capture the overall human health consequences of changes in multiple ecosystem services?

Reading

Brook RD and Brook JR. A road forward to improve public health. Circulation 2011;123:1705-1708.

Butler CD and Friel S. Time to regenerate: ecosystems and health promotion. PLoS Med 2006;3(10):e394.

Keesing F, Belden LK, Daszak P, Dobson A, Harvell D, Holt RD, Hudson P, Jolles A, Jones KE, Mitchell CE, Myers SS, Bogich T, and Ostfeld RS. Impacts of biodiversity on the emergence and transmission of infectious diseases. Nature 2010;468:647-652.



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