| Using Human Disease Outbreaks as a Guide to Multilevel Ecosystem Interventions Angus Cook, Andrew Jardine, and Philip Weinstein School of Population Health, University of Western Australia, Perth, Australia Abstract
Human health often depends on environmental variables and is generally subject to widespread and comprehensive surveillance. Compared with other available measures of ecosystem health, human disease incidence may be one of the most useful and practical bioindicators for the often elusive gauge of ecologic well-being. We argue that many subtle ecosystem disruptions are often identified only as a result of detailed epidemiologic investigations after an anomalous increase in human disease incidence detected by routine surveillance mechanisms. Incidence rates for vector-mediated diseases (e.g., arboviral illnesses) and direct zoonoses (e.g., hantaviruses) are particularly appropriate as bioindicators to identify underlying ecosystem disturbances. Outbreak data not only have the potential to act as a pivotal warning system for ecosystem disruption, but may also be used to identify interventions for the preservation of ecologic health. With this approach, appropriate ecologically based strategies for remediation can be introduced at an earlier stage than would be possible based solely on environmental monitoring, thereby reducing the level of "ecosystem distress" as well as resultant disease burden in humans. This concept is discussed using local, regional, and global examples, thereby introducing the concept of multilevel ecosystem interventions. Key words: bioindicators, disease control, disease outbreaks, ecologic management, ecosystem health, surveillance. Environ Health Perspect 112:1143-1146 (2004) . doi:10.1289/ehp.7122 available via http://dx.doi.org/ [Online 27 May 2004]
Address correspondence to A. Cook, School of Population Health, M431, University of Western Australia, 35 Stirling Highway, Crawley, 6009 Western Australia. Telephone: 61-8-6488-7804. Fax: 61-8-6488-1188. E-mail: acook@dph.uwa.edu.au The authors declare they have no competing financial interests. Received 26 March 2004 ; accepted 27 May 2004.
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