Integration of Human Health
and Natural Resources Management
in Southern Appalachia
- - - - -
Conference Minutes
3-4 February 1997
Table of Content

Table of Content
The U.S. Man and Biosphere (MAB) Program
Dean Bibles
Chair, US MAB

USMAB looks at the relationship between human health and natural resources, based on interdisciplinary research: social and natural scientists work together. 15 federal agencies are involved, in addition to private and public agencies, participation being purely voluntary. It has come obvious that no one can do everything all alone, and therefore USMAB is a worldwide leader in true inter-disciplinary research. By its variety, MAB really offers the perfect context for problem-solving.

MAB was really a result of the increased environmental awareness and the rising of environmental movments from the 1960s, as well as the thought at first that man was an intruder to the environment, and, later, as the sharing of scientific information occured after the cold war, the understanding that man was part of the environment.
USMAB first got involved in the relationship between human health and natural resources when they commited to provide 4,000 lbs of Pacific yew bark for Taxol research. The involvement and commitment of the employees was such that people were working on weekends, in harsh natural environments and furnished a total of 400,000 lbs of yew bark.

USMAB encourages study, research, education and biosphere reserves for the sustainibility of the human race. So far there are no treaty regulating the program or the 337 biosphere reserves created around the world, but this is not desired either. 3 research of the program are coming close to a call :
  • the tropical ecosystems division (South and Latin America)
  • the northern latitudes division (Northern part of Canada)
  • the marine and coastal division

So far actions are done at the national level but USMAB is now trying to go through political boundaries, especially with Canada and Mexico. USMAB is also strongly supporting regional approaches and is taking the actions necessary to assist the nation in goal achieving sustainibility in the early 21st century by exploring ways to open the national commitee to new players and at the same time play an active role in many actions that are taking place to address issues facing the nation and the world.
USMAB and human health fit together in the sharing of information, the prospection for medicinal plants, as well as the focusing of the research agenda, the necessity of designing research projects together.
Table of Content
National Institutes of Health Involvement in the U.S. MAB Program
Dr. Gordon Cragg
National Institutes of Health, Chief, Natural Products Branch; U.S. MAB National Committee Representative

NIH has the premier biomedical research institute. It is entirely funded through grants and contracts with a total budget of 30 billion dollars/year, a drop in the bucket compared to the total budget for healthcare of 200 trillion dollars/year. 70-80 % of the budget goes to funding grants, and only 15-25 % of the proposals submitted are actually funded. Of the 17 institutes belonging to NIH, the following are particularly interested in USMAB for the interaction between environmental changes and human health:
  • the National Institute of Allergies and Infectious Diseases
    • interest in the emerging and re-emerging of infectious diseases
    • concern with AIDS, sexually transmitted diseases, tuberculosis and drug resistant TB
    • vaccine development against asthma, allergic diseases, entheric diseases and immunologic diseases, respiratory diseases, and tropical diseases.
  • the National Cancer Institute
  • the National Institute of Child Health and Human Development
    • interest in surveys on the relationship between population density and environmental changes
  • the National Institute of Diabetes and Digestive and Kidney Diseases
    • interest in the link between nutrition and particular diseases
  • the National Institute of Environmental Health Sciences
  • the National Heart, Lung and Blood Institute
  • the National Institute of Mental Health
  • the National Institute of Aging
  • the Fogety International Center
Table of Content
The National Cancer Institute

Drug discovery and development, as well as cancer prevention and control, are 2 areas of interest for the National Cancer Institute with SAMAB. Cancer prevention and control is done through 2 programs: the Surveillance Epidemiology and End Results Reporting Program (SEER), that follows occurrence of cancers throughout cancers, tracing influencing factors, and the Prostate Lung, Colo-Rectal and Ovarian Cancer Screening Trial (PLCO), that studies the impact of screening for these various diseases.

The Developmental Therapeutics Program is based on rational drug design and synthesis, and large-scale screening, the major area for future discovery. Major emphasis is put on the discovery of new classes of active compounds. Natural through natural products, semi-synthetic products (derived from natural products), and synthetic products (modeled after natural products) represent more than 60% of the drugs. Nevertheless synthesis is not always economically viable, such as in the case of taxol. The following are examples of plant derived anti-cancer drugs:
  • Vinblastine
    Vintristine
  • Catharantus roseus

  • Etoposide
  • derivative of podophyllotoxin
  • Teniposide
  • podophyllum peltatum

  • Taxol
  • taxus species

  • OPT-11
  • derivatives of camptothecin
  • Topotecan
  • camptotheca acuminatus
Pre-clinical development takes 10 to 15 years and costs up to 300 million dollars. The components of natural product drug discovery are:
  • Collection contracts
  • Extraction lab
  • Repository
  • Screening lab
  • Chemical isolation
Plant collection is done in:
  • South-East Asia
  • Central Africa and Madagascar
  • Central and South America
Marine Organism collection is done in:
  • Indo Pacific
Microbial projects involve:
  • Fungi
  • Cyanobacteria (blue-green algae)
  • Marine anaerobes
  • Marine protozoa
A total of more than 400,000 samples are stored. The national repository has over 90,000 plant extracts, and about 20,000 marine organism extracts. The drugs are distributed to commercial companies only if an agreement is signed to give royalties to the original country, to get the country to grow the natural product, and to provide other compensation. In general 1 extract in 5-10,000 leads to a drug, and 1 in 40-50,000 to a cancer drug. Important collection data are:
  • Taxonomy
    • Family, genus, species
  • Plant part
  • Hazard oodle
  • Local name
  • Collection location and habitat
  • Medicinal use: parts used and preparation
Formulation has to provide a vehicle for administration: most drugs act like sand in water.
Pharmacology determines the route of administration, oral being the best, as well as the bioavailability, metabolism, routes and rates of excretion - what happens once injected:
  • some bound to proteins and can't get to cancer cells
  • some rapidly metabolize to inactive products
  • some go straight to the systems with no time to carry any action.
Toxicology determines the initial clinical doses, the organ toxicity, and the reversibility of toxic effects in rodents and dogs. The drug has to be determined to be non-toxic in three different animal systems, usually rodent, mice and rats.

Clinical trials are done in several phases
  • Phase I
    • Determine the maximum tolerated dose
    • assess toxicity
  • Phase II
    • Evaluate the efficacy against specific cancers
    • evaluate chronic and accumulative toxicities
  • Phase III
    • Compare efficacy of new agent with the best available drugs
    • determine the efficacy of combination of new agents and other drugs.

The bulk supply has to ensure alternative sources. Taxol for example requires the stripping of a lot of bark. The current yields are 1 g/30 lbs of bark (73% recovery) which represents 1.5 trees for each gram of taxol, each tree being 100-200 years old. A patient requirement is 500 mg/course with 4 courses necessary which means 2 g/patient. This represents, for the 12,000 patients in the U.S., 24 kg, which means 720,000 lbs of bark, equivalent to 36,000 trees. Alternative sources can be found in:
  • related species and genera
  • cultivation
  • tissue culture
  • synthesis/semi-synthesis (possible for taxol from the needles of trees)
Table of Content
  • The Research Association of Medical and Biological Organizations (RAMBO)
    New Mexico Public Health - Existing cooperation with Long-Term Ecological Research for studies on Hantavirus
    Dr. Gary Simpson
    • New Mexico Division of Public Health
    Dr. Terry Yates
    Chairman of the Department of Biology at the University of New Mexico

    The working group is made of an incredibly diverse number of organizations:
    • New Mexico Department of Health
    • Indian Health Service
    • Office of the Medical Investigator
    • Navajo Nation
    • University of New Mexico School of Medicine/University of New Mexico Hospital
    • Arizona Department of Health
    • Utah Department of Health
    • Center for Disease Control and Prevention
    • Colorado Department of Health

    In the spring of 1993 an unexplained death of a young couple was reported: they died of overwhelming respiratory failure of unclear etiology. It took from there 19 days to find out the etiology, and this entire investigation changed field sampling methods. The PCR was:
    • Hantavirus
    • Never seen before
    • Homologous sequences from different patients
    • Homologous sequences in deer mouse, the reservoir/vector rodent
    It is an extremely non-specific undifferentiated febrile illness with flu-like symptoms: fever, muscle-ache, feeling awful. The respiratory symptoms come later and arise suspicion. It takes about 36 hours for the onset of the sickness, and 12 hours then for the onset of the pulmonary death. The lab parameters are:
    • Elevated white blood cell count
    • Low platelet count
    • Atypical lymphocites
    The hantavirus was first called 'sin nombre'. It is a previously undescribed hantavirus of the family Bunyaviridas, described as the etiologic agent of 'hantavirus pulmonary syndrome' (HPS). Its mortality rate is over 50% and its primary reservoir is the deer mouse. Frozen tissue of the deer mice prior to 1993 at the Museum of Southwestern Biology tested positive for this virus.
    The deer mouse is pretty much distributed all over the U.S. and Canada. As far as trends are concerned, we witness little glitch of cases each spring and major outbreaks (5 times the number of cases of the spring) in the fall (October/November). The deer mouse population was 1 deer mouse/acre this fall, 12 in the spring, a very high density. A long term ecological research network was set up in the Sevillata site, an area where major American biomes meet: it provides a high diversity in plants and animals, including a lot of species of paramiscus.

    From this investigation was created the Research Association of Medical and Biological Organization (RAMBO). It involves:
    • University of New Mexico
      • Department of Biology
        • Museum of Southwestern Biology
        • Sevilleta LTER
      • Earth Data Analysis Center
      • Division of Governmental Research
    • New Mexico Department of Health
      • Public Health Division
      • Division of Epidemiology, Evaluation and Planning
      • Scientific Laboratory Division
      • Vital Records and Statistics Bureau
    • University of New Mexico School of Law
      • Institute of Public Law
    • New Mexico Health Policy Commission
    • Los Alamos National Laboratory
    • Sandia National Laboratory
    • New Mexico Medical Review Organization
    • Santa Fe Institute
    • National Center for Genome Research
    • U.S. Indian Health Service
      • HQ West Epidemiology Branch
    • Center for Disease Control
      • Southwest Field Activities National Center of Infectious Disease
    RAMBO is based on monthly working group meetings, a listserver (RAMBO@lanl.gov) and a webpage (acl.lanl.gov/RAMBO). RAMBO is based on connectivity, access to major databases. Its attributes are:
    • Opportunity driven (with vision)
    • Access to interorganization resources
    • Collaborative utilization of diverse databases and information resources
    • Multidisciplinary approach to complex problems
    • Specialized technical resources (communication, data access, security, patient confidentiality law,...)
    • "Process" group: group that looks at the interaction and issues in the process of the 2 demonstration project
    RAMBO initiatives, in 9 months only, have been:
    • Hantavirus and plague demonstration projects
    • Project to develop statewide infectious disease surveillance, telecommunication network
    • Facilitation of development of statewide immunization information system
    • Proposal to test telemed (distributed database clinical management system) in New Mexico primary care settings
    • Facilitation of investigation of infectious disease clusters
    • Facilitation of immunization strategy for high risk elderly (Alliance for Improved Senior Health)
    • Facilitation of Northern New Mexico telemedicine project
    • Facilitation of statewide nosocomial TB OSHA working group
    • Facilitation of statewide working group addressing issues of privacy and ownership of genetic medical information
    • Support of clinical database analyses by Parallel Data Mining Agents (PADMA)
    • Facilitation of Hispanic collaborative for research and education in science and technology initiatives
    • Facilitation of Russian-American cooperative infectious disease epidemiology project
    The RAMBO meeting of Sevillata gathered people who manage health related data and who want to act. Demonstration projects were chosen according to the following criteria:
    • Do-able within a reasonable time-frame
    • Every single organization has to contribute something
    The following 2 projects were selected:
    • Hantavirus outbreak are correlated with climate changes
    • The cyclic nature of human plague cases is predictable based on environmental data
    Cycles have been observed in the population of deer mice in Sevilleta. The virus is only present in desert shrub habitat locally extinct in other habitats. Increase in rodents started in 1991. The population of the mice is linked to El Niño, a water current caused by a water temperature difference between Tahiti and Darwin, Australia, under -1 degree. El Niño results in more moisture in the South-West, a late winter and an early spring rain and snowfall. This results in a bloom of C3 plants in Sevilleta (usually minor contributors to the ecosystem) that in turn produce large amounts of seeds. The consequence is an increase in food supply and therefore an increase in rodent population. All the reservoirs occur in one family of mammals, myradie. Each strain of the hantavirus is very host specific.
    As far as the evolution of the reservoir species is concerned, they got on the North American continent around 20 million years ago and diversified throughout North America. The expansion of grassland at the time allowed expansion of those grassland species who then adapted to other habitats. They got to South America around 7 million years ago. The hantavirus arrived in North America 20 million years ago and is predicted to happen in South America. There is a correlation between strains and hosts in an evolutionary sense. This is surprising, because a virus is expected to evolve too fast to be host specific.

    The Institute of Medicine factors in emergence of diseases are:
    • human demographics and behavior
    • technology and industry
    • economic development and land use
    • international travel and commerce
    • microbial adaptation and change
    • breakdown of public health measures
    • and more...
    This shows, in conclusion, that there is a necessity for multidisciplinary and longer term studies among the sciences of biological and human health.
    Table of Content
    Center for Disease Control Representative
    Dr. Chet Moore
    Division of Vector-Borne & Infectious Diseases, Ft. Collins, CO

    Emerging infections have gained a lot of attention from the public. The Institute of Medicine defines emerging infections as new, re-emerging or drug-resistant infection whose incidence in humans has increased within the past two decades or whose incidence threatens to increase in the near future. There are lot of active infectious diseases all over the world (hantavirus, dangi, ebola,...).

    In the South-East there is an increase in the number of Lacrosse encephalitis cases, an arthropod born virus (arbovirus) part of the California serogroup. This could be due to:
    • increased awareness in the medical community
      • specific diagnostic tests are required
    • increased exposure
      • more people living in areas where the virus is active
    The cycle of the virus is as follows:
    vertebrate host (birds) 
    /|\  |
  |  \|/
    virus 
    /|\  |
  |  \|/
    vector (mosquito) 
     |
 \|/
    dead end host

    The virus cannot bind to high enough level to become infective to the mosquitoes

    A lot of factors are influencing the life cycle of the virus:
    • Influence on the vector and the host:
      • weather and climate
      • predator and parasites
      • food resources
      • space
    • Influence on the host:
      • immune status for vertebrate hosts
    Spatial and temporal scales are different for each step of the virus cycle:
    • Virus
      • Spatial: one or few organ systems
      • Temporal: minutes to hours to reproduce
    • Vector
      • Spatial: meters to kilometers
      • Temporal: multiple generations in a single season
    • Host
      • Spatial: kilometers to continental or global
      • Temporal: years for generations
    Lacrosse in the Eastern U.S. is usually associated with wooded areas. An average of 75 cases are reported each year, with a number varying between 60 and 120 a year. Lacrosse is the mildest of the 4 major encephalitis of human importance.
    The symptoms are not very specific (headache, fever, nausea, vomiting) and death rate is under 1 percent.
    Sequeliae nevertheless have included in some cases residual neurologic damage lasting from a couple of weeks to months or longer. An increase in reporting peaked the interest of the CDC (Center for Disease Control and Prevention).

    The California serogroup project group goals are:
    • Define geographic range of Lacrosse and other California serogroup viruses in South-Eastern and Gulf Coastal states
    • Determine the public health importance of Lacrosse and other California encephalitis in these states
    • Revisit/re-evaluate selected traditional endemic Lacrosse foci (Upper Midwest)
    There was an increase in the reporting of cases in West Virginia (Nicholas County) beginning in 1987. Increase in awareness was not the only explanation for the increase in reporting. Lacrosse has mammals as vertebrate hosts as opposed to the important arbovirus. These hosts are: the eastern chipmunk, the gray squirrel, the fox squirrel, and maybe foxes too in certain areas.
    The insect vector is the treehole mosquito (aedes triseriatus). Its life cycle involves water and air stages: the egg is laid near water, the larva and pupa are in water and the adult lives in the air. It is highly specialized: it is found only in rot holes in some species trees (not oaks, not conifers,...), as well as in tires or artificial containers. The female mosquito can transmit the disease to her progeny.

    Study design:
    • Epidemiology of Lacrosse encephalitis
      • Improved case detection
      • Sero-survey and case-control study
    • Ecology of Lacrosse virus in West Virginia
      • Vector biology
        • Virus infection rate
        • Seasonal and multi-year population dynamics
        • Relation to temperature, rainfall
      • Vertebrate biology
        • Species abundance and activity patterns
        • Virus infection rates
        • Human ecology and behavior
      • GIS and remote sensing
        • Identify appropriate scale(s) of study
        • Plant cover/forest type as predictor of Lacrosse risk
        • Impact of elevation, slope and aspect on Lacrosse activity
        • Social economics and related factors from census data
        • Validation through field study results
      • Risk prediction
        • Predict selected high- and low- risk areas
        • Test predictions through field studies and epidemiology
        • Extend to neighboring states
    • Prevention and control of Lacrosse encephalitis
      • Public education
      • Source reduction
      • Chemical control
    It would take about 5 years to complete the project. So far, after one year:
    • The cases that happened have been located
    • The areas of substantial number of cases and those with no cases have been located
    Various data are available for GIS studies to find correlation on mosquito vectors, demographic data, vertebrate data, and environmental data.
    Table of Content
    State/Regional Perspective
    Dr. Paul Erwin
    State of Tennessee Department of Health, East Tennessee Regional Health Director

    There are 4 major topical areas:
    Table of Content
    Water Related Health Problems

    In Del Rio, half of the hepatitis A cases happened among people with an education level below 9th grade, and one-fourth among people below the federal poverty level.

    Epidemic:

    • Person
    4 children, 1 adult, 3 households, 1 child and 1 adult in the same household linked to the Knox County cases. No other recent travel to endemic/epidemic areas. Children not in day care. No increase in elementary school absenteism
    • Place
    The cases are spatially close
    • Time
    Children were presented with initial symptoms within one week of each other

    It was concluded that there was a common exposure (common vehicle epidemic) rather than exposure to each other or single individuals. It had to be foodborne or waterborne. Nevertheless there was no common meal. But the initial 3 households had positive fecal coliform in the water due to inadequate or unsafe waste water disposal. These households were also in close proximity to streams.

    3 new cases happened: 2 children in one family and one child in another. Both had positive fecal coliform in the drinking water. The 3 new cases were new to each other, downstream from the first 3 cases.

    19 houses close to the cases were sampled, 6 with document cases, 13 with no cases. 5/6 (83%) of the case houses had positive fecal coliform, 6/13 (46%) of the non-case houses had positive fecal coliform. The drinking wells were not safe, there was inadequate septic drain fields, and the gray water was sprayed on ground or dumped in the river.
    The stream was sampled at 14 sites, 10 samples/site over 30 days. The standard for recreation is a geometric mean of 200 fecal coliform colonies per 100 ml of water. 8 sites out of 14 (57%) were above the standard.

    In summary:

    • Clusters of cases in children in a small geographic area
    • The timing of the cases implies a common source
    • Water at household level tested positive for fecal coliform
    • Septic systems are often inadequate
    • Sampling of streams showed widespread contamination of streams in general areas where the cases were located
    As a follow-up, vaccination and legal measures for improper septic fields were taken.

    Table of Content
    Health risks via atmospheric dispersion

    The Oak Ridge health agreement studies a site which is part of the 1942 Manhattan project. In July of 1991 the State of Tennessee and the U.S. Department of Energy agreed for the State to conduct independent assessment of off-site human health risks. 5 goals were:
    • Design a dose reconstruction feasibility study
    • Complete a dose reconstruction feasibility study
    • Assemble a panel to oversee all health studies agreement activities (ORSHAP)
    • Enhance Tennessee cancer registry and develop a state birth defect registry
    • Review the U.S. Department of Energy worker health program
    OR Dose reconstruction feasibility study - technical tasks:
    • Describe historical operations and releases
    • Identify available environmental data
    • Identify complete exposure pathways
    • Identify environmental exposure pathways
    • Characterize potentially exposed populations
    • Describe hazards of important contaminants
    • Compile and index project documents
    Preliminary findings regarding X-10 and Y-12
    • X-10:
    production of radioactive barium/lanthanum (RaLa process) and release of I-131 as by-product. 
    X-10 -> air -> air inhalation
               deposition on green leafy -> vegetables
               deposition to grass       -> dairy cows -> dairy milk
    I-131 was found at 2.7 Bequerel/m3 at the nearest site of residence, 4000 m away, the dose equivalent to health risk if fatal and non-fatal cancer (thyroid especially) and severe hereditary effects. The highest risk is to women children drinking goat milk. There is a health risk of 1/1000 per year of exposure.
    • Y-12:
    lithium enrichment operation and release of mercury 
    Y-12 -> air   -> inhalation of inorganic mercury
              -> deposition to vegetables
     -> water -> livestock/game
     -> soil  -> vegetables -> ingestion
    Y-12: 11,000,000 kg of mercury used. An estimated 330,00 kg are lost to the environment. An additional 590,000 kg are not accounted for. Of the 330,000 kg lost to the environment, 15,000 kg went to the air.
    2.3x10-5 mg/m3 were found at 500 m which represents 59% of USEPA inhalation reference dose. At the surface water the dose was 2.9 times the ingestion reference dose, 1,400 times in the soil.

    We see that we can face high-tech (radiation) versus old-tech problems (hepatitis A).
    Table of Content
    Man encrochement in wildlife habitat

    Erlichiosis (lyme disease) outbreak in a golf oriented retirement community on cumberland plateau in East Tennessee in 1993.

    Ehliciosis is similar to RMSF both in its etiology and clinical impact. It is caused by ehrlichia chaffeeensis. It was first reported in 1987. There are usually 3-5 cases/100,000 people with peaks in the summer. The vector is the lone star tick (amblyomma americanum). The symptoms are severe headache, vomiting and abdominal pain. The signs are fever, low white blood cells and platelets, mild hepathitis. The diagnosis is clinical, elevated IgG and positive PCR. The treatment is achieved through doxycycline and prognosis is excellent with early treatment.
    In June of 1993, 4 men developed RMSF without rash. All lived in a golf retirement community in East-Central Tennessee. 3 were golfers and all reported recent tick bites.

    Out break investigation 

    Community A - where cases happened

    Community B - control community
    • Identification of cases
      • Retrospective
      • Prospective
    • Case-control study
    • Households sero-survey
      • 10% random survey of all households in A & B
    • Collection of ticks
      • Dragging
      • Animal collection
        • 16 white tailed deers
        • 20 other mammals

    Results of investigation

    Out of 11 cases, 10 occurred in the community A. The attack rate there was 330/100,000. Serosurveys showed 12.5% positive in the community A, and 3.3% in community B. As far as ticks are concerned, thousands of Lone Star Tick were found in community A, and only 3 in community B.

    Risks of infection

    • 4 or more tick bites
    • never using repellent
    • golfing
    • golf scores greater than 100
    The community A was made of newly constructed golf residence on the border of a wild life reserve.
    Man + new environment + appropriate vector provide the perfect conditions for a new disease.
    Table of Content
    Environmental poverty and its cohorts educational deprivation in geographical isolation

    More isolated, low education and poverty constitute the elements of locations with poor health performance.
    Table of Content
    Demonstration of the Southern Appalachian Assessment
    Dr. Cory Berish
    Environmental Protection Agency, Atlanta, GA
    Dr. Rick Dubrow
    Environmental Protection Agency, Atlanta, GA
    Dr. Karl Hermann
    Environmental Protection Agency, Denver, CO

    This presentation aimed at showing how data are collected and stored. The data usually come from all the member agencies and state participants, the private and the public sector, and the universities. Once collected, they were put on a CD, and used to put together ArcView presentations.
    Each view is called a scene. We have:
    • the atmospheric scene
    • the water quality scene
    • the population trend scene
    Dr. Berish demonstrated how the SAA contains variables such as:
    • the bear population; suitable habitat
    • the counties boundaries
    • the federal lands
    • the population density
    • the toxic release inventory sites
    • the particulates atmospheric release
    • the NPDS permits indicating the types of municipal sewage systems
    • the streams
    • the index of biological integrity, an index indicating the gravity of the impact in terms of organisms in streams
    • campground sites
    • fecal coliform levels
    • mines
    Geographical Information Systems allow:
    • to overlap layers of different data
    • to add new layers of information later
    • to put in queries such as showing the relationship between two factors (income and population for example)
    • to identify sites of interest and accessing the full record of data
    The boundaries considered on the screen can be set freely and can represent such thing as state boundaries, counties boundaries, watershed boundaries,...
    The data are mapped on a high to low scale, and a present or absent basis.
    Such a system allows, for example, to manage the black bear population as a whole instead of doing management on each unit. It would also be the perfect tool for the Del Rio case-study presented by .... It can answer specific questions one may ask such as 'Is the excess acid deposition related to childhood asthma?', and can also show the relation between level of poverty, ethnicity and water sources, and allow to make pro-active decisions.

    The effort to gather data has to continue and more people need to learn this technology. The future orientation is now to work with gap analysis groups.
    Table of Content
    Facilitated Discussion: Identify priority issues
    Patrick Bohan
    Center for Disease Control, National Center for Environmental Health

    A program based on the RAMBO model should be used for known and unknown infectious diseases. The task now is to get more practical with health specialists instead of putting the stress on the research. There is a great need for bridging the gap between environmental quality and public health. We should aim at producing material indicating the health procedures that prevent environmental problems and making sure the 'right' people get it. Public education is necessary to motivate people from other fields. It is also important to make sure that the info goes both ways and it is necessary to identify the institutions that have resources/expertise in problems and interest in solving those problems by building inventory databases.
    There is a need for cooperation between states so that one state facing or planned to be facing a certain problem may get information and advice from other states that have already faced and handled this particular problem (such as rabbies carried by raccoons that went through North Carolina and is now coming to Tennessee).
    Some problems such as straightpiping will not be solved by regulatory measures and therefore there is a need for a private groups to act locally.

    Human behaviors expose individuals to organisms or toxic contaminants but humans are also promoters of risk: they are encouraging the raccoon population, man changing the landscape results in an increase in vector population (clearcut,...). Human actions are two-sided though: clearcutting removes the habitat for birds that are vectors of EDE but also increases the number of cases of tick related diseases. The same thing is true with introduction programs. The red wolf reintroduction program shows that the problems created can be double-sided: on the one hand, red wolves may kill the red raccoons, but on the other end they may chase them to urban areas.
    Ethnoepidemiology, the study of how human behaviors expose people to diseases, should be part of the risk assessment process. If an introduction program is conducted, the ethnography/anthropology field could also help better understand how people can contribute or can be affected by the changes rather than just relying on statistics.

    Outbreaks result of a factor getting out of balance: potential predictive models should be emphasized and occuring incidences cannot be the only guideline.
    Back to
    SERAMBO    		 Back to
    the Agenda
    Questions?
    Email us!