253
T
able 20.1
The emer
gence of highland malaria in
Africa: e
xample system v
ariables
Causal le
v
el of health
determination
Institutional
Economic
Sociocultural
En
vironmental
Conte
xtual
Public
health infrastructure,
including a number of
health-care centers in highland
areas
Economic infrastructure
High
population gro
wth and
density resulting in demographic
pressures
Climate change, ecosystem
change
Distal
Health polic
y including ef
forts
to
reduce malaria, agricultural
policies
Slo
w economic
de
v
elopment, agricultural
sector de
v
elopments
Population mo
v
ement, high
po
v
erty rates
Substantial land use/co
v
er
change,
agricultural irrig
ation,
altered local climate re
gulation
Proximal
Pre-2000: lack of (access to)
health care and control/
surv
eillance acti
vities
–
Lack of immunity to malaria in
highlands, wrong use of
antibiotics
or bed nets, drug
resistance
Changes in local climate
including temperature rise,
increase in mosquito breeding
sites
Post-2000:
increasing malaria
interv
entions and control
20 Sustainability and Health
254
change, such as agriculture,
food security, migration, and poverty (IPCC
2007
;
McMichael et al.
2012
). Hence, it is increasingly recognized that research and pol-
icy in the field of climate change and health requires a systems approach (Huynen
et al.
2013
), building on insights from sustainability science.
Q: In what world regions will vector-borne disease, like malaria, be most sensitive
to climatic changes?
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