Emerging and re-emerging infections: the societal determinants

Emerging and re-emerging infections have changed the course of human history from the beginnings of human civilization. Currently, emerging infections such as HIV-AIDS and reemerging infections such as cholera and diphtheria are plaguing our society. There is now increasing concern about future emerging and re-emerging infections - arising on their own, induced by excessive or inappropriate use of antibiotics or deliberately inflicted on society (biologic warfare). There are multiple approaches to prevention, early detection and control of these infections. At present, the major focus is on achieving better surveillance, developing more sophisticated diagnostic techniques, and creating more effective public health infrastructures. An additional approach, which may be the most effective in minimizing the frequency and severity of these society-threatening epidemics, is amelioration of critical societal determinants that provide the milieu in which emerging infections arise and flourish. Excessive population growth and global warming are the two superordinating variables, in particular because once they have supervened, it would take decades, even centuries, to effectively mitigate their consequences. Other variables include: massive urbanization; wars; poverty; malnutrition; forced migration; human behavior (particularly sexual behavior); massive irrigation projects and dam construction; extensive travel; and planetary population aging. These determinants which, for the most part, are closely inter-related, are virtually all modifiable by individual actions, by small but important changes in oar educational system, and by political actions. (C) 2000 Elsevier Science Ltd. All rights reserved.