Barrett et al. 1998 Introduction Emerging infectious diseases: seen as a big problem currently Emerging infections: are not a recent phenomenon but have always played a major role throughout human history 3 epidemiologic transitions Importance of anthropology for research An Overview of Epidemiological Transitions Omran’s model criticisms Implies each stage of the transition is more advanced and desirable than the previous stages Using whole nations as units of analysis: buries the differential experience according to race, gender, and class Restricted to a particular set of historical circumstances in the recent shift Epidemiological Transitions: From the Late Paleolithic Age to the Industrial Revolution Paleolithic Age Baseline Populations were too small and dispersed to support communicable pathogens Pinworm Ectoparasites Enteric pathogens Rate of emergence of diseases: may have increased as tool use allowed exploitation of novel ecological niches and as migration increased The First Epidemiologic Transition Sedentism: led to larger groups + more interaction between people Increase in infectious disease mortality Accumulation of human waste Appearance of domesticated animals: provided a reservoir for zoonoses Agricultural practices Nutrient deficiencies Groups that most suffered: women, children, lower classes Increased severity of diseases Crowding in urban centers Epidemic outbreaks Increasing migration + trade: transmission of diseases Exploration + conquest: infections of Native Americans leading to pandemics The Second Epidemiologic Transition Industrial Revolution Decline in infectious disease mortality within developed countries Landmark for modernization Nutritional factors Extension of life expectancy: increased morbidity from chronic diseases Increasing of water + air pollution Differences in mortality based on social inequalities Improvements in child survival and life expectancy at birth in less developed nationsImmunizations + antibiotics The Third Epidemiologic Transition Emerging infectious diseases New diseases: contribute to adult mortality Increased incidence and prevalence of pre-existing infectious diseases that were thought to be under control Generation of antimicrobial-resistant strains at a faster rate than safe new drugs is developed Recently Emerging Infections 29 newly emerged pathogens since 1973 May be due to increases in detection rates Examples: HIV, Ebola, Marburg, Lyme disease, dengue fever, malaria, tuberculosis Earlier transmission of HIV to urban Haiti: by more affluent Westerns engaging in sex tourism These new outbreaks are linked to climatic fluctuations and ecological disruptions Re-emerging infections causes: warmer climates, climatic fluctuations, poorly developed urban environments, increase in mosquito populations, decreases public health expenditures, poverty, Inevitability of genetic adaptations of microorganisms to the selective conditions posed by human technology and behaviors Host susceptibility and comorbidity Overuse of antibiotics in industrial animal: causes the rise of multi-drug resistant strains of food-borne pathogens Human populations are converging into a single global disease ecology