Advances and retreats in tuberculosis in the last 30 years by ProQuest

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threats to wildlife than vice versa. In much of the world,                  8   Peres CA. Effects of subsistence hunting on vertebrate community
reducing disease in domestic animals would improve human                        structure in Amazonian forests. In: Robinson JG, Bennett, EL (eds),
                                                                                Hunting for sustainability in tropical forests. New York: Columbia
health and livelihoods, as well as to help protect wild animals
                                                                                University Press, 2000:168–98.
from livestock and other domestic animal diseases. Conversely,
our work in Central Africa with Ebola hemorrhagic fever in
gorillas and chimpanzees has shown that networks of local vil-
lagers and hunters, park managers and staff, government public
health officials, and regional laboratories can detect outbreaks
of Ebola in great apes and notify local communities of the risks.
                                                                            Advances and retreats in tuberculosis
We believe that due to these efforts in northen Republic of                 in the last 30 years
Congo, for the first time, outbreaks in animals have not resulted
in the spread of the disease to humans. This broader, one health            Paul Nunn, Coodinator, Stop TB Department, World Health
approach is much more effective and inexpensive than the tra-               Organization, Geneva, Switzerland
ditional ‘quarantine and stamping out’ efforts after an outbreak            Email: nunnp@who.int
has already begun. A set of guiding concepts on these themes,
called the Manhattan Principles, was developed by human and                 In the UK, the incidence rate of tuberculosis (TB) has changed
animal health specialists in conjunction with wildlife conserva-            little, from 19 per 100,000 population in 1980 to 13 by 2006.
tion professionals and is available at www.oneworldone-                     During the same period, however, the UK dropped from 12th to
health.org.                                                                 23rd in the league table of the 53 states in the European region
   Another large-scale example of a worldwide private–public                of the World Health Organization (WHO) – that is, 22 countries
collaborative effort is the Global Avian Influenza Network for              in Europe had a lower incidence by 2006.1 For the most part,
Surveillance of wild birds (GAINS), based on the premise that               these are small states in Western Europe with limited migration,
wild birds around the world can serve as sentinels for the early            eg Iceland, Luxembourg, Malta, the Nordic states and Slovenia,
detection of the virus’ presence to warn public health and                  where improving social conditions, as well as public health mea-
agricultural health professionals. Interest in the GAINS pro-               sures, have reduced the incidence. In the UK, there has been a
gramme continues to grow and working relationships with                     major shift from the bulk of cases arising in native-born people
local institutions are being built in over 34 developing coun-              to most cases being in the foreign born, especially in those from
tries (www.GAINS.org).                                                      the Indian subcontinent. In the former Soviet countries of
   Human and animal health practitioners need to understand                 Eastern Europe, eg Ukraine and Belarus, incidence has remained
that it is indeed our responsibility to become a part of a collabo-         high, but is lower than in the Caucasus, eg Georgia, Armenia
rative solution. We need to explain to our clients and our patients         and Azerbaijan, and in Central Asia, eg Kazakhstan (which,
that our health and the health of all living things in our environ-         for historical reasons, is classified as in the European region).
ment cannot be separated. We must engage the public in discus-              The underlying causes here include enduring poverty, economic
sion about our health rather than just telling them what to do.             crises, especially around the breakup of the former Soviet
Global health will not be achieved without a philosophical shift            Union, antiquated approaches to TB control, and inflexible
from the ‘expert dictates’ paradigm inherent to both science and            health systems. Overall, however, incidence in Eastern Europe is
medicine, to a broader, multi-stakeholder approach, based on the            now falling slowly.
understanding that there is only one world and one health.                     Meanwhile, rates in South East Asia have stayed almost con-
                                                                            stant, at around 180/100,000, but with a doubling of the popu
								
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