Mapping H5N1 highly pathogenic avian influenza risk in Southeast Asia.

The highly pathogenic avian influenza (HPAI) H5N1 virus that emerged in southern China in the mid-1990s has in recent years evolved into the first HPAI panzootic. In many countries where the virus was detected, the virus was successfully controlled, whereas other countries face periodic reoccurrence despite significant control efforts. A central question is to understand the factors favoring the continuing reoccurrence of the virus. The abundance of domestic ducks, in particular free-grazing ducks feeding in intensive rice cropping areas, has been identified as one such risk factor based on separate studies carried out in Thailand and Vietnam. In addition, recent extensive progress was made in the spatial prediction of rice cropping intensity obtained through satellite imagery processing. This article analyses the statistical association between the recorded HPAI H5N1 virus presence and a set of five key environmental variables comprising elevation, human population, chicken numbers, duck numbers, and rice cropping intensity for three synchronous epidemic waves in Thailand and Vietnam. A consistent pattern emerges suggesting risk to be associated with duck abundance, human population, and rice cropping intensity in contrast to a relatively low association with chicken numbers. A statistical risk model based on the second epidemic wave data in Thailand is found to maintain its predictive power when extrapolated to Vietnam, which supports its application to other countries with similar agro-ecological conditions such as Laos or Cambodia. The model's potential application to mapping HPAI H5N1 disease risk in Indonesia is discussed.

Investing in amnesia, or fantasy and forgetfulness in the World Bank's approach to healthcare reform in sub-Saharan Africa.

PIP: "Investing in Health," the World Bank's 1993 World Development Report, and a follow-up report, "Better Health in Africa," advocate investments in Third World health sectors as a means of increasing individual productivity and strengthening economic growth. Both reports maintain that structural adjustment policies have enhanced the physical health of low-income populations by improving the fiscal health of business elites. This essay critiques the World Bank's approach through a historical analysis of health care problems in sub-Saharan Africa with an emphasis on the devastating effects of colonialism, patriarchy, and imperialism. Although these documents contain many useful recommendations for Western donors (e.g., recognition of the destructive potential of alcohol and tobacco, the need for state regulation over key parts of the health sector, and the effects of gender on health status), they reflect an "investment in amnesia" regarding historical evidence on health care reform in Africa and an erroneous assumption that Western biomedicine is politically neutral. Foreign aid has tended to serve the needs of multinational corporations rather than African populations. Recommended, in place of structural adjustment policies, are measures such as a massive rebuilding of Africa's urban infrastructure, the enforcement of minimum wage laws, the preservation of ecosystems that supply traditional medicines, attention to the ecologic and health consequences of economic growth, and a feminist-led reproductive rights movement.^ieng