Achieving Millennium Development Goals for health: building understanding, trust and capacity to respond

Biomedical interventions promise achievement of health-related Millennium Development Goals provided social-, capacity- and knowledge-based constraints to scaling up and reaching marginalized people at risk, are addressed, and balance between prevention and treatment is struck. We argue for a new approach: multi-stakeholder capacity building and learning for empowerment: MuSCLE. MuSCLE is used as a way to frame three systemic weaknesses in traditional health science and policy approaches: (1) a lack of engagement with people at risk to build a collective understanding of the contexts of health problems, including social drivers; (2) a lack of multi-criteria evaluation of alternative interventions; (3) a lack of attention paid to integrated capacity building. The MuSCLE framework responds in three ways: (1) participatory assessment of the ecological, socio-cultural, economic and political contexts of health, identifying priorities using risk and vulnerability science, and modeling drivers; (2) selection among intervention alternatives that makes ecological, socio-cultural, economic and political tradeoffs transparent; (3) integrated capacity building for sustainable and adaptive interventions. Literature and field lessons support the argument, and guidelines are set down. A MuSCLE approach argues for a transformation in health science and policy in order to achieve Millennium Development Goals for health. (AU)

Selecting high-priority hazardous chemicals for tri-national control: a maximum-utility method applied to Mexico.

The dispersion of persistent, bioaccumulative toxic chemicals poses risks to human health and the integrity of the ecosystem on a continental scale. Mexico, the United States, and Canada sought to add two pollutants to an existing list of four subject to North American Regional Action Plans (chlordane, DDT, mercury, PCBs). Mexican negotiators used results from an internal selection process, applying 14 criteria in five categories-physicochemical, health-endpoint, data quality/quantity, exposure potential, and control feasibility-to a baseline group of over 4,700 substances. Using policy analysis by the multiattribute maximum-utility method, progressive application of criteria and weighting algorithms acted like successive filters to identify priority lists of 15 and 7 substances/substance groups for Mexico. The 15 are: 1) benzo-a-pyrene (1 other PAHs); 2) cadmium; 3) heptachlor; 4) hexachlorobenzene; 5) lead; 6) lindane (+ other HCH isomers); 7) 2,3, 7,8-tetrachlorodibenzo-p-dioxin (&plus other PCDDs); 8) aldrin; 9) arsenic; 10) chromium; 11) carbon tetrachloride; 12) 3-3'-dichlorobenzidine; 13) dieldrin; 14) nickel; and 15) toxaphene. The first seven are the priority list of seven.

Risk screening for exposure to groundwater pollution in a wastewater irrigation district of the Mexico City region.

Untreated wastewater from the Mexico City basin has been used for decades to irrigate cropland in the Mezquital Valley, State of Hidalgo, Mexico. Excess irrigation water recharges the near-surface aquifer that is used as a domestic water supply source. We assessed the groundwater quality of three key groundwater sources of domestic water by analyzing for 24 trace metals, 67 target base/neutral/acid (BNA) organic compounds, nontarget BNA organics, 23 chlorinated pesticides, 20 polychlorinated biphenyls, and nitrate, as well as microbiological contaminants--coliforms, Vibrio cholerae, and Salmonella. Study participants answered a questionnaire that estimated ingestion and dermal exposure to groundwater; 10% of the sample reported frequent diarrhea and 9% reported persistent skin irritations. Detection of V. cholerae non-01 in surface waters at all sites suggested a potential risk (surrogate indicator present) of diarrheal disease for canal and river bathers by accidental ingestion, as well as potential Vibrio contamination of near-surface groundwater and potential cholera risk, magnified by lapses in disinfection. High total coliform levels in surface water and lower levels in groundwater at all sites indicated fecal contamination and a potential risk of gastrointestinal disease in populations exposed to inadequately disinfected groundwater. Using chemical criteria, no significant risk from ingestion or dermal contact was identified at the method detection limits at any site, except from nitrate exposure: infants and young children are at risk from methemoglobinemia at all sites. Results suggest that pathogen risk interventions are a priority, whereas nitrate risk needs further characterization to determine if formal treatment is needed. The risks exist inside and outside the irrigation district. The method was highly cost-effective.