Public Health Capacity Building At the Andes-Amazon Region, in the Context of Changes in Land Use/Cover and Climate, Migration, Roads and Dams Building and (Re)Emerging Vector-Borne Infectious Diseases

In Amazonia, forest burning is used to convert forested areas into pastures or plantations. Climate projections point to a decrease in humidity and increase in temperature - climatic conditions that foster forest fires, closing the circle. Unprecedented regional changes due to hydroelectric dams, hydro-ways and paved roads will impact on the epidemiology of human diseases, over the next years. LUCC and the associated biodiversity-loss favour the disruption of natural cycles that impinge on vectors’ abundance. Increased migration and urbanisation will affect the spread of transmission of vector-borne diseases, by increasing the density of both people and vectors and the transit of people. The most striking changes already observed are American Cutaneous Leishmaniasis and Bartonellosis. 90% of ACL occur in 7 countries (among them Brazil and Peru), where new settlements, intrusion into primary forest, deforestation, human migration, agricultural development, and dams building increase the exposure to vectors and are leading to an increase in cases. The municipality of Assis Brasil, on the tri-national borders, present an average of 1,336 cases per 100,000 inhabitants (2001-2010): 20-fold the level of 71 cases considered of high transmission by the Brazilian Ministry of Health. Bartonellosis, spread in Peru from 4 Departments (1995) to 14 (2004), while its incidence soared from 4 to 40 cases per 100,000 inhabitants between 1997 and 2005. In 2004, 175 cases were reported in the Department of Madre de Dios, bordering the disease-free Peru-Bolivia-Brazil tri-national borders, where health professionals are not trained to diagnose or to treat the disease. This project aims at developing workshops for health-service managers and policy-makers, and short courses for undergraduate, masters and doctoral students. A better understanding of the role played by unsound regional development policies in perpetuating the above-depicted perverse circle will represent a timing response to the urgent need to advance scientifically informed decision-making.