GLOBAL CHANGE AND HUMAN SUSCEPTIBILITY TO DISEASE

Although the loss of good health is inherently unpredictable, human be havior at the individual and societal levels profoundly influences the incidence and evolution of disease. In this review, we define the hum an epidemiological environment and describe key biophysical, economic, sociocultural, and political factors that shape it. The potential imp act upon the epidemiological environment of biophysical aspects of glo bal change-changes in the size, mobility, and geographic distribution of the human population; land conversion; agricultural intensification ; and climate change-is then examined. Human vulnerability to disease is strongly and deleteriously influenced by many of these ongoing, int ensifying alterations. We then examine threats to human defenses again st disease, including immune suppression, loss of biodiversity and ind igenous knowledge, and the evolution of antibiotic resistance. Effecti ve responses will require greatly enhanced attention by and collaborat ion among experts in diverse academic disciplines, in the private sect or, and in government worldwide.