ENVIRONMENT AND HEALTH IN MADAGASCAR - AN OVERALL APPROACH TO HEALTH DETERMINANTS TO SERVE STRATEGIES OF DEVELOPMENT

The enhancement of the agricultural space, the development of urbanize d areas are as many factors which are modifying the epidemiology of ma ny pathologies. These processes are particularly important in developi ng countries. Unfortunately even if the health consequences of the env ironmental changes become present preoccupation of imported large deve lopment programs, they are considered most of the time as marginal whe n these modification processes occur within ''traditional'' social gro ups. For now, the very few important development projects in Madagasca r are especially found in the coast areas. Most of the rural populatio n live poorly with real difficulties. But the health consequences of t he processes of environment management are taken into account only by the existing development projects Nevertheless the stakes to work out public health strategies are considerable. The discussion is focused o n a geographical and medical survey which was conducted during July an d August 1995 in 61 villages located in the highlands and the middle w est of Madagascar. The results obtained during that survey revealed th e main health differences in the study area. In regard to these spatia l health variations, it is now possible to begin to explore the link b etween health and environment.