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106 JOHN MCDERMOTT AND DELIA GRACE


food lead to trade losses of up to US$1.2 billion a year. Indirect costs of disease are also important. Impaired human health lowers both labor productivity and human capital accumulation (as through schooling and training), worsening livelihood outcomes in both the short run and the long run. Malnutrition itself is responsible for 3 percent of the disease burden in low-income countries (WHO 2010). Malnutrition enhances vulnerability to disease and is, in turn, exacerbated by disease symptoms—leading, for example, to a 30-fold increase in the risk for death from diarrhea (Flint et al. 2005). Diseases are influenced by socioeconomics, environments, and policies. There


are two broad scenarios that characterize poor countries. At one extreme are neglected areas that lack even the most basic services; in these “cold spots” diseases that are controlled elsewhere persist with strong links to poverty, malnutrition, and powerlessness. At the other extreme are areas of rapid intensification, where new and often unexpected disease threats emerge in response to rapidly changing practices and interactions between people, animals, and ecosystems. These areas are hot spots for the emergence of new diseases (of which 75 percent are zoonotic). They are also more vulnerable to food-borne disease, as agricultural supply chains diversify and outpace workable regulatory mechanisms.


Metrics, Partnerships, and Systems Approaches to Solving Complex Problems


Improved Metrics What cannot be measured cannot be effectively and efficiently managed. Addressing agriculture-associated disease requires assessing and prioritizing its impacts, by measuring not only the multiple burdens of disease but also the multiple costs and benefits of potential interventions—across health, agriculture, and other sec- tors. For assessing the human health burden, the DALY is the standard metric. There are established methodologies, such as cost analysis and computable general equilibrium models, to measure the cost of illness to households and to the public health sector, as well as the economic costs of livestock disease to agriculture, food industry, and other sectors such as tourism. Costs in terms of non-marketed goods and services (such as loss of ecosystem services) can be estimated through willing- ness to pay and other indirect methods. (Sporadic and potential diseases are better assessed through decision analysis.) But these assessment tools and results have rarely been integrated to yield a


comprehensive assessment of the health, economic, and environmental costs of a particular disease. When they are brought together, surprising insights can emerge regarding the true impacts of disease and who bears them, with implications for


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