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AGRICULTURE-ASSOCIATED DISEASES 107


BOX 2 Brucellosis Control in Mongolia


In Mongolia, a cost-benefit analysis of brucellosis control, examining both medical and veterinary impacts, found that the public health sector reaps only about 10 percent of the benefits (Roth et al. 2003). Brucellosis control would thus appear less attractive than other disease control expenditure options, in an analysis based solely on DALYs averted. But when the benefits for the livestock sector were included, and the costs shared proportionally between the public health and the agricultural sector, the control of brucellosis actually offered a net gain for both sectors.


appropriate policy responses. An example comes from Mongolia, where brucellosis control was shown to be cost-effective from an integrated perspective (see Box 2). Improved metrics for estimating the full costs of disease would open new


approaches for the control of agriculture-associated diseases in developing coun- tries. But even with better assessment tools, there remains the challenge of using the results to inform policy decisions. Decisionmakers require more than metrics: they need clear evidence on control options and the expected health and economic returns, and they need to consider the sociopolitical factors that affect the feasibil- ity, sustainability, and acceptability of implementation. In the case of brucellosis, these assessments were relatively straightforward. For other agriculture-associated diseases, however, there are high levels of uncertainty regarding epidemiology, impacts, and control options. (This is true especially for emerging diseases and diseases sensitive to new drivers, such as climate change and evolving agroeco- systems and food chains.) Other diseases have persisted despite medical interven- tions—especially the neglected tropical zoonoses—indicating a need to tackle the underlying determinants of disease, such as poverty, inequity, lack of information, and powerlessness.


Stronger Partnerships Compiling convincing evidence is only the first step in shaping policy. Strong partnerships and high trust will be needed among researchers, stakeholders, and policymakers. Policy discussions must go beyond specific control measures to examine the incentives that underpin behavior and behavior change.


Systems Approaches The complexities of agriculture-associated diseases call for more integrated and comprehensive approaches to analyze and address them, as envisioned in One


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