Table 1.

Examples of distal environmental changes and diseases they may impact.

Environmental change	Description	Disease
Hospitalization	Increased people and time spent in hospitals	Tuberculosis (TB) Enteric and respiratory diseases
Urbanization	Increasing migration to and growth within towns	Dengue fever Diseases caused by fecal–oral pathogens Diseases caused by TB
Antibiotic usage	Emergence of antibiotic-resistant strains of bacterial pathogens	Multidrug resistant TB and salmonelosis Salmonella typhimurium
Water projects	Water flow changes due to dam construction and irrigation networks	Schistosomiasis Malaria
Agricultural intensification	Changing crop and animal management practices; fertilizer and biocide use; use of genetically modified organisms	Cryptosporiosis Diseases caused by E. coli
	Increased interplay between humans and domesticated animals	Influenza, severe acute respiratory syndrome (SARS), avian flu
Deforestation	Loss of forest cover, changing water flow patterns Reforestation and human encroachment along and into forested areas	Malaria Lyme disease Hemorrhagic fever AIDS
Transportation projects	Construction of roads, increasing access to remote areas	Malaria STDs
Natural perturbations	Large-scale climate and other changes such as El Niño events	Cholera and leptospirosis
Cataclysmic events	Localized landscape changes caused by earthquakes, tsunamis, large fires, and other	Water-related diseases like cholera
Climate change	Changing temperature and precipitation	Malaria, dengue fever, and schistosomiasis