The increasing burden of emerging infectious diseases worldwide confronts us with numerous challenges, including the imperative to design research and responses that are commensurate to understanding the complex social and ecological contexts in which infectious diseases occur. A diverse group of scientists met in Hawaii in March 2005 to discuss the linked social and ecological contexts in which infectious diseases emerge. A subset of the meeting was a group that focused on ''transdisciplinary approaches'' to integrating knowledge across and beyond academic disciplines in order to improve prevention and control of emerging infections. This article is based on the discussions of that group. Here, we outline the epidemiological legacy that has dominated infectious disease research and control up until now, and introduce the role of new, transdisciplinary and systems-based approaches to emerging infectious diseases. We describe four cases of transboundary health issues and use them to discuss the potential benefits, as well as the inherent difficulties, in understanding the social-ecological contexts in which infectious diseases occur and of using transdisciplinary approaches to deal with them.

ARTÍCULO / ARTICLE RESUMEN La epidemiología empírico-analítica asume como un pilar interpretativo la noción de "lugar" para las descripciones que construye. La epidemiología crítica supera esa noción restrictiva y propone una construcción innovadora del espacio de la salud urbana retomando los aportes de la teoría crítica del espacio y la geografía, y articulando estos avances con los de la propia epidemiología desde una perspectiva de la determinación social de la salud. Desde esta óptica se repiensa la relación urbano-rural a la luz de los procesos históricos de aceleración, drástica pérdida de sustentabilidad y profunda inequidad urbanas, así como del papel de la nueva ruralidad capitalista monopólica, en avivar el cierre del espacio de la vida en nuestras ciudades. Se busca superar el mito de la dualidad urbano rural, se cuestiona el paradigma dominante de la modernidad que impuso la comprensión de dos mundos prácticamente contrapuestos: la ciudad como rectora, cosmopolita, avanzada y pujante, y lo rural como un mundo atrasado, local, más simple, y secundario, pues en años más recientes, la distinción clásica entre lo urbano y lo rural se hace cada vez más difícil, lamentablemente con una perversa dialéctica de deterioro e influjos malsanos de uno a otro espacio.

BackgroundFocus on “social determinants of health” provides a welcome alternative to the bio-medical illness paradigm. However, the tendency to concentrate on the influence of “risk factors” related to living and working conditions of individuals, rather than to more broadly examine dynamics of the social processes that affect population health, has triggered critical reaction not only from the Global North but especially from voices the Global South where there is a long history of addressing questions of health equity. In this article, we elaborate on how focusing instead on the language of “social determination of health” has prompted us to attempt to apply a more equity-sensitive approaches to research and related policy and praxis.DiscussionIn this debate, we briefly explore the epistemological and historical roots of epidemiological approaches to health and health equity that have emerged in Latin America to consider its relevance to global discourse. In this region marked by pronounced inequity, context-sensitive concepts such as “collective health” and “critical epidemiology” have been prominent, albeit with limited acknowledgement by the Global North. We illustrate our attempts to apply a social determination approach (and the “4 S” elements of bio-Security, Sovereignty, Solidarity and Sustainability) in five projects within our research collaboration linking researchers and knowledge users in Ecuador and Canada, in diverse settings (health of healthcare workers; food systems; antibiotic resistance; vector borne disease [dengue]; and social circus with street youth).ConclusionsWe argue that the language of social determinants lends itself to research that is more reductionist and beckons the development of different skills than would be applied when adopting the language of social determination. We conclude that this language leads to more direct analysis of the systemic factors that drive, promote and reinforce disparities, while at the same time directly considering the emancipatory forces capable of countering negative health impacts. It follows that “reverse innovation” must not only recognize practical solutions being developed in low and middle income countries, but must also build on the strengths of the theoretical-methodological reasoning that has emerged in the South.

This paper is an invitation to confront the menacing forces producing our unhealthy societies and an opportunity to form fraternal partnerships on the intercultural road to a better world, where only an epidemiology of dignity and happiness will make sense.

This piece presents and analyzes a number of issues related to social medicine: the context of the emergence of social medicine; the differences between social medicine and public health; the theories, methods, and debates in social medicine; the main subjects or problems considered in social medicine; and the difficulties of disseminating the concepts of social medicine among English-speaking persons and among medical and public health professionals in general. Latin American social medicine has challenged other views by contributing to an understanding of the determinants of the health-disease-health care process and by using theories, methods, and techniques that are little known in the field of public health. Introducing Latin American social medicine, especially among English speakers, will be difficult due to the conceptual complexity of this field for persons who are accustomed to the theoretical framework of public health and medicine and also due to skepticism concerning research coming from the Third World. A multidisciplinary team is facing this challenge through two primary initiatives: 1) the creation of an Internet portal and database where there are structured abstracts in English, Portuguese, and Spanish of books, book chapters, and articles on social medicine and 2) the electronic publication of two journals on Latin American social medicine.

Maternal occupation in the cut-flower industry during pregnancy may be associated with delayed neurobehavioral development of children aged 3-23 months. Possible hazards associated with working in the flower industry during pregnancy include pesticide exposure, exhaustion, and job stress.

This book provides a groundbreaking approach to critical epidemiology for understanding the complexity of the health process and studying the social determination of health. It presents a powerful critique of Cartesian health sciences; the flaws of the “functional health determinants” model; and reductionist approaches to health statistics, qualitative research, and conventional health geography. It is a consolidated and well-sustained text that explains the role of social–gender–ethnic relations in the reproduction of health inequity, proposing a new paradigm with indispensible concepts and methodological means to develop a new understanding of health as a socially determined and distributed process. It combines the strengths of scientific traditions of the North and South to bring forward a new understanding and application of qualitative and quantitative (statistical) evidence that goes beyond the limits of conventional epidemiology—public and population health. The book presents alternative conceptions and tools for constructing deep prevention. It provides a neo-humanist conception of the role of health and life sciences that assumes critical, intercultural, and transdisciplinary thinking as a fundamental tool beyond the limiting elitist framework of positivist reasoning. It is an important source of fresh ideas and practical instruments for teaching, research, and agency, based on a renewed conception of the relation between nature, society, health, and environmental problems.

The results suggest a high prevalence of developmental delay and poor child health in this population. Child health status and the child's environment may contribute to developmental delay in this region of Ecuador, but sociodemographic factors affecting opportunities for stimulation may also play a role. Research is needed to identify what is causing high percentages of neurobehavioral developmental delay in this region of Ecuador.