Population Dynamics and Infectious Diseases in Asia, Adrian C. Sleigh, Chee Heng Leng, Brenda S.A. Yeoh, Phua Kai Hong, and Rachel Safman (editors), 2006, Singapore: World Scientific Publishing, 430 pp, ISBN: 978-981-256-833-5

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There are few topics more timely than population dynamics and infectious disease in Asia. Avian influenza, SARS, Nipah virus, Enterovirus, E. coli 0157H7, Cholera el tor, and others comprise a continuing rhythm of infections that have emerged within and from the region in recent years. The influences on these emergent infections are numerous. This volume is a compendium of papers that were first presented at a conference in Singapore in 2004. Bringing such a broad variety of topics and authors together in a single volume is tricky. As with all edited volumes, there is some unevenness of quality and thoughtfulness among the papers. Thus, the key for such work is to provide a clear framework in which to consider these diverse contributions. The editors of this volume chose “mobility of populations” to provide a framework, and through this theme the editors have succeeded in creating a useful reference text.

The editors present the general themes of urbanization, migration, and infectious disease as key concepts in the introductory chapter, but I would have appreciated a more thorough synthesis of the five subsequent framing chapters in this initial piece. These framing chapters are a rich variety of optics through which to view the ongoing emergence and transmission of infectious diseases. McMichael brings a combination of historical and ecological perspectives, and Bradley brings us landscape epidemiology: ecotones and chronotones. Sleigh looks at large water projects, and Becker and Glass discuss the role of imported infections. Finally, Hong and Lee present “Transitions in Asia: Comparative Health Policies for Emerging Infectious Diseases,” in which they provide insightful and valuable perspectives on aging, epidemiologic transition, and economic impacts in these vibrant economies.

The third section of the book, “Development and Infectious Diseases in Asia,” brings the reader into a series of case studies on infection in Thailand, China, Vietnam, and Singapore. Of particular interest is the discussion of the role of NGOs in translating experience in Thailand using the example of a Thai AIDS organization. Del Casino puts forward the argument that community outreach that realistically embraces local needs can be compromised when based upon hegemonic epidemiologic assumptions. Although initially this discussion may seem not to fit the context of the book, in fact Del Casino effectively places his discussion in a theory of circular migration, pointing out the importance of place specificity in rural approaches to coping with the challenges of mobile populations.

The studies described in Section 4, “Populations Mobility and Infectious Diseases in Asia,” may be the most compelling for scholars of the complex transmission of trans-national infection in the region. The authors in this section grapple with the key challenge of disease emergence, incidence, and transmission in the context of unprecedented movement of populations. Littleton presents the fascinating situation of Northwest Laos. In that chapter, the nexus between traditional behaviors, road construction, and the introduction of commerce are sensitively and thoughtfully outlined. The unexpected synergy between the elimination of the poppy crops and the movement of whole villages into roadside commerce demonstrates how well-intended public policy can have unintended consequences on risk of infectious diseases in the same population.

Xiushi Yang outlines important gender-related risk in internal migration for urban opportunity in Southwestern China. As China becomes increasingly mobile and the traditional registration system based on family residency declines, addressing disease risk and transmission in a floating population estimated at 150 million promises to be a daunting challenge for public health. The sociological changes in the role of women significantly complicate this challenge.

Finally, the work from the Northern Mountain region of Vietnam, penned by Tran Lam Nguyen, offers important insights into how impoverishment impacts the destinies of families affected by infectious diseases. While anecdotal, the case descriptions offered are powerful testimonials to the importance of social safety networks, especially where food supplies are fragile and highly dependent on crop yields and climate.

The SARS epidemic is the signature event that has shed light on the vulnerabilities of the public health systems in Asian countries. The profound challenges of combating this emerging disease are described in the fifth section, “Comparative Perspectives on SARS in Asia.” While much of the material has been described elsewhere, the authors in this section provide valuable new insights into the challenges in their respective countries. Of note is the excellent work by Yugao Li and colleagues on the fecal aerosols of Amoy Gardens. This elegant piece integrates both sound epidemiology and environmental assessment into a rigorous examination of a potentially important route of transmission. The implications for hospitals and other facilities are also thoroughly considered.

The final chapter, “Drawing Lessons from the Past to Respond to Future Challenges,” reviews some of the themes from earlier chapters on ecological and social influences and the core issue of mobility. The discussion focuses on the threat of Avian influenza, but unfortunately does not include the juggernaut of poultry intensification in its otherwise thorough discussion. The scope of the threat of a pandemic is described, but perhaps due to the timing of the development of the book, the very current debates about pre-vaccination and stockpiling of drugs and vaccines are not included. The question of “public” versus “private” good in the delivery of “international good” raised in Chapter 6 by Phua and Lee would have been interesting to reexamine in this context. The rapid implementation of the International Health Regulations passed by the World Health Assembly in 2005 is also not mentioned. Analysis of this major effort would have been a valuable inclusion.

On balance, I recommend this book highly. It is too diverse in content to serve as a primary text for teaching, but it is a valuable reference text. The volume will stand up well to multiple readings, although its length may discourage some. I will certainly use it as a reference text in my own teaching, and applaud the effort of the editors to bring such diverse and regionally authentic voices to the debates on the future of infectious disease control in the Asia Pacific.