From SARS to strategic actions reframing systems.
BACKGROUND
The developed world responds to new and re-emerging diseases through the discovery of medications. Disease can be transmitted around the world in a day, but the development of medications does not occur at this rate. The world has one environment and the focus in health care must be on identifying factors in this environment that coalesce to produce disease.


OBJECTIVE
The aim of this paper is to introduce the integrative model of environmental health and explore its potential to illuminate the Toronto SARS experience.


CONCLUSIONS
SARS affected people on three continents in a matter of days. Response to this new disease varied from one area to another and was dependent upon the level of integration of health services and communication across services. The present focus of the health care system is on treating the results of disease rather than the causative factors. Reacting to a new disease had grave social and economic consequences. The time for a new global environmental approach to health is now. The Toronto SARS experience was examined using the integrative model of environmental health and the upstream perspective as exemplars to interrupt the traditional approach to disease. All health care providers share the responsibility to learn about and to understand how our environment creates disease. This knowledge comes through research on topics such as; chemicals, pesticides, soil erosion, killing of forests, contamination of water, destabilization of climate, and social disruption from wars.


CONCLUSIONS
Health care systems in the developed world continue to focus on the treatment of disease. A global ecological initiative for an integrated disease prevention system must be negotiated among nations.
Hahn School of Nursing and Health Science, University of San Diego, San Diego, California, USA. marilynm@sandiego.edu
Marilyn T
MT
Macdonald
D002170:Canada / Q000453:epidemiology; D004196:Disease Outbreaks / Q000517:prevention & control*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D009732:Nursing Care / Q000379:methods; D011314:Preventive Health Services / Q000458:organization & administration*; D045169:Severe Acute Respiratory Syndrome / Q000517:prevention & control* / Q000635:transmission