title: Intensified food production and correlated risks to human health in the Greater Mekong Subregion: a systematic review.
abstract: BACKGROUND
  Intensified food production, i.e. agricultural intensification and industrialized livestock operations may have adverse effects on human health and promote disease emergence via numerous mechanisms resulting in either direct impacts on humans or indirect impacts related to animal and environmental health. For example, while biodiversity is intentionally decreased in intensive food production systems, the consequential decrease in resilience in these systems may in turn bear increased health risks. However, quantifying these risks remains challenging, even if individual intensification measures are examined separately. Yet, this is an urgent task, especially in rapidly developing areas of the world with few regulations on intensification measures, such as in the Greater Mekong Subregion (GMS).
  
  
  METHODS
  We systematically searched the databases PubMed and Scopus for recent studies conducted on the association between agricultural (irrigation, fertilization, pesticide application) and livestock (feed additives, animal crowding) intensification measures and human health risks in the GMS. The search terms used were iteratively modified to maximize the number of retrieved studies with relevant quantitative data.
  
  
  RESULTS
  We found that alarmingly little research has been done in this regard, considering the level of environmental contamination with pesticides, livestock infection with antibiotic resistant pathogens and disease vector proliferation in irrigated agroecosystems reported in the retrieved studies. In addition, each of the studies identified focused on specific aspects of intensified food production and there have been no efforts to consolidate the health risks from the simultaneous exposures to the range of hazardous chemicals utilized.
  
  
  CONCLUSIONS
  While some of the studies identified already reported environmental contamination bearing considerable health risks for local people, at the current state of research the actual consolidated risk from regional intensification measures cannot be estimated. Efforts in this area of research need to be rapidly and considerably scaled up, keeping pace with the current level of regional intensification and the speed of pesticide and drug distribution to facilitate the development of agriculture related policies for regional health promotion.
authors.affiliation: Center for Mountain Ecosystem Studies, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, 650201, China. carstenhrichter@gmx.de.|Graduate University of Chinese Academy of Sciences, Beijing, 100049, China. carstenhrichter@gmx.de.
authors.forename: Carsten H
authors.initials: CH
authors.lastname: Richter
authors.affiliation: World Agroforestry Centre (ICRAF), East and Central Asia Region, Kunming, 650201, China. blcuster@gmail.com.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Custer
authors.affiliation: Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, 01536, USA. jennifer.steele@tufts.edu.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Steele
authors.affiliation: Global Health Asia, Integrative Education and Research Programme, Faculty of Public Health, Mahidol University, Bangkok, 10400, Thailand. wilcox.bruce@gmail.com.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Wilcox
authors.affiliation: World Agroforestry Centre (ICRAF), East and Central Asia Region, Kunming, 650201, China. jxu@mail.kib.ac.cn.
authors.forename: Jianchu
authors.initials: J
authors.lastname: Xu
mesh_terms: D000383:Agriculture; D001210:Asia, Southeastern; D004785:Environmental Pollutants / Q000633:toxicity*; D015386:Hazardous Substances / Q000633:toxicity*; D006801:Humans; D016272:Occupational Health; D011634:Public Health
chemical_list: D004785:Environmental Pollutants; D015386:Hazardous Substances