Assessing changing vulnerability to dengue in northeastern Brazil using a water-associated disease index approach

Water management practices and access to safe water supplies have major implications for human health. While a range of assessments has been developed to assess water vulnerability, limited work has extended these concepts to health and wellbeing. Water-associated disease cycles are characterized by complex linkages between social and ecological determinants, thus conceptualizing vulnerability in the context of health offers a useful framework for analysis. This paper applies a water associated disease index (WADI) as a tool to deepen understanding of changing vulnerability to dengue, comparing conditions in 2000 and 2010 in Pernambuco, Northeast Brazil. Multi-dimensional data were integrated into indicators of exposure and susceptibility using the WADI approach, including water access, land cover, climate, and solid waste collection, and outputs were validated and visualized in map form. The findings illustrate heterogeneous patterns of vulnerability to dengue in the region, and highlight trends of seasonal and long-term changes. Highest vulnerability was observed in densely populated Recife and the surrounding coastal region in both time periods, with climate conditions creating seasonal trends in exposure to dengue. While more remote areas in the semi-arid Sertão showed low vulnerability overall, increases were observed in some areas between 2000 and 2010 due to land use intensification and growing population densities. These findings suggest that interventions should consider the dynamic nature of social and ecological factors that contribute to health outcomes and address current as well as future populations vulnerable to dengue transmission. This vulnerability mapping approach can be applied to other water-associated diseases impacted by global environmental change to highlight priority areas for further investigation and contribute towards improving interventions.