Wetlands Ecol Manage (2012) 20:165–171
DOI 10.1007/s11273-012-9264-4
ORIGINAL PAPER
Wetlands and human health: an overview
P. E. R. Dale • R. Connelly
Received: 28 May 2012 / Accepted: 29 May 2012 / Published online: 17 June 2012
 Springer Science+Business Media B.V. 2012
Abstract This paper provides an introduction to the
Wetlands and Human Health special issue and an
overview of the papers. It identifies the disjunct that
can exist between managing wetland health and
human health. There is a need to resolve the potential
conflict between managing wetlands for their values
and managing them for positive human health out-
comes. All authors have used the Ramsar definition of
wetlands and the World Health Organization defini-
tion of human health. The papers (several are reviews)
cover a range of wetlands and diseases from mosquito-
borne to snail or pathogen vectors. Mosquito man-
agement is a common theme, illustrating, for the
eastern USA, that wetland damage from the early to
mid twentieth century can be ameliorated by careful
restoration and, for Australia, that damage may be
avoided. Constructed wetlands provide an opportunity
to create ecosystem services and wetland value such
that careful design and operation can minimise
mosquito risks. Although the papers focus on negative
health impacts of wetlands they deal with these to
P. E. R. Dale (&)
Environmental Futures Centre, Griffith School of
Environment, Griffith University, Nathan,
Brisbane 4111, Australia
e-mail: p.dale@griffith.edu.au
R. Connelly
Florida Medical Entomology Laboratory, Institute of
Food and Agricultural Sciences, University of Florida,
200 9th Street SE, Vero Beach, FL 32962, USA
minimise health risks while restoring or maintaining
wetland function or by exploring knowledge needs
that would facilitate wise management.
Keywords Disease
Schistosomiasis
Cholera

West Nile virus
Ross River virus
Mosquito

Constructed wetlands
Management
Salt marsh

Mangrove
Background
Management of wetlands to minimise human health
risk is fraught with potential conflicts. This was not
always the case. Until at least the mid-twentieth
century, wetlands were generally perceived as prob-
lem areas (Boyer and Polasky 2004), as swamps
suitable mainly for draining and filling for develop-
ment or mosquito control. This view still persists in
some areas. According to Horwitz and Finlayson
(2011) there is ‘‘a persistent negative view of wetland
ecosystems…held by the public in general and the
public-health profession in particular’’ (p. 2). This
belief is held despite research demonstrating that
wetlands provide both direct and indirect benefits for
people. These benefits and positive wetland values are
frequently referred to in the literature, often in terms of
the ecosystem services they provide (e.g., Barbier
1992; Ramachandra et al. 2005; Thiere et al. 2009).
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In terms of human health, wetlands have both
positive and negative impacts. This was the theme of a
Ramsar meeting in 2008 (Bridgewater 2008) and has
recently been stressed by Horwitz and Finlayson (2011).
Wetlands contribute to mental and social well-
being, which are positive aspects of health. Whitehead
and Rose (2009) recently estimated the environmental
benefits of a range of natural processes including
wetland contributions to recreation, an aspect of well-
being. There are mental health benefits of experienc-
ing the natural environment and its therapeutic value,
including ‘ecotherapy’, exemplified by the recent
paper by Stevens (2010). Abraham et al. (2010)
reviewed over 120 studies related to well-being and
outdoor environments and the health promoting
impact of landscape. While these are not necessarily
focussed on wetlands, they have application to these
systems. Social well-being includes human well-being
generally, as recently noted by Horwitz and Finlayson
(2011) who provided a balanced overview and model
for managing wetlands to conserve ecosystem services
and thus protecting human health.
The physical health dimension perceived with
wetlands may be a negative one, with a range of
disease risks. Of the disease vectors, mosquito-borne
disease is the most often reported in the literature
and was reviewed in Dale and Knight (2008).
Negative health impacts may also be associated with
constructed wetlands or wetlands polluted by patho-
gens, heavy metals or pesticides which pose a health
risk particularly when human populations and their
activities encroach on the habitats. Thus Graczyk et al.
(2009) found human enteropathogens (Cryptosporidi-
um spp.) associated with constructed wetlands in
Ireland; Sekomo et al. (2011) recently found concen-
trations of a variety of heavy metals in natural
wetlands receiving wastewater in Rwanda which
posed a health hazard for local people. Parasites may
be found in natural wetlands, especially in those that
are degraded (Shapiro et al. 2010).
It is important then to manage the negative risks
associated with wetlands in order to conserve wetland
values as well as retaining the value for human well-
being referred to above. This is of increasing urgency
with climate and sea level changes. It can be inferred
that, in a warming world, many wetland related
diseases are likely to expand their range (Hughes
and McMichael 2011) and the disease transmission
cycle may be accelerated (with the possible exception
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Wetlands Ecol Manage (2012) 20:165–171
of diseases where very high temperatures may inhibit
survival of the pathogen). Sea level change will
directly affect the intertidal habitats of disease vectors,
thereby also affecting human health risks (Millenium
Ecosystem Assessment 2005).
This Special Issue aims to bring together papers that
address both human health and wetland management
issues from a range of perspectives. Authors used the
Ramsar article 1.1 definition of wetlands (1971), and
the World Health Organization definition of health,
which is one that has not changed since its inception in
1948 (WHO 2012).
Wetlands are thus defined as ‘‘areas of marsh, fen,
peatland or water, whether natural or artificial,
permanent or temporary, with water that is static or
flowing, fresh, brackish or salt, including areas of
marine water the depth of which at low tide does not
exceed 6 m’’ (Ramsar Secretariat 2012).
‘‘Health is a state of complete physical, mental, and
social well-being, and not merely the absence of
disease or infirmity’’ (WHO 2012).
Bringing health and environment generally
together Stevens (2010, p. 268) notes ‘‘Well-being
requires a healthy environment, local and global, to
‘be well’ in.’’ This is the general area addressed in the
papers in this issue. They can be grouped into three
categories: managing constructed wetlands, manipu-
lated wetlands and specific diseases (Table 1). The
following sections provide an overview of the papers,
followed by a synthesis.
Overview of the papers in this issue
Constructed wetlands
Constructed wetlands comply with the Ramsar defi-
nition of a wetland and can perform a dual benefit by
creating wetland value while also treating effluent.
However, constructed wetlands can provide prime
habitat for various mosquito species resulting in the
potential to create a human health risk. Walton has
reviewed the international research literature on
constructed wetlands and risk of mosquito production.
He explores a range of water management issues and
suggests design characteristics and operational pro-
cesses that should satisfy both the water purification
objectives as well as minimising mosquito-borne
disease risk.
Wetlands Ecol Manage (2012) 20:165–171 167

Table 1 Overview table showing wetland type, location, health issue, purpose and scale
Paper Wetland type Area Human health Purpose Scale

Constructed wetlands
Walton Constructed USA Mosquito vectors of To review literature and management to Global review
(Review) for water disease minimise pollutants and mosquitoes with a local
quality Californian
management example
Manipulated wetlands and environment
Rey et al. Coastal salt Florida, USA Mosquito-borne To manage the wetlands sustainably. Regional:
marsh and disease (especially Identified inter alia spoil heap issues Indian River
mangroves West Nile virus) from the early grid ditching projects Lagoon
and nuisance Stresses health and well-being, even if
no disease
Taylor Coastal salt Florida, USA Mosquito-borne To restore wetlands by purchase and Local: Indian
marsh and disease and removal of spoil heaps River Lagoon
mangroves nuisance (1 site)
Rochlin Coastal salt NE USA Mosquito-borne To restore grid- ditched marsh consistent Regional
et al. marsh disease (West Nile with minimal mosquito production
virus) and nuisance
Dale and Coastal salt Queensland Mosquito-borne To balance wetland values and health National
Knight marsh and and New disease (Ross River issues with case study examples responsibility
mangroves South virus) and local
Wales, examples
Australia
Griffin and Mangroves New South Mosquito-borne To integrate knowledge about fish and Local
Knight Wales, disease (Ross River mosquitoes, their relationships within
(Review) Australia and Barmah Forest mangrove systems and the potential for
viruses) biological control
Wetland disease focus
Appleton Streams, Southern Schistosomiasis To review the ecology of Schistosomiasis Regional
and rivers, Africa transmission in different wetlands in
Madsen pools, lakes, southern Africa
(Review) dams
Neogi et al. Estuary, Bangladesh Cholera To assess relationships between Vibrio Local
(Review mangroves cholerae and environmental parameters
and case in a tropical estuarine system
study)

Manipulated wetlands and environment
Rey et al. provide a balanced review of intertidal
wetland management for mosquito control in Florida,
USA. The review includes the history of mosquito
control, which aimed at reducing nuisance, improving
health and well-being (as well as disease), thereby
facilitating settlement and development of the state.
Mosquito control in the early days (from the 1920s)
involved ditching, dredging and filling and impound-
ing. All were highly destructive of wetland values. As
environmental concerns grew in the 1980s mosquito
control focussed efforts on restoring marsh function
while minimising mosquito problems. Those more
recent advances were underpinned by state and
mosquito control district collaborations, and have,
since around the 1980s, taken an approach that aims to
restore environmental values in the intertidal man-
groves and salt marshes. Rey et al. demonstrate a long-
term collaboration between agencies at all levels of
government that has facilitated what might be reason-
ably referred to as ‘wise management’.
The paper by Taylor discusses at a more local level
aspects of the management of the Indian River Lagoon
referred to in the regional level paper by Rey et al.
Highlights include the restoration of dredge and fill
sites and subsequent selling of the dredge material,
which would otherwise be a waste product, to fund the

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projects. The restoration was achieved by restoring the
tidal system (restoring the marsh elevation so as to
restore tidal flushing) and, in the 7 years after
construction, intertidal vegetation has colonised the
new surfaces. Taylor notes that the original surface is
below the current one and this could mean either a
change in sea level or subsidence (or compaction) of
the sediment.
Rochlin et al. review the literature on marsh
management for mosquito control and then report a
project that combined marsh restoration with mos-
quito management. They note that the implementation
and relatively long term monitoring (in their case
5 years post-modification) of such projects is not
common, largely being resource limited. The project
has been successful as it involved interagency collab-
oration from an early stage, thereby facilitating
approvals, and it made use of existing resources,
thereby minimising costs.
Wise management can be achieved, balancing both
wetland and human health issues. The paper by Dale
and Knight shows how the Ramsar principles of wise
management can be achieved when wetland and
disease management are planned and implemented
concurrently with inputs from both scientists and local
managers. It takes as a starting point the Ramsar
Convention joined in 1975 by Australia (post-dating
the earlier period of wetland damage and destruction
by mosquito control in eastern USA). They over-
viewed the relationship between environment and
health focussed legislation in the state of Queensland
and the potential conflicts that might arise from strict
compliance with the health requirements. This needs
an ideal balance between a wide range of stakeholder
interests (mosquito control agencies, government
agencies, researchers) in an interdisciplinary frame-
work. To put the discussion in a practical framework,
two examples are presented showing how wise
management and capacity building were achieved in
a salt marsh and later extended to a mangrove
modification (source reduction) project.
To successfully modify or otherwise manage an
ecosystem for mosquito control a sound knowledge
base of the system is essential. Griffin and Knight,
focussing on mangroves, review an essential compo-
nent of an integrated program: the fish-mangrove-
mosquito interaction. In a well-structured paper they
show that much of what is known in the area tends to
be in the mangrove fringes and that little attention has
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been paid to interactions within the mangroves.
However, recent research has identified complex basin
structures within mangrove systems and this is a field
of research with relevance to addressing the gaps
identified by Griffin and Knight. The evidence for fish
predation on mosquitoes shows potential for this to be
an effective part of an integrated wetland program, but
it depends on understanding within mangrove fish-
mangrove-mosquito relationships. Dale and Knight
(this issue, referred to above) provide a practical
example of a pilot project that uses detailed knowledge
of a mangrove system to plan and implement a small
modification project designed to increase fish access to
a mosquito habitat in a back basin. There are
implications for management’s adaptation to climate
and sea level fluctuations resulting in changes to
mangrove distribution that might be expected to have
flow-on effects to the fish-mangrove-mosquito system.
Wetland related diseases
There are two papers that focus mainly on diseases, one
on schistosomiasis, which is transmitted to humans by
snails in wetlands, and the other on cholera, a
waterborne pathogen. Reviewing schistosomiasis (also
known as Bilharzia) a serious disease in southern
Africa, Appleton and Madsen refer to a wide range of
freshwater wetlands, both natural (streams, pools) and
man-made (dams of various sizes, irrigation canals).
Human behaviour which results in contact between
humans (particularly children) and water is a risk factor
for schistosomiasis, but such contact is part of the way
of life in the affected areas and so is difficult to manage.
Management, e.g., for food production, can exacerbate
the problem. For example, irrigation projects and dam
construction are management actions, both of which
can lead to the disease proliferating in areas previously
with low incidence. Wetland restoration or construc-
tion may also result in conditions favourable for
schistosomiasis to become endemic, thereby high-
lighting the conflict between conserving positive
wetland values and managing negative ones (from a
human health perspective).
Neogi et al. review the ecology of cholera in the
Karnaphuli mangrove estuary in Bangladesh. The
pathogen (Vibrio cholerae) is favoured by relatively
high temperatures and high pHs and thus mangroves
are suited to its survival. There are associations with
some vegetation [e.g., duckweed (Lemna minor) and
Wetlands Ecol Manage (2012) 20:165–171
water hyacinth (Eichhornia crussipes)], both of which
are not uncommon in wetlands and so vegetation
management may be an option to reduce human health
risks. Another factor is that the pathogen has potential
to multiply when bottom sediments are disturbed,
resulting in increased suspended particles and associ-
ated chitins. Although not specifically mentioned,
dredging operations related to development would
pose a human risk factor as well as affecting wetland
processes. From the perspective of climate and sea
level changes, increases in mangroves and tempera-
ture may extend the habitats favourable to the cholera
pathogen.
Synthesis
Wetland related diseases whose management is
discussed in the papers in this issue include a
preponderance of mosquito-borne viruses, mainly
from USA and Australia. This reflects a general
abundance of research on these arboviruses reported in
the literature (Dale and Knight 2008). They all have
the dual aim of managing disease and nuisance while
also maintaining or restoring wetland function and this
is consistent with the increasing adoption of a wise
management approach to wetlands. However there are
other relevant diseases such as schistosomiasis and
cholera which provide a somewhat extended range
with examples in Africa and Bangladesh (Appleton
and Madsen; Neogi et al.). In those cases environ-
mental management has less focus and managing
human behaviour may be a more effective approach.
Reducing human-water contact, especially at times
when the organism or pathogen is prevalent, or
modifying behaviour in the water (e.g., reducing urine
inputs from children swimming) has the potential to
lower the risk of such diseases.
How wetland management for mosquito control has
developed is noted in several papers. The impetus was
to make otherwise mosquito infested areas habitable
(such as Florida USA). In the early twentieth century
in USA the obvious approach was to destroy the
mosquito habitats (and at the same time create areas
suitable for development). Thus wetlands in the USA,
especially coastal ones, were seriously damaged or
destroyed by grid-ditching and impounding. Wetland
loss was specifically mentioned by several authors,
related to the ‘reclamation’ of wetlands for
169
‘development’ or destruction for mosquito control.
Taylor noted a loss of up to 90 % of wetlands in the
Indian River Lagoon (east coast Florida and part of it
now designated by Ramsar) and Rey et al. provided
information on the historical damage to wetlands by
mosquito control. Rochlin et al. referred to the loss of
wetlands as high as 50 % in some states. They
focussed on superimposing management of intertidal
wetlands on previously damaged or destroyed
marshes. This has not been the case in the Australian
examples, as mosquito management (although initi-
ated in 1959 in Queensland on the Gold Coast to
provide amenity and encourage settlement), was not
seriously undertaken until the 1980s (Dale et al. 2008)
and, by then, environmental concerns, as noted in Dale
and Knight, ensured that grid-ditching was not con-
sidered as an option.
A somewhat controversial aspect of mosquito
control is the use of pesticides. This relates not only
to developing vector resistance but also to cost, public
health and environmental concerns. Reducing pesti-
cide use has positive benefits for the environment and
people, if mosquito production can be effectively
limited by other means (Dale and Knight; Griffin and
Knight; Rey et al.; Rochlin et al.). One way to reduce
pesticides is to rely on other methods, including the
role of biological agents. Rey et al., Rochlin et al. and
Walton and Taylor, refer to the role of fish, relevant as
predators, as well as indicators of wetland condition.
This is the main focus of the paper by Griffin and
Knight. In contrast, Appleton and Madsen note the
possibility of pesticide pollution reducing the snail
population that acts as an intermediate host in
schistosomiasis transmission, thereby reducing the
human health risk from that disease, but perhaps
increasing other health risks.
Mosquito management requires significant
resources. Although pesticide applications may be
less costly in the short-term, modifying the environ-
ment can provide more cost effective long-term
mosquito control (Dale and Knight). Resources are
usually limited and this is an important issue in areas
where intervention in wetland ecology is a manage-
ment objective, as can be the case with mosquito
control, and which cannot easily be resourced from the
mosquito control agency alone. Several papers refer to
this. In the research by Rochlin et al. existing resources
using several stakeholders were deployed for the
construction activities; in restoring marsh function
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Rey et al. noted the role of Mosquito Control Districts
and government bodies; Taylor reported a novel
approach, not available in all cases, whereby
unwanted dredge material was sold to finance oper-
ations. Underpinning these resource issues is the need
for collaboration and sharing as noted by Dale and
Knight, Rochlin et al. Rey et al. and, to a more limited
extent, by Taylor.
Climate and/or sea level changes and their effects
were noted or could be inferred from most authors.
With direct reference to climate or sea level change
Dale and Knight referred to the need to balance
wetland and human health in a changing environment;
Rochlin et al. in the context of wetland restoration,
noted that accelerated sea level rise and climate
change creates challenges for managers. Two issues
related to sea level change emerge from the paper by
Taylor: one is sea level affecting sediment in marshes
that would affect restoration success; the second is
mangrove encroachment into salt marshes, potentially
increasing the area of mosquito producing systems and
hence the need for control. The effects of climate
change may be inferred from information in papers
whose systems are specifically tropical (as these may
expand under global warming scenarios). These
include Neogi et al. (tropical climate and cholera),
Walton (referring to constructed wetlands in sub
tropical and tropical systems) and Appleton and
Madsen (increased temperature may reduce the inci-
dence of schistosomiasis); although not specifying sea
level changes, the paper by Griffin and Knight
demonstrates mangrove characteristics that would be
sensitive to this.
In conclusion, this Special Issue of Wetlands
Ecology and Management has brought together a
variety of papers with relevance to both wetlands and
human health. There are three areas. The first is about
constructing wetlands, where the issue is to retain
ecosystem services and wetland value; the second is
about manipulating wetlands to restore or maintain
wetland function. Both of these have the common aim
of minimising mosquito-borne disease risk. The third
area focuses on two diseases common in tropical
countries, often those with limited resources. Themes
that have emerged include management issues involv-
ing limited resources and the importance of collabo-
ration and the interaction between climate and sea
level changes.
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Wetlands Ecol Manage (2012) 20:165–171
Acknowledgments We thank all the authors for contributing
to this issue and sharing their experiences and insights into
aspects of wetlands and human health.
Funding The overview paper was prepared using salary and in
kind resources provided by Griffith University (Dale) and
University of Florida (Connelly).
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