Great ape range coincides with some of the poorest countries of the world. The threat that the rural poor can pose to great apes and their habitat is explained in the threat section. The risks and consequences of disease transmission between humans and apes are predicted to increase as human populations and their activities continue to increase, and wild ape populations become increasingly fragmented, reduced and stressed (Butynski, 2001). These risks are exacerbated by a heavy dependence on natural resources and inadequate poor social and health care amenities. Linking the conservation of biodiversity directly to human well-being is a relatively new concept but this emerging approach offers opportunities to reduce poverty, increase support for conservation and at the same time reduce the risks to wild great apes.

At the same time there are a number of sites where tourists can view great apes putting them in close proximity, and sometimes in direct contact. Furthermore large numbers of staff (and researchers) support tourism sites and the management of protected areas (and other great ape habitat). The presence of all these different groups of people poses a potential serious risk to great apes.

With more people living around national parks (and other great ape habitat) apes are coming into increasing contact with humans, their waste, and domesticated animals. Rural communities have limited or no access to health services due to their remote location and limited human and financial resources, and typically are not vaccinated against diseases (Guerrera et al., 2003; Tutin et al., 2005). Health outreach programmes that aim to improve disease and hygiene factors in local villages are important adjunct programmes in all great ape conservation sites. For tourism sites, it has been argued that habituation increases the potential exposure to human communities, and tourists and staff also spend time in community areas as they access ape tourist sites. Improving the health of people, will not only directly reduce the health threat to apes through improvement of public health practices, but also provide a much needed benefit to neighbouring communities, helping to reduce poverty, and improve community attitudes toward wildlife conservation. In areas such as these, health education can be a powerful conservation tool, bringing together public health and conservation (Kalema-Zikusoka, 2005; Kalema-Zikusoka & Gaffikin, 2008; Osofsky et al., 2005). Emphasizing the link between human health and ecosystem integrity, the “One Health Paradigm” takes a broader ecological definition of health and attempts to bring together previously isolated disciplines (of human and public health, epidemiology, veterinary medicine, toxicology, ecology and conservation biology) to create an enabling environment for expanding benefits to protected areas (and the species that live within them) and local people (Osofsky et al., 2005).

Occupational health programmes for employees that move through ape habitat or come into close proximity to apes help address a basic need for staff while at the same allows for screening, prevention and treatment for common diseases that pose a risk to great apes. It can promote good relations and increases morale, promotes good health (and in doing should lead to increased productivity), and likely reduces disease threats to apes from this group of people. The Great Ape/Human Health Working Group, part of the World Conservation Society's Animal Health for the Environment and Development (AHEAD) initiative states that protecting (park) employee health should be considered a ‘critical control point’ in terms of protecting the health of wildlife, including conservation programmes for wild apes (WCS-AHEAD, 2005).

Tourism can both support ape conservation but also threaten it (refer to the section on tourism). Of the negative impacts and costs to great apes and their habitat from tourism, the most critical is disease transmission. IUCN has developed specific guidelines to help minimize risks (Macfie & Williamson, 2010). The guidelines can apply equally to researchers and indeed anyone that comes into close (direct and indirect) contact with great apes.

A long standing concern in development and conservation is that investment in communities surrounding protected areas (PAs) encourages immigration to the area for the real or perceived economic and social opportunities (through the creation of jobs, roads, schools, clinics and improved sanitation systems) they provide. In some cases park-centred investment far exceeds international funds for more distant communities, and there is a higher than average population growth on the borders of PAs (Wittemyer et al., 2008). Whilst this highlights the value of PAs for local people, it also points toward a looming threat to biodiversity. Given the strong linkages between human and environmental health, landscape planning and PA management must take into account patterns of human settlement and the needs of local communities. Targeting areas further removed from PAs to increase benefits to those rural poor, may reduce immigration towards PAs and unsustainable exploitation of natural resources that PAs aims to sustain.

The use of face masks for tourists is somewhat controversial (Macfie & Williamson, 2010). Under ideal conditions facemasks can be an effective barrier to exhaled pathogens. However, apes must be habituated to visitors wearing them and tourists must be educated to ensure compliance, especially as any discomfort with use could reduce compliance. The use of masks may give tourists a false sense of security about the risk they pose (and so they may get closer) to apes.

Community health programmes can incorporate a wide range of activities. Following scabies outbreaks in gorilla groups in Bwindi Impenetrable National Park (BINP), Uganda, health education workshops were conducted with local communities surrounding the park (Kalema-Zikusoka, 2005). The outbreaks were thought to be associated with scabies in the local human community. An assessment of community needs and opportunities, led to a series of recommendations, divided into three main categories: medical (e.g., mobile clinics, local nurse, safer water), non-medical (more health education programmes, strengthening human-gorilla conflict interventions) and hygiene (covering rubbish heaps, digging proper and deeper pit latrines), the implementation of which was shared between government and local communities. Protected area managers were initially concerned that local communities would believe they valued the gorillas more than people. This was not the case and local communities (particularly those that had received direct benefits from the creation of the park) saw the benefits of improving their health and hygiene not only for themselves, but also to protect a sustainable source of income from gorilla tourism. Before mountain gorilla tourism came along, these rural communities had very little hope of overcoming their poverty. It is important however to make explicit linkages between interventions and conservation so that beneficiaries make the conceptual link (Blomley et al., 2010; Margoluis et al., 2001).

Recommendations to successfully integrate health and conservation at the community level include (Kalema-Zikusoka, 2005; Margoluis et al., 2001): project design (e.g. local involvement is crucial for long-term success, the intervention needs to be practical and builds on the conceptual link between health and conservation, transparency about the conservation goals from the onset); project management (e.g., development of relationships with capable and appropriate partners to share expertise and scarce resources, promotion of community ownership, seek opportunities where building capacity in health will also build capacity for conservation, inclusion of local health and development workers into conservation activities); and project monitoring and evaluation (e.g., monitor both the health and conservation conditions and outcomes, and evaluate the strength of association between health and conservation activities and results).

Employee occupational health programmes provide preventative, clinical assessment and case management (referral, follow-up, and treatment as indicated) services to protected area conservation employees. Common components of these programmes include protocols for vaccination against preventable diseases, diagnostic and routine tests, first aid provision and training, and health education with key messages on hygiene and sanitation. A number of great ape sites currently operate employee health programmes. The Mountain Gorilla Veterinary Programme has significant experience in developing employee health programmes in four national parks (Nutter et al., 2001; Ali et al. 2004; MGVP 2004). IUCN is developing ‘Best Practice Guidelines for Health Monitoring and Disease Control’ (Leendertz et al., in prep.). It is important to consider staff living situations, and extending the programme to include immediate household members, who by virtue of their close contact, potentially pose a risk of infectious disease transmission to the employees and therefore also indirectly to the apes. To be a successful conservation-related intervention employee health checks need to be considered as a means of protecting both the employee and wildlife, and must be sustainable. Only in this way will the likelihood of pathogen flow between humans and apes be reduced, as well as the rights of employees to minimal occupational hazards be maintained (MGVP, 2004). To ensure longer-term sustainability, employees should be referred for whatever services and programmes are available locally in the country. Care should also be taken to minimize disparities in health care between employees and local community members that could lead to bad relations, while at the same time providing adequate care for employees (and ideally their immediate family).

There are a variety of safety measures intended for tourists visiting great apes. These start at the time of booking the trip, at arrival and also during the visit. At the time of booking, tourists (and other visitors) should be presented with regulations explaining the rationale behind measures intended to minimize disease risks and also any vaccination requirements (Macfie & Williamson, 2010). On arrival appropriate information on the various impacts of tourism should be given to visitors; this can be in the form of displays, signage, presentations and demonstrations. Role play on how to respond to an approaching ape can be particularly helpful; if acted out tourists are more likely to remember what they have been told. Vaccination certificates should be checked, a checklist of symptoms and exposure to any significant risks conducted, and exclusion of anyone who is unwell. Adherence to regulations concerning visitor numbers, distance, duration of visit, use of masks (if applicable), and the number of visits per day, is crucial. Staff must fully understand the rules, be able to explain and enforce them, be provided with refresher courses, and performance monitoring. All of these measures can help protect both ape and visitor health.

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Wildlife Conservation Society, Animal Health for the Environment and Development (AHEAD), and Great Apes/Human Health Working Group (2005). Consensus document outlining practical considerations for reducing health risks to African great apes and conservation employees through an occupational health program. http://www.wcs-ahead.org/print.html

Wittemyer, G., Elsen, P., Bean. W.T., Burton, C.O., Brashares, J.S. (2008). Accerlated human population growth at protected area edges. Science 321:123-126.