Alteration of natural disturbance regimes (via control of natural variation via flood control projects for example) reduces resilience, while secondary disturbance events (wildfires, storms, floods, and earthquakes) precipitate events caused by crossscale influences (e.g., a thunderstorm igniting a fire locally that spreads regionally as a result of fuel build-up from years of artificial fire suppression). Regional environmental change such as that associated with population growth development often does not accommodate the need to maintain resilience (21) . Such ecosystems have been described as 'over-connected' or 'brittle' and, as stated above, 'accidents waiting to happen' (8, 22) . Floods, often associated with waterborne disease outbreaks, occur more frequently and with greater severity as a result of lost resilience in natural systems due to attempts to 'control' (in contrast to manage) natural variation. Conversion of upland forests to plantations or cropping systems for more 'efficient' natural resource production is another, as is agriculture generally. Both result in a reduction of heterogeneity in ecosystems that tend to 'buffer' against disease outbreaks, which can spread more readily across the more uniform landscape including immunologically vulnerable domesticated species. Gunderson et al. (8, 23) describe this as general pattern of institutional behavior. It begins with the targeting of a natural variable for control, followed by increasing institutional efficiency and inflexibility in the control methods used. As the target variable and ecosystem changes and initial signs of failure are ignored, the ultimate result is a crisis. This 'pathology of regional resource and ecosystem management' and is apparently applicable to infectious disease management as well.