How Does Globalization Relate to Health
It isn’t difficult to imagine how increases in international commerce and in the movement of
people—two defining features of globalization—might influence health. More goods go more
places today than at any point in history. More people travel farther, more frequently, and
come in contact with more people and goods, than at any point in history.
This increased movement of both goods and people increases opportunities for the spread of
disease around the world. And it’s not just goods and services that can travel across oceans
and state borders—so can diseases like AIDS, malaria, or tuberculosis. The outbreak of BSE, or
“mad cow disease,” in several European countries is only one example of how trade can
promote the spread of dangerous diseases. Mosquitoes that carry malaria have been found
aboard planes thousands of miles from their primary habitats, and infected seafood carrying
cholera bacteria have been shipped from Latin America to the United States and Europe.
But just as globalization increases the frequency and ease with which diseases can move
around the world, it also can improve access to the medicines, medical information, and
training that can help treat or cure these diseases.
Drug companies and governments now have the ability to ship drugs to remote parts of the
world affected by outbreaks of disease. Institutions and professionals seeking to put
medicines, or other treatments, in the hands of needy people can now make use of
the product distribution networks, communications technologies, and transportation
technologies that have promoted globalization over the past decade.
Diseases and Human History
Travel by people and the transportation of goods across regions of the world contributed to the spread
of infectious diseases long before anyone had conceived of globalization. In fact, a great deal of human
history has been written by disease. In the second century A.D., measles was spread between Rome
and Asia along caravan routes. In the following century, these same trade routes were responsible for
carrying smallpox, which wiped out as much as one-third of the population in affected areas.
The next truly massive epidemic occurred in the 13th and 14th
“Epidemics of cholera centuries, when Mongol horsemen carrying infected fleas brought
follow major routes of bubonic plague from northern Burma to Eastern Europe, and then rats
commerce. The disease helped carry the disease throughout the rest of the continent. All of
always appears first at the travel and trade that were taking place in Europe made the
seaports when extending continent a veritable petri dish for infectious disease.
into islands or continents.”
After enduring wave after wave of epidemics, the disease-hardened
descendants of these caravan traders, horsemen, and sailors brought
- John Snow, “On the Mode about an unprecedented human catastrophe when they began
of Communication of traveling to the Americas after 1492. The indigenous population of
Cholera,” 1849. North and South America, which had lived in comparative isolation,
then became victim to perhaps the greatest mass loss of life in human
history.
In the two hundred years following the arrival of Columbus in the Americas, historians estimate that
the Native population of the Americas declined by 95 percent (from a total population of perhaps 100
million), mostly due to imported diseases. The new microbes brought by Europeans included smallpox,
measles, typhus, diphtheria, chicken pox, and influenza.
Soon afterward, Europeans began the African slave trade into the Americas, bringing laborers to
replace the many indigenous people who died. And with the trade ships and human cargo that crossed
the Atlantic came new epidemics of diseases from Africa, including malaria, yellow fever, and dengue
fever.
The opening of the Americas by Europeans beginning at the end of the 15th century created, for the
first time in the world, a substantial economic linkage between Europe, North and South America, and
Africa. Some health authorities have also referred to this as the “microbial unification of the world”
(Berlinguer cited in Aginam).
What Is a Global Disease?
What is a “global disease?” Are cholera, HIV/AIDS, malaria, and TB global diseases?
Jean Lanjouw, an economist from Yale University, has argued that we should distinguish between
global diseases and other diseases that target poor countries. Dr. Lanjouw defines a global disease as a
disease that exists both in developed and developing countries. Diseases that mainly afflict poor
countries are not truly global in scope. According to WHO figures, over 99 percent of worldwide cases
of malaria, measles, and diarrheal diseases are found in low- and middle-income countries.
The distinction between global and other diseases becomes important when we consider ethical and
practical questions relating to how we respond to public health crises. The drugs that treat cholera,
HIV/AIDS, malaria, tuberculosis and other diseases often cost a lot of money to produce and distribute,
and, in many cases, the drug companies that produce them have sole ownership rights to their
production and sale. This means that agreements need to be struck with drug companies if people want
to make sure that treatments are available at prices poorer countries can afford.
As we noted earlier, recently drug companies have agreed to offer medicines to treat HIV/AIDS at
substantially reduced prices in certain poor countries. One reason the drug companies can afford to do
this is because they can recover part of the cost of providing the drugs at reduced prices in poor
countries by charging normal, higher prices in developed countries. Put differently, drug companies
can afford to cut the cost of AIDS treatments in a country like South Africa because they can charge
full-price for the same drugs in the United States. U.S. consumers, in effect, subsidize the sale of drugs
to South Africa.
But there is no meaningful market in developed countries for drugs that treat cholera and malaria,
because those diseases are largely found in poorer regions of the world. Without the opportunity to
make sales in rich-country markets, drug companies sometimes lack the financial motivation either to
develop new drugs for the treatment of diseases common to developing countries or to cut prices for
existing drugs. Drug manufacturers believe they will be unable to recover the high costs of drug
research and development through sales of new drugs in countries where people cannot afford to pay a
lot for treatment. This means that some of the money to develop new drugs will have to come from
other sources, not exclusively from private drug companies. Additional funding is also needed to help
purchase and distribute drugs. Generating the necessary funds will be a major challenge for
governments in the coming years.
Diseases Go Global
According to one estimate, by the time of the European colonization of the Americas, plagues such as
smallpox and measles could travel around the world within the span of a year. Today, of course, with
international air travel, an infected person can carry a disease from almost any point of the globe to
any other point in less than 36 hours.
One of the particularly threatening aspects of this compression of time is that people can now cross
continents in periods of time shorter than the incubation periods of most diseases. This means that, in
some cases, travelers can depart from their point of origin, arrive at their destination, and begin
infecting people without even knowing that they are sick.
The new ease with which infectious diseases can be transmitted globally is having a direct and
dramatic effect on morbidity and mortality around the world. Annually, an estimated 16 percent of all
deaths worldwide result from infectious diseases (Center for Strategic and International Studies, n.d.).
Infectious diseases also account for 30 percent of all disability-adjusted life years (DALYs) worldwide,
1.5 billion total DALYs per year (one disability-adjusted life year is one lost year of healthy life); hence
their impact is even larger (World Health Organization, 2004).
According to the United Health Foundation, within the United States, there has been a large percent
decrease in the incidence of infectious disease between 1990 and 2010, dropping from about 40
percent to 17.5 percent (America’s Health Rankings, n.d.). However, the World Health Report 2007
states that worldwide infectious diseases are currently spreading faster and emerging quicker than ever
before: “Since the 1970s, new diseases have been identified at the unprecedented rate of one or more
per year.” Climate change is facilitating this process, spreading diseases to regions where they were
previously absent (International News Service, 2011).
Several new infectious diseases, including severe acute respiratory syndrome-associated coronavirus
(SARS-CoV), henipaviruses (Hendra and Nipah), avian influenza virus, and the H1N1 virus (Swine
influenza) are some of the newest diseases that have received much attention, due to their rapid
spread around the world. Other historic, infectious diseases, such as West Nile fever, human
monkeypox, dengue, tuberculosis, and malaria are reemerging as well. Other well-known, historic
infectious diseases, such as tuberculosis, are also unfortunately making a comeback; in the United
Kingdom, which had almost completely eradicated tuberculosis from the British Isles by 1953, about
9,000 new cases of the disease are reported annually (Public Health England, n.d).
The dangers posed by these diseases go beyond simple medical concerns. In 2008, Pentagon Reports
(Storming Media) issued a statement, describing the vast consequences of the global spread of
infectious disease. The report asserted that:
The global community has suffered recently from newly emerged infectious diseases, including
HIV/AIDS and severe acute respiratory syndrome (SARS), and from reemerging diseases once thought to
be in decline. Additionally, it is increasingly recognized that infectious disease can pose a significant
threat to U.S. and world security. To best understand and mitigate this threat, U.S. policy makers
require adequate and timely information about the occurrence of infectious disease worldwide.
The threat of political instability—which can be defined as war, ethnic conflict, and violent regime
transition—is most likely to endanger developing countries. In these nations the burden of disease can
strain already meager national budgets, set off competition for resources, and result in the death or
disability of important government officials.
In many African countries in particular, the most skilled and wealthiest segments of the population are
often the most likely to become affected by the HIV virus. This tends to be the case because the
wealthier segments of the population are often more mobile and have more opportunities for sexual
partners.
Similarly, the armed forces of some African countries are “….the concept of [domestic] as
estimated to harbor infection rates of between 10 and 60 distinct from “international health”
percent. Losses of key military leaders and senior officers can is outdated. Such a dichotomous
lead to breakdowns in the chain of command, and make it concept is no longer germane to
more tempting for younger officers to launch coup attempts. infectious diseases in an era in which
commerce, travel ecologic change
Of course, the problems of health and instability are not and population shifts are intertwined
limited to Africa or to the HIV virus alone. Political instability on a truly global scale.”
is most likely to arise in the presence of broad social
upheaval. A study by Ted Robert Gurr, et al. indicated that -U.S. CDC, “Addressing Emerging
“the causes of state instability in 127 cases over a 40-year Infectious Disease Threats: A
period ending in 1996 suggests that infant mortality is a good Prevention Strategy for the United
indicator of the overall quality of life, which correlates States,” p . 12
strongly with political instability.” The National Intelligence
Council evaluated all 127 cases for the presence of certain variables or indicators of social and political
turmoil. Out of the 75 factors they analyzed, three factors proved to correlate the most significantly as
predictors of political instability. These three most powerful determinants were:
• incomplete democratization,
• low openness to international trade
• infant mortality
In particular, they found that high infant mortality within a state that is only partially democratic is
most likely to produce instability.
HIV/AIDS
AIDS (Acquired Immune Deficiency Syndrome) is an incurable disease that destroys the patient’s
immune system. AIDS is caused by infection with HIV (Human Immunodeficiency Virus). HIV is
transmitted through the exchange of bodily fluids. People can become infected by HIV through sexual
contact, by using needles that are contaminated with the virus, or by coming into contact with
infected blood.
The immune system of a person infected by HIV becomes weaker over time, and the person is less able
to fight off infections; this process can take months or years. The final stage of HIV is the development
of AIDS. As their immune systems collapse, people with AIDS become increasingly vulnerable to
infection by a variety of life-threatening diseases.
HIV/AIDS is truly a global disease. While infection rates are highest in poor countries that lack
developed public health services, roughly 50,000 Americans are infected every year (DeNoon,
2011). According to statistics, by the end of 2012, more than one million Americans had been
diagnosed with HIV/AIDS (aids.gov, n.d.). Additionally, at the end of 2011, 34 million people worldwide
(with 2.5 million newly infected), 23.5 million people in Sub Saharan Africa, 4.8 million in Asia, and 1.4
million in Eastern Europe and Central Asia were HIV-positive or have AIDS s
By taking a mixture of what are known as anti-retroviral drugs, AIDS patients can prolong their
lives for many years. Many of these patients might be able to survive until an AIDS cure is developed.
But AIDS medicines are very expensive, even for patients in the world’s rich countries; most people in
developing countries cannot possibly afford them on their own. In addition, many developing countries
lack adequate public health systems and trained health care personnel. As a consequence, they have
limited capacities to educate people about how to avoid HIV infection, to distribute AIDS medicines,
and to treat people with AIDS.
The international community is responding to this Brazil
global health threat in a number of ways. Through Successful Response to an Epidemic Brazil was
UNAIDS, the United Nations has launched an out on the forefront among nations facing the
international effort to bring relief to countries that AIDS crisis. A 1996 law proposed by President
cannot afford medicines or implement prevention or Jose Sarney guaranteed every AIDS patient
treatment programs. The World Health Organization state-of-the-art treatment. To do this, Brazil
also has runs a major program on AIDS. It is began producing generic copies of 8 of the 12
partnering with UNAIDS and private companies to antiretrovirals used to treat AIDS. Also, Brazil
help countries bring their epidemics under control launched a World Bank-financed prevention
through prevention, treatment, and vaccine program. Since Brazil began producing its own
research. drugs in 1998:
Some countries, such as Brazil and India, have begun
• price has fallen by an average of 79
producing generic copies of name-brand medicines
percent
and distribute them to AIDS patients at a fraction of
• the epidemic has stabilized
the cost of the original drugs. Developing countries in
Africa and elsewhere have expressed an interest in • Brazil has had the same number of new
buying these lower-priced versions of name-brand cases in the last three years
drugs. • the death rate has been cut in half
The replication of name-brand AIDS drugs is
controversial. The companies that produced the original drugs believe that the companies that copy
their drugs are cheating them out of earnings. Developing country governments and some health
experts say it would be immoral for people to be denied life-saving drugs simply because they cannot
pay for them.
In response to the competition from manufacturers of lower-priced generic drugs, many of the U.S. and
European countries that invented AIDS drugs decided to sharply discount the prices of their medicines
in the world’s poorest countries.
HIV/AIDS FACTS (from the “WHO Progress report 2011: Global HIV/AIDS response”)
• In 2010, an estimated 2.7 million people were newly infected with HIV/AIDS. There are about 34
million people living with HIV/AIDS today (est. 2010).
• Sub-Sahara Africa accounts for two-thirds of all infected people
• After the primary HIV infection, there are four clinical states of HIV/AIDS.
• 390,000 children were newly infected, 30 percent fewer than the peak seen in 2002 and 2003
Tuberculosis
Tuberculosis (TB) is another disease that infects people across the globe. Tuberculosis spreads through
the air when people who are infected with it cough, sneeze, or speak. People infected by TB often
have no symptoms of the disease. It is only when a person’s immune system is compromised that he or
she develops symptomatic TB. Symptoms include a lingering cough, fever, weight loss, night sweats,
loss of appetite, and fatigue.
Tuberculosis is most prevalent in areas with high population density. As economies become more
industrial and less rural, urban populations grow and the conditions improve for the spread of TB. The
disease is most common in poor areas, where multiple families share housing and work in buildings with
poor ventilation; in refugee camps, where people are forced to live together (it is estimated that as
many as 50 percent of the world’s refugees are infected with TB); and among homeless populations
(T.B. is a global peril, 2002).
Tuberculosis is not only found in poor and distant countries; it is a public health concern in the United
States as well. According to the CDC, 9.951 new TB cases were reported in the United States in 2012.
This represents a drop of 6.1 percent since 2011 (CDC, 2012)
TB is not only a problem in areas with high concentrations of people, like cities; it is also a problem in
schools, where children spend a lot of time close together in classrooms, and among people with
compromised immune systems. Individuals with HIV/AIDS are particularly vulnerable to catching fatal
cases of TB.In fact, 24 percent of TB deaths [are] HIV associated (World Health Organization, n.d.).
(See The Link between TB and HIV.)
Estimated TB incidence, prevalence and mortality, 2011
Incidence1 Prevalence2 Mortality
% of global
No. in No. in thousands No. in
WHO region total
thousands thousands
26.1% 2500 220
Africa 2300
330 21
The Americas 260 3%
7.5% 1000 99
Eastern Mediterranean 660
4.3% 500 45
Europe 380
39.7% 5000 480
South-East Asia 3500
19.3% 2500 130
Western Pacific 1700
100% 995
Global total 8800 11830
1
Incidence is the number of new cases arising during a defined period.
2
Prevalence is the number of cases (new and previously occurring) that exists at a given
point in time.
3
Pop indicates population.
On the whole: TB can be cured, but treatment typically involves taking at least four different
medicines over a 6-12 month period. Many TB patients are not able to follow this treatment routine,
and health care systems in developing countries, in particular, often lack the staff and resources
necessary to monitor TB patients effectively.
From a public health perspective, poor or incomplete treatment of diseases like TB can be more
damaging than no treatment at all. Poor treatment can encourage the development of new strains of a
treatable disease that are resistant to available medicines. As with malaria, a strain of TB has become
drug-resistant. This strain has been labeled “MDR-TB” (multiple drug-resistant tuberculosis). This form
of TB is much more difficult and costly to treat. While the typical six-month treatment for regular TB
can cost $10, treatment for MDR-TB can cost $20,000 and take several years.
The strategy for treating TB recommended by the WHO is called DOTS. DOTS combine political
commitment, detection, drug supplies, and monitoring services to treat and prevent the disease.
According to the WHO, DOTS can produce a 95 percent cure rate, even in poor countries. In July 2001,
the WHO, a non-governmental organization called Doctors without Borders, and Harvard University
Medical School launched an effort to provide poor countries with affordable drugs that are effective in
treating MDR-TB. The plan calls for some countries to receive medicines at prices reduced by as much
as 94 percent.
In 2007, this combined effort led to its first huge success. The first Doctors without Borders patient,
N.L. from Armenia, completed treatment of MDR-TB. According to Doctors without Borders Field News
(November 6, 2007), “Up until two years ago, there was no medical treatment for such strains of TB in
Armenia due to the complexity of the treatment, which takes at least two years, including several
months of hospitalization.” Doctors without Borders are expecting many more such positive results.
Says Robert Parker, MSF head of mission in Armenia: “We are now able to respond honestly to the
recurrent question from our patients: ‘Does this treatment work?’ ‘Has anyone ever been cured with
this treatment?‘”
TUBERCULOSIS FACTS
• An estimated 1.3 – 1.6 million people died from TB in 2010.
• Less than nine million new cases of TB develop worldwide every year
• One person is infected with TB every second.
• TB is contagious and spreads through the air (e.g. sneezing, coughing, etc.)
• Left untreated, each person with active TB will infect 10-15 more people each year.
• 1 in 10 people infected with TB will become sick with active TB.
• People with HIV are at much greater risk to become sick, once infected with TB.
• Over 1.5 million TB cases occur every year in Sub-Saharan Africa.
• TB is the second leading cause from infectious disease worldwide (HIV is number one)
Malaria
Malaria is a disease that is spread by mosquitoes. Mosquitoes pick up malaria parasites from the blood
of infected humans. While there is only one type of mosquito that can carry malaria parasites, there
are four different types of malaria parasite, so there are four different types of malaria people can
catch. Symptoms include fever, shivering, pain in the joints, headache, vomiting, convulsions, and -
ultimately- coma. If an infected person is not treated, he or she can die.
The mosquitoes that carry malaria breed in warm, damp climates. As forests are bulldozed to build
roads and housing in developing countries, conditions improve for mosquito breeding. War has also
been identified as a factor that can increase malaria outbreaks. Refugees who spend long periods of
time exposed to the elements and who travel across borders fleeing violence are more likely to come in
contact with malaria-carrying mosquitoes.
But even ordinary travelers are at risk. Malaria-carrying mosquitoes can stow away on international
flights and bring the disease far from infected areas. Geneva, Brussels, and Oslo have had outbreaks of
“airport malaria” in the past few years. In fact, 30,000 cases of malaria were reported among
Europeans traveling abroad in 2008-and the numbers are increasing.
The health threat posed by malaria is worsening because the disease is becoming resistant to the most
common drug prescribed to prevent it, chloroquine. In some parts of Asia, the four main drugs used to
fight malaria have become ineffective. Moreover, the mosquitoes that carry malaria are becoming
resistant to pesticides. Unless new medicines and pesticides are developed soon, the numbers of
people catching malaria and dying from it will rise.
MALARIA FACTS (WHO –
Malaria: http://www.who.int/mediacentre/factsheets/fs094/en/index.html)
• In 2010, there were 216 million cases of malaria.
• In Africa, a child dies of malaria every minute.
• Malaria killed 660,000 people in 2010, mostly children in Africa.
• 600,000 African children, most under the age of five, died from malaria in 2010. Malaria is
the cause of 25 percent of all childhood deaths in Africa.
• 90 percent of all malaria cases occur in Sub-Saharan Africa.
• Malaria can decrease gross domestic product by as much as one percent in countries with high
disease rates.
• The number of malaria cases has fallen globally by 25 percent since 2000 by 33 percent in
Africa.
Cholera
Cholera is a disease caused by a bacterial infection of the intestine. It makes people sick, and
sometimes kills them, by causing persistent diarrhea. Cholera infections are often mild, but
approximately one in 20 of those infected develop severe symptoms. Once the disease has progressed
to this state, death can occur within a few hours.
When the fluids lost through diarrhea are promptly replaced, cholera patients rarely die. When cholera
occurs in an unprepared area, as many as 50 percent of newly infected individuals may ultimately die.
People catch cholera by drinking water or eating food that has been contaminated with the cholera
bacterium. It spreads most rapidly in areas where public sanitation is poor and drinking water is
untreated. Unlike HIV/AIDS and tuberculosis, person-to-person infection is not likely.
Cholera has had an adverse impact on economic development in many countries. Families face
hardships paying for hospital stays and medicine used to treat cholera. Countries face economic losses
from the lost productivity of the caregivers. Productivity losses can be high, especially in sub-Saharan
Africa where people do not retire, due to the lack of a social security system. Cholera can also
negatively impact the tourism sector and subsequent loss of livelihoods. . The economic damage
caused by cholera can be compounded by the international reaction. When Peru experienced a cholera
outbreak in 1991, the country lost $770 million due to sharp drops in food exports and tourism.
By 2005, cholera had been reported in almost 120 countries: “As the disparity between industrialized
and less-developed countries grew, cholera, which previously had been a global disease, seemed to
have become yet another burden to be borne by impoverished nations of the Third World.” (Britannica
Encyclopedia).
To prevent cholera outbreaks, countries must provide adequate public sanitation, clean drinking water,
and instruction on good food hygiene. Providing these services requires a long-term commitment of
significant resources, often with the assistance of international bodies such as the WHO and the UN.
CHOLERA FACTS
• In 2010, The World Health Organization (2012) reported three to five million cases of cholera
with 100,000 to 120,000 deaths. Cholera is transmitted by eating foods or drinking water that
is contaminated with the cholera bacterium.
• Approximately 75 percent of people infected with cholera do not develop any symptoms, 80
percent of those who develop symptoms have mild or moderate cases, while 20 percent of
those who have symptoms have severe cases (World Health Organization, 2012).
• 783 million people currently lack access to safe water, and about 2.5 billion people have no
access to improved sanitation (UNWater, n.d.).
• Once a cholera infection reaches a severe state, a patient can die within two hours.
• In the aftermath of the 1994 war in Rwanda, more than 58,000 cases of cholera were reported,
with 23,800 deaths, within one month.
• 80 percent of cases can be treated with oral rehydration salts (World Health Organization,
2012).
