|A. The State of Global
||Assessments of global health differ
significantly. There are optimistic projections that claim that we will continue to
build on the medical advances of the past century until virtually everyone enjoys a
standard of health now enjoyed by the relatively well-to-do of the wealthy nations.
Others are more pessimistic, pointing to the unequal distribution of health resources, the
continuing increase in environmental pollution, the increase in antibiotic resistant
disease, and the emergence of new diseases such as HIV/AIDS. The readings in this
section provide some overviews of the state of global health and some projections of what
to expect in the next century.
Reading 1b. Enemies
of Health, Allies of Poverty
||Each year the World Health Organization issues its report
on the state of global health. This is the summary of the report.
The 2001 report concentrates on examining the unequal distribution of health
services and the consequences for the poor. These two brief
selections from the report provide a good summary of the major health
problems in the world today.
Risk Factors and Disease (PDF)
These charts from the 2002 World
Health Organization Annual Report, connect the major risk factors
(e.g. hunger, tobacco, etc.) with specific injuries and disease and show
their percentage distribution. You can also view the main
causes of death from the years 1985, 1990, and 1997 from the 1998 WHO
Worlds Collide: Micro Vs. Macro
historical tour of the battle between medicine and infectious
microbes. The tour is part of the site, Bioactive. The above
links will take you to page that contains the main link along with an
|Reading 4. The Silent Emergency
This brief report from UNICEF's State of the World's
Children: 1998 details the health dangers of malnutrition now affecting half of the
world's population. Most at risk are infants and children under five years of age.
|Exercise 1. Infant Mortality
||One of the supposed success stories
of modern medicine is the reduction of infant mortality rates around the world. Yet
these advances are, like many, very unevenly distributed as these statistics
|B. The Dynamics of
||The readings in this section focus on the
dynamics of disease. We need to understand the biological relationship between
pathogens that cause disease and their human hosts. We also need to understand the
social factors that expose some people more than others to infectious pathogens.
|Reading 5. Social Inequalities
and Emerging Infectious Disease
||This is not an easy article, but it
is well worth the effort. Paul Farmer argues that while researchers and others have
examined the social and cultural factors in emerging infectious disease, they have largely
neglected the role of social inequalities. Farmer maintains that the questions we
sometimes ask about disease and the way that we classify it often obscures the extent to
which disease is a marker of poverty. Even the term "emerging infectious
diseases" masks the fact that often they are simply reemerging from the ranks of the
poor to affect the well-to-do. Other concepts, such as that of health transitions can be
misleading. An epidemiological transition occurs when the most frequent cause of death in
nation-states changes from infectious disease to death from malignancies and coronary
heart disease associated with old age. Yet speaking of such transitions, says Farmer,
masks the existence in rich countries of pockets of infectious disease among the poor.
Researchers, he argues, must learn to ask more of the hard questions: What are the
mechanisms by which changes in agriculture have led to outbreaks of Argentine and Bolivian
hemorrhagic fever, and how might these mechanisms be related to international trade
agreements, such as the General Agreement on Tariffs and Trade and the North American Free
Trade Agreement? How might institutional racism be related to urban crime and the
outbreaks of multidrug-resistant TB in New York prisons? Does the privatization of health
services buttress social inequalities, increasing risk for certain infectionsand
deathamong the poor of sub-Saharan Africa and Latin America? How do the colonial
histories of Belgium and Germany and the neocolonial histories of France and the United
States tie in to genocide and a subsequent epidemic of cholera among Rwandan refugees?
What is the affect of sexism and racism on disease? He then examines Ebola,
Tuberculosis and AIDS and the extent to which these disease are markers of poverty.
Tuberculosis, still the world's leading infectious cause of death in adults, has not
"emerged," he says. It simply withdrew to nest among the poor,
returning to the general population as an opportunistic infection associated with AIDS,
and as a new, antibiotic resistant form. In sum, Farmer insists that we must determine the
mechanisms through which infectious disease affects some populations and not others.
|Exercise 2. Influenza 1918
||In 1918 an influenza epidemic
spread around the world; its mortality rate among the young and the lack of ways to treat
it led leading health authorities in the United States to believe that it might wipe out
most of the population. But it ended almost as mysteriously as it appeared after
killing hundreds of thousands. This is the companion site to a PBS special on the
epidemic. It contains, in addition to a transcript of the show, supporting
documents, photos, and interviews. Read, for example, some of the measures people took to prevent or cure the disease, all of which
Factors in Global Health
||Arguably the greatest threat to global
health is the continuing destruction of the environment and the increased exposure of
people to toxic chemicals and waste. The use of chemicals in the United States alone
increased from approximately 3500 kg per person in 1941 to some 10,000 kg per person in
1995. Urbanization is increasing people's exposure to disease. Greater densities of
population create the need for increased sanitation services for which most countries lack
resources. Developing countries dump some 95% of their untreated urban sewage into surface
waters. Estimates are that 2 billion infections from waterborne diseases each year lead to
4 million deaths, largely among infants and young children. The following readings
document some of the environmental factors in disease emergence and spread.
|Reading 6. Mortality
and Environmental Pollution
||According to a report that appeared
in the October, 1998 issue of the journal Bioscience, 40% of world deaths can be
attributed to environmental factors. This reading consists of a press release from
Cornell University where the study originated. The full article by David Pimentel
and his associates, Ecology of Increasing Disease: Population Growth and Environmental
Degradation." is available at Die Off at http://dieoff.org/page165.htm.
The article should be read in its entirety.
|Reading 7. Reemergence of
Epidemic Malaria in the Highlands of
||This article from the journal Emerging Infectious Disease
illustrates how environmental alteration contributes to the spread of disease, as well as
how colonialism created conditions for disease transmission. The discussion of the
British colonialization of Kenya and the Kikuyu rebellion in Chapter 10 of Global Problems and the Culture of Capitalism will
give additional background.
|Reading 8. Environmental
Pollution and Disease
||This brief article highlights the
relationship between water pollution and disease. As we discuss in Global Problems
and the Culture of Capitalism, water-borne disease tends to be severe because the
organisms that are responsible have no need to spare their human host. Pollution of
water supplies is also more prevalent in regions of poverty.
|Reading 9. The Sanitation Gap
||Three billion people in the world
lack that most basic element of sanitation--the toilet. And anywhere from one-third
to one-half live in cities. The result is increased exposure of people to disease;
diarrhea, the most common disease spread by feces contact, kills two million children a
year. Furthermore, 90% of all infectious disease in developing countries is waterborne.
Even in the United States, 40% of the treated drinking water is contaminated with
microbial pollutants. Before the development of sanitation systems, the life
expectancy in core cities ranged from twenty-five to thirty-five years of age. But
when these cities constructed their sanitation systems, they were among the richest in the
world. Lack of sanitation facilities now plagues the poorest. This brief
article by Akhtar Hameed Khan describes the problem and its consequences.
|Reading 10. Big Tobacco's Global Expansion
||The two major causes of premature
death in the world are HIV/AIDS and tobacco. But, while societies encourage
abstinence as a preventive measure for AIDS, they actively encourage and subsidize
the sale and use of tobacco. Smoking causes approximately three million deaths a
year, and there are predictions that it will cause ten million by the year 2025.
This report by Ross Hammond documents some of the health consequences of smoking, but,
more importantly it describes how, when there is a conflict between corporate profit and
human health, profit wins. Easily.
|D. The Global
||In Global problems and the Culture of
Capitalism we suggest that AIDS is the signature disease of our age. By that we
meant that the condition for its development and spread were created by the patterns of
beliefs, attitudes, and behaviors characteristic of the culture of capitalism.
By the end of 1997, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and
the World Health Organization reported that as of 1997, 30 million people worldwide were
infected with HIV, or one out of every one hundred sexually active adults. Transmission
rates in 1997 amounted to 16,000 new infections each day. If those rates of transmission
continue, 40 million people would be affected by the year 2000. Of those infected, 90
percent live in the periphery; since there are few facilities for testing, it is estimated
that nine out of every ten people who are HIV-positive have no idea they are infected. In
1997, 2.3 million people died of AIDS a 50 percent increase over the 1996 death rate.
Nearly half those who died deaths were of women, and 460,000 were children. The
following selections provide additional information on the epidemic and the affects it has
had, particularly in developing countries. You can also get a compendium of recent
reports on the AIDS epidemic at Communicable
Disease Prevention and Control.
|Reading 11. Report on the Global AIDS/HIV Epidemic-1998
||Some of the most up-to-date
material on the global HIV/AIDS epidemic can be found at UNAIDS: The Joint United Nations Programme on HIV/AIDS. With
their permission we have included their 1998 report on this site for easy loading.
The report contains information on the global distribution of HIV/AIDS; parts of Africa,
for example, have been particularly devastated by AIDS. In Botswana more than 25% of
adults are infected, and children born early next decade can expect to live just past
their 40th birthday. Without AIDS, they could have expected to live to
the age of 70.
|Reading 12. The Impact of AIDS in
||This brief report from the World
Bank describes some of the measures taken to prevent the spread of HIV/AIDS.
Internet Resources on Disease