Global Problems and the Culture of Capitalism

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VIII Readings on Disease

Job2.jpg (15138 bytes) Medical advances, say some, mark one of the most notable success stories of the culture of capitalism.   Worldwide life expectancy in 1955 was 48; in 1995 it was 68, and it is expected to rise to 73 by 2025.  In 1955, 148 out of 1000 children born, died before their first birthday; in 1995 it was 59, and it is expected to be 29 in 2025.  This generation has witnessed the discovery of a cure for polio and the global elimination of smallpox.   Yet, in spite of these advances, huge problems remain.  Malnutrition, one of the greatest causes of illness, is a greater problem than ever before; in 1950 it is estimated that 20% of the world's population was malnourished; today the estimate is 50% (three billion people).  Environmental devastation, another major cause of illness, disease, and death, is increasing; 40% of all the deaths in the world are now attributed to environmental factors. Urbanization contributes to the spread of disease, and presently half the people in the world live in cities of more than one million people;  by 2025, two-thirds will live in cities. Furthermore, one of the greatest tragedies is that whatever advances have been made in preventing and curing illness are remarkably unequally distributed; 42% of deaths in the periphery were caused by infectious disease, as opposed to 1.2 % in core countries.  The following readings and exercises address such issues as how environmental factors contribute to disease and how our ways of life contribute to disease and illness. 


A. The State of Global Health
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.
new.gif (1508 bytes)Reading 1a. World Health Report-2002 -Overview

Reading 1b. Enemies of Health, Allies of Poverty
answer_pad.jpg (2605 bytes) 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.
Reading 2. Disease 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 Report.


new.gif (1508 bytes)Reading 3. When Worlds Collide: Micro Vs. Macro
A fascinating 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 index.   
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 Rates
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 show.


B. The Dynamics of Disease Causation
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 infections—and death—among 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 proved ineffective.


C. Environmental 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 The article should be read in its entirety.


Reading 7. Reemergence of Epidemic Malaria in the Highlands of
Western Kenya
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 HIV/AIDS Epidemic
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 Developing Countries
This brief report from the World Bank describes some of the measures taken to prevent the spread of HIV/AIDS.


Additional Internet Resources on Disease


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Richard H. Robbins

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