Editors Choice
May 15, 1999

Culture and Disease

Medical advances, say some, mark one of the most notable success stories of modern society.   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 developing world were caused by infectious disease, as opposed to 1.2 percent in the wealthier countries. 

One of the areas that anthropology contributes is in the study of the relationship between culture and disease.  Why is it that some areas of the world suffer disproportionately from infectious disease?  How does the way we live expose us to illness?  Are there things we could do to prevent another epidemic such as HIV/AIDS?  There is a lot on the Web to help you answer some of these questions.

For example, 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 following sites provide some overviews of the state of global health and some projections of what to expect in the next century.

Each year the World Health Organization issues its report on the state of global health.  World Health Report-1998 is the summary of the report. You can also read an abbreviated account in the press summary of the report.  The 1998 report concentrates on examining what we might expect for global health in the next century, and focuses on women's health and the implications for health of an aging population. 

Causes of Death: Distribution of Death by Main Causes by Level of Development, 1985, 1990, 1997 will provide you with a quick overview of how causes of death vary between the developed and the developing world.   You can quickly see the extent to which medical resources are unequally distributed by examining the number of deaths attributed to infectious disease. 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 distributedInfant Mortality Rates  from the Center for International Health will allow you to review these rates for different parts of the world and from different countries.

We often forget that we share our living and breathing space with millions of microorganisms, remembering them only when one or another tries to eat us.  Yet understanding our relationship to them is critical for understanding, not only our susceptibility to disease, but also how the way we live, our culture, influences that relationship.  Virulence, that is how deadly a disease is, varies with how difficult or easy we make it for a microorganism to infect us.   The article Evolution and the Origin of Disease by Randolph N. Neese and George C. Williams, reprinted from Scientific American, describes how our evolution influences our susceptibility to disease.

If you want to examine the dynamics of an epidemic, particularly before the existence of antibiotics, check out Influenza 1918.  That year 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.

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 sites document some of the environmental factors in disease emergence and spread.

For example, 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.   Mortality and Environmental Pollution consists of a press release from Cornell University where the study originated.  The article, Pollution and Disease, highlights the relationship between water pollution and disease.  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.

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, The Sanitation Gap by Akhtar Hameed Khan describes the problem and its consequences.

Finally, 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.   You can get a compendium of recent reports on the AIDS epidemic at Communicable Disease Prevention and Control. 

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 and their publication, Report on the Global AIDS/HIV Epidemic-1998The 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.


You can find more Internet resources on population growth at my Website, Global Problems and the Culture of Capitalism at the health and disease resources page.

I'd appreciate your comments; you can reach me at robbinrh@splava.cc.plattsburgh.edu