| A. The State of Global
Health |
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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.
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Reading 1. World Health Report-1998
(Executive Summary)
http://www.who.int/whr/1998/exsum98e.htmSee also the 1999 Report
or the Press
Release |
 |
Each year the World Health Organization issues its report
on the state of global health. This 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. |
Reading 2. 50 Facts from the 1998 World
Health Report
http://www.who.int/whr/1998/factse.htm |
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These 50 facts from the 1998 WHO
Report highlight some of the findings about the state of global health. |
Reading 3. Causes of Death: Distribution
of Death by Main Causes by Level of Development, 1985, 1990, 1997
http://www.who.int/whr/1998/fig6e.jpg |
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This chart 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. |
Reading 4. The Silent Emergency
http://www.unicef.org/sowc98/sum01.htm |
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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
http://www.cihi.com/imr.htm(no longer available: check http://unsd.ics.trieste.it/pmappl/unesco/sld022.htm) |
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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. This data from the Center for International Health will allow
you to review these rates for different parts of the world and from different countries. |
| B. The Dynamics of
Disease Causation |
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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.
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Reading 5. Evolution and the Origin of
Disease
http://www.sciam.com/1998/1198issue/1198nesse.html |
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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.
This article by Randolph N. Neese and George C. Williams, from Scientific American, describes how our
evolution influences our susceptibility to disease. |
Reading 6. Social Inequalities
and Emerging Infectious Disease
http://www.cdc.gov/ncidod/EID/vol2no4/farmer.htm |
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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
www.pbs.org/amex/influenza/ |
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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 |
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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.
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Reading 7. Mortality
and Environmental Pollution
http://www.news.cornell.edu/releases/Sept98/ecodisease.hrs.html |
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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 is available on line (for a $2.50 fee)
at Northern Light. The title
of the article is "Ecology of Increasing Disease: Population Growth and Environmental
Degradation." The article should be read in its entirety. |
Reading 8. Reemergence of
Epidemic Malaria in the Highlands of
Western Kenya
http://www.cdc.gov/ncidod/eid/vol4no4/malakooti.htm |
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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 9. Pollution and Disease
http://www.cnie.org/pop/pai/water-21.html |
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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 10. The Sanitation Gap
http://www.unicef.org/pon97/water1.htm |
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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 11. Big Tobacco's
Global Expansion
http://www.essential.org/action/addicted/main.html |
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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 |
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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.
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Reading 12. Report on the Global AIDS/HIV Epidemic-1998
http://www.plattsburgh.edu/legacy/global_AIDS1998.htm |
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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.
You can also access the document directly in pdf format here. 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 13. International Epidemiology
of AIDS/HIV
http://hivinsite.ucsf.edu/akb/1997/01epiint/index.html |
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This is a selection from The AIDS Knowledge
Base, an Online textbook on HIV disease from the University of California, San
Francisco and San Francisco General Hospital. It documents the prevalence and
affects of HIV/AIDS infections in different parts of the world. In the textbook you
can also find a chapter on Epidemiology of HIV/AIDS in the United States, as well on information on
the nature and spread of the disease. |
Reading 14. The Impact of AIDS in
Developing Countries
http://www.worldbank.org/aids-econ/confront/press-1/index.htm |
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This brief report from the World
Bank describes some of the measures taken to prevent the spread of HIV/AIDS. |
Reading 15. The Demographic Impact of HIV/AIDS
http://www.popin.org/pop1998/6.htm |
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The AIDS epidemic has forced
demographers to reappraise their estimates of population growth in areas hit hardest by
the epidemic. This brief report from the United Nations describes how rates of
population growth and life expectancy have changed in some regions because of AIDS. |
| Reading 16. Being Alive:
AIDS in Africa. A Personal Report http://library.jri.org/library/news/alive/alve9609k.html |
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Statistics depersonalize events,
turning people into portions of percents. Yet illnesses such as AIDS affect more
than the person infected. You very probably know someone who has HIV/AIDS. In
this final selection, a young woman from Zambia describes what it is like to have AIDS,
and how it affects her social networks. |
Additional
Internet Resources on Disease |
