Globalization is characterized by liberalization of international trade, increased travel between countries and migration, and more exposure to the dominant Western media. Knowledge and technology are now shared at great speeds among people of different nationalities because of the wider availability of Internet connection. Governments around the world have more opportunities to work together in the globalized world. Despite the enormous positive benefits of globalization however, it also has negative consequences. Before the world became globalized, infection more or less remained on each country’s borders. With the ease of international travel today however, people all over the world are in greater risk of infection by diseases coming from different countries. While the risk of infection may be higher in a globalized world, there are also more means to control the spread of such diseases through the coordination of new international public health partners.
The World Health Organization (WHO) recognizes that health itself became globalized along with the world. Globalization has various effects on the health of populations, especially in developing countries which have fewer resources to deal with the phenomenon. With planes travelling nonstop across the globe, infectious diseases can now spread from one country to another in a matter of days or hours. People’s lifestyles are also changing, including patterns of food consumption, alcohol and tobacco use, and physical activity. Many of these changes are negative in nature, for instance, the diminishing physical activity of people. The WHO thinks that such transformations are more harmful to developing countries which have to deal with infectious diseases such as tuberculosis, HIV/AIDS and malaria, as well as non-communicable diseases like diabetes, cancer and cardiovascular disease (O’Laughlin et al., 2004, p.12).
Economic processes, political events, technological developments, cultural systems, and environmental factors are all forces that drive globalization. These forces may determine whether a certain pathogen can survive and spread in a given territory, infect populations, and cause the outbreak of disease. There are also many ways by which globalization may affect the treatment and control of diseases. For example, migration of workers can affect the rate of household incomes and the availability of health professionals. Health standards across the globe are also changing because of international agreements about healthcare systems. Thus, globalization may increase or decrease infections depending on where a certain population lives. Many experts agree however, that globalization is generally harmful in terms of healthcare in developing countries (Kawachi & Wamala, 2007, p.20).
Poor nations are less equipped to deal with the increased risk of infection because of their developing institutions. The WHO says that undernutrition is the leading cause of disease and death among children in developing countries. Undernutrition is basically a result of poverty and the consequent malnutrition in these nations (O’Laughlin et al., 2004, p.13). Globalization also poses a challenge for developed countries. Many experts in the United States have proposed that the country should include health in its foreign policy agenda. Accordingly, the US should do its part in developing a global health law that would protect its citizens from the increasing risk of infectious diseases on a global scale. Some have argued that issues such as infectious diseases and bioterrorism should be paid more attention since they concern national security. Government policies should also consider the security of national borders and the increasing mobility of people and pathogens (Institute of Medicine, 2003, p.40).
The current global spread of the A(H1N1) virus, commonly known as “swine flu” and the recent outbreak of SARS (severe acute respiratory syndrome) in East Asia demonstrate the new and greater challenge that the globalized world faces. The world today is just beginning to realize how big the threat of infectious diseases really is. People in developed countries used to think that infectious diseases have been conquered because of the wide availability of vaccines and antimicrobial drugs. Current issues in international health are now forcing people to view the situation more seriously however, as governments move toward international cooperation to better control the spread of infectious diseases (Fidler, 1999, p.6).
The realities of globalization all point to the greater risk of diseases spreading across bigger populations. For example, agrarian societies located near domesticated animals are more susceptible to zoonotic infections, such as cowpax, swine flu, and SARS. Urbanized communities where large numbers of people live in close proximity to each other are also vulnerable to infections transmitted through human contact, like influenza and plague. The constant travelling of people, from rural to urban and urban to rural communities, increase the likelihood of these diseases from spreading in wider territories (Merson, et al., 2006, p.687).
The threat of infectious diseases in a globalized world can be better understood if we review the association of meningococcal disease with the Haj, the traditional pilgrimage of Muslims to Mecca in Saudi Arabia. Because of easier ways to travel and increasing incomes, more and more people attend the Haj with a 100% increase in numbers each decade since 1949. In 2001, almost 2 million people went to the Haj, 75% of them coming from other countries. The setting of the Haj is perfect for the transmission of infectious diseases since large numbers of people interact with one another during pilgrimage. Medical experts have long discovered that the Haj actually regularly results in epidemics of meningococcal disease. The pilgrimage is linked to cases of meningococcal disease in many countries around the world. Secondary epidemics also usually occur two years after in countries where the participants return to (Merson, et al., 2006, p.687).
The fact that epidemics of meningococcal disease are linked with the Haj is a testimony to the seriousness of the challenge the world currently faces in terms of international health. Fortunately, while meningococcal disease is deadly when left untreated, there are vaccines that can prevent the transmission of this illness. The bigger problem is when the world encounters an infectious disease that has unknown prevention and cure. The SARS outbreak in East Asia in 2003 demonstrates the difficulty of controlling the spread of infectious diseases from one country. Currently, the apparent spread of A(H1N1) from Mexico to countries even in Southeast Asia also show how dangerous the situation is.
The A(H1N1) virus is a new form of the swine flu virus that has existed a long time ago. The world was unprepared for a deadlier version of the virus though, and many people in different countries panicked when the virus spread to their shores. Mexico, the apparent origin of the virus, was unprepared for the outbreak of the disease which took away several lives. However, it seems as if wealthier countries like the United States are as unprepared as Mexico in dealing with the transmission of the infection. Weeks after cases were reported in Mexico, A(H1N1) has reached countries such as Canada, China, Hong Kong, and many more. Although airports implemented policies aimed at containing the virus, the transmission of the virus from one country to another wasn’t stopped. There is currently no vaccine against the virus and the world seemed to be relieved to find out that the virus isn’t as deadly as initially feared. What happens however, if the virus suddenly evolves into a deadlier form? How will governments worldwide react to the absolute danger it poses to their populations? It is safe to say that people were just lucky this time that the virus turned out to be mild. Had it been more deadly, it would have caused more destruction, especially in developing countries where governments have fewer resources to control the spread of infectious diseases.
Globalization may affect the spread of infectious diseases not only through the increased mobility of people, but also through the increased trade worldwide. The WHO seeks to decrease trade barriers between nations. Trade agreements led by the WHO have resulted in increases in gross world population and trade. Populations of people living in market economies also increased because of the promotion of free trade. The wealth created in this type of trade determines the amount of resources a government may use to provide for the health care of its people. For example, the Asian financial crisis had some negative effects on the health of people since governments had less money to spend for the control of infectious diseases. This resulted in greater rates of infections like tuberculosis, HIV/AIDS and other sexually transmitted diseases or STDs (Kawachi & Wamala, 2007, p.21).
Some experts point out that the widening economic inequality within and between countries is a major factor in the vulnerability of poorer populations to infectious diseases. This is evident in the spread of multi-drug resistant tuberculosis (MDR TB) and HIV in populations with poor healthcare. Outbreaks of MDR TB have been reported in institutions like prisons, homeless shelters, and medical facilities in cities like San Francisco, Boston, and Washington DC. Breakdown of social order and political fragmentation are also associated with the rate of infectious diseases as evidenced by Russia and Eastern Europe in the 1990s when social cohesion was in deep trouble because of the uncertainty in Russian states. All of these clearly point out that developing countries which exhibit all these characteristics of relatively weak institutions are in more danger of succumbing to infectious diseases (Orme et al., 2007, p.19).
Bridging of the different countries of the world has always been associated with the spread of communicable diseases. When trade routes by land and sea were opened in the 1st Century to link the Mediterranean, China, and India, infectious diseases spread in many countries in the world. In the 13th century, massive outbreaks of infectious diseases occurred during the Mongol expansion to Europe (Jacobsen, 2007, p.170). The great plague in A.D. 165 is associated with the growing commerce between the Mediterranean and Asia at that time. The plague killed a quarter of the population of the Roman Empire. The “black death,” the epidemic which took away a third of the European population, was also transmitted to China as the Mongol empire expanded in central Asia. The disease later reached the Mediterranean and the Crimea as caravans went from one border to another due to trade (French, 2000, p.41).
Today, trade routes are not only restricted to two or three regions in the world, in fact, they encompass the entire globe. Planes, ships, and automobiles are much faster than the caravans and sailing ships of olden days. In a matter of hours, living and nonliving things that may carry infectious diseases are transported from one country to another (Apostolopoulos & Sonmez, 2007, p.8). These developments in trade and geographical mobility of people are definitely changing the way infections spread to different populations. In the case of SARS, international air travel was one of the biggest factors in its spread. Unlike in the old days where a ship identified as carrying infection can be easily quarantined in a port, today, the round the clock operation of airports make it almost impossible to stop an infection from spreading fast. In fact, it took smallpox centuries before it was able to cross the Atlantic. SARS however, spread to 30 different countries in five continents in just a few weeks (Bennett & Tomossy, 2006, p.3).
The SARS epidemic and the current A(H1N1) spread across the globe both demonstrate the need for healthcare systems in the world to improve their ability to respond immediately. Epidemics take greater tool on the healthcare systems of developing countries which can’t deploy enough resources to control the spread of the disease. In both of these cases, poor policies in hospitals and medical centers have also led to the disease infecting medical workers themselves. In the case of SARS in Beijing, 123 fever clinics were immediately set up, 79 new radiograph machines, 76 new ambulances, and 759 new mechanical ventilators were obtained to respond to the outbreak. Canada took notice of this surge capacity and observed that all nations should develop the capacity to boost their healthcare systems when epidemics strike. The spread of A(H1N1) at various points in the globe underscored this need once again, which developing countries may find difficult to meet because of economic constraints (Bennett & Tomossy, 2006, p.4).
One of the most important aspects of infectious disease control in a globalized world is the availability of epidemiologic and clinical data. Today, the furthest nations have come to international cooperation regarding infectious disease control is the International Health Regulations (IHR) which was adopted by the WHO in 1951 and revised in 1973. While the regulations were admirable because of its coordination of efforts by member countries, it only covers cholera, plague and yellow fever. The IHR needs to improve on specific policies on how countries may notify the world about outbreaks, incentives for compliance with such policies, and mechanisms for collaboration regarding control of infectious diseases (Merson, et al., 2006, p.689).
The Mexican government was recently heavily criticized because of its slow release of data about the spread of A(H1N1). The international media initially didn’t know what was exactly happening, what the disease was, and how many people had already succumbed to it. The same thing happened to China during the SARS outbreak in 2003. Many experts believed that the real reason the Chinese government didn’t immediately report the outbreak was because it feared to lose investment and trade revenues. Both these instances show the need for the WHO to create incentive programs to reward nations for their compliance on international health regulations, as well as penalize nations which do otherwise (Merson, et al., 2006, p.690-691). Had Mexico and China moved quickly in disseminating information about their respective outbreaks, governments of other countries would have had more time to put resources in place to stop the transmission of such diseases to their shores.
International health regulations are not the only solution to the problem of infectious diseases in a global world. Another potential solution is to further improve information and communication technologies that are critical in the sharing of knowledge. The Internet has been enormously useful in informing people about new and emerging diseases. Its use must be better promoted by healthcare systems so everyone will be ready in case another epidemic begins to manifest. Some countries are now using the Internet to make specialists available for consultation to other medical professionals around the world. This system reduces the cost of providing healthcare by making data available online instead of sending actual medical workers to destinations around the globe (Institute of Medicine, 2003, p.39). Developing countries would benefit more through this kind of system of healthcare as they have fewer resources to pay for the services of foreign physicians in their countries.
All in all, controlling infectious diseases in a globalized world must come in the form of international cooperation. A single nation can’t handle the threat of an outbreak alone. It must appeal to the help of others to effectively stop the outbreak immediately. The WHO must continue developing its international regulations on infectious disease control by adding more diseases to the list, such as A(H1N1) and SARS. All member countries should then be clearly informed of these regulations and they must comply with them regardless of possible consequences on their trade profits. Security in airports and other points of entry must also be fortified since infections can travel at amazing speeds in the globalized world. Detection and diagnosis must be quick in all points of entry to ensure that an outbreak is immediately contained.
Different modes of communication must be more extensively used to share information more quickly regarding infectious diseases. Internet use must be promoted in all medical institutions, so knowledge can quickly be disseminated. In all of these solutions to infectious disease control, developed countries must always be concerned of the plight of developing countries. Developed countries must help them the best they can to stop infections from reaching their countries. Globalization may be dangerous in terms of infectious diseases but it also carries with it the solutions to eliminate the problem.
References
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