1. Globalization, Health, and Pandemic Diseases 1. Globalization and Health 2. Infectious Diseases and Pandemics 3. Causal Factors 4. Case of HIV/AIDS

2. Global health revolution: Global life expectancy: 1948 – 46 years1999 – 65 years Global health revolution: health care and prevention, communications, agricultural productivity, trade

3. Science and the “Conquest” of Infectious Disease  Scientific triumphs: antibiotics, vaccines, sanitation  Led scientists 50 years ago to proclaim would conquer infectious disease by turn of 21 st century (1977: Smallpox Zero)

4.  Optimism based on false assumptions:  Diseases could be geographically isolated  Microbes didn’t change

5.  Since 1973:  31 Emerging Infectious Diseases (EIDs)  HIV/AIDS, Hepatitis C; Lyme Disease, Ebola, Hantavirus, SARS  20 Reemerging Diseases  TB, diphtheria, malaria, cholera, yellow fever)

6. Health and Pandemics  The Reemergence of Infectious Diseases as a Global Problem  Links between reemergence and globalization

7. Nils Daulaire, Globalization and Health Development 1999 “No microbe in the world is now more than 24 hours away from the gateways of every industrial country.” “No microbe in the world is now more than 24 hours away from the gateways of every industrial country.”

8. Infectious Diseases  caused by viruses, bacteria, parasites, fungi and other microbes  spread by direct contact:  contaminated food or water  insects  contaminated surroundings (e.g. air, animal droppings)

9. Disease Classifications  Localized Occurrence = occasional infection (e.g., malaria, cold, food poisoning)  Epidemic = unusual occurrence of a disease across a population (e.g., flu, measles, strep)  Pandemic = worldwide epidemic affecting large proportion of global population

10. The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2000. All rights reserved Equality index of child survival World Health Organization

11. Why is the Reemergence of Infectious Disease a Global Issue?  Infectious Disease is the leading cause of death globally  Greatest impact in LDCs (sub-Saharan Africa 50% of deaths from ID globally), exacerbating other problems  Growing evidence infectious pathogens contribute to other diseases (cancers, heart disease)  High economic costs: trade disruptions, tourism

12. Factors Leading to Emergence and Reemergence of Infectious Disease  I. Microbial Adaptation  Genetic mutation and evolution  Resistance to antibiotics  Resistance to pesticides by vectors  (e.g. influenza, HIV, malaria, staph.)

13. II. Social and Environmental Changes (Human activity)  A. Demographic Factors  Population Growth (densities spread disease)  Urbanization. rural-urban migration  Sudden movements of people: refugees and internally displaced populations

14. II. Social and Environmental Changes (Human activity )  B. Human Behaviors  Multiple sex partners  Sex industries  Intravenous drug use  Misuse of antibiotics  Institutions (hospitals, daycare) that incubate

15. II. Social and Environmental Changes (Human activity)  C. Global Commerce and Travel  Air Travel since the 1970s (speeds transmission)  Movements of People (tourists, migrants, military personnel) spread pathogens to new populations  Commerce spreads contaminants across borders via food, plants  Hitchhiking insects. E.g. Foot and Mouth Disease

16. II. Social and Environmental Changes (Human activity)  D. Globalization of Food Supplies  Free trade and comparative advantage  Limited regulation of food production, preparation, handling and outdated laws  Cheap animal feed (Mad Cow Disease and new variant -- Creutzfeldt-Jakob)  (cf. human food lobby and McDonalds)

17. II. Social and Environmental Changes (Human activity)  E. Economic Development and Environmental Degradation  Changes in land use: reforestation; encroachment on tropical forests; conversion of grasslands to farms; clearance of rainforest for farming spread  Zoonotic diseases (jumps from animal to human)  Flus, SARS

18.  Changes in water management (dam building) spreads water-breeding vectors (mosquitoes, snails)  malaria in Nile valley Undermines local livelihoods forcing migration

19. II. Social and Environmental Changes (Human activity)  F. Climate Change  Global warming favors mosquitoes, rodents, other insects: spread of malaria in highland areas; spread of subtropical diseases into US  Ocean algae blooms  Weather patterns (impact of floods, droughts)

20. II. Social and Environmental Changes (Human activity )  G. Breakdown of Public Health  Complacency: faith in antibiotics and vaccines undermined spending  Failure to keep up with new technologies  National disasters and economic collapses (impact of structural adjustment programs)

21. Difficulties of responding to the threats  High costs of drugs and vaccines (intellectual property rights?)  Beyond ability/resources of national governments  WHO does not have sufficient resources or ability to influence broader social and economic policies

22. HIV/AIDS pandemic:  Begins in 1950s; explodes in 1970s; identified 1980s  HIV/AIDS: unifies many elements responsible for the recent emergence of new infectious diseases

23. Pandemic: HIV/AIDS in Africa  http://www.time.com/time/2001/aidsinafrica/m ap_flash.html http://www.time.com/time/2001/aidsinafrica/m ap_flash.html http://www.time.com/time/2001/aidsinafrica/m ap_flash.html  http://www.securethefuture.com/aidsin/data/ai dsin.htm http://www.securethefuture.com/aidsin/data/ai dsin.htm http://www.securethefuture.com/aidsin/data/ai dsin.htm

24. HIV/AIDS pandemic: 68% of those with HIV/AIDS live in sub-Saharan Africa In Botswana, Namibia, Swaziland and Zimbabwe over one person in five aged 15-49 is living with HIV or AIDS. In some parts of Africa, HIV/AIDS has reduced life expectancy to around 43 yrs and lower

25. AIDS orphans Categories of orphans: no parents will soon loose remaining parent(s) will loose parents within 3-5 years will loose grandparents/caregivers is also infected In some cities in South Africa, no burial space left in city graveyards

26. Senegal’s success High risk factors: low income high illiteracy traditional customs migrant worksex trade Senegal’s anti-AIDS campaign  Sex worker registration and regular health checks  Islam – abstinence, fidelity, ban on alcohol  Islamic leaders’ support for anti-AIDS programs  Government information programs

27.  Brazil’s ‘condom campaign’:  http://www.lifeonline.org/archive/citylife18script. html# http://www.lifeonline.org/archive/citylife18script. html# http://www.lifeonline.org/archive/citylife18script. html#  LifeonLine: http://www.lifeonline.org/archive/citylife18script. html# http://www.lifeonline.org/archive/citylife18script. html# http://www.lifeonline.org/archive/citylife18script. html#  A multimedia initiative about the impact of globalization

28. International Responses and Action http://www.aids2000.org/

29.  United Nations Aids Organization  http://www.unaids.org/en/default.asp