Globalization and Epidemic Disease
The Rise of Globalization
Although international exchange and interdependence have occurred as long as global trade has existed, today's globalization is exceptional because of the unprecedented worldwide integration of markets and the increased role of transnational corporations and international financial institutions in social policy making. The World Bank, International Monetary Fund (IMF), and World Trade Organization (WTO)—together with corporate interests—have enormous influence over global and domestic social and economic policy making; international health policy is, in turn, dominated by a market-led paradigm that fosters privatization and overlooks the underlying determinants of disease.
For much of the post–World War II period, it was assumed that economic development and technical progress would eliminate the problem of infectious disease; global life expectancy has indeed increased, and there have been some key advances in disease control (most notably, the eradication of smallpox) as a result of international cooperation. However, not all attempts at disease control have been so successful. Many diseases once thought to be in retreat, including malaria, cholera, and tuberculosis, have reemerged, partly as a consequence of current global economic patterns and policies. Newer diseases, such as HIV/AIDS and Severe Acute Respiratory Syndrome (SARS), are also linked to economic conditions and global interrelations.
For both new and reemerging diseases, the privatization and dismantling of government-funded social protections and programs that have accompanied economic globalization—in many developing countries via the Structural Adjustment Programs of the World Bank and IMF—have increased vulnerability to disease for marginalized groups.
As an example, the resurgence of cholera in South America in the early 1990s began with a freighter ship's discharge of cholera-infected ballast water from China off the coast of Peru. The cholera bacteria infected local shellfish and entered the food supply, reaching the Peruvian population. Thereafter, the bacteria spread rapidly through overcrowded slums. Government cutbacks in public health, sanitation, and infrastructure—imposed by IMF and World Bank loan conditions starting in the 1980s—enabled the disease to spread unchecked, killing thousands in Peru and neighboring countries.
Like mass refugee movements in war-torn African nations, the trade, travel, and economic development accompanying contemporary globalization have exposed new disease reservoirs and expanded opportunities for exposure between pathogens and people. Today's mass movements of people and goods increase the chances of disease vectors being introduced into areas where they previously did not exist. The large-scale exploitation of natural resources leads to human encroachment on previously uninhabited areas where they may be exposed to pathogens to which they have no immunity. In central Africa, for example, logging, and consequent road construction, has brought people into contact with the Ebola virus via contact with wild animals. The transmission of insect-borne diseases has also been affected by warmer temperatures and expanding habitats associated with climate change, which many scientists link to industrialization.
Travel and Emigration
Perhaps the most visible link between globalization and the spread of disease is the increased speed and volume of global travel. As demonstrated by the SARS outbreak of 2003 and the COVID-19 outbreak that began in 2019, an infectious agent appearing anywhere in the world can circulate around the globe in a matter of days. SARS also illustrated the ability of globalization to help contain disease; the speed of global communication enabled accurate surveillance, reporting, quarantine, and eventual containment.
Globalization has also affected nutritional patterns, interpersonal violence, medical practices and personnel, and environmental health problems such as pollution. In some cases, rapidly diffused information helps to address disease, for example through the sharing of medical information and techniques via open source journals and international training programs. But in other ways, the work and living patterns of a "globalized world" increase people's susceptibility to disease as a result of work stress, consumption of unhealthy food, and exposure to pollutants in the home, workplace, and surroundings.
Along with increasing exposure and susceptibility to disease, globalization has also limited governmental capacity to address ill health. The migration of doctors and nurses from developing to wealthier countries—the "brain drain"—is a key factor here. Drawn by higher wages, improved working conditions, and better supported health care systems, thousands of health care workers trained in developing countries (usually with public resources) have emigrated to wealthier nations, worsening the human health-care resources deficit in their home countries and widening health-care inequities worldwide.
Trade and Patent Restrictions
The supremacy of trade liberalization has also limited governments' abilities to address epidemic disease, as international trade agreements promote profits over human well-being. The WTO's agreement on Trade Related Intellectual Property Rights (TRIPS), negotiated in 1994, has exacerbated the impact of diseases such as HIV/AIDS in low-income countries by protecting profit-making, patented pharmaceuticals, effectively blocking treatment for millions of people. The WTO's 2001 "Doha Declaration" affirms the rights of states to protect public health in emergency situations, transcending TRIPS requirements. Many developing countries, however, lack the capacity to adopt the Doha provisions. Moreover, many developing countries are pressured to avoid adopting measures to protect public health in order to safeguard trade interests.
Marginalized populations—the poor, migrant workers, refugees—bear the brunt of (re)emerging epidemic disease, but in a globalized world everyone feels threatened. This perception of threat—often fueled by overblown media coverage of remote risks such as "mad cow disease"—has led to the intensification of health diplomacy and the formalization of foreign health policy on the part of many nations in both the developed and developing world.