Epidemics have shaped world history. One has only to look at Black Death in Europe and the devastating effects of smallpox, measles, or syphilis on the indigenous populations of the New World to realize how the spread of disease affects human development. The Industrial Revolution of the 19th Century also offers important lessons about the impact of industrial pollution and adverse working conditions on overall health, especially of urban populations.

But the situation has changed dramatically as we begin the 21st century. The increasing population densities and globalization of the economy during this century have magnified the impacts of disease and environmental degradation by speeding communication and virtually erasing boundaries, which previously might have slowed the spread of pathogens. HIV-AIDS, West Nile Disease, and Ebola are a few examples of the many potentially lethal diseases that are truly international in scope.

By the same token, acid rain and other environmental conditions pose a similar threat to public health worldwide. Just as the outbreak of an epidemic in one corner of the world ultimately affects us all, so is it linked directly or indirectly to all the other major world issues such as population growth, governance, the rich poor gap, or the environment.

Population growth and movement have had a profound effect on the spread and genesis of disease worldwide. For example, those who move from rural to urban areas are susceptible to new diseases; increased population density in urban areas also guarantees that disease will spread more quickly. One of the most far-ranging developments of the 21st century is the aging of the world’s population. It is a well-established fact that population grows primarily because of a decline in mortality rather than an increase in fertility. As the population ages, priorities in health care change accordingly and different kinds of services are required. In wealthy nations result has been a marked decline in public health programs and increased emphasis on chronic diseases and diseases that affect the aging population.

In poorer nations the needs of pregnant women and newborn children are quite different and just as pressing. The major goals of the World Summit on Children for the year 2000, which focus on the reduction of the five year old and under mortality rate and the maternal mortality ratio, have not been met, especially in the poorest countries of the world. The resulting impacts on population trends in the developing world are profound. If women in the poorest countries had access to reproductive health services and could be assured that all of their children would survive beyond five years of age, the number of children born into those families would decrease dramatically.

Limited access to adequate health care only widens the gap between rich and poor in the world and intensifies the vicious cycle, which leads to further impoverishment. One only needs to compare the impact of the HIV-AIDS epidemic on the poor nations of Africa and South Asia to the United States to see how money talks when it comes to medical treatment. Even so, there are millions of U.S. citizens who have no health insurance and many more in the aging population who contend with substandard care and inadequate provision of drug treatment.

As the medical establishment responds to the needs of the rich countries and the affluent members of society, more emphasis is placed on treatment of chronic illnesses like cancer and heart disease, and less on preventive public health. In medical education, specialization is the watchword, with precedence given to more expensive diagnostic processes and end-of- life care. It’s been estimated that currently the per capita health spending in rich countries is $2,000. Experts contend that if we set aside only $38.00 for every person in the world we could reverse many of the negative trends in health care provision.

Poor governance often plays a critically important role in the failure to deliver adequate health care to all citizens. As we’ve seen in our exploration of other issues, globalization has increased the indebtedness of poor countries and given multinational corporations extensive power over the decisions of governments, which are dependent on their investments. When governments must decide between taxing cigarettes to limit smoking and the profits to be gained from their deregulated sales, they frequently opt for the latter.
Corrupt government practices influence everything from the funding of public hospitals to medical education programs, especially in the poorer countries. When you combine lack of accountability at all levels with pressure from international lending institutions like the International Monetary Fund (IMF) to privatize health services and remove the safety net, it’s not surprising that only the privileged few in most countries have access to adequate health care.

To a growing number of people, the failure of governments to acknowledge their AIDS epidemics and to provide low cost drugs is a gross violation of their human rights. Following the lead of Amnesty International, most international human rights organizations are insisting that the governments of the world must adhere to the major provisions of the International Covenant of Economic, Social and Cultural Rights. This means that pharmaceutical companies, for example, need to provide affordable retroviral drug treatment rather than guarding their patents and pricing drugs out of reach in those countries. Accepting the universality of human rights also means that governments and the international medical establishment must work against practices that have negative consequences on the health of young women such as female genital mutilation.

Food and water security are key links in the chain that leads to good health at all levels of a society and in the family of nations. There are probably no more essential elements in the preventive approach to disease than good diet and a clean, adequate water supply. Both ends of the economic spectrum are affected by diet: affluent countries suffer from the maladies of affluence like cardiopulmonary disease and other diseases associated with obesity and unhealthy diet and those who live on rice and beans are simply malnourished. Goal 3 of the 2000 World Summit for Children was to cut in half malnutrition rates among children under the age of five. We’ve fallen far short of this goal, and, in fact, the absolute number of malnourished children has increased in Africa. Many predict that, unless priorities are seriously reordered, water shortages will plague most of the world, especially if water sources are privatized as part of the process of globalization.

A changed environment challenges good global health. There are countless examples of the connection between environmental change and increased disease. For example, the anopheles mosquito has moved into larger and larger areas in response to global warming, and the increased rainfall in many parts of the world has led to a higher incidence of cholera, dysentery, typhoid, and other water-borne disease. Everyone is familiar with increased skin cancer due to our depleted ozone layer, the harmful impacts of herbicides and pesticides on both agricultural workers and consumers, and the impact of air pollution on young and old alike. In the industrialized world, workplace-related mental illnesses often associated with stress are becoming commonplace. Although some scientists are convinced that genetically modified organisms are the only answer to world hunger, others argue equally forcefully that they pose a profound threat to the flora and fauna of the world, as well as pose potential adverse impacts to human health. At the beginning of the 21st century it appears that an ailing environment is having a profoundly destructive impact on the health of world citizens.

Finally, ill health is a security threat to the world. Health problems have the potential to reduce economic output to the point that entire regions might be destabilized. The HIV-AIDS pandemic has had this effect on Africa where, in some countries like Uganda, Botswana, and Malawi, nearly an entire generation of farmers has died, crippling the ability of those countries to support themselves. As we have seen in our analysis of food and water security, unhealthy people are more vulnerable to military control and more likely to become involved in intercommunity conflicts out of desperation. A healthy population is more productive and less likely to become involved in the civil conflicts which plague many parts of the world today, as in Sri Lanka, the Middle East, and Afghanistan. In a destabilized world, it is also possible to weaponize pathogens as the ultimate chemical biological weapon available to terrorists or rogue states. There is no more lethal threat to global security than fast-spreading epidemics against which we have no real defense.

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