Globalization, Communicable Disease and Equity: A look back and forth
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Development. Copyright © 1999 The Society for International Development. SAGE Publications (London, Thousand Oaks, CA and New Delhi), 1011-6370 (199912) 42:4; 35–39; 010918.
Poverty, Health and Sustainable Development
Globalization, Communicable Disease and Equity: A look back and forth KELLEY LEE
ABSTRACT Kelley Lee explores the links between globalization and communicable disease and the extent to which globalizing forces may be contributing to widening inequities in the burden of communicable disease. Evidence shows that communicable diseases have long been characterized by inequity, and that different phases of globalization have contributed to this. Lee argues that there are distinct epidemiological patterns in recent decades of certain diseases suggesting that globalization, in its present form, is reinforcing existing, and perhaps even creating new, forms of health inequity.
Globalization and communicable disease in historical perspective Robertson’s definition of globalization, comprised of five historical stages since 1500, fits well with the work of many medical historians. On the history of communicable disease, the age of exploration from the 15th century and the arrival of Columbus in the Americas in 1492 is cited as a significant event in the geographical spread of disease across continents. Hence, diseases such as plague, typhus and influenza were transported via trading routes from Asia to Europe, and then onwards by land and sea throughout the old and new worlds. Similarly, syphilis is believed to have arrived from the Americas to Europe via explorers, while Europeans introduced measles, plague, smallpox and poliomyelitis to the Americas. Moreover, the slave trade brought hookworm, yaws, filariasis, leprosy and, it is believed, schistosomiasis and malaria to the Americas. It is from this period that medical historians date the advent of true pandemics.1 Increasing intensity of human interaction from the 16th century, the steady and at times rapid growth of human populations, growing urbanization, frequent military conflict and the process of industrialization beginning in Europe from the 18th century, offered many communicable diseases opportunities to spread more widely (spatial dimension) and frequently (temporal dimension).
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Development 42(4): Poverty, Health and Sustainable Development
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A key feature of this history is a clear pattern of inequity in the burden of communicable disease within and across countries. Each phase of this gradual globalization process has featured widespread social, economic and political changes that, in turn, have created winners and losers and often undermined traditional systems of social welfare centred on local communities that provided some modicum of public health provision. It is perhaps unsurprising, therefore, that one of the health impacts of this particular history of globalization has been the uneven spread of communicable disease to disadvantaged individuals and populations. The initial coming together of peoples
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