History of Medicine Pandemics part 5 - Globalization + disease transmission.pdf

HISTORY OF MEDICINE AND PANDEMICS Dima Karam Fall 2023 Globalization, disease transmission & health These lectures offer insights into medicine’s past, ask what has shaped contemporary medicine, highlighting the evolution in medical theory, understandings of how the body works, how disease occurs...

HISTORY OF MEDICINE AND PANDEMICS Dima Karam Fall 2023 Globalization, disease transmission & health These lectures offer insights into medicine’s past, ask what has shaped contemporary medicine, highlighting the evolution in medical theory, understandings of how the body works, how disease occurs and advances in treatment. The course will also address essential medical breakthroughs so that you have a firm general grasp of major advances in the history of medicine. We will follow a chronological order to cover the following periods: Session 1: Session 4: ★ classical antiquity Covid-19 timeline: Pandemic of modern times ★ arab and medieval medicine Session 2: Session 5: ★ early modern Globalization, disease transmission & health ★ 20th and 21st century medicine Session 3: Session 6: ★ History of the most marking pandemics Future frontiers in medicine HISTORY OF MEDICINE AND PANDEMICS PART V GLOBALIZATION AND DISEASE TRANSMISSION Globalization Global Health How globalization impacts health One Health Initiative Zoonotic Diseases  Globalization ★ Refers to the increasing integration of economies around the world, particularly through the movement of people, goods, services, technology, and capital across borders. ★ It describes the ways in which nations, businesses and people are becoming more connected and interdependent across national borders through: Easier travel and communication Mixing of customs and cultures (“cultural diffusion”): increased interactions between different regions and populations Integration of national economies (removal of barriers to international trade and finance) – ‘liberalization’ or ‘openness’  Globalization The term "globalization" is used to describe a variety of economic, cultural, social, and political changes that have shaped the world over the past 50 years: From the revolution in information technology: Internet, communication technology to the shrinking national and geo-political boundaries in an always expanding, transnational movement of people, goods, services, and capital All these features are one way or another, attributed to globalization: Rapid spread of diseases Making consumer tastes similar (Zara, iphones, smartfones "McDonaldisation" of food and culture Expansion of corporate power (Banks, businesses) Sharp increases in wealth and poverty Growing presence of liberal ideas everywhere Globalization So globalization also involves the development of int trade: → Trade in human resources, goods, technology + h05ealthcare Globalization means we cannot view national health, interventions and policies in isolation from: – other countries – other sectors (e.g. travel, finance) Example: availability of medicines in Lebanon, healthcare costs How Globalization aspects can affect health Cross-border disease transmission Effect on health from economic growth (health + wealth) Environmental degradation (air, water pollution) Improved access to knowledge & technology Marketing of harmful products (vapes, fast food, cigarettes) Conflict & security Positive and negative effects of globalization Globalization can’t be described as either “good” or “bad” for health. Rich countries can fear/perceive threat from low-income countries: o Acquiring certain acute and epidemic infections: tuberculosis, malaria, Hepatitis B, ebola, severe acute respiratory syndrome (SARS), HIV/AIDS o The potential financial burden of unhealthy populations migrating from the developing world Risks of products exported by high-income countries to other parts of the world such as tobacco and fast food: not fully estimated. → the increased movement of people and other factors create a complex equation of pluses and minuses for each society.  Globalization and health – negative effects Low access to vaccination, medicines + healthcare in a pandemic: Lebanon, trade agreements for vaccines Cross-border transmission of disease Environmental degradation (e.g. air, water pollution) Marketing of harmful products and unhealthy behaviors: alcohol, tobacco, drugs, fast foods Conflict and security Displacement of people, through deforestation or urbanization or conflict Trans-national businesses applying lower professional/social standards (headquarters in one country but with business operations in others) Concentration of hazardous waste in developing countries Harmful forms of work and exploitation: child labor, working hours, poor health + sanitation conditions  Globalization and health – positive effects Link between health and wealth: o Globalization helps increase wealth through trade, health improves to a certain extent as countries get richer. Improved access to knowledge and technology: o Sharing good practices: increased access to medicines, medical info + training: shipping drugs to remote regions through improved transport + communication Movement of people: o Travel for healthcare, migration of health professionals for better opportunities in needy places o Medecins sans frontieres, NGOs etc..”Cuban Medical Internationalism”: Doctors Without Borders-like program by the government  Global health and health risks So health risks in the 21st century are trans-national and are not affected by boundaries. Grouped in: 1. Infectious diseases 2. Obesity concern: Food – drink – obesity 3. Mobility of people Global health and health risks 1- Infectious diseases Easy and quick spread of infectious diseases: - Travel - Tourism - Trade - Ecology: coming close to wild animals - Migration - Urbanization, population growth and density: crowding The potential for emerging infectious diseases to spread rapidly and cause global epidemics is a major concern. Global health and health risks 1- Infectious diseases - In 2007 WHO warned that infectious diseases are emerging at a rate not seen before - Disturbances to the environment caused by human activity and imbalances in the ecosystem between humans, animals, germs, and the environment can also create conditions where diseases can reappear or can emerge. - Many widespread infectious diseases in humans are caused by germs that emerged from animal hosts moving to new environments: a recent example being Covid-19. - Understanding the factors in the balance between the environment, germs, and hosts is important when planning measures to control outbreaks Global health and health risks 1- Infectious diseases (Cont’d) The role of environmental changes is directly linked to IDiseases 1. Long-distance + rapid trade + deforestation affect the redistribution of some species of animals which affect the environment and disease transmission. 2. Increase in food production is associated with increased use of energy and nitrogenous fertilizers, leading to some changes in the constitution of soil and so leading to new diseases. Urbanization Desertification Changes in food-producing Global climatic changes ecosystem  Global health and health risks 2- food – drink – obesity Obesity epidemic associated with: ○ Lower production cost and overuse of fat-sugar-salt (associated with low physical activities) ○ Affordability and accessibility issues ○ Intensive marketing; lack of regulations on advertisements ○ Lack of/or ineffective health promotion activities Global health and health risks 3- People mobility Increased mobility of Migration women New slave markets Rural to urban Forced prostitution Domestic Public to workers private Health workers Poor to rich countries Low paid service work People might contract a disease in one country and travel to other countries before they are symptomatic.  Global health and health risks 3- People mobility: human resources for health (HRH) WHO: Shortfall of 18 million health workers by 2030, primarily in low- and middle-income countries Globalization involves movement of labour, including medical professionals: ratio of physicians to people in Lebanon was one of the highest in the Eastern Mediterranean Some think globalization is good: movement of goods, technology, labour etc. makes the world richer Some think the opposite: people lose out through this process Example: “Brain Drain” The exit of highly skilled workforce (‘brains’) from countries who then lose out: e.g. Nurses from Nigeria/Philippines head hunted to work in the UK  What is One Health? One Health Initiative emerged from the idea of the “World becoming a single entity”: people’s health is connected to animal health and the environment: animal feed, human food, animal and human health and environmental contamination are closely linked. One Health is an integrative collaborative approach to implement health programs & policies across multiple sectors to reach optimal health for people, animals, and our environment. One Health is geared towards: Improving the lives of all species (human and animal) + environment Through the integration of human medicine, veterinary medicine, and environmental science Dedicated to issues like: controlling animal to human infections, food safety, combating antibiotic resistance, vector-borne diseases, environmental contamination and other health threats like effects of climate change  One of the lessons learned from COVID-19 is that emerging infectious diseases that have an animal cause are here to stay and fighting new disease threats requires One Health collaboration We can only prevent future pandemics with an integrated One Health approach to public health, animal health and the environment Oddly, the COVID-19 pandemic is giving us a unique opportunity to drive real change” One Health was the focus of G7 (world leaders (industrial nations)) and G20 meetings (19 countries + EU) in 2022 WHO will host secretariat of a One Health High Level Expert Council  What is One Health? (Cont’d) Human Animal Environmental Traditional public health One Health approach model So a one health approach: Recognizes the relationships between the human, animal, and environmental health (and how their health is interconnected) Many of the same germs infect animals and humans, as they share the ecosystems they live in: to effectively contain them, a well-coordinated approach in humans and in animals is required as well as enviro protection. What is One Health in a rapidly developing international context? The approach has been formally adopted by many international organizations such as : o World Health Organization (WHO) o The European Commission, the US Department of State o US Centers for Disease Control and Prevention (CDC) o World Bank o UNICEF, United Nations System Influenza Coordination (UNSIC), UN Environment Programming (UNEP), World Organization of Animal Health o Food and Agriculture Organization of the United Nations (FAO) o Various Universities The current One Health movement is an unexpected positive development that emerged following the Highly Pathogenic Avian Influenza. Example One Health concept Example One Health concept Why is One Health important? Around 75% of emerging and reemerging infections are zoonotic diseases Source: International Livestock Research Institute  What are zoonotic diseases? Zoonotic diseases: Infectious diseases transmitted between species: from Animals to Humans or vice versa https://www.grida.no/resources/13594  What are zoonosis? Recently, researchers have determined that more than 75% of emerging infectious diseases in people actually come from animals (CDC 2021) Examples: Covid-19 The flu - Influenza A virus Bird Flu H1N5 HIV/AIDS Mad cow disease Severe Acute Respiratory Syndrome (SARS) MERS Measles Hepatitis E How do germs spread between animals and people? + airborne: transfer of viruses  Reasons for the emergence of zoonotic diseases Growth in population Rapid urbanization Increase in microbial resistance Poverty and susceptibility (vulnerability) to infection International travel/globalization Increase in trade + --->  Who is at a higher risk of serious illness from zoonotic diseases? Same people at risk for serious illness usually: Children under the age of 5 years Adults over the age of 65 years Pregnant women People with weakened immune systems Videos Globalization explained https://www.youtube.com/watch?v=JJ0nFD19eT8 What is globalization https://www.youtube.com/watch?v=xPD477FuqtY One Health https://www.youtube.com/watch?v=l5vqmyS6aTw: 1.44 minutes https://www.youtube.com/watch?v=Ndfi9QbdXVY Infographic: One Health explained: Interconnectedness of Antibiotic Resistance https://www.cdc.gov/drugresistance/pdf/threats-report/One-Health-Challenge-508.pdf Article: One Health at the G7 summit: G7 leaders commit to greater pandemic preparedness https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(21)00156-7/fulltext  Global health and health risks 1- Infectious diseases prevention 1. Control and monitor cross-borders movement and trade o Balance between reserving the rights of the industry and protecting public health is challenging 2. Management of outbreaks at different levels (economic, social + even political) o Quarantine in big epidemics o Tracking & reporting approaches, surveillance systems and their link to the capacity of developing countries to detect cases o Role of international health regulations and their benefits and problems: ie PCR testing etcc One Health priorities can be achieved through: Prevention of zoonosis Handle food safely: o Cooking all foods of animal origin to safe temperatures: meat, eggs, dairy, fish o Thoroughly washing vegetables shortly before eating Handwash after contact with animals or surroundings Prevent bites from mosquitoes, ticks, and fleas Where safe water is unavailable, drinking water should be boiled, filtered, or otherwise treated to remove pathogens Avoid bites and scratches from animals (Tetanus shot) Avoid accidental ingestion of lake or stream water Globalization, Climate Change, and Human Health EFFECTS OF GLOBALIZATION ON THE ENVIRONMENT 1. Increased Transport of Goods: Increased emissions: The farther a product travels, the more fuel is consumed, and a greater level of greenhouse gas emissions is produced.These emissions contribute to pollution, climate change, and ocean acidification around the world and have been shown to significantly impact biodiversity. Habitat destruction: Transportation—especially when land-based—requires infrastructure like roads and bridges. The development of such infrastructure can lead to issues including habitat loss and pollution. Invasive species: Every shipping container and vessel presents an opportunity for a living organism—from plants to animals to fungus—to hitch a ride EFFECTS OF GLOBALIZATION ON THE ENVIRONMENT 2. Economic Specialization Trading partners for goods they don’t produce themselves Illegal deforestation in Brazil due to an increase in the country’s cattle ranching operations, which requires significant land for grazing Overfishing in coastal areas that include Southeast Asia, which has significantly contributed to reduced fish populations and oceanic pollution Overdependence on cash crops, such as coffee, cacao, and various fruits, which has contributed to habitat loss, especially in tropical climates EFFECTS OF GLOBALIZATION ON THE ENVIRONMENT 3. Decreased Biodiversity Increased greenhouse gas emissions, ocean acidification, deforestation (and other forms of habitat loss or destruction), climate change, and the introduction of invasive species all work to reduce biodiversity around the globe. According to the World Wildlife Fund’s recent Living Planet Report, the population sizes of all organisms—including mammals, birds, fish, amphibians, and reptiles—have decreased 68 percent since 1970. Latin America and Africa—two rapidly developing regions important to global trade—have seen disproportionate levels of biodiversity loss