The Coming Global Public Health Revolution in the Post Exotic Age

[Guest guest]

The Coming Global Public Health Revolution in the Post Exotic Age

By Brown Childs

Sociology Dept.

Univ. of California, Santa Cruz, 95064

jbchilds@...

3 January 2008

We recently got a wake-up call about the need for global public health

when the story of "the first outbreak of a tropical disease in modern

Europe" appeared in the 23 December 2007 New York Times.

beth Rosenthal, in her article entitled "As Earth warms Up, Virus

from the Tropics Moves to Italy" describes "panic" spreading over the

northern Italian village of Castiglione Di Cervia in August of this

year, as resident after resident "fell ill with weeks, of high fever,

exhaustion and excruciating bone pain." After some misdirected initial

blame aimed at migrant African farm workers, the contributing cause

was discovered to be from a local Italian who had visited India, and

been infected with the mosquito-borne chikungunya virus. This

infection, plus the current presence of large numbers of Tiger

Mosquitoes in Italy that can pass the micro-organism on from person to

person, are the links in this world spanning disease chain.

Of course, in one sense there is nothing new about the spread of

infectious diseases, think about the bubonic plague transmitted via

rats and fleas throughout medieval Europe. My own maternal Native

American ancestors, the Massachusaug people of coastal New England,

were among the hundreds of thousands of East Coast indigenous peoples

impacted by diseases brought by the European colonists in the early

1600's. Estimates are that the Massachusaug people (in the Blue Hills

south of what is now Boston) were reduced from around 20,000 people in

1600 to about 600 after major 1617-1619 epidemics. The same pattern of

indigenous population decimation due to introduced European diseases

(often leaping ahead of the explorers and colonizers themselves) is a

tragic story from Tierra del Fuego to the Arctic and out across the

Pacific.

But there some significant new elements in the pattern of this

infectious disease that hit the people of Castiglione di Cervia. One of

course is the high efficiency and relative ease of long distance

travel. Visits by millions of tourists to "far-off places," that

require only a couple of days on planes at most, must be compared to

months of sea voyage for very small numbers of European explorers and

colonists across the Atlantic and Pacific in the 17th and 18th

centuries. Today, more people moving faster over great distance equal

more possibility for spread of infection. The Italian traveler to

India is but one example of this situation. But there is another even

more important element in the story by Rosenthal. The Tiger Mosquitoes

that spread the disease in that Italian town are there in hordes

precisely because of climate change-warming that environment. As warm

moist climates move north due to global warming so also move some of

the flora and fauna that go with those conditions. Sub-tropical areas

can become tropical, temperate areas can move to being sub-tropical.

The harsher longer winters that protected against the spread of

disease bearing insects such as Tiger Mosquitoes, are moving north

leaving the milder climate field to those insects and the parasites and

micro-organisms that they can carry.

So the usual "us vs. them" response of "closing borders" to keep out

so-called aliens is misplaced. Such shut-the-border-down thinking does

not address the core climatic problem at issue here. Nature is

crossing borders as the climate changes. Regardless of one's

ideological position about causation, these changes are becoming more

and more apparent as we see in Northern Italy (to name but one

location). The result is nothing less than the end of the exotic. We

are moving into a Post-Exotic Era, in which infections, once

prejudicially considered to be bizarre emanations of far-off places,

become as domestic as house pets. The world consists of complex

diversities of a myriad of sorts. The Post-Exotic world is not one of

homogenization. Rather it is one in which we (meaning all of us

everywhere) consider differences as part of the same structure (just as

a family can be one group with many different kinds of relatives).

Respect for difference and recognition of commonality are linked in

what elsewhere I call a "transcommunal" understanding. Nothing is

exotic in the sense that we are all kindred no matter how different and

separated. By the same token, we are not all clones of one another,

precisely because of our various pluralities of location and vantage

points, pressures and resources.

For this very reason, many of us in the affluent "Global North," or to

be more precise, those of us who are among that portion of relatively

affluent people in the United States and the rest of the Global North,

along with those making millions in the rich skyscraper enclaves of the

Global South (for example Dubai, Mumbai, Singapore, Taiwan, and Japan),

are going to have to shift their perspectives about public health. It

is no longer sufficient for separate countries to provide (varying

degrees) of basic public health to many of their own citizens, if

billions of people in large areas of the world are being impacted on a

daily basis by diseases such as chikungunya that are spreading

globally. For anyone who thinks this chikungunya story is a one-off

weird example, consider "West Nile Virus" now endemic from New York to

California (the River Nile being quite far away from those locations).

What used to be "exotic diseases" are being integrated into the

familiar domestic lives and places of the Global North because the

world environment is changing in ways that favor the de-exoticizatized

spread of infection.

So, public health, provided by separate nations or even regional

systems of nations, such as the European Union is inadequate. What we

need now at this opportune early warning moment, before things get

really out of hand, a la Laurie Garrett's negative but important

emphasis "The Coming Plague," is a massive world-wide Public Health

Initiative that would expand on the kind of public health

transformations that we see more and more at the beginning of the 20th

century in the United States with the development of systems for

sewerage treatment, clean drinking water, and public hospitals. I

certainly applaud Laurie Garrett and others for warning us about dire

possibilities. But we also need to emphasize that right now there is

the capacity for positive pre-emptive world-wide health strategies and

programs. Diseases of the "poorer areas" of the world can and should

be viewed as serious right now for the developed nations regardless of

whether there is a plague or not (rather than seeing them only as

external issues about "foreign" others, to be left to compassionate

but limited humanitarian relief by well-meaning peoples in rich

countries). The World Health Organization would seem a logical place

to start with such an Initiative, but the constraints of bureaucracy

may require other simultaneous pathways that can put constructive

pressure on the WHO, national governments, and the pharmaceutical

industry. In effect, we need transcommunal cooperation among widely

diverse medical and public health specialists/advocates in many

different locations around the world. Such cooperation will respect

and draw from the expertise of diverse participants, including those of

specialists in countries such India and in the African countries, which

has been built up over decades of often lonely work helping their

people.

This

Initiative, if truly world-wide and effective, would be nothing less

than a Global Public Health Revolution. It would involve partnerships

with WHO, local specialists and practitioners, national governments, the

pharmaceutical industry, and dedicated groups like Doctors Without

Borders and Nurses Without Borders. Such a transcommunal partnership

is absolutely essential if we are to avoid even further turmoil and

upheaval due to the negative aspects of globalization. It is the

positive aspects of globalization, namely high speed and effective

communication, combined with transcommunal respect for diversity, that

make a Global Public Health Revolution feasible.

Some

readers may find my tone of inevitability in the wording "Coming…Health

Revolution" too optimistic. Certainly human history is filled with

negative examples of xenophobic, inward-looking, exclusionary

self-interest that trumps compassionate, outward looking, and

inclusionary altruism. Indeed the lack of deep sustained concern in

much of the Global North for what seemed to be only "exotic" diseases

among distant peoples is an example of such parochial self-interest.

But today, self-interest and altruism are becoming partners not

opponents. It is my own best interest if the people in other parts of

the world, who have been denied pharmacological research and consequent

available medications to stop diseases once considered only exotic and

local, are given the necessary resources. It is in my own best

interest if ways are found to control mosquitoes everywhere, in ways

that do not cause further environmental harm, but which severely limit

the spread of infections in a wide variety of localities.

Today, as we live more and more in what Luther King, Jr., called

the "World House," --with its many different rooms but one common

structure--that old compassionate idea to the effect that "the

suffering of one is the suffering of all," has even greater meaning.

Let us look out for ourselves and also care for others. Both are

necessary if either is to be successful. Or to put it a bit more

accurately and globally-let us care for one another no matter where we

are and who we are in the world.

--------------------

Brown Childs is Professor of Sociology at the University of

California, Santa Cruz. He is the author/editor of Transcommunality, from the Politics of Conversion to the Ethics of Respect (2003); Hurricane Katrina, Response and Responsibilities (2005); and Global Visions: Beyond the New World Order (1993). He recently founded the on-line magazine Transcommunal ation News.

Stand in the light of the Sun and Full Moon with the

intention to receive the new information and it will be

given.