Populations, Public Health, and the Law

10. Globalizing Population-Based Legal Analysis

C H A P T E R 1 0 Globalizing Population-Based Legal Analysis Someone who has TB in India can infect you here. They cough, maybe they are working at an airport, the germs slither onto the plane, then you get on the plane, and you are infected. —Archbishop Desmond Tutu, HIV/AIDS and the Global Community: We Can Be Human Only Together I t is banal but true to say that we live in a global age. Advances in communication technology (especially the Internet) and travel have combined with the integration of markets and the spread of capitalism to knit the world in new ways. This integration, or globalization as it is widely called, can create novel risks for population health, both by increasing health disparities around the world and by facilitating the spread of disease-causing vectors, either microbial or man-made. On the other hand, globalization also has the potential to promote population health, both by supporting the diffusion of health-promoting interventions and technologies and by highlighting the interdependency of population health. In either case, globalization creates new challenges and opportunities for population-based legal analysis. This chapter looks at some of those challenges and opportunities. 244 globalizing population-based legal analysis 245 A Global Population In discussions of international public health, two seemingly contradictory facts stand out. First, as Allyn L. Taylor has observed, there has been an increase in the ‘‘number and the scale of transboundary public health concerns. . . .’’1 Second, despite the growing interdependence of the world’s populations, enormous and potentially growing disparities exist between the health status and needs of different populations around the world. In a global era, a population perspective requires recognition of both interdependency and distinction. Consider first the phenomenon of global interdependence. To a significant degree, it has always existed. The Black Death of the fourteenth century traveled from the steppes of Asia along trade routes to Italy and ultimately throughout Europe.2 Likewise, the Spanish conquest in the New World in the fifteenth century began a migration of germs between the Eurasian and American continents.3 In the nineteenth century, cholera epidemics traveled from the Indian subcontinent to cities around the world.4 These epidemics helped spur the International Sanitary Conference of 1851, the first international effort to control the spread of disease through diplomacy.5 Today, of course, travel is both faster and more frequent than ever, exacerbating the risks that emerging or re-emerging infections will rapidly proliferate around the globe.6 Although Yersinia pestis (the microorganism that is believed to have been the cause of the Black Death) traveled in the fourteenth century at the speed of horses and sails, HIV and SARS spread in the twentieth and twenty-first centuries with the swiftness of jet planes. Likewise, dramatic increases in the international trade of food supplies have increased the risk that food-borne diseases will traverse the planet.7 In a global era, an infection in any region of the globe can rapidly be transplanted to any other region. This is the danger that Laurie Garrett warned of in 1994 in her frighteningly named but prescient book, The Coming Plague.8 The health risks created by globalization are not limited to infectious diseases that spread from the developing world to the developed world. Globalization instead affects almost all determinants of health. Moreover, the trajectory of travel is multidirectional. Although some diseases such as 246 chapter 10 HIV or dengue fever may emerge from the developing world and later pose a risk to populations in developed nations, other health threats such as tobacco or fast food migrate in the other direction.9 In addition, global environmental problems, such as climate change and the depletion of the ozone layer, arise from activities that occur all over the world, from the cutting of the rain forests to excessive reliance on carbon-based fuels, exacerbating a broad array of public health problems, including asthma and malaria.10 Indeed, climate change has the potential to affect almost all aspects of human health. Moreover, by altering the economies and influencing the cultures of the entire world, globalization necessarily influences myriad social determinants of health and therefore can be expected to have powerful, if not fully understood, impacts on all of the planet’s populations .11 In that critical sense, by interconnecting the world’s economies and cultures, globalization has necessarily increased the...