Health Without Borders: Epidemics in the Era of Globalization

115 Pages·2017·1.1 MB·English

by  Paolo Vineis (auth.)

Paolo Vineis
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Health
WITHOUT
Borders
EPIDEMICS IN
THE ERA OF
GLOBALIZATION
Health Without Borders
“From morality to molecules, environment to equity, climate change to cancer, and
politicstopathology,thisisawonderfultourofglobalhealth–consistentlypresented
inaclear,readableformat.Really,animportantcontribution.”
—ProfessorSirMichaelMarmot,Director,InstituteofHealthEquity,
UniversityCollegeLondon,Authorof“TheHealthGap”
“Paolo Vineis provides convincing evidence that ourfailingeconomic systems and the
plunderingofourenvironmentalresourcesarethreatstohealththatcannotbecombatted
byleadingahealthylife-styleorbytheeffortsofnationalgovernments.A‘mustread’for
politicians, skeptics and those of us who are attempting to promote international
collaborationinenvironmentalprotection,economicstrategiesandpublichealth.
Thisbookhasastarkmessage—ifwecarryonasusual,theglobalgainsinhealthmay
bereversed.Readhowwegotintothismessandhowwemaybeabletogetoutofitby
means of international economic and environmental collaborations. Vineis’ book is a
major contribution to global health thinking which should influence policy and
practice.”
—ProfessorShahEbrahim,LondonSchoolofHygiene&TropicalMedicine
“Thisisanexcellentandtimelyintroductiontothemostimportanthealthissuesofour
time.Globalhealthispresentedasa‘well-conceivedthriller’withmanyactorsandan
uncertainending.Thisisanexcellentoverviewoftherapidglobalchangeswearefacing
inourenvironment,theirconsequencesforhealth,andthepotentialsolutions.Should
be essential reading for all those involved in global health, health research and health
services,aswellasallthoseconcernedaboutthehealthoftheplanetanditsinhabitants.”
—NeilPearce,HeadofDepartmentofMedicalStatisticsandProfessorofEpidemiology
andBiostatistics,LondonSchoolofHygiene&TropicalMedicine
“Thisbookisasalutaryandsoundlyarguedreminderthatthe‘commongood’isnot
simply what remains after individuals and groups have appropriated the majority of
societalresources: itisinfactthefoundationonwhichanysociety rests andwithout
whichitcollapses.
Strengthening this foundation is vital to successfully tackling the growing global
environmental and economical challenges, which are unequally distributed between
and within countries. The book emphasizes that for this purpose technical solutions
based on political choices inspired by social solidarity are called for. They represent
feasiblealternativestothedismalandhazardousprospectsthatthesurvivalofhuman-
kindwilllieinchanginghumansintotrans-humansthroughbiotechnologicalmanip-
ulation,orintheescapetoMarsoranexoplanetforaveryfewpeopleoutofbillions.”
—RodolfoSaracci,SeniorVisitingScientist,InternationalAgencyfor
ResearchonCancer,Lyon
PaoloVineis
Health Without
Borders
Epidemics in the Era of Globalization
PaoloVineis
ImperialCollege
London,UnitedKingdom
ISBN978-3-319-52445-0 ISBN978-3-319-52446-7 (eBook)
DOI10.1007/978-3-319-52446-7
LibraryofCongressControlNumber:2017941007
©SpringerInternationalPublishingAG2017
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fi
Europehaseveryrightandeverycapacitytobeabletoofferthe nestmodelofsocial
welfare on earth: we must stop squandering our opportunities!
Thomas Piketty
New York Review of Books, February 25, 2016
ThisbookisdedicatedtoLudwikFleck,agreatphilosopherandscientist,andTony
McMichael,agreatepidemiologistandamasterofintegrity,inthehopethatfuture
generations will read their work.
Preface
Why This Book
Like in a well-conceived thriller, many different trends in the world are now
converging to create an almost unbearable suspense about what our future
—
holds although the plot remains blurred, it is clear that life has become
increasingly unsustainable and uncertain for many. Climate changes, mass
migrations,wars,theeconomiccrisis,pandemics,theepidemicsofobesityand
diabetes and unprecedented environmental degradation can no longer be
considered separate threats to be dealt with in isolation. Rather, these and
other global threats to human health and well-being often share common
causesandhaveimpactsthatareconvergingdangerouslytowardsanunknown
future.Theconsequencesforhumanhealthhavenotbeenfullydescribedand
remain poorly understood. The principal motivation behind this book is to
attempt to draw some of these threads together into a more coherent picture,
to understand what the evidence suggests about the emergence of multiple
healththreatsfromglobalchangesandtheirinteractions.Theguidinghypoth-
fi
esisisthatwehaveallcontractedadoubledebt:oneis nancial(andiswell
known) and one is environmental (and is underestimated, particularly in
health circles, and more serious). A second theme that is explored through-
—
outthebookisthat,liketheeconomy,thestateofhealthofhumankind that
—
on average has always improved so far may become increasingly unstable
with areas of decline, accompanied by an ongoing widening of the socio-
economic divide particularly within nations.
ix
x Preface
“ ”
After an introductory chapter that explains what global health is and
describestheintertwiningofthethreatsthattheplanetisfacing,thefollowing
chaptersaredevotedtothemaintopicsthatcontributetoglobalhealth;thatis,
the impact of globalisation on the onset and distribution of diseases. These
chapters address, for example, food, climate, environmentalpollution andthe
impactoftheeconomiccrisisonhealth.Aseparatechapterisdevotedtocancer
because its many and varied forms epitomise the multidimensional aspects of
the problem: the divergence between increasing incidence and decreasing
mortality rates in rich but not in poor countries (where both trends are
increasing); the role of improved diagnosis; differential access to therapies;
the changing landscape of risk factors; and the political problems of cancer
control. Another chapter addresses a fundamental recent discovery about the
mechanisms of disease, which promises to be of great relevance for global
“ ”
health: epigenetics provides a new perspective on the ability of the environ-
ment to modulate the expression (functioning) of genes. In an era of con-
—
stantly changing environmental landscapes like in the quality and
—
composition of food epigenetics may prove to be essential in mediating the
health effects of environmental change. The last two chapters draw some
conclusions on how policies could be directed towards creating potential
fi
solutions for the problems described, and how only rede ning the environ-
“ ”
ment and health as common goods requiring our concerted protection can
be effective in sustaining quality of life in the medium to long term. It is
obvioustomanythatwaitingforpotentialsolutionstoemergefromthelawsof
themarketaloneisnotgoingtobeenoughtomeetthehealthchallengesofthe
fi
twenty- rst century. If the environment and health are not eventually con-
ceived and appreciated as common goods of humanity, then the separate
problems described in this book will not be resolved.
London, UK Paolo Vineis
September 2016
Acknowledgements
I am particularly grateful to Shah Ebrahim and Elisabete Weiderpass for their
verythoroughreadingofthemanuscriptandthemanysuggestionsandstimuli
they gave me. I am also very grateful to Rodolfo Saracci, David Blane, Kris
Murray, Cristina Savio, Enrico Casadei, Roberto DeVogli, Pietro Ortoleva,
Pietro Terna, Nerina Dirindin, Luca Carra and Roberto Satolli for their
attentive reading and precious advice.
Part of this book is taken from the lectures on the course of Global Health
that I have coordinated for the past seven years (together with Helen Ward,
Graham Cooke and Mariam Sbaiti) for the students of Medicine at Imperial
College of Science, Technology and Medicine, London. The following link
gives access to part of the course contents: http://tinyurl.com/pnlagc7.
IthankDemranAliandShahibaBegumfortheirworkonNauruattheBSc
–
in Global Health at Imperial College in the years 2009 2011.
xi
Contents
1 The Double Debt: Economic and Environmental 1
The Economic Crisis 1
The Environmental Debt 2
The Baumol Disease and the Funding of the State 4
fi
Co-bene ts of Climate Change Mitigation 5
Final Remarks 7
2 An Overview of What Global Health Is 9
Economy and Health 10
Converging Trends: The Quest for a Minimal State,
Misconceptions on Science, Fragmented Research 11
Political Crisis, Health Crisis 13
Health in a Global World 14
Three Exemplary Cases: Nauru, Greece and Bangladesh 15
Obesity in Nauru: A Story of Early Globalisation 15
Greece: The Health Effects of Economic Crisis 16
The Case of Bangladesh 18
3 Food 21
The Two Faces of Nutritional Problems 21
The Global Food Industry 23
xiii