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2 Examining the Consequences: A Changing Landscape
Pages 49-79

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From page 49...
... Most notably, the growing demographic and economic divides between rich and poor countries, combined with increasing levels of access to information even in the remotest corners of the world, are expected to fuel widespread discontent, armed conflict, and the massive displacement of people, the public health consequences of which are often disastrous. Refugee populations are among the most vulnerable to emerging and reemerging infectious diseases.
From page 50...
... . These funds are expected to have both direct and indirect benefits for the prevention and control of emerging and reemerging infectious diseases in general, whether intentionally or naturally introduced, by strengthening the public health community's ability to make constructive changes in a way never before possible.
From page 51...
... The situation will be exacerbated by the fact that infectious diseases, particularly HIV/AIDS, will continue to depress economic growth in the hardest-hit countries by as much as one percent of their gross domestic product (GDP) per year; over the course of many years, the impact of this will be huge.
From page 52...
... Most populations engaged in communal conflicts suffer from irresponsible or malignant leadership, and such conflicts occur in collapsing or failing states where human rights abuses are rampant. Most of the nonstate actors who wage such wars or who cause complex humanitarian emergencies (as the public health community refers to them)
From page 53...
... Refugee populations are among the most vulnerable to emerging infectious diseases, even more so than migrants (see Chapter 1)
From page 54...
... Workshop participants noted that refugees are not the only people who serve as infectious disease vectors during wartime. Peacekeepers do so as well.
From page 55...
... In addition, biological evidence suggests that the infectivity rate is highest during the early phases of HIV infection, when the viral load is very high; therefore, newly infected soldiers with many sexual partners initiate spirals of disease propagation. One participant asked whether, when peacekeeping forces are assembled, deferred compensation is ever considered as a means of constraining the social impact of the economic imbalance between the peacekeeping forces and the general population, especially since this economic imbalance is what drives the sex trade.
From page 56...
... The criteria used to determine who will be screened before arrival include the incidence rates of specific infectious diseases in the country of origin, the category of the applicant (e.g., refugee vs. migrant)
From page 57...
... However, with the realization that reliable partners in other countries are capable of much more sophisticated predeparture management, more challenging goals are being set. This is true not just for patients with TB, but also for those with other infectious diseases.
From page 58...
... that monitor the health status of mobile populations, has increasingly focused on refugee health clinics. When the network was established in 1996, its initial emphasis was on collecting disease- or syndrome-specific diagnoses on returning travelers, immigrants, and foreign visitors (Freedman et al., 1999)
From page 59...
... Such programs will need to involve both predeparture screening in countries of origin and postarrival screening in receiving countries. The greatest challenge is probably faced by policy makers and researchers; this is true not only for TB, but also for HIV/AIDS and other infectious diseases.
From page 60...
... Even if foodborne infectious disease outbreaks do not occur more often than the numbers that have been recorded, the potential for such outbreaks is undoubtedly on the rise. One of the main challenges associated with trade-related infectious disease surveillance is that subsequent epidemiological investigations are necessary to link detected outbreaks or occurrences of infectious diseases to trade.
From page 61...
... , reflect an increasing concern with trade-related infectious diseases. APEC leaders identified infectious disease surveillance as a priority issue when they met in Shanghai, China, in 2001 and are in the process of creating a network of networks to enhance the regional capacity for infectious disease surveillance throughout the Pacific.
From page 62...
... Use of Funding for Biodefense in the Context of Emerging and Reemerging Infectious Diseases One of the greatest challenges posed by the new funding for biodefense is how to use this vast amount of resources within the context of emerging 7This section is based on the workshop presentations by Cash (2002) , Corber (2002)
From page 63...
... Improved communication would also benefit both biodefense and the prevention and control of naturally introduced infectious diseases. (For further discussion of surveillance, see the section on surveillance earlier in this chapter and the section on global surveillance in Chapter 3.)
From page 64...
... This type of dialogue was crucial in the case of the anthrax attacks, as no single entity had all of the information necessary for a prompt, effective response. Communication and cooperation are vital components of any program for the global control of emerging and reemerging infectious diseases, whether the goal is to thwart potential bioterrorist attacks or to protect the general public health.
From page 65...
... biodefense efforts. In theory, then, funding for biodefense should be a great help in combating infectious diseases, but it remains unknown whether the money will actually be spent in a way that will aid the most people as efficiently and quickly as possible.
From page 66...
... As it was, the response effort required the participation of thousands of people from the public health and law enforcement communities. Indeed, since September 11, 2001, law enforcement officials have responded to more than 8,000 incidents purportedly involving weapons of mass destruction.
From page 67...
... This disjunction between supply and demand could potentially devastate the long-term capacity of the federal government to manage the response to intentionally or unintentionally introduced infectious diseases. The problem is compounded by the fact that great sums of money are being directed toward academic centers and other nongovernmental organizations, which could result in a brain drain from the federal sector and leave it at grave risk of
From page 68...
... It is unrealistic to expect other parts of the world to care about a handful of deaths from anthrax in the United States when they are experiencing such tremendous death tolls from TB, malaria, AIDS, and other infectious diseases. When developing biodefense programs and policy, the United States must integrate its own strategic needs with the real needs of its international partners.
From page 69...
... EFFECTS OF THE DISSOLUTION OF THE FORMER SOVIET UNION ON PUBLIC HEALTH IN RUSSIA8 The post–cold war situation in Russia illustrates the public health impact of rapid socioeconomic change induced by globalizing forces in a country where state social programs were previously the sole provider of 8This section is based on the workshop presentations by Demin (2002) and Netesov (2002)
From page 70...
... Although the situation in Russia is unique, it reflects what is happening globally in both the developed and the developing worlds: funding for public health and the public health infrastructure are failing, the health of migrants has become a key issue, and something must be done. In the mid-1960s, the Soviet Union's public health and social security systems were comparable to those of many western countries.
From page 71...
... Lower life expectancy is particularly drastic among males as a result of poverty, substance abuse, and disease. Russia's public health problems are further complicated by the reality that, because of insufficient funding, infectious diseases among the considerable flow of migrants from states of the former Soviet Union are neither monitored nor controlled.
From page 72...
... ; the fourth was pulmonary disease, including influenza, pneumonia, TB, and various other infectious and noninfectious diseases (65.1 deaths per 100,000) ; and the fifth was other infectious and parasitic diseases (24.3 deaths per 100,000)
From page 73...
... Tuberculosis Roughly 2 million people die each year from TB worldwide (WHO, 2002b) , with the vast majority of these deaths (98 percent)
From page 74...
... The newly independent states of the former Soviet Union have recently seen a dramatic rise in syphilis rates, from 5–15 per 100,000 in 1990 to 120–170 per 100,000 in 1996 (WHO, 2001a)
From page 75...
... Currently, the European Union comprises 15 states, and the hope is that it will expand eastward and add five new countries by 2004. Along with the success of the European Union, however, have come several new challenges associated with the movement of people, capital, and resources, all of which have important implications for the emergence, reemergence, and control of infectious diseases.
From page 76...
... In response to this situation, the European Union has established a Europe-wide rapid alert system, which is integrated into a larger worldwide rapid alert network. Movement of Resources The European community has probably been sharing resources on a much greater scale than could ever be achieved at the international level.
From page 77...
... Presentation at the Institute of Medicine Workshop on the Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities, Washington, D.C. Insti tute of Medicine Forum on Emerging Infections.
From page 78...
... . The Global Application of Tools, Technology, and Knowledge to Counter the Consequences of Infectious Diseases: A Discussion of Priorities and Op tions.
From page 79...
... 2001. Emerging infectious diseases in Russia, 1990–1999.


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