Socio Economic Causes of Ill Health
It can be seen that the new economic reforms that
have been imposed on the Third World and the changes in the global
economy which have led to increased export led growth, privatisation,
deregulation and free trade have had drastic consequences on the social
fabric. It has led to the collapse of social systems; increased social
inequities, resulted in conflicts; displaced populations; and increased
migration. It has created a development model of production and
consumption with far reaching impact on the physical environment
worldwide. The environmental crises can be seen from the following
indicators:
Threat to life support systems
-
Carbon dioxide (C02) emissions have quadrupled
over the past 50 years. The North with one fifth of the world’s
population account for 53 percent of the C02 emissions which is
projected to rise between 30 and 40 percent by 2010;
-
Global temperatures have risen especially in the last
three decades - the period when C02 levels have been rising most
rapidly. C02 concentrations are projected to double pre-industrial
levels this century leading to global temperature increase by at least
one degree Celsius and four degrees (two-seven degrees Fahrenheit);
-
Climate change from global warning will reduce crop
yields in Africa, South Asia and South America. Harvests will drop by
more than 30 percent in India and Pakistan by 2050;
-
Sea level is projected to rise from a minimum of 17
centimeters to as much as one meter by 2100;
-
The above developments will alter every ecosystem on
Earth;
-
A sixth of the world’s land area, some two billion
hectares is now degraded (from erosion, compaction, salination, water
logging and chemicalisation): by 2050 more than two billion people will
live in regions facing land scarcity with extensive and increasing
desertification in SS Africa and South Asia;
-
Some one billion people in 40 Third World countries
risk losing access to their main source of protein as overfishing driven
by export demand for animal feed and oils puts pressure on fish stocks;
-
A growing number of synthetic chemicals are endocrine
disruptors: they are linked to male and female reproductive disorders,
immune system disorders, neurological toxicity, low birth rates, slowed
foetal development and male infertility among others. They amass in body
fat and are carried up the food chain from prey to predator,
bioaccumulating at higher concentrations; working their way into
innocent species and distant ecosystems; migrating through the
atmosphere, condense and deposit in soil or water and evaporate again
spreading to all corners of the globe;
-
The 132 million people in water stressed areas are in
Africa and the Arab world: by 2050, the number may rise to 1-2.5
billion;
-
Over the last two decades South America and the
Caribbean lost seven million hectares (ha) of tropical forest, Asia and
SS Africa four million ha each;
-
Biodiversity loss will mean loss of food, medicines,
energy, fibres, translated into destroyed livelihoods and human needs
deprivation for two thirds of humanity;
-
Sulphur emissions in the US alone were 20 million
metric tons in 1993 compared with 38 million metric tons for 20 Asian
countries. Acid rain is a major problem in Southeast China, Northeast
India, Korea, Thailand;
-
Ozone layer depletion is fast depleting thinning by
some ten percent in the temperate regions: ultra violet light induced
cataracts claim the sight of 17 million people a year;
-
By the year 2023 the number of cars now more than 500
million may top one billion;
-
Lead emissions (most of them in the Third World)
could increase fivefold between 1990 and 2030: leaded petrol is
crippling human health permanently impairing the development of children’s
brains. In Bangkok up to 70,000 children are at risk of losing four or
more IQ points because of high lead emissions: in South America around
15 million children under two years of age are at similar risk (UNDP
1998; Brown et al 2000a).
Thus, the deterioration of the global environment and
the ecological crises manifested as climate change, ozone depletion,
degradation of food producing systems, depletion of fresh water sources,
loss of biodiversity, the spread of invasive species, and chemical
pollutants are threatening the biosphere and its capacity to sustain
healthy human life.
Global warming from C02 emissions affects the entire
world and represents one of the most serious environmental threats in
the new century. The UN Intergovernmental Panel on Climate Change
estimates that it will require 60-70 percent reduction in emissions to
halt the rise in atmospheric concentrations of the greenhouse gases.
Burning of fossil fuels and the emissions of green house gases have
increased global warming. The US, which is the world’s largest emitter
of greenhouse gases will see average temperature increases by three to
six degrees Celsius by 2100 (AFP 14 June 2000).
Extreme weather conditions linked to global warming
have resulted in extremes of temperatures, fiercer winds, deadlier
floods, longer droughts (the El Nino effect), increasing dust storms,
tsunamis, tornadoes, hurricanes and cyclones. It has raised sea levels
in the Pacific. In 1997 and 1998 El Nino and La Nina brought wild swings
in temperature and rainfall. El Nino is estimated to have displaced
nearly 5 million people, injured 118 million and caused almost 22,000
deaths. Worldwide costs of the El Nino disaster were judged to be as
high as $33 billion. The storms have ruined harvests and fuelled fires
from Indonesia to Brazil (UNDP 1999:43). Weather related
disasters are costing the world economy some $50 billion per year. They
have caused suffering to more than two billion people since 1965 and
three million have lost their lives (Smith 2000:36). For example, in
China, the clearing of thousands of forests for economic and urban
development around the Yangtze had stripped 85 percent of its forest
cover. The monsoon in 1998 resulted in flooding of the Yangtze river
which destroyed huge swathes of territory and made 223 million people
homeless and $30 billion in damages (Brown et al 2000b: 24).
Debt-Induced Disasters
In Central America, socio-economic policies over the
last three decades marginalised and impoverished the rural peasantry,
who were forced off their agricultural lands onto degraded hillsides and
shanty towns on floodplains, which were prone to floods and mudslides.
When Hurricane Mitch struck in 1998, thousands lost their lives. The
governments of Nicaragua and Honduras paralysed by a decade of
structural adjustment did not have the resources to evacuate people.
With the health system and social infrastructure destroyed, there was no
money for vehicles, for vaccines, no staff, no petrol, no ability to
stockpile drinking water. Honduras could not put the country on alert as
it could not muster sandbags, plan evacuations, and organise back-up
power supplies. Structural adjustment made it incapable to prepare for
disaster-readiness. The country suffered $1 billion worth of damage to
infrastructure and received $16 million of aid in return (Cockburn, St.
Clair & Silverstein 1999: 459-462). In 1997, over half of state
revenue in Nicaragua went to service the $6 billion debt: the amount it
repaid on loans (over $600,000 per day) although it has consistently
failed to service its debts in full, was more than double that spent on
health and education combined. Over 40 percent of Nicaraguans do not
have access to safe water and sanitation: 84 percent of Nicaraguan
children live in poverty. In October 1999, hundreds of people outside
Managua were struck by leptospirosis, a disease caused by rats,
following heavy rains and flooding: by mid-November some 2500 had become
ill (IFRC & RCS 2000: 13). The natural disaster in Central
America was a man made catastrophe. La Nina killed some 9,000 people and
left more than a million homeless in Nicaragua and Honduras (UNDP
1999:43).
A replay of this disaster struck Venezuela in
December 1999. Two weeks of unprecedented rainstorms caused by La Nina
swept hundreds of bodies and entire buildings into the sea. Fifteen
metre waves inundated coastal areas destroying entire communities.
Unofficial estimates put the death toll at 30,000 making it South
America’s worst natural disaster of the 20th century: 23,200 houses
were destroyed and over 110,000 people made homeless. Some 85 percent of
Venezuela’s 22 million people live in urban areas, mostly shantytowns
on degraded hilltops from two decades of rural urban migration due to
unemployment and poverty. Some one quarter of a million jobs were lost
in Vargas state alone, nearly 30 percent of the health infrastructure
was damaged or destroyed (IFRC & RCS 2000:10).
In 1997 Southeast Asia was enveloped in a haze which
was considered a global environmental disaster. Coupled with the dry
season (related to the El Nino phenomenon) the massive uncontrolled
burning of tropical forests in Kalimantan and Sumatra for plantation
agriculture reduced visibility all over the region: haze affected the
Philippines, Malaysia, Brunei, and Singapore. The State of Sarawak in
Malaysia declared a State of Emergency because of the hazardous
pollution and almost zero visibility. Air traffic grounded to a halt,
deaths from traffic accidents due to poor visibility resulted. Acute
respiratory problems among the young and asthmatics were reported. Those
who could afford left the region with their families for fear of the
long-term effects on health and safety. Experts estimated that the loss
due to the fires in terms of biodiversity was incalculable and
irreversible. The Indonesia fires cause the deaths of more than 1000
people and more than 20 million suffered smoke related respiratory
problems (UNDP 1998).
Over 80 percent of the fires were caused by private
companies: conservative estimates have put the damage caused by the
fires and haze at $4.4 billion which is 2.5 percent of Indonesia’s GDP
at the time. The losses does not include malnutrition due to crop
destruction, deaths and diseases and loss of livelihoods to millions of
indigenous peoples. (Down to Earth 2 Aug 1999). On 14th July,
2000, the Malaysian government warned that the haze had returned to the
region. The air pollution Index (API) in Singapore reported unhealthy to
hazardous levels of air pollution in July. For fear of the economic
repercussions and negative image the haze was creating worldwide, the
Malaysian Government decided to withhold the API readings from the
public (Ritikos 19 July 2000).
The forest fires are linked to the IMF-World Bank
prescriptions to deal with Indonesia’s crippling debt, which currently
stands at $150 billion; and worsening economic crisis. Indonesia was the
hardest hit by the Asian financial crash in 1997. In that year, IMF
disbursed $43 billion: since then $5.9 billion had been pledged (Down
to Earth 2 Aug 1999). Export led growth and the development of oil
palm plantations via the IMF-World Bank model has been the driving force
for the destruction of Indonesia’s forests.
Diseases Out of Control
Global economic forces have given rise to a situation
where exposure to pathogenic microorganisms has increased and human
resistance has been weakened. It has led to new emerging diseases and
old diseases have staged a comeback.
In 1993, WHO estimated 14.4 million people died of
infectious diseases. In the US, TB rose by 18 percent between 1985 and
1992. One third of the world’s population is said to be carrying the
infection. The spread of the HIV virus, which destroys the immune cells
that keep the TB germ under control in the body, will cause many to die
of the disease. With several strains of the TB bacterium now resistant
to all anti-TB drugs, the WHO admits that the disease ‘is out of
control in many parts of the world’. Diptheria has reemerged as a
major killer of adults in Russia. Plague has resurfaced in India, while
malaria has returned to regions which it had been eliminated and is
spreading to previously unaffected areas. Cholera has re-emerged as a
major killer in South America. Epidemics of dengue fever transmitted by
the Aedes Aegypti mosquito have swept parts of Venezuela, Brazil,
India and Australia the first time ever. Yellow fever is on the increase
in Africa.
Chemicalised and commercialised farming and food
preservation have resulted in salmonella and listeria epidemics;
transference of antibiotic resistance to humans from livestock and
poultry; hormone or endocrine disrupters in agricultural pesticides,
which affect foetal development, sperm counts and cause cancer; mad cow
disease arising from modern large-scale methods of breeding and feeding
livestock; and mad sheep disease which now can be transferred to humans
and make them mad as well.
According to the Harvard Working Group on New and
Resurgent Diseases, the major economic strategies of privatisation,
export agriculture, deregulation and free trade, and economic growth
have altered the epidemiology of our species through multiple pathways.
Some of the factors or pathways that have affected human health include
the global microbial traffic, altered ecosystems, and climate change
(Harvard Working Group 1996:160).
Global Microbial Traffic
Modern transportation has made possible the large
scale movement of goods and people rapidly. This increases the
probability of vectors and non human carriers of disease being
introduced into areas where they did not exist, often with fatal
results. For instance the reintroduction of cholera to South America in
the 1990s is thought to have resulted from a freighter discharging
ballast water from China into Peruvian coastal waters. The water carried
the cholera germ which flourished in algae which are eaten by seashells,
fish, prawns and other marine life which in turn are eaten by people.
Once it entered South America, the infection spread rapidly encouraged
by urbanisation and IMF-WB SAPs cutbacks in sanitation and public health
programmes. As of December 1994, millions of South Americans had become
ill and thousands had died.
Migration as a result of rural displacement has
contributed to the resurgence in malaria. In Malaysia, P. falciparum
malaria in urban centres has been traced to Indonesian migrant workers.
The same concern regarding yellow fever has been generated: its increase
in Africa could be carried over to the urban areas from the savannah and
forest fringes through migrants seeking work in the towns thus spawning
an epidemic.
Altered Ecosystems
Environmental degradation and disturbed habitats can
eliminate predators and competitors creating opportunities for new
species to take up residence. For example, Oceania has been devastated
by the colonisation of rats, goats, or weeds as the few native species
could not compete with the intruders. The spread of water hyacinths in
East Africa’s Lake Victoria from Brazil is now a breeding ground for
the water snail that transmits schistosomiasis and for the proliferation
of diarrhoeal disease organisms (Epstein, PR 1998).
There is a major threat of new epidemics of malaria
as a result of changes in land use associated with development
activities. In Thailand, the removal of forest cover and the cultivation
of commercial tree crops like rubber led to malarial epidemics. Malaria
which was endemic in natural forest disappeared when clearing took place
but reappeared in plantations which offered suitable habitats and hosts
for mosquitoes. In Vietnam, people from the North were relocated in the
south to work in plantations. Thirteen years after the stands were
created, the country recorded its highest death rates from malaria, a
significant proportion in rubber plantations, where the trees had
reached the age at which they provide highly favourable conditions for
the anopheles dirus which transmits P. falciparam malaria
(Gomes, M., 1998).
Infrastructure development, poverty and pollution
have combined to create new niches for pathogens (disease causing
agents). Sewage and fertilisers draining into marine ecosystems, the
over-harvesting of fish and shellfish, the loss of wetlands and myriad
climatic changes have caused massive algal blooms in coastal areas
worldwide providing a rich environment for diverse communities of
microorganisms. High sea surface temperatures foster the growth of more
toxic forms of pathogens among them a new variant of the cholera germ V.cholerae
0139. Antibodies that react to other known cholera variants do not
recognise this new variant which is now present in at least ten Asian
nations. There are fears that this environmentally hardy new form of
disease could easily be the agent of a global cholera epidemic.
As the affluent urban environment becomes
increasingly engineered through the impoundment, treatment and
distribution of water and design of closed buildings in which air
circulates, organisms that can survive in disinfected and ‘hygienic’
environments prosper. Disease like legionellosis, cryptosporidiosis and
‘sick building syndrome’ are the result. Institutions like prisons,
nursing homes, and hospitals, where residents are more prone to
infection, have been the sites for the transmission of TB and
antibiotic-resistant infections.
Climate Change
Global climate changes have severe implications for
human health. Not only does it change global patterns of temperature,
precipitation and climatic variability, exposing populations to thermal
extremes and regional variable increases in weather disasters;
substantial risks to human health occurs as a result of the disruption
of complex ecological systems that determine the geography of
vector-borne infections (such as malaria, dengue fever, and
leishmaniasis); and the range, seasonality, and incidence of various
food borne and water borne infections; the yield of agricultural crops;
the range of plant and livestock pests and pathogens; the salination of
coastal lands and freshwater supplies due to rising sea levels; and the
climactically related production of photochemical air pollutants, spores
and pollens (McMichael, & Beaglehole 2000).
Changes in global temperatures carry with them,
changes in wind and precipitation patterns, ocean currents, humidity,
soil composition and vegetation. These affect human activity and
movement, vector redistribution, and new breeding sites for diseases. In
Zimbabwe and western Mozambique, periods of drought associated with El
Nino affect, have regularly led to major infestation of rats, which are
carries for a number of diseases. In India and Colombia, a warmer
climate is believed to be responsible for the spread of Aedes aegypti
mosquitoes at altitudes above 2,000 metres; previously they were
confined by temperature to altitudes below 1000 metres.
According to Paul R Epstein, Associate Director of
the Centre for Health and Global Environment at Harvard Medical School,
global warming influences health through several routes: more directly,
it can generate more, stronger and hotter heat waves; in some places the
number of deaths related to heat waves is projected to double by 2020.
Prolonged heat can enhance the production of smog and the dispersal of
allergens both effects have been linked to respiratory symptoms. Heating
of the atmosphere increases the frequency and intensity of droughts and
floods, which promote by various, means the emergence, resurgence and
spread of infectious disease.
Global Warming Spreads Diseases
Diseases carried by mosquitoes such as malaria,
dengue fever, yellow fever and several kinds of encephalitis are among
those causing the greatest concern as the world warms. Malaria is
reappearing north and south of the tropics: it has returned to the
Korean peninsula, parts of Southern Europe and the former Soviet Union,
to the coast of South Africa along the Indian Ocean. Dengue has
broadened its range in the Americas in the last ten years and reached
down to Buenos Aires by the end of the 1990s: it has also found it its
way to Northern Australia.
The incidence of vector borne and water borne
diseases climbs during El Nino and La Nina years, especially in areas
hit by floods or droughts. Longterm studies in Colombia, Venezuela,
India and Pakistan reveal, that malaria surges in the wake of El Ninos:
regions stricken by flooding or drought during the El Nino of 1997-1998
(the strongest of the century) often experience a convergence of
diseases borne by mosquitoes, rodents and water. Additionally, in many
dry areas, fires raged out of control, polluting the air for miles
around.
According to Dr. Epstein, several climate models
predict that as the atmosphere and oceans heat up, El Nino will become
more common and severe which means weather disasters they produce and
diseases they promote could become more prevalent. Since 1976 the
intensity, duration and pace of El Ninos have increased: during the
1990s every year was marked by an El Nino or La Nina extreme. These
trends bode ill for human health in the 21st century. Increased climate
variability accompanying warming fuels outbreaks of certain vector-borne
diseases for eg. warm winters followed by hot dry summers favour the
transmission of St. Loius encephalitis and other infections that cycle
among birds, urban mosquitoes and humans.
This was the pattern that led to the emergence of the
West Nile virus in New York City last year. The persistence and spread
of the virus was aided by mosquitoes, which was responsible for the
transmission of the disease. The mild winter of 1998-99 enabled
mosquitoes to survive into the spring, which arrived early. The drought
in spring and summer allowed them to breed better while killing off
mosquito predators, and encouraged birds to congregate more, many of
them sharing the water holes frequented by mosquitoes. Once the
mosquitoes acquired the virus, the heat wave speeds up the rate at which
the virus inside the insects reproduces and mature.
In 1997, 527 people in Bucharest, Romania were struck
with West Nile virus and 50 died. In 1999, the virus killed seven in New
York and by 2000, scientists have warned that it has spread all over the
Americas. The infection is endemic to Africa, Asia and Europe where it
resides harmlessly in many bird species but kills others. The virus is
transmitted to humans from the culex mosquito, which is infected
by birds. Migratory birds congregating on mosquito infested wetlands
will spread the disease far and wide (Mackenzie, 8 July 2000).
If increased warming and weather extremes result in
more ecosystem disturbance, that disruption may foster the growth of
opportunist populations and enhance the spread of disease.
Rains brought by a warmed Indian Ocean to the Horn of
Africa in 1997 and 1998 led to flooding, setting off epidemics of
cholera and two mosquito born infections: malaria and Rift Valley fever
fatal to both livestock and people. In the aftermath of Hurricane Mitch,
Honduras reported thousands of cases of cholera, malaria, and dengue
fever. In February 2000, unprecedented rains and a series of cyclones
inundated large parts of Southern Africa. Floods in Madagascar and
Mozambique killed hundreds, displaced thousands and spread both cholera
and malaria.
New diseases are triggered by climatic disruption in
the form of floods. In late 1993, a new disease emerged in the Four
Corners region of the US. A 37 year old farmer died after experiencing
flu like symptoms for several days including fever, nausea and vomiting
which progressed to coughing and shortness of breath. An X-ray showed
fluid in both lungs, the farmer developed respiratory distress and died.
The Centres for Disease Control in Atlanta, linked the mysterious
disease to a new strain of Hanta virus - one of a group of viruses that
have been associated with haemorrhagic fevers and kidney disease in
Europe and Asia. Studies linked the emergence of the disease to a sudden
increase of deer mice, which are carriers of the Hanta virus, following
the end of a six year drought in the spring of 1992. Heavy rains flooded
the area, producing an explosion of pinon nuts and grasshoppers - the
food for mice. Deer mice flourished, but the drought had eliminated all
of their predators. Between May 1992 and May 1993, the numbers of deer
mice increased ten fold. As of February 1995, 102 cases of Hanta virus
pulmonary syndrome had been reported mostly in the Southwest. Fifty-two
percent were fatal. The hanta virus pulmonary syndrome has appeared in
South America, where some ominous evidence suggests that it may be
passed from one person to another.
In Malaysia in 1999, the Nipah virus led to the
deaths of millions of pigs, in Penang, Selangor, Negri Sembilan and
Melaka, virtually wiping out the pig industry in some regions. One
hundred and five people succumbed to the disease while others were
totally incapacitated with coma. Farmers lost millions of dollars, some
almost their entire families. The new virus emerged again in June 2000,
hundreds of thousands of pigs were culled although no humans have been
affected at the time of writing. The Nipah virus is assumed to be
transmitted by direct contact with infected individuals and their body
fluids or urine. It is not known whether the Nipah virus is highly
infectious or whether it is transmitted from person to person.
Scientists say that the virus is not indigenous to pigs or humans: it
must have reservoirs and circulate naturally among some unknown wildlife
animal species like birds or rodents. As long as the ecology, reservoirs
and natural transmission cycles of the Nipah virus in Malaysia are
unknown, real preventive measures are not within reach (Third World
Network 1999). Unless an interdisciplinary and integrated study is
conducted to understand the Nipah virus ecology, the Nipah viral
epidemic will remain a constant threat to the pig and human population.
Today, with increased international commerce and
travel, an infectious disorder that appears in one part of the world can
quickly become a problem continents away if the pathogen finds itself in
a hospitable environment. According to a WHO report, between 1969 and
1999, 89 cases of malaria were reported among people living close to
airports in countries where malaria is not endemic. They included France
(26 cases); Belgium (17 cases); Britain (14 cases); North America (4)
and at least five deaths recorded (The Financial Times Aug 22,
2000).
Disease cannot be understood and tackled in isolation
from the social, ecological, epidemiological and evolutionary contexts
in which it emerges. Disease cannot be reduced to a single cause. Thus
the network of factors that lead to a disease is complex and
conventional classification of diseases as infections, environmental,
psychosomatic, autoimmune, genetic and degenerative is applicable only
to a few diseases where one factor overwhelms all others (Harvard
Working Group 1996:169).
Failure to address this remains the hallmark of the
institutions that govern global health policy. Technological, quick fix
approaches do not address the multiple causes of diseases; it does not
help to create new social and ecological processes and conditions that
would minimise the disease burden in Third World countries. With
increasing globalisation that further undermines the environmental and
social wellbeing of societies everywhere, we can envisage further
threats to health. Large-scale technological solutions promoted by the
WB and the global health institutions like the WHO-UNICEF further masks
the social and environmental causes of ill health (Ibid).
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