Protecting the Nation's Health in an Era of Globalization: An Introduction

Phi Kappa Phi Forum, Fall 2003 by Dowell, Scott F, Leavitt, Alexandra M

Centers for Disease Control and Prevention

It is not possible to adequately protect the health of our nation without addressing infectious-disease problems that occur elsewhere in the world. In an age of expanding air travel and international trade, infectious microbes are transported across borders every day, carried by infected people, animals, and insects, and contained within commercial shipments of contaminated food. "Old" diseases such as malaria, measles, and foodborne illnesses are endemic in many parts of the globe, and new diseases such as acquired immunodeficiency syndrome (AIDS, caused by the human immunodeficiency virus [HIV]) - as well as new forms of old diseases such as multidrug-resistant tuberculosis (TB) - can emerge in one region and spread throughout the world.

Moreover, unforeseen disease problems continue to appear. Recent examples include vancomycin-resistant infections of Staphylococcus aureus in the United States and Japan, avian influenza in Hong Kong, a new disease called Nipah virus encephalitis in Malaysia, and outbreaks of dengue fever in Texas and West Nile encephalitis in New York [and even more recently, Severe Acute Respiratory Syndrome, or SARS - Editor]. Increased CDC engagement in efforts to improve global disease-surveillance and outbreak response will help us detect new or unusual diseases of any kind and respond to health emergencies of any kind - including both naturally occurring and intentionally caused outbreaks.

Left unchecked, today's emerging diseases can become the endemic diseases of tomorrow. This is what happened with HIV/AIDS, which spread from a remote part of Africa to all other continents twenty years ago and is now entrenched all over the world, necessitating a major international control effort. Because United States and international health are inextricably linked, the fulfillment of CDC's domestic mission - to protect the health of the U.S. population - requires global awareness and strategic thinking.

U.S. INVESTMENT IN GLOBAL PUBLIC HEALTH

The United States must participate more fully in combating infectious-disease threats around the world. These efforts will yield multiple benefits:

* Protecting the health of U.S. citizens at home and abroad. Controlling disease outbreaks as well as dangerous endemic diseases wherever they occur prevents those diseases from spreading internationally, saving lives and dollars. U.S. citizens cannot be adequately protected from diseases such as measles, HIV/AIDS, and tuberculosis if our public-health efforts are restricted to persons residing within our borders.

* Furthering U.S. humanitarian efforts. The potential for saving human lives by preventing infectious diseases overseas is tremendous. Every year, an estimated three million infant and child deaths are prevented by vaccination and other preventive health measures. Many families and communities, including refugees and displaced people, also benefit from international investigations that lead to prompt control of outbreaks.

* Providing diplomatic and economic benefits. Because health is an area of concern for all nations, international projects that address infectious-disease issues can open avenues of communication and ease tensions between the United States and other nations. Improvements in global health will also enhance the U.S. economy and contribute to global prosperity. Reductions in disease burden will promote economic growth in nations that represent growing markets for U.S. products. Investments in global health will also reduce U.S. healthcare costs by decreasing the number of cases of imported diseases and by eradicating diseases currently included in childhood-vaccination programs.

* Enhancing security. Slowed economic growth fueled by poor health and disease can impede democratic development and political transitions in poor and former-communist nations, contributing to military conflicts and humanitarian emergencies. The HIV/AIDS pandemic is already destabilizing poorer nations, damaging their economic, social, political, military, and educational infrastructures, and creating vast numbers of orphans. The recent intentional releases of biologic agents in the United States also have intensified international concerns about bioterrorism. Because of the ease and frequency of modern travel, an intentionally caused outbreak that begins anywhere in the world can quickly become an international problem. A contagious bioterrorism agent such as smallpox can spread rapidly from person to person and from country to country. A noncontagious agent such as anthrax can be spread by unexpected methods, including international mail. The United States must be prepared to work with other nations to prevent illness and deaths caused by acts of bioterrorism.

Although the United States participates in health projects in many parts of the world, much more can be done, at relatively low cost, with political will, national leadership, and a clearly articulated global strategy.

CDC'S ROLE IN PROMOTING GLOBAL PUBLIC HEALTH