Breakdowns in Public Health Systems
Breakdowns in Public Health Systems

Standing out against this backdrop of concerns are the world’s public health systems. Very often, small changes in the level of preventative care or treatment that is provided by these systems can combine with other disruptions in the environment or social conditions to create the necessary environment for the explosion of certain diseases.

The growth of shantytowns, squalid living conditions, and inadequate health care services are all conducive to epidemics. Even more dramatically, the disruptions caused by wars, civil disturbances, or economic collapses can lead to the erosion of the public health system.

The most deadly epidemic of the 20th century was the influenza outbreak of 1918, which was fueled by effects relating to World War I. The war led to the concentration of hundreds of thousands of troops in trenches, barracks, and hospitals, many of whom suffered malnutrition and other diseases due to the privations of the fighting. Taken together, these factors formed a combustible mixture that fueled a worldwide epidemic that killed 20 million people.

Health conditions in Russia today are among the greatest concerns of international epidemiologists, where unstable political conditions, severe pollution, large migrations of people and serious economic disruption have accompanied a collapse of the public health system, leading to many new serious epidemics.

Malcolm Gladwell in The Tipping Point details an incident within the United States that illustrates well how small changes in the public health system can lead to the appearance of an epidemic:

In Baltimore in the mid-1990s, several small and unrelated events combined to create a serious epidemic of syphilis. Within the inner city of Baltimore, the city had undertaken an urban renovation project and began dynamiting old public housing buildings. This led to the physical relocation of hundreds of families. Other neighboring row houses began to empty out as well, creating a small diaspora of the local population. At the same time, the city, due to budget cutbacks, eliminated seven of the 17 medical personnel who serviced public clinics in these neighborhoods. As a result of the medical cutbacks, the number of people being treated for syphilis per year fell from 36,000 to 21,000.

Until that time, the number of cases of syphilis per year had been relatively constant, and largely confined to a specific and relatively insular population within these small sections of the city. However, this collision of eventsthe cutbacks in the clinics and the forced and voluntary relocationsserved to disperse the infected population across the city at the same time that access to treatment was curtailed.

The result? An unexpected epidemic of syphilis across the city. The number of cases of children born with syphilis increased by 500 percent over the course of a year, all because of a few small changes in how people lived.

For Malcom Gladwell’s The Tipping Point please click here.

One of the most serious criticisms of globalization pertaining to public health is the allegation that international financial institutions have, in some instances, put economic priorities ahead of public health concerns. Accordingly globalization has augmented  the necessity for governmental budgetary oversight, which can cause substantial cuts in public health expenditures.  In the end, this process sometimes fails to prove economical prudent, as costs increase in the end and general health declines.

In many cases, the disputes are over short-term versus long-term economic consequences. For instance, a nation’s inability to control inflation – which is often caused by too much government spending – can have serious consequences for its long-term growth potential. And the best way to ensure a nation’s long-term health is to promote economic prosperity, raising income levels and living standards.

The question often boils down to the specific areas in which the governments in question choose to slash their budgetsfor instance, on preventative care versus treatment. The matter is sure to remain one of the most sensitive controversies about health and globalization.


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