The Globalization of Disease

Second Quarter 2001

by C. Everett Koop

Late last year, at a United Nations summit on globalization, C. Everett Koop, former U.S. surgeon general and now senior scholar at the Koop Institute at Dartmouth College, presented a paper on globalization and health. "I still believe," he told the Public Justice Report, "regardless of any economic pundit's point of view, that it is impossible to achieve the globalization of economics unless there is a globalization of health as well." The following remarks have been excerpted from Dr. Koop's UN talk.—Ed.

Despite the existence of truly global markets today, we have still not witnessed real political and economic globalization. National pride, particularism, protectionism, and special interests are alive and well and are able to frustrate even economic globalization.

However, there is one area where globalization exists. We have achieved the globalization of disease. And now that we have globalization of disease, we have no other choice but to match it with the globalization of our efforts in health. It is true, of course, that disease has always disregarded frontiers. The plague or black death of the 14th century may have been one of the first examples of globalization. The tens of millions of American Indians who died from European-borne disease in the 16th century was a horrible side effect of European exploration and colonization of America. The influenza pandemic of 1918-19 is a more recent example. And AIDS seems to have traveled to North America on an airplane, with an aisle seat. Some of the participants in this forum will have brought to New York viruses from their homeland that, in an earlier age, could not have made the trans-oceanic voyage.

When I speak about the globalization of disease, I refer to two phenomena. First there is the pervasive role of sickness in human society. Globalization efforts in the areas of politics and economics and even culture will founder if the societies targeted by globalization efforts are preoccupied with illness.

This basic human problem was first made clear to me years ago, at a time when most efforts to improve the lot of the world's splintered tribes and small ethnic groups was taken on by medical missionaries. Back in the 1950s, I assisted missionaries working in southwestern Mexico. According to anthropologists, the Tarascan Indians had not changed their way of life in 400 years. My Mexican physician friends told me I would find them lazy, unable to do a day's work, and lacking any ambition to improve themselves. Indeed, that's what they looked like. But they all had multiple intestinal parasites. They were all anemic and many had unhealed external lesions like ulcers. Their diet was tortillas and beans—and not much of those—supplemented once a week by a cup of fish broth made by boiling a fish head in water for a family of four. Those who lived around a lake had malaria; those at higher altitudes had syphilis. Those Indians weren't lazy or lacking in ambition. They were sick!

The second meaning of globalization of disease refers not to the pervasiveness of illness in the world, especially in the developing countries, but to the ways in which a particular disease spreads so rapidly around the globe, as AIDS has done. This summer, right here in New York, health officials moved to combat the West Nile virus. That disease, named for a river in Egypt, makes my point all too well. There is no disease anywhere that is someone else's problem.

So, if disease has become globalized, health care must also lift up its eyes to gain a global outlook. One way to do this, of course, is through the organizational structures that already exist to promote worldwide health, to foster cooperation between various governments on health-related issues. But international health is not global health. Think of international health as a jigsaw puzzle being assembled: run your finger across the face of the puzzle and you'll feel the holes where pieces are missing and the bumps where pieces join. Global health should be seamless. So, while I support the efforts to advance international health, I think there are faster ways to promote global health, and I'll mention just one of them. Internet technology, especially in health information, can make up for the current organizational impediments in international health. This technology is still in its infancy. As we combine our main methods of communication and increase the speed of transmission, nothing known in New York will be unknown in Delhi or Botswana. I am convinced that the Internet will change the way medicine is practiced because knowledge empowers patients to make decisions in tandem with their physicians. Public health will be better understood and practiced.

I've spent my life delivering two messages to Americans: (1) take care of your health and (2) there is no prescription more valuable than knowledge. Those messages must now be shared globally. Nothing delivers them better than the Internet. Remember Lauterbach, that great proponent of literacy? How did he do it? "Each one teach one." That could be the operational message for the globalization of health.