Globalization: Enemy or Friend?

Globalization has impacted infectious disease in both negative and positive ways[1]. As global organizations join forces to address disease in deprived populations, globalization has also shown to bring about more disaster into the same deprived people. Western economic ideals may affect the way leaders perceive their own countries and allocate their resources in different areas while ignoring the health needs of their people. Not only are deprived populations affected by globalization, developed nations are also influenced by the global trades happening in our time. The increased transportation of products from around the world has not only made food and materials accessible to everyone, but we have also come in contact with a diverse pathogens.

Zimbabwe’s cholera outbreak has been described as the “one of the world’s largest ever recorded” by the WHO[3]. As of January 2009, it has infected more than 60,000 people and killed more than 3,100. Before this outbreak, Zimbabwe had been successful at keeping cholera under control through national prevention programs. According to the WHO, half of the cholera cases were recorded in Budiriro, on the western outskirts of Harare[3]. Some other major concentrations places have been Beitbridge, and Mudzi. This cholera outbreak displayed common oversights of many countries. For instance, we perceived the country’s reluctance of acknowledging that they were experiencing the first signs of a severe outbreak, as well as country’s inability to disperse their health care providers to the places where they were needed the most.

The idea that globalization could have a positive impact on other countries is exemplified by the WHO efforts in conjunction with the Ministry of Health and Child Welfare’s efforts to control the epidemic. Their struggle has focused on increasing awareness on prevention and treatment. They have noticed that most of the deaths have occurred in remote areas of the country because people do not have the resources and the transportation to access health services. At the same time it has been difficult for the government to provide their citizens with suitable health facilities and staff[5]. Unfortunately, the government of Zimbabwe has not been able to mobilize resources to pay their medical staff or to organize them into brigades that reach remote areas in need of health services.

Globalization has allowed nongovernmental organizations to provide basic needs to different areas that have been affected by the cholera outbreak. These organizations are able to bring doctors, nurses and other health staff to places that where the government has been able to reach. It has been suggested that in order to control this massive outbreak, it is necessary for nongovernmental organizations, the United Nations and local government to join forces and focus on case management, water and sanitation, social mobilization and provision as well as mobilization of financial resources[4]. Zimbabwe needs to provide for its local health care professionals as well as increase the number of staff able to reach diverse regions affected by the cholera outbreak.

Another great example of the positive impact of globalization has been the successful efforts to eradicate polio from Latin America and the Caribbean [2]. The Pan American Health Organization introduced a campaign, in countries that had endemic cases of polio that focused on national vaccine days where children under five would be immunized. These campaigns were complimented by crusades that visited each household that had not been reached by the twice-a-year campaigns [2]. It was a cost-effective program that cost $120 million saved millions from Polio’s debilitating symptoms such as, paralysis, and other life-threatening motor problems.

The impact of cholera on the Zimbabwe people has been attributed to the flaws in water sanitation and transportation as well as the unavailability of oral rehydration salts. Oral rehydration salts are solutions made of glucose and other salts that should be added to clean water in order to save patients from dehydration. The Global Task Force on Cholera Control reports that about 80% of individuals infected with cholera could have been treated with oral rehydration therapy and thus prevented many deaths.

Joining forces had proven to be the best response to epidemics and infectious outbreaks. In the case of Polio, the Inter-Agency Coordinating Committee, using representatives from the PAHO, UNICEF, The US Agency for International Development, the Inter-American Development Bank, and the Canadian Public Health Association integrated their efforts and contributed $110 million to the cause [2]. Together, they were able to reach more areas with high risk of Polio infection. Not only was mobilization improved, but also strategies of vaccine provision and health education were enhanced. Financing the immunization campaigns became more effective as well as increasingly organized. Leaders were able to set up surveillance programs capable of attending to any new cases and keeping them under control.

The government of Zimbabwe committed an error when they encouraged their inhabitants to prepare homemade solutions of the oral rehydration solution out of salt and sugar. This act prevented the successful treatment of many people affected by dehydration as a result of the cholera. The WHO guides case management to concentrate on health education and preventive measures. Health educators are encouraged to focus on instructing individuals to prepare the solution at home by using clean water. They can learn how to administer the solution to their children and how often the children should drink it.

Zimbabwe’s response has been criticized because it was not as promptly as it needed to be. According to the WHO, Zimbabwe underreported the cholera cases when the outbreak first erupted. As a result, the Cholera Command and Control Center have been established along with epidemiologists, logisticians, water and sanitation experts, and health workers [4]. Countries that rely greatly on tourism are many times reluctant to report their first signs of an outbreak because they fear that their tourism will be affected especially when it involves an infectious disease like cholera. Globalization allows ideas, cultures, and practices to be exposed to more parts of the world. Unfortunately, many times, this has a negative impact on those marginalized communities. The exposure of different practices allow for stigma to arise which is represented by the fear of certain governments to acknowledge when they are experiencing an outbreak.

The common culprit in cholera outbreaks is consumption of water from contaminated sources [4]. Zimbabwe’s inhabitants were affected because of defective water-piping systems. Health educators have concentrated on teaching hand-washing but many of these individuals cannot rely on clean water sources. Water-piping systems have to focus on safely disposing of sewage water in order to prevent the entry of bacteria into the clean water used for consumption and washing.

As mentioned by Saker et al, economic crisis leads many governments to reduce their amount of health expenditure in order to allocate the majority of financial resources in immediate predicaments. Structural adjustment of many governments is also mentioned as being the cause of a country’s inability to control an outbreak. Prompt response can be limited when authorities have to focus on other governmental crisis.

1. Saker et al. “Infectious Disease in the Age of Globalization”. Chapter 2. 19-35

2. “Eliminating Polio in Latin America and Caribbean” Class reading. 39-46

3. Gardwood, Paul. “Global, national efforts must be urgently intensified to control Zimbabwe cholera outbreak” World Health Organization. 2009

4. “An old Enemy Returns” World Health Organization. 2009

5. Gardwood, Paul. “ Health System Problems Aggravate Cholera Outbreak in Zimbabwe”. World Health Organization. 2009

6. London, Owen D. “ WHO’s Attempt to Eradicate Polio are Thwarted in Africa and Asia”.