Health across the world continues to show major contrasts. Infectious diseases primarily affect countries of the South. Outside of Africa, people are more affected by non-communicable diseases, most of them related to lifestyle and our increasing lifespan. Access to healthcare is a major factor of discrimination in places where there is no universal healthcare and due to the investment and pricing decisions of world pharmaceutical companies.
In the Neolithic Age, when agriculture and husbandry brought people into sustained contact with animals, there were many epidemics. The rise of long-distance trade by land and sea around 1000 CE promoted the globalization of pathogens in Eurasia, and transatlantic voyages subsequently contaminated the Americas and Oceania in the late fifteenth century. From the sixteenth to the nineteenth centuries, most countries adopted a system of quarantine or cordons sanitaires to avoid the spread of infectious diseases (plague, flu, measles, yellow fever, syphilis, cholera, tuberculosis, leprosy, etc.).
Is another epidemic on the way?
The late 19 th century saw the foundation of international organizations to coordinate the fight against epidemics. Into the 1970s, medical advances offered the hope that epidemics could be eradicated through vaccination and the discovery of new treatments. Since that time, the identification of new pathologies (AIDS, SARS [Severe Acute Respiratory Syndrome], bird flu), the rise of certain diseases (dengue, chikungunya, meningitis) and the re-emergence of diseases supposedly eradicated (tuberculosis, smallpox, plague) suggest the possibility of a new outbreak fostered by globalization, climate change, the risk of bioterrorism and inadequate food security.
Infectious diseases primarily affect countries of the South (accounting for 56 % of mortality in Africa, 5 % in Europe). Topping the list of global parasitic diseases is malaria, which affects 216 million people a year and causes 445,000 deaths, 91 % of them in Africa. The failure of attempts at eradication by spraying with insecticide, causing agricultural devastation and the development of resistance in mosquitoes, led to the development of effective drug treatments, but these remain too expensive for most sufferers.
Comment: The table reveals the links between the main causes of mortality and the average level of income per inhabitant in 2015. The populations of high-income countries are more liable to die from non-communicable diseases (neurological causes and cancer in particular) while in low-income countries, people die from infectious diseases (tuberculosis, diarrhea, HIV/aids) or malnutrition. This reverse gradient is less marked in the case of diabetes (due to there being two types) and heart disease.
Non-communicable diseases on the rise
Outside Africa, more people are killed by non-communicable diseases, and this trend is growing. It is thought that in 2030 three-quarters of deaths will be caused by cancer, diabetes, cardiovascular, bronco-pulmonary and neurodegenerative diseases, obesity, mental illness, musculoskeletal problems and road traffic accidents. Most of the diseases listed are linked to lifestyle (diet, alcohol consumption, smoking, sedentary lives, etc.) and the fact that people are living longer.
Diabetes is widespread in rich countries, particularly among the poor, and is now spreading to poorer countries subject to food shortages and nutritional imbalances. In cities, traditional foods face competition from pre-prepared dishes that are higher in fat and sugar. In a sign that a pandemic is on the way, the number of diabetics in the world has multiplied by four in under 40 years, from 108 million in 1980 to 422 million in 2014.
The rate of smoking, which is responsible for 10 % of adult mortality (7 million deaths per year), is stagnating and indeed falling in rich countries, due to prevention, taxation and prosecution of the tobacco industry. Conversely, the rate of direct and indirect smoking is rising in emerging countries and developing countries, promoted by aggressive marketing by cigarette companies; 80 % of today’s 1.1 billion smokers live in low or intermediate income countries, where smoking is growing among women and the young.
Comment: The world distribution of death by non-communicable disease shows marked contrasts. The countries with very ageing populations are more susceptible to neurodegenerative illnesses. Those suffering from a combination of unbalanced diets, high alcohol and tobacco consumption, sedentary lifestyles, and exposure to pollution are more affected by cardiovascular diseases and cancer. Mortality from diabetes now impacts the whole world, starting with the poorest.
What price medical care?
The evolution of diseases and global increases in heath spending have stimulated the global pharmaceutical industry. However, the large multinational companies based in developed countries show little concern for the needs of developing and emerging countries: less than 10 % of investment in medical research goes to the so-called neglected diseases that account for 90 % of global morbidity (leishmaniasis, leprosy, Chagas disease, sleeping sickness, malaria, etc.).
Yet diseases such as hepatitis C––chronically carried by 71 million people and killing nearly 400,000 a year––could be eradicated. New antiviral drugs provide an effective cure in over 95 % of infected individuals. In the absence of universal healthcare, access to costly diagnosis and treatment remains beyond the reach of disadvantaged populations, who are also the most likely to be affected by an epidemic, due to the modes of contamination. Vulnerable populations are also more likely to fall prey to the boom in counterfeit drugs (10 % of the global market, rising to 30 % in developing and emerging countries), the controversial practices of some pharmaceutical companies (testing new drugs before market authorization) and environmental effects (pollution of waste water by the active ingredients of drugs).
Comment: These data, produced by the pharmaceutical industry itself, show the influence of the large multinationals in the sector (10 American and 8 European among the top 20, adding up to almost 500 billion dollars of revenue), the contribution of their flagship medicines to their total revenue and the type of pathologies they treat (cancer: 8.8% of revenue, diabetes: 5%).
- international organizations > International Organization
- In the words of Clive Archer, an IO is “a formal, continuous structure established by agreement between members (governmental and/or non-governmental) from two or more sovereign states with the aim of pursuing the common interest of the membership.” Marie-Claude Smouts identifies three characteristics of IOs: they arise out of a “founding act” (treaty, charter, statute), have a material existence (headquarters, finance, staff), and form a “coordination mechanism.
- climate change > Climate changes
- The UN defines climate change as “a change of climate which is attributed directly or indirectly to human activity that alters the composition of the global atmosphere and which is in addition to natural climate variability observed over comparable time periods” (United Nations Framework Convention on Climate Change [UNFCCC], 1992). The expression is used to describe global warming of the Earth’s surface, whose extent and rapidity are without precedent in the planet’s history, and results from the increase in anthropic greenhouse gas emissions (principally carbon dioxide and CO2, but also methane, nitrous oxide, perfluorocarbons, hydrofluorocarbons, and sulfur hexafluoride).
- risk > Risk
- Risk refers to the perception and recognition of dangers and threats to individuals and to the environment. Having first appeared in academic and political thinking in the late 19th century, with the emergence of a welfare state whose role was to protect against the new social risks, the notion of risk developed in recent decades in the light of the globalization of trade and scientific and technological innovation. In his book Risk Society (1992), German sociologist Ulrich Beck analyzes the transition from “modern” societies built on the dogma of economic growth and technological progress to “post-modern” societies based on the production, management and regulation of risk. This is reflected in the rise of the precautionary principle, which seeks to anticipate the possible or probable consequences of natural and industrial disasters, epidemics or technological innovation, in order to protect the affected populations.
- food security > Food Security
- The notion of food security emerged at the World Food Conference of 1974 and has developed since then to include various aspects – access, availability, quality, stability – which were summed up as follows at the World Food Summit of 1996: “Food security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life.” It is one of the seven dimensions of human security set out in the United Nations Human Development Report (HDR) of 1994.
- rich countries > Developed Country
- At point 4 of his Inaugural Address of 1949, American President Harry S. Truman outlined a program of aid for “underdeveloped areas. This phrase refers to all the countries regarded as “lagging behind” in progress toward what thus becomes the model set by the developed, industrialized countries, which at that time had stronger growth and higher standards of living. The evolution of the terminology from underdeveloped to developing and developed countries has not altered the linear, evolutionist aspect of the overall vision. Nor has it in any way nuanced the homogenization and reification of the groups so described.
- emerging countries > Emerging Country
- This term arose in the 1980s among economic and financial actors, who used the adjective “emerging” to describe markets where investment was risky but profitable. With its emphasis on growth and suggestion of rising movement, it reflects a linear, Western-centered understanding of development. As adopted and challenged by political actors, the label refers to the international, economic, political and/or diplomatic integration of some countries. It invites us to interrogate the way it is used both by actors who adopt it and those who reject it.
- multinational companies > Multinational corporation
- Company that has undertaken foreign direct investment (FDI) giving it access to facilities that it owns fully or in part (subsidiaries). The first MNCs date from the late 19th century; corporations of this kind have become widespread in the early 21st century. The majority of FDI takes place between industrialized nations. Such companies are now transnational rather than multinational, the largest among them tending to evolve into global corporate networks.
- counterfeit > Counterfeit
- Counterfeiting means the reproduction, imitation or total or partial use of an intellectual property right without the authorization of its owner (brand, model, patent, copyright, software, etc.) and for the purpose of cheating the buyer. It involves all sectors of the economy and is now further stimulated by e-commerce. It forms a high proportion of international crime (500 billion dollars in 2016) in which Chinese manufacturers have a dominant place. The populations of developing countries are particularly exposed to dangers from the sale of counterfeit medicines, especially in Africa.
- environmental > Environment
- In broad terms, the environment is understood as the biosphere in which living species cohabit, while ecology studies the relations between these organisms and their environment. The environment encompasses very diverse natural areas from undisturbed virgin forests to artificialized environments planned and exploited by humans. In a more limited definition of the term, “environmental” issues are those relating to natural resources (their management, use and degradation) and biological biodiversity (fauna and flora). As a cross-cutting public concern, the environment encompasses issues of societal organization (production models, transport, infrastructure, etc.) and their impacts on the health of humans and ecosystems.