Globalization and Cholera: Implications for Global Governance

Abstract

Plague and pestilence have become an increasingly popular theme since the end of the Cold War among policymakers, journalists, fic tion writers, and film directors searching for new threats to personal and national security. Ill health and, in particular, infectious diseases have generated a spate of popular, and often alarmist, literature.1 This has been accompanied by growing high-level concern within governments and the medical community with global health issues that threaten national inter ests.2 The emphasis in many of these discussions has been on emerging health threats that are perceived to pose potentially sudden and serious dangers to public health. We begin this essay with the premise that the process of globalization has particular impacts on health and that there is a clear need to better un derstand and more effectively respond to these impacts. However, with out underplaying the dangers posed by health emergencies caused, for ex ample, by the genetic mutation of viral agents or epidemics of emerging infectious diseases, we seek to develop a broader understanding of the his torical and structural factors behind the health challenges posed by glob alization. As we discuss later, globalization can be defined as a process that is changing the nature of human interaction within a range of social spheres. Globalization's impact on health can be seen as part of a longer historical process firmly located in social change over decades, and per haps centuries, rather than recent years. From this perspective, an understanding of global health issues at the turn of the twenty-first century could benefit substantially from the volu minous literature on globalization from international relations, including the subfields of social and political theory and international political econ omy. This is a rich and highly relevant literature. It documents what struc tural changes are occurring toward a global political economy, how power relationships are embedded within this process of change, what varying impacts this may have on individuals and groups, and to what extent global governance could effectively mediate this process. These issues counterbalance the strong focus in the health literature on biom?dical re search, information systems, and other technical solutions. Although