Media Globalization and the Discovery Channel Networks (Routledge Advances in Internationalizing Med

Yet, continuity also characterizes the internationalization of media Globalization and the Discovery Channel Networks (Routledge, ).
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Some historians do regard such an enterprise as legitimate and claim to find the antecedents of contemporary globalization deep in the past. Nevertheless, I recognize that earlier periods do bare some resemblance to globalization, in that one can observe connections that had acquired a degree of stability and affected large numbers of people. European expansion was accompanied or preceded by that of other peoples including the Arabs and Chinese. Forces of integration were also at work beyond the empires of Europe.

Although some of the old empires of Asia experienced stagnation and decay, others, like that of the Safavids, were forged anew. Indeed, the majority of people remained subjects of polities that were only tenuously linked to European systems. Confined to small trading concessions on the coasts and major rivers, Europeans had relatively little power or influence. But European imperialism was a radically disruptive force. During the next hundred years—through to roughly the middle of the nineteenth century—some of the great early modern empires, such as that of the Mughals, were fatally weakened, a process fomented and exploited by Europeans.

By the nineteenth century, new technologies of communication such as steam propulsion and the electric telegraph enabled disparate colonial possessions to be welded into relatively cohesive empires. The global dimensions of this new economy are indicated not only by the volume and variety of commercial transactions but by long-distance labor migration and the harmonization of prices for certain commodities.

This was particularly evident in agriculture, where improvements in transportation and new technologies such as refrigeration enabled New World farmers to undercut producers in Europe. Cheap meat and processed foods flowed into European markets, spurring calls for protection. In Europe itself, the rapid rise of Germany intensified imperial rivalry and strengthened those forces that urged self-reliance and trading preferences for their own empires. These rivalries provided the conditions for a global war in —18, stalling the process of integration and reconfiguring international politics.

After the war, a new spirit of internationalism, epitomized by the League of Nations, briefly flourished but soon foundered on political and economic realities. The onset of the Great Depression sharpened these divisions, while creating demands for economic protection and self-sufficiency. The war marked the end of fascist imperial ambitions and hastened the decline of the empires assembled by Britain and France.

As this period of conflict came to an end, a new phase of integration began. After , a concerted attempt was made to construct a new world order, the most prominent symbol of which was the United Nations. But integration proceeded for the most part within ideological blocs, capitalist and communist, and within them, too, significant divisions emerged. However, other important changes, including decolonization, the rise of multinational corporations, foreign aid, and the emergence of new forms of transnational consumerism, laid the foundations of contemporary globalization.

The Soviet Bloc later began to exhaust its resources in competition with resurgent and ideologically driven Western nations, while the process of dialogue initiated by President Nixon in the early s saw the gradual opening of China and the beginning of market reforms. The fall of the Soviet Bloc in —91 permitted economic integration to proceed apace, harnessing new communication technologies, most obviously the Internet. The revolution in IT also had the effect of altering perceptions of time and space, both of which were compressed. The effect was at once liberating and disorientating.

Social and cultural forms that had existed for generations were rapidly dissolved, to be replaced by more cosmopolitan habits and trends. This complex, unstable world, marked by cruelly ironic juxtapositions of poverty and wealth, is the one we inhabit today. In the remainder of this article I show how these successive periods of integration have shaped not only the global contours of disease but the rise and expansion of Western medicine and concepts of health. By the twentieth century, some traditional medicines and medical products also came to be distributed on a global basis.

But Western medicine was the chief beneficiary of global integration and arguably still is, even in countries known for their distinctive medical traditions. These developments are considered in four sections. The first three examine disease, medicine, and health up to the late twentieth century, while the last charts the effects of globalization since the s. I have chosen to consider the recent past separately because the sources on which my analysis is based are different from those of previous sections. While the first three are able to draw on an abundance of historical scholarship, coverage of the recent past is sketchy, and most of the works cited in the final section are utilized as primary sources to make provisional observations on the consequences of globalization.

Pathogens know no borders and lend themselves to histories that are global or transregional in scope, Alfred W. Since then, the field of disease history has become crowded, to say the least. These works are too numerous to mention, and to review them would detract from my argument. In this section I argue that disease histories that fail to take into account structural and ecological change gravely oversimplify the relationship between disease and global integration.

This means examining not just the movement of pathogens but the transformation of social and ecological conditions—changes that affected indigenous as well as recently imported infections. Nor should we neglect the affects of global integration upon lifestyles and the diseases arising from changing patterns of work or cultural preferences. For example, the long-term impact of disease on the South Pacific islands has been shown to depend crucially on the nature of imperial rule.

Where settler capitalism dominated—in other words, where indigenous peoples were dispossessed of their lands—populations took far longer to recover than in those colonies in which Europeans formed a small managerial elite. The real question is where the emphasis should lie: The answer depends on the case to be examined, but, in general, we can learn much from the approach taken by John R.

McNeill in his recent study of the Caribbean. He shows how pathogens and disease vectors were shipped from Africa to the Americas on slaving vessels and how they became naturalized in environments profoundly altered by the rise of plantation agriculture. But it would be impossible to undertake a similarly fine-grained analysis for a larger area, and so far there has been little appetite for similar research on other regions. Regional studies of disease in Europe are largely confined to medieval visitations of the plague, later known as the Black Death.

If our aim is solely to understand disease as contemporaries did, then its biological identity is relatively unimportant.

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But the insistence that we must avoid using modern disease categories prevents us from charting the spread of disease or explaining the rise and fall of epidemics and their relationship to economic, political, and environmental changes. These are surely legitimate questions. They are also vital if we are to attempt anything more than a localized study. If cross-cultural comparisons are to be attempted, or long-distance connections explored, then it is clearly useful to establish the identity of the disease in question.

It is not always possible to do so with certainty, but analysis of ancient and modern DNA and stable isotopes is improving rapidly, and there are now many techniques that enable us to determine the existence of pathogens in the past. Bio-archaeological and paleogenetic techniques will assuredly become important tools for those who wish to write the history of disease from a global or long-term perspective, and will be particularly important where manuscript and other documentary sources are fragmentary or ambiguous.

This may be one reason why the disease history of parts of Asia is currently underdeveloped, but it is unlikely to be the only one, for sources relating to epidemics in the Indian subcontinent are relatively abundant and could permit detailed explorations of the relationship among disease, trade, conquest, and environmental change. Crosby and John R.

McNeill—a lacuna that presents a major opportunity to scholars with the requisite skills. The historical coverage of most of Africa prior to is even more limited, although in this case it is the absence of documentation that is largely to blame. After , the epidemiological contours of Africa and most other parts of the world are more distinct and the scholarship more abundant. But while the geographical coverage is more even, it remains fragmented. Historians have tended to view disease largely within national or colonial borders, their principal intention being to examine tensions within the body politic.

In this sense, the historiography of disease in nineteenth-century Asia and Africa has largely mirrored that of Europe and North America. The s saw the greatest redistribution of pathogens the world has ever known. Human, animal, and plant diseases circulated in many directions, with enormous social and political ramifications. This global picture usually appears as a dimly illuminated backdrop to a local or national story. It is therefore necessary to think more deeply about the connections between these apparently disparate events.

In the s, the dawn of this new epidemiological era was heralded by a resurgence of yellow fever in the Caribbean.

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An epidemic subsequently developed in the western Atlantic amidst the tumult of war and revolution. For nearly three decades it erupted sporadically but powerfully along the Mediterranean coast, creating havoc in cities such as Cadiz and Barcelona. The same is true of plague, which spread from the Middle East in the s and s as far west as Malta and later of cholera, which radiated out of South Asia from the s.

As this tumultuous century drew to a close, plague was unleashed from its confines in parts of Asia and North Africa to reach every inhabited continent. Hitherto, the term had rarely been applied to such epidemics, even in the case of cholera. By the early twentieth century, however, the modern meaning of the term had become dominant. This was due in large part to plague but also to two major epidemics of influenza: These were truly global infections, being oblivious of borders and social rank.

Much has been written about these pandemics—or at least their local manifestations—but the connections between them are seldom considered. Nor have they been seen in relation to other pathogenic exchanges that arose from the global trade in agricultural commodities. Livestock plagues such as rinderpest, rabies, foot and mouth, and East Coast fever, 59 as well as plant infections like the blight that caused the Great Irish Famine, 60 brought hardship and death to millions. Contemporaries saw these phenomena as linked and many regarded the simultaneous spread of cattle plague and cholera as a sign of a world gone awry.

Although most originated in Asia and Europe, some came from elsewhere, including the Americas. The blight that destroyed the Irish potato crop, for instance, was most likely imported into Europe in shipments of guano from Peru; the diseases and pests that devastated European vineyards at the end of the century were also of American origin. Each of these diseases was related to specific patterns of movement, such as those occasioned by trade, war, economic migration, and religious devotion.

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The most important of these was trade, which expanded massively in scale and scope in the course of the century. But the ramifications of the new world economy were by no means confined to the imperial powers and their colonies. A massive surge in the volume of commodity exports and investments was followed by an unprecedented convergence of prices. We cannot understand the full impact of economic integration unless we consider how environments were changed by their incorporation into a global market.

Capturing the complexity of these dynamics in a single narrative is formidably difficult, but one way of doing so is to examine a variety of localities in order to determine how ecosystems were altered as they were drawn into a global web. This is, perhaps, most easily achieved by focusing on an industry or type of economic activity rather than any particular disease.

Plantation agriculture is well suited to this, for it illustrates both the global migration of pathogens and their sensitivity to social and ecological conditions. As they developed during the sixteenth and seventeenth centuries, the sugar plantations of the Atlantic came to rely almost exclusively on African slaves. While slavery lingered on in the American South, it was progressively abolished elsewhere and, by the mid-nineteenth century, most plantations in the Caribbean and Latin America depended on an influx of cheap labor from overseas. The majority came in the form of indentured workers from South Asia and China, and the same was true of the plantations that came to be established in parts of Southeast Asia and tropical Africa.

The epidemiological consequences of these migrations have been examined most carefully with respect to the shipment of indentured workers from South Asia to the Caribbean. From these studies, we know that cholera, smallpox, and other diseases often broke out on migrant vessels and that these pathogens were carried to many parts of the world.

In Russia, the abolition of serfdom in the s resulted in an eastward migration of peasants who seized land from nomadic pastoralists. Deprived of the means of subsistence, many former herders had little option but to work on the farms and mines established by the immigrants. There, they encountered malaria, which had recently been brought into the region. Unable to afford relief in the form of quinine, they suffered terribly from the effects of parasitic infection. Indentured laborers were transported to tea plantations in Assam and elsewhere in the Northeast by river, bringing with them a variety of infections including those causing leishmaniasis, known locally as kala-azar.

By the s, as the rail link to Calcutta was nearing completion, Assam also experienced what appears to be its first epidemic of cholera. Cholera was common among the laborers who built the railway, and they were often seen as responsible for infecting new areas. The same was true of the parasitic infection, hookworm. As hookworms are transmitted in feces, the poor sanitation on most plantations meant that the disease became firmly established in many parts of the world. Tamil laborers were brought in to work on tea and rubber plantations established by the British, whose brutality and neglect had deterred most of the native Singhalese from seeking employment in them.

Conditions in the plantations were so bad that the hookworm infection rate had reached 90 percent by Another way of exploring the impact of the global market on disease is to examine its connections with particular commodities. Commercialized rice production, for example, is closely associated with a number of diseases, one of which is malaria. The relationship between rice cultivation and malaria is extremely complex, much depending upon prior exposure of laborers to infection, the stability of previous transmission patterns, and species of mosquito.

The commercialization of agriculture and the expansion of large-scale rice cultivation in the American Midwest led to malaria becoming a serious problem in southern Illinois, just as it was beginning to decline in older areas of production in the South. Workers traveling to new areas of cultivation often brought with them new strains of parasites or were exposed to infection for the first time. Despite growing awareness of the transmission of malaria at the turn of the twentieth century, the profitability of rice cultivation in countries such as Italy stalled attempts to curb exposure by regulating working hours and improving accommodation.

The industrialization of rice farming, especially the process of milling, resulted in the growing prevalence and incidence of the deficiency disease beriberi. Milling reduced the vitamin-rich husk and in many parts of East, South, and Southeast Asia, populations unable to find the vitamin in other items of diet began to suffer severely.

Other methods or diseases could serve this purpose equally well. Tuberculosis, for instance, came to prominence as a disease of the industrializing West but later became prevalent elsewhere; not primarily because of infection by Europeans but because of rapid economic change. In Britain, the highest rates of tuberculosis were often in areas in which coal and other forms of mining were the principal sources of employment. The high incidence of diseases such as pneumoconiosis and silicosis probably predisposed miners to develop tubercular infections.

Though it was the principal cause of death, consumption was regarded by Edwin Chadwick as a disease whose causes were too complex to fall within the remit of his enquiry into the health of the laboring poor. This pattern was evident in South Africa from the s, as mining developed rapidly in Kimberley and on the Rand. In both cases, the contrast with the preindustrial past was striking. Tuberculosis was scarcely acknowledged as a problem affecting Indians until the s but by the end of the century it was rampant in the cotton towns of Western India and the jute manufactories of Bengal.

Over the course of the next half century, mortality from tuberculosis and other respiratory diseases rose sharply as deaths from other common infections declined. Nevertheless, it took a long time for the problem to be recognized and it was forced onto the official agenda only through the efforts of Indians trained in public health.

The outbreak of the First World War, which saw colonial troops and labor corps mixing with soldiers from the West, caused tuberculosis to spread even more widely. European doctors, whose countries were now experiencing a decline in tuberculosis, began to regard the disease as rite of passage through which all industrializing societies must pass.

In their view, it was part of the price to be paid for the advance of civilization. The circulation of pathogens through the new global economy and, later, during the war presented great difficulties, the most obvious of which was how to regulate the flow of people and commodities without disrupting either the economy or the war effort. As far as labor was concerned, the peacetime balance tilted in favor of movement, as health checks were often cursory and seldom posed much of an obstacle to immigration.

Quarantine and sanitary embargoes were established means of controlling the spread of infectious disease, but nations were regularly embroiled in disputes over the legitimacy of such measures, some of which devastated their economies. The depression of the late nineteenth century and increasing transportation of bulky commodities such as animals, meat, and grain sparked trade wars in which the supposed risk of infection figured prominently. A more difficult question was how to temper development in the interests of public health.

The balance was struck differently in different places: Disease affected productivity after all, and this was increasingly recognized during the twentieth century as more attention was paid to the health of the workforce. It was not until the s that South African mining officials became seriously concerned about the health of their African workers, for example. Only at that point did they began to realize that the supply of black labor was finite, whereas recognition of the need to protect the health of white workers, whose numbers were more restricted, came considerably earlier.

Before moving on to examine medicine, I wish to reiterate the main point of the discussion so far: Disease is a powerful agent of change, but it never operates in a vacuum and to regard it is a force of globalization is simplistic. Only in this way can we account for the differential impact of disease and its longer term consequences.

It is important to remember that the nineteenth century saw the emergence of markedly different regimes of mortality, despite the global circulation of pathogens. From the middle of the century, public health interventions and improved nutrition resulted in falling death rates in many Western countries, while mortality rates in their colonies remained stable or increased. This included not only Europe and North America but also some of their dominions, such as New Zealand, which grew rich as a result of long-distance trade in agricultural commodities.

By the early s, New Zealand was well on the way to becoming a social laboratory that others would emulate. These refugees from forest and field—concentrated in the European colonies—were the losers of the new global system, much as their counterparts today. One characteristic of historical scholarship over the past two decades has been its sensitivity to different voices and experiences. From this standpoint, the rise of Western medicine is not the only story worth telling, and to write a global history of medicine solely from that perspective would be unacceptable to many.

Yet these chapters sit rather uneasily with the others, which are devoted to Western medicine through the ages and in various manifestations. It is probably impossible to give equal weight to all medical traditions in a single volume, and to do so would require a breadth of scholarship far beyond the majority of historians. Such an ambitious undertaking might be feasible as a collective enterprise, but a more expedient approach for the lone scholar would be to examine interactions between medical cultures over a shorter time span.

Even then, one encounters a multitude of problems, not the least of which is deciding when to begin. Dates that are significant for one tradition are not necessarily significant for another. Deciding where to begin is no easier. As late as , Western medicine was not as widely diffused as tibb , a descendent of ancient Greco-Roman medicine that was practiced widely throughout the Islamic world. My task in this article is fortunately less ambitious, for it is to examine the impact on health and medicine of the global market.

Until the turn of the twentieth century, this was most clearly evident in the rise of Western medicine, and any general study has to acknowledge that fact. Other medical traditions lacked the expansionist and hegemonic aspirations of Western medicine and even the most widely disseminated—tibb—adapted to those localities into which it had spread.

Other medical cultures such as ayurveda made a virtue of locality and of their organic relationship with places and peoples. Western medicine was different because its truth claims were universal and because it was bound closely to ideas of progress and reform. The expansion of long-distance commerce fostered an empirical sensibility in Europe and its Asian and American colonies, and this contributed to the emergence of new forms of knowledge. Similar opportunities were not available in Europe until the early nineteenth century, but ideas and practices from the colonies began to filter through to Europe before that, contributing to a growing clamor for reform.

Centers of innovation in Europe existed in a dynamic relationship with one another and with the colonies, linked by networks of long-distance trade, correspondence, and a plethora of new medical journals. Medicaments and dried plant specimens sometimes accompanied by relevant literature followed routes that originated within but ultimately expanded beyond imperial networks. Their assertiveness reflected newfound confidence in the experimental sciences which had begun to have an impact on medicine , but it had an ideological dimension, too, and this acquired its sharpest definition outside of Europe and North America.

One obvious difference was between missionary medicine—with its conflation of science and faith—and the more systematized medicine practiced in major hospitals. During the nineteenth and early twentieth centuries, the crossover was most evident in the fields of bacteriology, parasitology, and public health. Much of the pioneering research on malaria and cholera—still very much European diseases—was done using personnel and medical facilities in the colonies.

By the end of the nineteenth century, Western medicine was thoroughly international. There were flows and counterflows of ideas, people, and practices, following the contours of the new global economy. Some took familiar pathways, but others—like those resulting in international medical congresses—were novel and exhibited a strong commitment to progress. For a long time, the answer appeared to be simple: Western medicine was self-evidently superior, and people came to prefer it to less effective local remedies. But while certain drugs and procedures such as vaccination against smallpox had enormous potential, it took some time for this to be realized due to technical and other practical constraints, let alone the cultural and political obstacles that impeded their introduction.

Backed by the power and resources of government, they argue, Western medicine came to enjoy immense prestige while other traditions were relegated to a position of inferiority. Many indigenous traditions were able to survive and even to thrive throughout the nineteenth century. In the late nineteenth century, most countries were transformed by the economic forces described in the last two sections. The commercialization of agriculture, industrialization, urbanization, and labor migration placed many more people in contact with Western medicine and its products. Medicines and medical services were widely advertised and available in shops and in the workplace through numerous vendors and practitioners.

This encouraged many people to experiment with a range of therapeutic alternatives to traditional remedies. Those who had invested considerable time and money in a medical education were acutely aware that they were being undercut by cheaper, unlicensed competitors and began to demand the registration of medical practitioners. Legislation like that which had been enacted in Europe and North America was increasingly passed in other parts of the world. By , for example, all provinces of British India had introduced a Medical Registration Act modeled on the one passed in Britain in This legislation prevented unqualified people from calling themselves doctors, but it did little to curb the activities of irregular practitioners who peddled a bewildering array of patent medicines.

Although most of these remedies offered little more than hope, there were enough reasonably effective drugs on the market quinine tablets for example to sustain the growing belief in the efficacy of Western medicine. The process by which this new medicine came to be embedded in Asian and African countries was not dissimilar to what had happened in Europe a century earlier. Then, an influx of exotic drugs such as fever bark from which quinine was later synthesized and newly discovered indigenous ones such as willow bark from which Aspirin was later derived boosted confidence in medicine while fueling a burgeoning market in patent remedies.

That the boom in pharmaceuticals and advertising paved the way for the dominance of Western medicine is also indicated by the response of many traditional healers. They recognized that they could compete effectively with Western medicine only by employing similar tactics: As we shall see in the final section, practitioners of ayurveda, tibb, and Chinese medicine used these methods not only to survive but ultimately to extend their influence beyond local markets. At first sight, health would appear to be an unpromising subject for global history. Its subjective nature lends itself to the investigation of difference rather than shared or connected experiences.

And yet, it is possible to think globally about health in a way that acknowledges difference and change over time. Over the past two hundred years, conceptions of health have been transformed as a result of insights from immunology, physiology, psychology, and other sciences. Health has come to be regarded not simply as the absence of disease but as a state of optimal fitness or well-being. This conception of health has provided scope for self-realization, but it has also been deliberately encouraged and manipulated.

Citizens were encouraged to think about their collective and national responsibilities, and many aspects of their lives came to be regulated in the name of public health. New institutions such as medical colleges, modern hospitals, and dispensaries played an important part in this, but no less important were the media through which the public sphere was constituted.

Newspapers and journals of all types and in myriad languages popularized Western notions of health and hygiene through their articles, editorials, and advertisements. The pills and tonics advertised in the pages of popular journals were the material artifacts of a new culture of health that blended imported, Western perspectives with local ones. One is accustomed to seeing these things as national or colonial phenomena, but there was a substantial degree of convergence between countries despite their different cultures and political systems. Imperial competition, social Darwinism, economic hardship, and the threat or actuality of armed conflict placed a premium on bodily and mental efficiency.

The educated elites of many Asian and African countries also came to view health as an index of social fitness, and its promotion was championed as a means of racial and national improvement. Decades of colonial critique had been internalized, and colonized peoples strove to overcome and surpass the physical standards set by their masters. In some cases, most obviously in Japan, the cultivation of health was seen as the path to modernity and imperial dominance.

Around the world, the promotion of health was embraced by the state and modernizing reformers. As taught in schools and inculcated in institutions such as the armed forces, hygiene conveyed the rudiments of Western medical science and led to rising demand for products legitimated by bacteriological conceptions of disease.

In some cases, elements of modern of science were blended with insights from non-Western medical traditions, religions, and philosophies. Paradoxically, this became evident at the same time as modernist conceptions of health were articulated with most conviction. During the s, for example, some individuals in Western countries began to promote alternative visions of health, some of which were explicitly or implicitly critical of modernity and its tendency to fragment human consciousness.

Yet, universal principles were increasingly evident: Although these bodies were intended primarily to manage populations and the effects of economic change, they raised aspirations and set global standards by which public health and its outcomes could be judged. In the case of the Rockefeller Foundation, they also exported a model of public health that included the establishment of urban and rural health units, demonstration projects, and education in hygiene from school to university.

Although the RF had little lasting impact on British India, for example, its programs were implemented widely elsewhere, particularly where they complemented local initiatives and nationalist projects of regeneration. By the s differences in health indicators could be measured fairly precisely due to the centralization of mortality data in the League of Nations and bodies such as the Pan American Health Organization. However, the internationalism of the immediate postwar era began to evaporate as relations between the West and the communist powers deteriorated.

The notion that health was a human right was also criticized in some quarters as vague and impossible to define. Nevertheless, most affluent nations continued to spend generously on health and to promote its development in poorer countries through foreign aid. Thus, the two superpowers—the United States and the Soviet Union—were major players in the most high-profile public health intervention of the postwar era: The United States and the Soviet Union also gave technical and financial assistance to international health campaigns in the hope that it would improve their standing in countries regarded as ideological battlegrounds.

This proved beneficial or divisive depending on the context. In this final section of this article I consider some contemporary issues that would benefit from an historical perspective, starting with the most obvious consequence of globalization—pandemic disease. However, nearly all of these studies examine disease in the context of particular cities or nation-states; only a few offer a global or comparative perspective.

The pandemics of the past few decades have already left a mark on our consciousness and this is particularly true of AIDS, which the historian Allan Brandt regards as the catalyst to new ways of thinking about public health. Brandt sees clear differences between global health and the era of international health that preceded it. In particular, he points to the much greater emphasis that the global health movement places on human rights, the more active role envisaged for recipients of health care, and the integration of public health with clinical medicine.

The tensions within what would become the global health movement were present at its inception. Chief among these were concerns over security; that is, the protection of national interests. The devastation caused by AIDS in sub-Saharan Africa led intelligence agencies to contemplate the implications of the pandemic for the stability of allied and strategically important states.

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The aims of different global health agencies do not necessarily contradict one another, but there is certainly some tension between them. At the dawn of the new millennium, fear of new infections—originating mostly in tropical countries—led some in the West to demand tighter controls on the movement of peoples and commodities from areas deemed to have a higher risk of infectious disease. Although it killed relatively few people by contrast with most other pandemic diseases 8, recorded cases and deaths , the uncertainty surrounding SARS caused great alarm and threatened for a time to destabilize the global economy.

The response to SARS invariably took the form of quarantine and isolation, violation of which, in some countries, was severely punished. In all these senses, SARS was typical of the majority of epidemic or pandemic diseases. AIDS, by contrast, was a slowly unfolding tragedy rather than a time-limited event or sequence of events.

The main focus of these concerns was influenza or influenza-like diseases, which were capable of spreading rapidly in an age of mass air transportation and of engendering a panic that could destabilize the global economy. These threats were and are real enough, but they also reflect the volatility of financial markets and other anxieties arising from globalization. These fears were stoked by estimates of mortality that were invariably inflated, sometimes egregiously so. This was not solely because public health officials played to the media but because the methods they employed were flawed.

Influenza is perhaps the most protean of infections, and most models designed to predict its behavior have proved unsatisfactory. During the H1N1 pandemic in , for example, many countries imposed a ban on pork imports from North America despite a declaration from the WHO that such produce was safe. This prompted allegations of sanitary protectionism—a familiar refrain since the dismantling of formal tariff barriers and the creation of the World Trade Organization in The losers tend to be those that rely on export earnings to improve the health and prosperity of their people.

The fragmented response to H1N1 contrasts starkly with the consensual, internationalist rhetoric of the global health movement. Though pandemics are universal risks, they continue to elicit nationalistic responses, and the trend toward global governance, which some claimed to discern in the response to SARS, has stalled.

As we have seen, this is especially true when sanitary concerns impinge on those of commerce. Most nations employ specialist lawyers and scientists who are engaged to calculate the sanitary risks posed by the trade in certain commodities. Calculations of risk also shape other aspects of pandemic prevention. Most countries have national risk registers in which pandemics figure prominently, while insurance companies make their own influential assessments. Risk assessments are unavoidable and, in many respects, beneficial features of public health.

However, we ought not to assume that they are objective statements of reality. It is vital to understand how risks are calculated and who stands to gain from such assessments. Individuals, social groups and even nations can be pressurized into altering their behavior in conformity with these calculations—whether by the dictates of insurers or through fear of legal redress.

All manner of assumptions and interests come into play as communities or organizations decide how to interpret and act upon the risk assessments they receive. It is also important to reflect upon the ways in which risk assessments affect inter-personal relationships. Humanitarian and cosmopolitan sentiments can easily evaporate once risk groups have been identified. Risk assessments can be utilized in the service of such ideals, but they tend to pull in the opposite direction.

This is clearly the case with vaccination, the uptake of which has dropped in many high-income countries, especially in wealthy areas. Parents make choices based solely on the risks and benefits of vaccination for their own children, as opposed to notions of collective responsibility. Herd immunity has come to be seen not so much as a social good but as a factor in individual decision making. Risk relationships may be no better or worse than earlier foundations of public health, but they are different and need to be reckoned with.

Faced with a multiplicity of risk factors, national governments, charities, NGOs, and global institutions are left to decide which to prioritize and how to act on them. Since the appearance of SARS, there has been a clear preference to deal with the risk of pandemic diseases by tracking their emergence and spread, with the aim of containing outbreaks or buying valuable time. Calls for more and better surveillance therefore persist. Moreover, this response deals with only one element of risk—the risk of transmission; the risk of the emergence of new diseases or strains receives considerably less attention.

All periods of global integration have left their mark on these relationships and the past few decades are no exception. Deforestation—largely as a consequence of logging for the global market—has brought human beings into contact with a wider range of infections, as humans invade the wild habitats of other animals. The rapid growth of cities such as Kinshasa and Chongqing reflects the economic advantages to be gained from concentrating people and resources, but a penalty has usually to be paid.

Dense populations allow diseases to circulate and mutate more quickly. Poorly planned construction provides ample breeding sites for mosquitoes carrying diseases such as dengue and malaria. Burgeoning populations outstrip the supply of wholesome water. Most worrying of all, perhaps, are the consequences of feeding such conurbations.

In many parts of Asia, rapid urbanization is the chief driver of intensive animal production, as it was in the West a century or so before. As well as affording greater opportunities for the mutation of viral diseases such as influenza, the subtherapeutic use of antibiotics in intensive farming has been linked to bacterial resistance, for example, to the drug tetracycline.

In view of the powerful interests involved, and the desire to maintain or secure competitive advantage, the prospect of concerted global action appears dim. So far, I have discussed globalization in relation to pandemic diseases and that is largely because the epidemiological consequences of integration are generally seen in that way. However, there is growing recognition that changing lifestyles, which are directly and indirectly linked to globalization, are transforming patterns of morbidity in both highly developed and low-income countries.

Globalization has lifted millions from poverty and has contributed in many instances to the improvement of health infrastructure and the provision of vital utilities such as clean water. It has also enabled governments in developing countries to afford more medicines and vaccines, thereby reducing deaths from easily preventable and curable diseases. These results have been most spectacular in nations such as Bangladesh that have high levels of civic activism, female education, and state involvement in health care.

Causing around 25 percent of deaths worldwide in , infectious diseases were responsible for less than 16 percent of global mortality in However, longevity and prosperity have created new problems. An aging population is more likely to suffer degenerative diseases such as dementia, and this is placing an enormous burden on even the richest nations. Rising incomes in developing countries have also brought an increase in alcohol- and tobacco-related diseases.

Global mortality from tobacco-related illness, for example, is projected to increase to around ten million per year by The costs for the countries that are most affected—principally China and India—will be staggering, not to mention the impact on productivity. These rapid changes in food culture have been fueled by some of the indirect effects of globalization such as economic insecurity and urbanization, while their detrimental effects on human health have been exacerbated by more sedentary working patterns and increasing reliance on motor transport.

It is presently unclear whether these harmful trends can be countered, but the problem appears rather differently in different countries. In rapidly developing countries there are stark contrasts between the mortality and morbidity profiles of the new middle class and the very poor, many of whom still die as a result of exposure to infectious diseases, accidents, and violence.

Obesity, cardiovascular disease, and type 2 diabetes are usually to be found among those unable to reap the benefits of globalization: In many affluent and middle-income countries there is also a third group of persons who present a complicated mixture of problems: Low-skilled migrant workers are not always from foreign countries but are often first-generation immigrants from rural areas. Like their foreign counterparts, they tend to lack basic rights, including the right to health care and health insurance; their hours of work are long and their job security low.

They typically suffer from health problems that show the consequences of new dietary habits e. Migrant workers—whose status is sometimes that of illegal immigrants—also exhibit a range of mental health problems caused by overwork, poverty, abuse, and deracination. They share these problems with many persons who arrive in countries of all types as refugees following famine, war, and natural disasters. For some, globalization may provide a release from social and cultural restraints, whereas for others economic insecurity results in depression and anxiety. What is certain, however, is that current problems of mental health, like those of physical health, cannot be understood independently of the global forces that govern so many aspects of our lives.

The effects of globalization have been equally apparent in the field of health care, most obviously in a shift from public to private provision. The mid-twentieth century saw the idealization of the state as a provider of health care and in most countries its contribution continued to grow for decades.

Western social democracies expanded the range of health care available to the public, while some authoritarian regimes like South Korea under Park Chung-hee favored state-funded health insurance as a way of co-opting and mobilizing the population for nationalist ends. By the s, however, a radically different form of consensus was emerging, closely aligned with the ascent of neoliberal ideology.

Neoliberalism was sustained by the growing belief that the state impeded efficiency and prevented formerly dominant nations from competing in a global market with states that had lower taxes and production costs. However, the effects of neoliberal thinking were most immediately apparent in low-income countries that were forced to cut back on state expenditure as a condition for financial assistance. So-called public-private partnerships were promoted vigorously by governments of all complexions. Beginning in Australia in the s, but later taken up enthusiastically in the United Kingdom and other European countries, PPPs seemed to offer substantial savings.

The results, however, were mixed, and the cost of such schemes was often massively underestimated. Privatization has been driven by rising costs as much as by political ideology. In countries with substantially state-funded health services, access to new drugs is normally regulated by bodies that assess value for money and clinical efficacy, so the cost of health care has risen more slowly than in countries in which the private-sector dominates.

In , the United States, with its predominantly private system of health care, spent However, the insatiable demand for new medicines is no longer confined to the West, if it ever was. Medical consumerism is now a global phenomenon, and its appetites are sharpened by a cosmopolitan market in goods and services. Western medicine has to compete with other forms of healing such as traditional Chinese medicine and ayurveda, both of which have found niches in a global market.

Ironically, the globalization of these products and the medical traditions which purportedly spawned them was possible only because they emulated many features of Western medicine and pharmaceutical manufacture. The tendency toward uniformity has been most evident in the pharmaceutical sector, however. Although they have been marketed as alternatives to mass-produced, synthetic pharmaceuticals, many so-called traditional medicines are manufactured industrially and sold in much the same way as their Western counterparts.

Purveyors of these pharmaceuticals have created many global brands but practitioners of non-Western medicine have also had to adapt to local cultures. This is the case with traditional Chinese medicine in East Africa, where, despite the training of African practitioners in Chinese institutions, local expectations have led to significant modifications of practice.

While some forms of traditional medicine have taken advantage of globalization, others—such as Korean medicine—have yet to establish themselves internationally. Nor should we exaggerate the status that even the most successful forms of non-Western medicine currently enjoy. In some Chinese hospitals, integration of Western, TCM and ethnic minority medicines works extremely well, assisted by the fact that practitioners of all systems have identical pay scales.

IM also affords less equality to traditional medicines than might be supposed, for non-Western therapies—which were originally formulated to meet the needs of individual patients—are appraised by randomized control trials and other methods that take no account of such variations. Biomedicine therefore remains in the ascendant in most countries and is becoming more powerful in some which had vibrant traditions of their own.

Western medicine is now seen as a lifestyle choice—just as alternative medicines are for many people in the West—affirming modernity and membership of a global community. It also provides quick and effective remedies that are well suited to the pace of life in a modern, globalized world. As a result of these and other local factors, practitioners of traditional medicine in some countries have seen their status fall.

Traditional medical schools in South Korea, which used to attract the best students from high school, now appear to be struggling to fill places as star pupils flock to colleges of Western medicine. The choices made by individuals within the global market are normally innocuous but in some cases the most affluent exercise their choice at the expense of the poorest and most vulnerable. Perhaps the most notorious example of this is the trade in organs intended for transplantation.

Though this trade is distasteful to many, a number of prominent ethicists have made strong arguments in favor of it, albeit in strictly controlled circumstances. Questions of equity and efficiency also come into play when the global market is allowed to govern matters of public health, not least the development and distribution of vaccines. During the H1N1 influenza pandemic of , stocks of vaccine were quickly exhausted as they were purchased by affluent nations. Practically none of the vaccine reached African countries, but ironically much of the unused stock from rich countries was dumped there.

In this article I have made a case for the relevance of global history to historians of health, disease, and medicine. It has not been my intention to be prescriptive or to devalue other approaches but merely to affirm that a global perspective can illuminate some of the central problems of our field. A global perspective also enables us to see connections between what at first appear to be random events, such as the growing prevalence of many diseases human, plant, and animal; infectious and noninfectious simultaneously in different parts of the world. All manner of pathogens came to circulate the globe, while the environments receiving them were transformed by commercial agriculture and industrial enterprise.

It soon became clear that a divergence had occurred, for the countries that gained most from global integration enjoyed improving health while conditions often worsened elsewhere. Better nutrition and sanitary infrastructure in the richer nations began to reduce mortality from infectious disease, but improvements occurred fitfully or considerably later in their colonies. It was not until the s that the situation began to improve. At that time, international comparisons, rising expectations, and concerns over international competitiveness led to an escalation of state intervention and more standardized conceptions of health and illness.

This transition was aided by the increasing availability of Western pharmaceuticals and services, particularly in industrial and commercial centers that had grown with the global market. These products paved the way for medical and sanitary interventions by normalizing Western medicine and the biological concepts that underpinned it.

Our present era bears some resemblance to this earlier period of integration. Once again, there is an increasing threat from certain infectious diseases, but with the exception of tuberculosis and influenza these are different from those that plagued the nineteenth century. There are other differences, too. Chronic diseases and degenerative conditions once found predominantly in the West are now ubiquitous, while health inequalities within nations—even affluent ones—are almost as striking as those which exist between them.

This gradual shift reflects the emergence of a social structure that has global dimensions and of a distribution of power that is less geographically localized than in the age of empires. The response to health problems arising from global integration is also rather different. Although the organizations involved in public health and health care have always been diverse, the period from roughly to was characterized by the growth of the state.

Its increasing role in matters of health reflected a belief that government intervention ameliorated social inequalities and that the welfare of all classes was mutually dependent. Though spurious in many respects, this internationalism brought real improvements and helped to stabilize the global economy.

Today, there is no real consensus on how to deal with the health problems arising from global integration. Whereas previous generations looked primarily to the state, its role in the provision of health care is decreasing in rich and poor countries alike. While global threats to health appear to have increased, the authority of global institutions has not. All over the world, the young and idealistic are drawn to work in a field which appears to embody humanitarian ideals. But global health remains an elusive concept. It is not at all clear whether it is a noble aspiration or a new type of policy that transcends the concerns of nation-states.

However, the mantle of global health often disguises other motives. The term frequently dignifies the pursuit of national interests, not simply the protection of borders but foreign health interventions that are designed primarily to secure economic and political objectives. It would be unrealistic to expect otherwise, especially in view of the competitive pressures exerted by globalization.

But global health can be more than an aggregation of interests. While public health has always been part of statecraft, it has also—since its inception—reflected a shared understanding of health as a common good. The author would like to thank the editors for their constructive criticisms of earlier drafts of this article, as well as professors at Peking and Kyung Hee universities for giving him the opportunity to visit hospitals and medical schools of varying types.

magnetic disk drive technology heads media channel interfaces and integration Manual

He also expresses his gratitude to the Wellcome Trust for their support whilst researching this article. M ark H arrison is professor of the history of medicine and director of the Wellcome Unit for the History of Medicine, University of Oxford. Politics, Economics and Culture. Stanford University Press; Globalization in World History. University of California Press; University of Chicago Press; Globalization and Global History. Turning Maritime History into Global History: Research in Maritime History. Maritime History as Global History. International Maritime Economic History Association; Notes towards a Reconfiguration of Early Modern Eurasia.

History in Transnational Perspective. Comparing Global History to World History. Military Innovation and the Rise of the West, — Cambridge University Press; The Rise of the West: A History of the Human Community. The Birth of the Modern World — Cross-Cultural Trade in World History. Princeton University Press; The Modern World System.

Duke University Press; Civilizations and World Systems: India in the Early Modern World Economy: Modes of Production, Reproduction and Exchange. European Commercial Enterprise in Pre-colonial India. Birth of the Modern World. The Eighteenth Century in Indian History: Oxford University Press; Consumer Behavior and the Household Economy, to the Present. Luxury and Pleasure in Eighteenth-Century Britain. Technology, Environments, and Western Imperialism, to the Present. Victorian Visions of Global Order: The Three Waves of Globalization: A History of a Developing Global Consciousness.

To End All Wars: Its Fall and Rise in the Twentieth Century. The Condition of Post-modernity: Leaks, Hacks, and Scandals Tarek El-ariss. Teaching to Transgress Bell Hooks. Look Closer David R Coon. Analyzing Digital Fiction Hans Rustad. The Nonhuman Turn Richard Grusin. Teaching Critical Thinking Bell Hooks. Biopolitical Screens Pasi Valiaho. Beautiful Evidence Edward R Tufte. Diversity and the Media Monika Metykova. Doing Visual Analysis Per Ledin. A Critical Introduction Liz Wells.

Google Me Barbara Cassin. Gender Trouble Judith Butler. Sexography Nicholas De Villiers. Other books in this series. Audience Studies Toshie Takahashi. Online Journalism in Africa Jason Whittaker. Global Convergence Cultures Matthew Freeman. Iranian Media Gholam Khiabany. Global Media Ecologies Doris Baltruschat. Children and Media in India Shakuntala Banaji. Table of contents Foreword Paddy Scannell 1. Decolonizing and provincializing audience and internet studies: Media culture in Africa? A practice-ethnographic approach Jo Helle Valle 3.

Popular engagement with tabloid TV: Audience perceptions of radio stations and journalists in the Great Lakes region Marie-Soleil Frere 7. Agency behind the veil: Audiences and Users, we finally have a gem of an exploration into African media functioning as an integral part of Africans' lived realities - whether it is the legacy media of newspapers, radio and television or the newer forms of social communication powered by the Internet and the rapid increase in the uptake of mobile telephony across the continent.

Audiences and Users addresses this question by taking a closer look at everyday media cultures in Africa in an age of proliferation of dazzling media options for Africans to push the boundaries of creative agency and innovation. By taking seriously the socio-cultural context in which Africans embrace the new communicative technologies at their disposal, and by recognising the hierarchies that inform human relations, this book reiterates the centrality of ethnography and kindred observational research techniques for understanding the dynamics of persuasive communication and how audiences of different social backgrounds and positions relate to the media that target them and how they in turn target others with their very own media content.

Using Africa as an entry point, Audiences and Users discusses how the quality of audience research in any context requires paying closer attention to the lived realities of media audiences and users. The book's message is refreshingly simple and urgent: As communication scholars we need to continually listen to, draw on, interact with and edify the importance of media audiences and users in their local contexts, and involve beyond rhetoric and tokenism those researched in the production of knowledge about their realities and predicaments. Normative and prescriptive media theories may have their value, but that should not entail a stubborn insensitivity to context and social change.

Asking the right questions and building science entails carefully and critically situating the object of study within existing knowledge by drawing on and feeding back into it in terms of theory, methodology, issues and debates.