Globalization and disasters: issues of public health, state capacity and political action.

AuthorBurkle, Jr., Frederick M.
PositionRELIEF and RESPONSE

Historically, the first cycles of globalization began with people trading goods, ideas and rudimentary technology, and migration brought cultures across borders and oceans. Initially, the wealth brought by globalization was limited to a tiny minority of the most fortunate. Only recently has globalization produced sustained living standard improvements in entire societies. (1) This has happened to such a degree that today many people associate globalization with the "opportunity" to gain economic and human security.

Human security, "often referred to as 'people-centered security' or 'security with a human face,' focuses on freedom from fear and want of human beings rather than states." (2) Whereas "human security emphasizes the complex relationships and often-ignored linkages among disarmament, human rights and development," it is suggested here that human security also takes center stage in the way the world appreciates and deals with the impact of large-scale disasters on populations. (3)

Especially in disaster-prone areas increasingly inhabited by the poor, large-scale disasters provide comparative benchmarks that distinguish the haves and have-nots, and often expose deep imperfections in basic human rights protections. Creating socially sustainable forms of disaster management that meet expectations of an increasingly informed, demanding and globalized world population is a major challenge. In reality, such disaster response requires global investment that places human security above state priorities.

Civil society expects that the public health be protected from the consequences of crises, including threatening disasters. Disasters keep governments honest: They define a state's capacity to protect its population while exposing its vulnerabilities to political upheaval in the aftermath of poorly managed crises. These concepts can be extrapolated to a global society and a fledgling global culture. More strongly than ever, the public demands equity and transparency in global public health mechanisms during disaster management.

Global responses to large-scale disasters have, too often, been imperfect, ad hoc and politically motivated. Misguided emphasis is placed on short-term emergency response rather than prevention and preparedness leading to long-term sustainability and improved state capacity. International organizations and governments, often using military assets, have tended to unilaterally aid other states facing disasters.

We must invest in global disaster responses that purposefully reflect increasing expectations arising from globalization. Three elements critically define the requirements and limitations of an investment in global responses: (a) the recognition that public health must take precedence over politics, (b) the depth and reach of a nation-state's capacity to protect public health during crises and (c) the expanding political interference with efforts to coordinate and invest in responses to major disasters. It is argued here that a unique opportunity exists, amid discussions of potential UN reform, to invest in a global disaster response architecture that supports the expectations and demands brought about by globalization and emerging global culture.

Public Health

The Global Cultural Sphere

Elements of an emerging global culture are evident throughout the world. Human development researcher Jeffrey J. Arnett suggests that the generation of the 21st century has already developed a bicultural identity combining individual local identity with an identity linked to the global culture. (4) Never has cultural identity change been more visible than in the formerly silent societies once hidden behind covered openings of adobe huts and refugee tents. Except in the most repressive regimes, the technical elements of globalization cannot be stopped. Massive flows of technology-based, real-time information increasingly build expectations of improved local governance, employment and everyday human security. (5)

Yet major social, economic and political inequities, amplified by globalization, risk increasing the disparities among the world's populations. These disparities are no surprise. Today the world sees media coverage of a local tribal leader in an area struck by an earthquake, looking exhausted and distraught when he finally receives delayed relief supplies to his remote village. The world hears him compare his country's poor response to what he knows is better in other countries half way around the world. And in 2005, Hurricane Katrina exemplified the relationship between disparities and disaster vulnerability in even the wealthiest nation.

The Changing Definition of Public Health in a Disaster-Prone World

Skills and arts passed along to succeeding generations have defined cultural practices in regards to public health, human rights and human survival. (6) When a culture is lost, so too is the inextricably connected professional and institutional memory of public health measures.

More than 50 years ago, environmental and public health professionals were defined by a "narrow sanitary engineering approach." (7) Over the last two decades during complex internal state emergencies in Africa, the Balkans, South America and Asia, the humanitarian community struggled to maintain public health infrastructure. (8) In these cases, the destruction or inaccessibility of protective elements of clean water, sanitation, shelter, food and basic healthcare led to public health catastrophes in which 90 percent of the deaths resulted from easily curable diseases such as diarrhea, malnutrition, pneumonia and malaria, and from the deadly complications of vaccine preventable diseases such as measles, diphtheria, tuberculosis and polio. Although the public usually associates complex emergencies with violence, less than 10 percent of the deaths are weapon-related. (9)

Public health no longer refers only to medical care, but more accurately reflects governance, transportation, communication, public safety, the judiciary and other civil sectors. (l0) This interdimensional public health is defined globally as both a national and international responsibility that must be adhered to in any crisis, not just war and conflict. Technically and politically, the international public health community has mobilized accordingly. For example, the Red Cross Movement now staffs and regularly deploys over one hundred water and sanitation professionals to major emergencies worldwide.

What happens locally, whether a region-wide natural disaster or a highly communicable disease, has immediate global ramifications. Thus people around the world now look to governments to support public health as part of their international responsibilities. With the influence of globalization, all that differs between nation-states is the quality and quantity of otherwise similar public health programs and the desire to improve them. Nation-states, for the most part, recognize that the core functions of public health transcend national sovereignty and include promotion of international research, development and sharing of scientific advances and participation in the surveillance of infectious disease.

Even in the midst of wide multicultural diversity, public health is the bridge to a common ground and the source of shared security. This concept is readily understood without the necessity for translation. Much of the public health community "is increasingly seeing itself as a political actor capable of influencing world affairs and is carving out a role for itself in combating poverty, inequity and unsustainable development." (11)

Disasters--complex, natural and technological--have come to define public health vulnerabilities in infrastructure, organization and leadership. Even small-scale disasters requiring cohesive sociopolitical and economic interventions help define a country's public health capacity. These occurrences can reveal vulnerabilities and inequities that, unless addressed, typically lead to future problems. A number of factors can contribute to future complex emergencies: (1) urbanization of global populations; (2) the demographic prevalence of the world's poor in urban settings; (3) failing public health infrastructure; (4) lack of moral integrity of governments; (5) availability of and access to weapons, including weapons of mass destruction; (6) economic inequities and corruption; (7) undisciplined military, paramilitary and police; (8) suspension of the rule of law; (9) wanton violations of protective treaties; (10) failures in environmental and ecological security; (11) food and water insecurity; and (12) transmigration of populations due to conflict or political, economic and environmental issues. (12)

Disasters keep all of us honest. For example, when fledgling Central American democracies of the 1950s failed to provide adequate public health responses to natural disasters, they succumbed to the pressures of rival political parties and military coups. (13) No country is exempt from shouldering the responsibility of protecting the public health. Furthermore, no country can simply rely on faulty claims of robust disaster preparedness without risking disastrous consequences. That over 100 countries and UN agencies offered aid to the United States after Katrina was for some a national embarrassment, suggesting that countries that have previously experienced these kinds of events recognized the public health emergency of Katrina before the United States did. Yet individual nation states, regardless of their resources, do not always have the capacity to address many conventional or modern day problems such as the regional impact of an earthquake or religious- or ethnic-based security concerns.

Globalization and Public Health

Whereas humanitarian action is synonymous with restoring public health, the word "humanitarian" is a relatively new term. In many languages it does not even exist. The "idea of a country or a people or...

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