Health geography is influenced by medical geography, it deals with the interaction between people and the environment, it views health from a holistic perspective and focuses on wellbeing and broader social models of health and healthcare. Some of the main themes in Health Geography include health inequality, globalization, and urbanization. It is also closely aligned with epidemiology.
Globalization is one of the most discussed themes in health geography, it refers to the process by which the world is interconnected, the interaction between people, companies, and governments globally. According to Stieglitz, Nobel Prize Winner for Economics (2001) “Globalization is the closer integration of the countries and peoples of the world which has been brought about by the enormous reduction of costs of transportation and communications, and the breaking down of artificial barriers to the flow of goods and services, capital, knowledge, and people across borders.” Globalization affects everyone in the world, it affects many of social aspects including health. Public Health has been influenced by this phenomenon, both positively and negatively. Although globalization in many ways has a beneficial influence on our lives at the same time it also has negative effects as well. Greater connectedness between people and new interaction with environments leads to more diseases, Micro-organisms are not bound by geographical boundaries. A new disease can emerge in one part of the world but can spread across the globe through travel and trade in a matter of time. Globalization has a significant impact on the spread of some of the deadliest infectious diseases, it is one of the main drivers that has influenced the rapid spread of infectious diseases around the globe.
Globalization in many ways is linked to infectious diseases. In the article “Changing patterns of infectious disease” Cohen linked globalization to infectious diseases, Cohen breaks down six factors related to globalization that affect public health, the six factors include Technology & industry, environmental change and use, microbial change and adaptation, demographics and behaviors, breakdown of public health measures and one of the prime factors contributing to the geographic spread of several infectious diseases is international travel and commerce. Human migrating from one region to another serve as couriers for different infectious diseases and vectors.
According to World Health Organization (WHO) “Infectious diseases are caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi; the diseases can be spread, directly or indirectly, from one person to another”. Globalization has impacted the spread of the infectious diseases in many ways. However, enhanced transportation technology such as aircraft has increased the frequency of the potentially fatal disease outbreaks around the world. International travel is one of the fastest growing businesses around the world, each year an estimated 700 million tourists cross the international border. There also has been a significant increase in international air travel in and t Middle East and Africa, places where many new infectious diseases are emerging. While the travelers themselves are at a risk of spreading the disease, the airplanes on which they travel also serve as potential sources of vector introduction. Diseases such as HIV, Tuberculosis, and Dengue are being spread to the remotest corners of the globe due to the increase in travel.
Dengue is a significant international health concern, it is an infectious disease carried by mosquitoes causing a severe flu-like illness, according to the World Health Organization (WHO), it is the most important mosquito-borne viral disease. Dengue fever is mostly found in tropical and subtropical areas of the Caribbean and Central and South America, Africa, Southeast Asia and China, India, the Middle East, Australia and the South and Central Pacific. (World Health Organization, 2018) There are four distinct dengue virus serotypes, they are termed as DENV-1, DENV-2, DENV-3, and DENV-4 Each of the serotypes had been individually found to be accountable for dengue epidemics and connected with more severe dengue. (Murray, Quam, & Smith, 2013) Severe cases of Dengue can lead to serious illness and death among children in Asian and Latin American countries.
The occurrence of dengue has developed significantly around the globe in the recent decades. Before 1970 only 9 countries experienced severe dengue epidemics, however, today the disease is endemic in more than 100 countries. As per the World Health Organization, approximately 50-100 million infections are now estimated to occur annually in over 100 endemic countries, putting almost half of the world’s population at risk. (World Health Organization, 2018)
Although the actual number of dengue cases are underreported and numerous cases have been misclassified a study in 2013 indicates approximately 390 million dengue infections occur each year. Another study, of the prevalence of dengue, estimates that 3.9 billion people, in 128 countries, are at risk of infection with dengue viruses. In 2015, 2.35 million cases of dengue were reported in the Americas alone, of which 10 200 cases were diagnosed as severe dengue causing1181 deaths. (World Health Organization, 2018)
Worldwide, 50 to 100 million cases of dengue contamination occur each year, this includes about 200 cases reported in the United States, for the most part in individuals who have recently traveled to abroad. Since the mosquitoes can cross the ocean by riding in the airplane wheels, the increased travel from dengue-endemic areas affected the spread of dengue worldwide. An example of transport of vectors through commodities is the introduction of the Asian tiger mosquito, Aedes albopictus one of the vectors of dengue fever, to the North American continent on rubber tires that were shipped to the port of Houston. (Adel Mahmoud, 200)
Moreover, most cities in the world have airports through which millions of people pass every day, Thus the number of passengers traveling by air increased. In 2011 approximately 2.75 billion people traveled by airplane, many of them to and from tropical urban centers where dengue is endemic. (Gubler, 2011). According to the statistics, In the past 60 years, dengue cases have been associated with travel in the United States. Case reports suggest that there are approximately 100 imported cases in the United States each year. Therefore, the imported cases of dengue through international travel may result in the formation of an autochthonous disease cycle and new regional outbreaks in previously non-endemic regions. (Gardner L, Sarkar S, 2013). Furthermore, Europe is not only the host of the vast immigration population, but Europeans also travel around the world. Europeans make eight million trips overseas each year, involving 28 million border crossings. Thus, despite the fact that Europe is far north of tropics numerous tropical Infectious diseases such as malaria, yellow fever, dengue, and even hemorrhagic fevers, are being imported on a large scale.
Additionally, Dengue can be linked with poverty. The annual number of dengue fever is much higher in developing countries such as India. Since the mid-19990’s epidemics of dengue in India have become frequent
and larger. Regular and progressively larger dengue outbreaks have been reported throughout India in the recent years. According to a study by US and Indian researchers, the annual number of dengue cases is nearly 300 times higher in India than officially reported. Poor sanitation and crowded living conditions create an ideal atmosphere for A. aegypti, one of the vectors for dengue. In addition, heavy rains also trigger the dengue outbreak in developing countries. After the heavy rains water often accumulates on the roads due to the poor drainage system in developing countries, standing water is a breeding ground for mosquitos. The 2013 dengue outbreak in India occurred due to the heavy rains, more than 55,000 cases were reported. (Burke, 2014) People migrating from dengue-endemic regions also serve as a potential threat of spreading the disease globally.
In conclusion, globalization has been a leading factor that has impacted the transmission of infectious disease. It has expanded the rates of international travel and trade. Faster and more efficient modes of transportation either by air, land or sea using modern technology implies that people can travel around the globe in much less time. Despite the fact, that the current modes of transportation allow Individuals and products to travel around the globe at a significantly faster speed, it also opens the airways to the transcontinental movement of infectious disease vectors. As people, products, capital, and food travel the world in exceptional numbers and significant speed so does the myriad of disease-causing microorganisms. Tourists, airplanes or any other mode of transportation often carry the micro-organism and disease vectors, providing rapid means of spread of diseases among countries. The worldwide resurgence of dengue fever, the introduction of West Nile virus into New York City in 1999, the rapid spread of human immunodeficiency virus (HIV) infection in Russia, and the global spread of multidrug-resistant tuberculosis (TB) are some of the examples of the severe effects globalizing forces on the emergence, distribution, and spread of infectious diseases. (The impact of globalization on infectious disease, P.1). Aedes albopictu, one of the dengue vectors in Asia has spread to North America and more than 25 nations in the European Regions mainly due to international travel and trade in used tires. Secondly, to prevent the global spread of dengue, crowded living conditions in developing countries needs to be improved. Crowded living conditions, poor sanitation, inadequate drainage system and wastewater management create the ideal conditions for the proliferation and transmission of the vector and virus. People frequently migrate from developing countries and along with people and commodities vectors are also transported in previously non-endemic regions Another factor that has increased the severeness of dengue is the lack of vaccines and recognition of the disease in non-endemic regions. Physicians who practice outside dengue-endemic regions must adapt the recognition of potentially fatal remerging diseases such as dengue.