nature, disease, and globalization: an evolutionary perspective

Nature, Disease, and Globalization:An Evolutionary Perspective

Dennis C. Pirages

Department of Political Science, University of Nevada, Las Vegas

Contemporary globalization represents the culmination of a long evolutionaryprocess that has produced larger and more complex social units over time.Although precursors of contemporary complex human societies emerged ineastern Africa more than 300,000 year ago, our interest in Homo sapiens, theglobalizer, begins about 100,000 years ago when small bands of our speciesbegan to migrate out of eastern Africa toward the north and west. The factorsresponsible for this migration out of Africa remain speculative, but populationgrowth, climate change, fluctuating food supplies, and human curiosityundoubtedly were involved. Within sixty to seventy thousand years, bands ofHomo sapiens had settled in the far corners of the world, showing a remarkableability to adapt to the most varied environments (Cavalli-Sforza and Cavalli-Sforza 1995:56).

According to Walter Wallace (1997:15), Homo sapiens has spent nine times asmany years moving apart as the species has spent coming together. The greatestdispersal of these human societies (maximum social entropy) occurred betweenten and fifteen thousand years ago. For most of human history the fates of thesescattered clans and tribes were largely determined by the local constraints of nat-ure as well as by the availability of food, water, and other resources and by localencounters with pests, predators, and pathogens. Over the last 5,000 years, how-ever, beginning with the emergence of the great civilizations in western Asia,populations of Homo sapiens, for the most part, have grown significantly in sizeand density and have repeatedly been incorporated into larger and more com-plex units; these expansions and consolidations being precursors of processesthat have culminated in contemporary globalization (McMichael 2001:103).These persisting social units now are increasingly being integrated into a verycomplex global system; their fates are no longer determined locally, but areincreasingly being shaped by more global forces.

It would not be easy, nor particularly rewarding, to quantify precisely thenumber of distinct human societies that have survived previous periods of con-solidation and maintained their identities well into the twenty-first century.Because of the dynamics of contemporary globalization, however, their num-bers are rapidly dwindling. The number of actively spoken languages in theworld is a good surrogate measure. There are currently about 6,000 spokenlanguages, but linguists think that nearly one-half of them will be dead ordying within the next 50 years (Ostler 1999:34). The point here is not tolament the passing of these distinct societies, although cultural diversity isimportant. Rather, the focus is on the evolutionary dynamics that have beenand still are associated with the integration of smaller social units into largerand more complex ones. Just as natural forces played a major role in shapingthe prospects for and fates of early societies and agrarian-era empires, similarforces still shape, and perhaps will limit, the prospects for the deepening inte-gration of remaining societies into a global system.

� 2007 International Studies Review.Published by Blackwell Publishing, 350 Main Street, Malden, MA 02148, USA, and 9600 Garsington Road, Oxford OX4 2DQ , UK .

International Studies Review (2007) 9, 616–628

Organizations of humans (tribes, clans, ethnic groups) have been evolvingand devolving into more and less organized and complex forms over thou-sands of years. The dynamics of the rise and fall of early civilizations, empires,and more recent colonial networks represent episodes of ‘‘proto-globalization’’from which much can be learned. All of these past experiments in increasingsocial complexity eventually peaked and declined, often because of environ-mental changes; only fragments and traces of these early civilizations andempires remain in the contemporary world. The current round of globaliza-tion is denoted by creation of a much larger and more complex global sys-tem, an achievement well beyond the capabilities of those organizing theseearlier empires. But the ultimate fate of this endeavor remains unclear, asforces akin to those that limited the reach of earlier complex civilizations andempires now threaten to slow, or even reverse, the course of contemporaryglobalization.

Human societies, like all living systems, are embedded in varied physical envir-onments that present different kinds of challenges and opportunities. Theseenvironments normally provide such societies with a steady flow of energy andother resources that are required to sustain their growing complexity. As JosephTainter (1988:91) has put it:

More complex societies are more costly to maintain than simpler ones, requiringgreater support levels per capita. As societies increase in complexity, more net-works are created among individuals, more hierarchical controls are created toregulate these networks, more information is processed, there is more centraliza-tion of information flow, there is increasing need to support specialists notdirectly involved in resource production, and the like.

The contemporary global system represents the most complex social organiza-tion yet developed. But just as previous attempts at building more complex socialorganizations have eventuated in some form of collapse, the current round ofdeepening globalization is vulnerable as well. In the end nature usually bats last.There is no reason to expect that this round of increasing social complexity isimmune to the evolutionary dynamics that have been responsible for societal col-lapses throughout history. In fact, given deepening globalization’s growingresource requirements in the face of fledgling forms of governance, it wouldseem to be extremely vulnerable.

As was the case with the preceding complex civilizations, this current episodeof continually increasing complexity requires ever greater resource flows to main-tain it. At the same time, the mechanisms by which human groups acquire anddistribute basic resources are conditioned by, and integrated within, sociopoliti-cal institutions. Energy flow and sociopolitical organization are opposite sides ofan equation. Neither can exist, in a human group, without the other, nor caneither undergo substantial change without altering both the opposite memberand the balance of the equation (Tainter 1988:91). Those responsible for gov-erning complex social organizations have to struggle constantly to establish andmaintain legitimacy. Maintaining legitimacy, in turn, has required the perpetualmobilization of resources to ward off the forces of social entropy, an unrelentingcost that complex societies must bear. The contemporary round of globalizationis no exception. It has received a major impetus from the concerted post-warefforts of a hegemon (the United States) to build a global system that serves itsown interests. Significant resources have been and must continue to beexpended and new forms of governance must be developed in order to over-come growing obstacles to the continuing integration of diverse societies into anincreasingly complex global system.

617Dennis C. Pirages

The Forces of Nature and Complex Societies

Understanding the evolutionary dynamics that present possible limits to globali-zation begin with the obvious, but important, observation that Homo sapiens isone of millions of species co-evolving within the ever changing constraints of nat-ure. Like other primates, Homo sapiens has spent much of its history living insmall, relatively isolated units that biologists call populations and social scientistsrefer to as societies. These diverse populations ⁄ societies have been shaped overtime biologically and culturally through continued interaction with the physicalenvironments in which they have been embedded. Biological and socioculturalevolution, two parallel and linked processes, have facilitated the survival and suc-cess of these groups of Homo sapiens over the centuries by adapting both bodiesand behavior to changing environmental constraints (Harris 1979; Hallpike1986; Durham 1991). Those populations ⁄ societies that have been able to adaptto changing environmental circumstances usually have been able to flourishwhereas those less adaptable have not.

This evolutionary perspective raises two critical points. First, those societiesthat have persisted and maintained their identities well into this era of deepen-ing globalization are bound by primordial ties that are difficult to break (Geertz1973:259). The resulting biologically and socioculturally similar extendedfamilies, clans, or tribes have been fundamental sources of identity, loyalty, andgovernance for thousands of years. The integration of these tightly integratedsocieties into more complex units, such as states or empires is a costly endeavorrequiring significant resources and even the use of force to break the tight tiesthat bind them and differentiate them from others. Second, and most important,because these smaller societies historically have been continually buffeted by theforces of nature, those that have persisted over the centuries have either foundthemselves in idyllic environmental circumstances or have been unusually wellorganized to deal with periodic resource shortages, disease outbreaks, predatorattacks, and natural disasters.

On a larger scale it is no coincidence that the current period of growing socialcomplexity and deepening globalization has unfolded over several decades that,from a long-range historical perspective, would be characterized as a period ofunusually benevolent conditions; climatic stability, and relative resource abun-dance. Even though Homo sapiens (and its predecessors) has suffered through atleast eight ice ages and countless other less dramatic periods of global and regio-nal environmental turmoil over the last 730,000 years, it has been the relativelylimited periods of environmental stability, benevolent climate, and productiveagriculture that have offered an opportunity to construct and maintain morecomplex social units and empires (Ladurie 1971; Fagan 2000).

Environmental factors have been responsible for the historical collapse of asubstantial number of complex societies. Depletion of critical resources anddeclining agricultural productivity, whether due to human mismanagement or tochanges in nature, have been instrumental in the collapse of many historical civi-lizations (Bryson and Murray 1977; Tainter 1988:44–51). Natural disasters, suchas earthquakes or volcanic eruptions have taken their toll on others (Tainter1988:52–54). Disease has also been a significant factor limiting the expansion ofmajor civilizations throughout history (Cartwright 1972). Jared Diamond (2005)has found environmental damage and climate change to be two of five factorsthat account for societal collapse, but adds that a society’s response (or lackthereof) is also a very important consideration in explaining the collapse of com-plexity.

Significant historical volcanic eruptions offer vivid examples of how these spec-tacular low probability but high impact ‘‘wildcard’’ natural forces have repeatedlyaltered climates, stifled agricultural productivity, promoted disease, and thus

618 Nature, Disease, and Globalization: An Evolutionary Perspective

played a major role in shaping the course of human history. Volcanologists haveidentified more than 5,560 major eruptions, the most powerful of which havedestroyed many major civilizations since the end of the last ice age (Fagan2000:169). Many of these eruptions had only a regional economic impact, butthe more powerful of them have had far-reaching (even global) economic andpolitical fall-out.

The three largest known volcanic eruptions have occurred in Indonesia. Thelargest was the Toba eruption that occurred 74,000 years ago. It is estimated thatthe eruption ejected 2,800 cubic kilometers of magma and created a tremendousplume of dust that reached around the world. The related cooling lasted severalyears and is thought to have lowered temperatures by as much as 10�C. So manypeople were wiped out worldwide that an evolutionary ‘‘bottleneck’’ was created,‘‘the number of humans being pared to about 10,000, bringing the human raceclose to extinction’’ (deBoer and Sanders 2004:156).

More recently the Tambora (1815) and Krakatoa (1883) eruptions, also occur-ring in Indonesia, left a much more empirically verifiable trail of chaos anddestruction. The Tambora eruption resulted in the ejection of 50 km3 of magma,but created a plume of dust that blanketed the world and made 1816 theyear without summer. In the northeastern United States there were snowstormsand killing frosts all summer. There were also bouts of severe weather, famines,and social unrest in Europe (deBoer and Sanders 2004:139–144). The years1816 and 1817 were very cold and wet with widespread crop failures. Food riotsoccurred in various parts of France and grain carts on the way to markets wereambushed by peasants. Weather changes, crop failures, and malnutrition quitenaturally led to disease outbreaks. A typhus epidemic broke out in Ireland andkilled more than 100,000 people. Cholera broke out in India and spread toNepal and Afghanistan. Over the next 15 years, cholera spread north to Europeand west to Egypt (deBoer and Sanders 2004:148–151). The subsequent Krakatoaeruption was much smaller, but left a similar trail of global disruption.

The political fallout from the year without summer was considerable. Accord-ing to Brian Fagan (2000:172–175), social unrest, pillaging, rioting, and criminalviolence erupted across Europe in 1816, reaching a climax the following spring.In England, marauding crowds attacked houses and burned barns. In France,the grain riots of 1816–1817 were marked by violence levels unknown since theFrench Revolution. Large vagrant bands plundered the countryside. The subsis-tence crisis also triggered a massive European migration. Violence associatedwith the unusual weather and associated famine were also reported in the Otto-man Empire, parts of North Africa, much of Europe, and in New England andCanada (Fagan 2000:177).

There can be little doubt that another major volcanic eruption in the presentdensely populated world would deal a death blow to growing social complexityand deepening globalization. This is especially true since almost no preparationhas been made to mitigate the impact of such a low probability-high impact‘‘wildcard’’ event. Such future wildcard events are not considered to be policyrelevant; the world remains ill-prepared for the period of austerity, hunger,chaos, and simplification that would follow.

There are, however, three much more likely and imminent ecological chal-lenges to social complexity and deepening globalization that are potentiallymuch more manageable than catastrophic volcanic eruptions. The first is thenear-term threat of rapidly moving and deadly pandemics (global epidemics)fueled by an accelerated worldwide movement of people and pathogens asso-ciated with deepening globalization. The second is a medium-term threat inher-ent in the increasing fragility of the vital global transportation network that hasbecome heavily dependent on insecure supplies of petroleum and natural gasincreasingly found in geographically remote or politically unstable parts of the


world. The third is a longer term threat of global climate change that will raise awhole set of divisive environmental and economic issues between countries likelyto emerge as winners and losers in an impending era of global warming. Thelimited focus in the rest of this essay is not on eruptions, fossil fuels, or globalwarming, all topics worthy of future exploration, but on the seemingly mostimminent of these three challenges to increasing social complexity and deeperglobalization, the dynamics and likely impact of a rapidly moving pandemic.

Social Transformations and Infectious Disease

Throughout history serious disease outbreaks have been responsible for largenumbers of deaths and untold human suffering. Outbreaks and epidemics seemto be a price that nature exacts for increased social complexity. There is consid-erable historical evidence that the growing complexity of societies, changes inrelationships among them, or changes in relationships between them and theenvironments that sustain them have been associated with serious disease out-breaks (McNeill 1976; Hobhouse 1989; McMichael 2001). In the past, new settle-ment patterns, the evolution of larger and more densely populated societies, orany form of increasing physical contact among previously separated civilizationshave frequently been associated with a significant increase in the incidence ofinfectious diseases.

Clear evolutionary logic underlies these dynamics. Populations of Homo sapienshave been continually coevolving with a host of microorganisms that are essentialto human well-being. This multitude of microbes decomposes various kinds ofwastes, enriches soils, and performs vital biological functions in human digestivesystems. Only a small portion of these microorganisms are pathogens, represent-ing disease threats to people, plants, or animals. And most of these pathogensare only nuisances, generally causing relatively little serious damage to people.Yet, there have been many historical periods when very deadly pathogens haveemerged and moved rapidly through and among societies, leaving a trail ofsuffering and death in their wake.

Human immune systems have been sharpened by repeated encounters (learn-ing experiences) with a wide variety of pathogens on the local level and havedeveloped effective defense mechanisms for dealing with most of them. Prior tothe growth of more complex societies and empires, these early human-microbeinteractions responsible for building immunity were restricted by the boundariesof relatively isolated societies and ecosystems; local peoples adapted to localpathogens. Significant disease outbreaks, for the most part, only have occurredwhen, for one reason or another, people have come into contact with deadlynew pathogens to which they have developed little immunity.

This normal evolutionary equilibrium between people and pathogens can beupset in several ways. For example, people can settle in new geographic loca-tions, thus exposing themselves to a different array of pathogens. Or, as was thecase during the early stages of the agricultural revolution, people can come intocloser contact with animals, thereby increasing the potential for new pathogensto jump from animals to people. Perhaps most important, particularly in an eraof increasing globalization, greater interaction among previously separated socie-ties can also be a source of disease outbreaks, since people themselves can carrypathogens from one locality to another.

Tony McMichael (2001:89) suggests that there have been at least five transfor-mational epochs in human history during which this dynamic equilibrium thatnormally exists between peoples and pathogens has been significantly disturbed.Much about potential microbial challenges to future globalization can belearned by analyzing them. The first such period of transformation occurred inpre-history when people started to hunt game and eat meat, thus exposing


themselves to a wide variety of previously unknown parasites and pathogens car-ried by the game that they hunted. The second large-scale destabilization of thepeople-pathogen relationship undoubtedly occurred with the migration of tribesout of Africa into new environments and climates, which brought these vulner-able migrants into contact with a host of unfamiliar pathogens.

There have been three more recent discrete periods during which significanttransformations of relations between humans and the physical environment orincreased contact among peoples have led to waves of debilitating disease out-breaks (McMichael 2001:89). There is much evidence that a new era, potentiallyone of pandemics that could drastically alter the course of our increasing com-plex global civilization has now begun (Garrett 1994).

The first of these more recent epochs of debilitating disease outbreaksresulted from transformations in the human condition that began to gathermomentum more than 5,000 years ago when a sedentary agrarian way of lifebecame more established in various parts of the world. The increasing domesti-cation of animals, and living in proximity to them, brought people closer to thepotentially dangerous pathogens that these newly tamed species carried. Further-more, the growth of agrarian communities, and eventually more complex townsand city-states, created denser populations, bringing people into more frequentcontact with each other and with accumulating urban wastes that often con-tained disease organisms. There is evidence that the fledgling kingdoms estab-lished during this early period were significantly impacted by infectious diseases.The Egyptians apparently suffered serious disease outbreaks after enslaving Israe-lites during the period of the Middle Kingdom. And the Hittites, in turn, suf-fered similar maladies, very likely coming from enslaved Egyptians (McMichael2001:100–104).

A second period of transformation in human–pathogen relationships beganabout 2,500 years ago as wider and more frequent travel brought increased con-tacts among the expanding civilizations and empires of Eurasia, and betweenthese core civilizations and the more peripheral areas of the world. Early in thisperiod a deadly plague, thought to have been carried back from Ethiopia, movedthrough Athens in 430 BC, substantially destabilizing Athenian society and weak-ening its military and economic power (McMichael 2001:107). About 2,000 yearsago, emissaries from the expanding Roman Empire began to make regular con-tact with the Han Dynasty Chinese via overland trade routes. Pathogens appar-ently traveled with explorers and merchants in both directions causingnumerous disease outbreaks and epidemics (McMichael 2001:107). In Rome dur-ing Republican times, there were at least 11 major disease outbreaks. Theyundoubtedly originated in the Empire’s periphery, and proved to be a significantlimitation on Rome’s imperial ambitions. The Antonine smallpox epidemic in165 AD was the most serious, spreading throughout the Empire. It has been esti-mated that between one-quarter and one-third of those coming in contact withthis pathogen died (McNeill 1976:115–117). This plague played a significant rolein the decline of the Roman Empire. Since history is written by the winners andnot the losers, the impact of any pathogens that might have been carried out-ward from Rome to the periphery is not well documented. Additionally, small-pox and measles apparently moved east from Europe and cut the population ofNorthern China in half in the third and fourth centuries AD (McMichael2001:107).

At the very end of this era, the bubonic plague spread westward from China toEurope and North Africa, moving with caravans along newly established traderoutes (McNeill 1976:163–168). The black rat (Rattus rattus) brought fleas bear-ing this bacillus to the cities of Southern Europe in 1346. The plague movedthrough Europe over the next few years, killing as many as 40% of those whocame into contact with it, essentially decimating European civilization. It is


estimated that eventually this incidence of the ‘‘Black Death’’ wiped out nearlyone-third of the European population (McMichael 2001:108–111).

The most recent period of substantial disease outbreaks and epidemics accom-panied the expansion of European colonial activity. The outbreaks began in thelate fifteenth century, this time the diseases moving primarily from Europeancore countries to the periphery, as explorers spread fatal diseases to indigenouspeoples in the Western Hemisphere. When Christopher Columbus and his crewset foot in the Americas in 1492, they brought hitchhiking pathogens from theEuropean disease pool with them. Diseases, such as smallpox, measles, and influ-enza wiped out a large portion of the indigenous peoples who had little immu-nity to them. The military history of the period is filled with tales of miraculousconquests of large numbers of indigenous peoples by mere handfuls of Eur-opean troops. But there were no real miracles involved. This was simply foreignpathogens at work, striking down previously isolated locals who were now unableto mount a decent defense of their territories (McNeill 1976:208).

Over time, these imported diseases killed approximately two-thirds of the indi-genous peoples who were exposed to them. The island of Hispaniola (contem-porary Haiti and the Dominican Republic) is thought to have had nearly1 million inhabitants in 1498, when it was first settled by Europeans. By 1520 dis-ease had played a large part in reducing this number to less than 1,000 (Hob-house 1989:25). Unlike earlier disease outbreaks occurring when expandingcomplex civilizations encountered each other, pathogens usually moving in bothdirections, these were basically unequal exchanges. The flow of pathogens movedmainly from core European countries to the periphery. Apparently, there werevery few serious communicable diseases (with the possible exception of syphilis)endemic to the much less densely populated Western Hemisphere.

European diseases, as well as European flora and fauna, also spread to otherparts of colonial empires, including much of the Pacific region (Crosby 1986).Australia’s Aborigines, New Zealand’s Maoris, and numerous Pacific island socie-ties were devastated by these foreign diseases. The native Hawaiian populationdeclined from 300,000 to 37,000 within 80 years of the arrival of Europeans in1778 (McMichael 2001:114).

The Coming Plagues?

There is convincing evidence that the huge increases in trade and travel that areat the core of contemporary globalization are exposing humanity to the risk ofanother round of serious disease outbreaks (Garrett 1994, 2005). Such outbreaksmay well be serious enough to limit, or at least reshape, the nature of globaliza-tion. Over the last three decades, 20 previously known diseases have reemergedor spread geographically and at least 30 diseases not previously known have beenidentified, many of them jumping from animals to people in tropical areas ofthe world. The most obvious mechanism creating this threat is the increasingcomplexity associated with population growth, large-scale industrialization, andthe dynamics of deepening globalization. The co-evolution of human immunesystems and pathogens is no longer primarily the local affair that it has been his-torically; this affair is now taking place on a global scale.

Ecological globalization, a much neglected component of the broader process,involves vast changes in relationships among people, between them and otherorganisms, and between them and the physical environment (Pirages and DeGe-est 2004:chapter 6). The dynamics of contemporary globalization are linkingtogether peoples, pathogens, and ecosystems that historically have been sepa-rated by geographic, political, and cultural barriers. Although there has alwaysbeen a limited ‘‘natural’’ movement of organisms among the world’s diverse eco-systems, the contemporary flow of people, plants, pests, and pathogens through


ever more porous borders is producing a planetary mixing of unprecedentedmagnitude. This growing ecological globalization holds significant consequencesfor the future well-being of the human race and highlights a growing need fornew and more coherent forms of global governance.

This current period of growing system complexity, increasing travel and com-merce, intense industrialization, growing resource dependence, continuingpopulation growth, increasing urbanization, and growing environmental pollu-tion shares much in common with the earlier periods of disease misery andcould well contain the seeds of a new wave of outbreaks or even pandemics. Thechanges now under way are creating three sets of interrelated challenges for theworld health community. First, a rapidly accelerating movement of people, pro-ducts, produce, and pathogens across traditional national borders is increasingthe odds of deadly infectious diseases rapidly making their way around the worldand into epidemiologically naive populations. Second, serious infectious diseasesendemic to the less industrialized countries of Africa and Asia are becoming ofmuch greater concern because they can now spread more easily to the industria-lized world due to significant increases in North-South travel and commerce.Third, the continuing spread of industrialization and related urbanization carrieswith it the risk of more serious disease outbreaks, both because of increasedurban pollution and the increasing rapidity with which diseases can spreadthrough densely populated crowded urban areas.

Although there have been substantial recent advances in medical technology,the impact of infectious diseases is still substantial. Nearly 15 million people diefrom communicable diseases each year, albeit by far the largest portion of themin the less developed countries. Respiratory infections are the leading cause ofdeath, taking about four million lives each year, and HIV ⁄ AIDS follows closebehind with 3 million deaths. Diarrhea, tuberculosis, and malaria combine foranother 5 million deaths (WHO 2004).

Aside from the physical suffering and millions of deaths caused by infectiousdiseases each year, they also exact a significant toll in lost economic growth andrepresent a continuing threat to deepening globalization. History’s great plaguesclearly played a major role in reshaping sociocultural evolution, limiting thegrowth of commerce, and restraining or even reversing the expansion ofempires. The destructive plagues that repeatedly afflicted Rome during republi-can times undoubtedly substantially reduced Roman power and thus the reachof the empire. Similarly, the bubonic plague in fourteenth-century Europe wipedout such a large portion of the population there that it arguably reshaped thesocial and economic face of Europe, possibly setting the stage for a burst oflabor-saving innovations that eventually gave rise to the Industrial Revolution(Hobhouse 1989:18–20). More recent disease outbreaks, although limited inscope, also have had significant political and economic consequences, which iswhy some governments have gone to great lengths in an attempt to keep themsecret.

Three recent disease outbreaks (HIV ⁄ AIDS, SARS, avian flu) could well beharbingers of more serious challenges to come. Suspected of jumping fromchimpanzees to humans in Central Africa, HIV ⁄ AIDS, first identified in 1981,has slowly but inexorably spread around the world. Although this virus usuallycan only be passed through intimate contact, its long incubation period,during which individuals may experience no symptoms, has facilitated itsspread. It is estimated that HIV ⁄ AIDS has already killed in excess of 25 millionpeople. An estimated 38.6 million more people are now living with the HIVvirus. Moreover, about 4.1 million new infections occur each year. And an esti-mated 2.8 million are now losing their lives to the disease each year (UNAIDS2006: 6, 17). This disease is expected to increase significantly in India, China,Nigeria, Ethiopia, and Russia over the next few years. By 2010, it is estimated


that between 50 and 75 million people will be infected in these five countries(NIC 2000:2).

Late in 2002 another previously unknown disease apparently jumped frompalm civet cats to people in China’s Guangdong Province. Although it only sick-ened about 8,500 people, resulting in close to 900 deaths, this SARS (SevereAcute Respiratory Syndrome) virus offered an example of how quickly infectiousdiseases can move across borders and disrupt travel and commerce. In only a fewweeks the disease had reached much of Asia and within 6 months SARS hadbeen reported in 29 countries (Fidler 2004). It had a major impact on trade andtourism in Asia and shaved nearly 100 hundred billion dollars from economicgrowth in the region before it was brought under control.

Finally, although it had only taken about 100 human lives by the end of 2006,a widespread outbreak of avian flu (H5N1) among fowl has focused attention onthe possibility of a related rapidly moving flu pandemic developing among peo-ple. Keeping in mind the heavy toll from three significant influenza pandemicsof the last century (1918–1919, 1957–1958, 1968–1969), disease experts are nowconcerned about the possibility that the avian flu virus could provide the basisfor a new pandemic in a much more densely populated world (Garrett 2005).The current strain of avian flu is very deadly to birds, but it has jumped fromthem to people only on rare occasions. The fear is that a slight change in thevirus could transform it into a killer disease that could be passed easily from per-son to person, thus creating a twenty-first century influenza pandemic.

Disease and the Global Future

The contemporary global system is much more complex, and thus perhaps muchmore fragile, than its predecessors. It is therefore likely that a future pandemicwould be much more disruptive than the more limited epidemics of the past.There are two ways to speculate about the global impact of such a catastrophicevent. First, the recent SARS outbreak that moved rapidly through East Asia in2002–2003 offers a useful scale model and thus some indication of how a futurepandemic could affect the course of globalization. Second, epidemiologists haveconstructed very useful speculative models of future pandemics based on pastexperience.

The recent SARS outbreak, although very limited in its human casualties, hada devastating impact on commerce and travel within Asia as well as on theregion’s global linkages. It was only a few weeks after the first SARS-related deaththat fear of the disease put the economies of China, Taiwan, and Singapore intoa tailspin. The SARS outbreak led to a substantial reduction in travel and exportsas the region was increasingly cut off from the rest of the world. Air traffic cameto a near standstill, with major carriers grounding up to 40% of their flights.The number of passengers passing through Singapore’s airport, normally about29 million annually, slowed to a trickle. In South China and Hong Kong, severalmajor hotels operated at only 10% of capacity. The Canton Trade Fair, whichusually results in $17 billion in business deals, was an economic disaster. Fewpotential buyers were willing to brave exposure to the disease in order to attend(Engardio, Clifford, and Shari 2003).

The ultimate impact on travel and commerce was considerable. In China, thetourism industry lost an estimated $7.6 billion in revenue and 2.8 million jobs.The loss to China’s overall travel economy in 2003 was around $20.4 billion. Sin-gapore’s tourism industry took a hit of some $1.1 billion and 17,500 jobs (Prystay2003). Economists shaved nearly 1.5 percentage points off the 2003 growth esti-mates for the economies of Hong Kong, Singapore, and Malaysia (Engardio, Clif-ford, and Shari 2003). Fortunately, the disease proved to be susceptible tocareful sanitary measures, did not spread widely beyond the region, and


disappeared rather quickly. Should the disease have spread much more widely,the Asian panic could have been replicated worldwide.

The ongoing avian flu (H5N1) pandemic among fowl, which first appeared insouthern China in 1997, represents a much more significant potential threat tothe global system. Although the disease is very deadly to the fowl that it infects,it has jumped to humans on relatively few occasions. If the virus should changeslightly into a form that could easily be passed among people, the world wouldlikely experience a disaster much greater than the 1918–1919 Spanish flu, whichbest estimates now indicate killed at least 50 million people. A recent study extra-polating from the 1918–1919 Spanish flu data indicates that a similar influenzaoutbreak moving through the more integrated and complex contemporary glo-bal system would kill 62 million people, 96% of them in the less industrializedcountries (Murray et al. 2006).

Warwick McKibbin and Alexandra Sidorenko (2006) have explored in muchmore detail the potential human casualties and economic losses that would beassociated with such a future influenza pandemic in our densely populated worldof more than 6.5 billion people. They have explored four scenarios in which theseverity of a possible future pandemic ranges from ‘‘mild’’ to ‘‘ultra.’’ A mildpandemic would take 1.4 million lives and the global economy would lose $330billion dollars worth of output. This would be about .8% of total world product.Their more serious ultra pandemic, by contrast, would take 142 million lives andresult in a loss of $4.4 trillion, about 12.6% of world product.

There would be a differential impact on the fortunes of countries and regions.Their ‘‘severe’’ pandemic, with dynamics similar to those of the Spanish flu of1918–1919, would wipe out 71 million people. These fatalities likely would beconcentrated in China, India, and other less developed countries since theywould not likely have adequate access to vaccines or medications. China wouldexperience 14.2 million fatalities, India 12.1 million, and the rest of the lessdeveloped world 10.0 million (McKibbin and Sidorenko 2006: Table 1). By con-trast, there would be approximately 1.0 million deaths in the United States, 3.2million in Europe, and 1.1 million in Japan. But the economic shocks associatedwith the spread of the disease would be considerable in all impacted countriesand would undoubtedly spread across borders and paralyze world commerce.GDP in the United States would drop 3.0%, in Europe it would fall 4.3%, andJapan would be hit by an 8.3% decline. China’s GDP would decline 4.8%, India’sGDP would decline 4.9%, and the GDP in other less developed countries woulddecline by 6.3% (McKibbin and Sidorenko 2006:Table 7).

Influenza pandemics on this scale would dramatically slow, or even reverse,the growth of worldwide trade and travel for an extended period. Should thepandemic linger or should another pandemic develop, the consequences couldbe severe. Such events could dramatically transform or even curtail this round ofglobalization. Given the three significant influenza pandemics in the nineteenthcentury, and the resurgence and emergence of many diseases, it would seem thathighly infectious diseases represent a serious threat to increasing social complex-ity and deepening globalization. Given the nature of this challenge, what hasbeen the response?

Moving beyond Westphalia

As Tainter (1988:91) has deftly put it, growing complexity requires more sophisti-cated forms of governance. It is clear that future threats from the forces of nat-ure, in this case pandemics, are likely to pose a deepening challenge toglobalization as well a to human security in general. This obviously requiresre-thinking traditional approaches to international cooperation and globalgovernance.


Until the middle of the nineteenth century, infectious diseases were consid-ered to be primarily national health issues; there was only very limited interstatecooperation in arresting their spread. Beginning in Italian city-states in the fif-teenth century, European countries slowly adopted unilateral quarantine mea-sures to stop infectious diseases from crossing their borders. By the latter half ofthe seventeenth century, it had become common to require ships leaving foreignports to obtain a bill of health from the destination state’s diplomatic representa-tive there, guaranteeing the last port of call to be free of epidemic diseases, suchas cholera, plague, or yellow fever. But these efforts ‘‘relied exclusively ona nation’s own governmental capabilities—diplomats abroad and quarantineofficials at home’’ (Fidler 2004:27).

As threats from infectious diseases grew in the first half of the nineteenth cen-tury, the major European powers tried to take a more systematic approach todealing with their spread. Beginning with an international sanitary conference inParis in 1851, the European powers had some limited success in crafting a seriesof international sanitary conventions. But these conventions were based on West-phalian principles, with a strong emphasis on sovereignty, and they wereintended mainly to restrict trade and travel during periods of medical emergen-cies. The rules did not address potentially dangerous conditions that could harmothers that might exist within states. And they required no actions by states inimplementing public health regulations. (Fidler 2004:26–30). The first attemptto set up a worldwide health organization resulted in the Office d’Hygiene Publi-que being set up in Paris in 1907. Its mandate was to study epidemic diseases,administer international conventions, and to facilitate the exchange of diseasedata (Gomez-Dantes 2001:397).

More contemporary attempts to cooperate in dealing with global public healththreats can be traced back to the founding of the World Health Organization(WHO) within the framework of the United Nations in 1948. The WHO adopteda set of International Sanitary Regulations in 1951 that are now called the Inter-national Health Regulations. Within the WHO, a World Health Assembly, com-posed of all WHO member states, has the power to adopt regulations that inprinciple are binding on member states. But members may ‘‘opt out’’ or refuseto be bound by specific provisions of these International Health Regulations. Inthis respect the regulations are very similar to conventional treaties; sovereignstates are bound only by those agreements that they ratify. A set of InternationalHealth Regulations was adopted in 1969 and was updated in 1973, 1981, and2005. Originally, the regulations did not really require WHO members to domuch more than notify the organization of outbreaks of plague, cholera, and yel-low fever and to maintain certain public health capabilities at ports and airports.The significant 2005 update, completed at a time of concern over a potentialinfluenza pandemic, requires member states to notify the WHO of all majorhealth threats with the potential to spread. This includes notification of any bio-terrorism events. The revised regulations also require both the WHO to assistmember states in responding to disease threats and greater international coop-eration to limit the spread of disease.

Thus, at the beginning of the twenty-first century, prior to the outbreak ofSARS, capabilities for dealing with large-scale disease outbreaks were somewhatlimited for at least three reasons. First, a revolution in health care in the wealthycountries had created overconfidence, if not arrogance, in the battle againstcommunicable disease. Second, the most deadly diseases, and by far the greatestnumber of disease victims, were located in the world’s poor countries. It was amatter of ‘‘out of sight-out of mind.’’ But deepening globalization has now chan-ged all this and diseases can now move rapidly from poor to wealthy neighbor-hoods in the emerging global city. Finally, even the HIV ⁄ AIDS outbreak, a trulyfull-blown but slow moving pandemic, failed to excite people because it was


associated with ‘‘misbehavior.’’ Unlike influenza, people were thought, for themost part, to have exposed themselves to the disease as a result of their ownchoices.

But since the SARS outbreak, pressures for worldwide cooperation in fightinginfectious diseases have been growing. Significant progress has been made inincreasing surveillance to detect disease outbreaks, in responding to them, inusing anticipatory thinking to prepare for and possibly prevent future pan-demics, and in encouraging greater transparency in countries likely to experi-ence disease outbreaks. The Program for Monitoring Infectious Diseases (ProMed-Mail) is an Internet based service that rapidly circulates reports of diseaseoutbreaks around the world to its 30,000 subscribers. Moreover, the WorldHealth Organization uses the Internet to link together its Global Outbreak Alertand Response Network (GOARN), which it founded in 2000. And a nascent glo-bal health community dedicated to stemming infectious disease outbreaks isemerging. Yet, the World Health Organization still lacks adequate resources andenforcement power and depends heavily upon other organizations, as well asmoral suasion, to contain new disease outbreaks.

To sum up, it is clear that this round of globalization is creating an ever moreinterdependent and complex global society that is increasingly vulnerable to thesame forces of nature that have limited the reach of past civilizations. The mostimmediate and likely of these challenges from nature is another influenza pan-demic, perhaps of much greater severity than those that took place in the twenti-eth century. A race is now under way between deepening globalization, with itspotential for the more rapid spread of deadly diseases, and the ability of thescientific community to locate disease outbreaks and to move quickly to containand remedy them. But the latter requires the willingness of political leaders torecognize that in the contemporary world infectious diseases cannot be stoppedby borders and that dealing with future such challenges of nature in a muchmore complex global system requires a paradigm shift in defining and buildingglobal security.

References

Bryson, Reid A, and Thomas J. Murray. (1977) Climates of Hunger: Mankind and the World’s ChangingWeather. Madison: University of Wisconsin Press.

Cartwright, Frederick F. (1972) Disease and History. New York: Thomas Y. Crowell.Cavalli-Sforza, Luigi Luca, and Francesco Cavalli-Sforza. (1995) The Great Human Diasporas.

Reading, MA: Addison Wesley.Crosby, Alfred W. (1986) Ecological Imperialism: The Biological Expansion of Europe, 900-1900.

Cambridge: Cambridge University Press.De Boer, Jelle Zeilinga, and Donald Theodore Sanders. (2004) Volcanoes in Human History: The

Far-Reaching Effects of Major Eruptions. Princeton: Princeton University Press.Diamond, Jared M. (2005) Collapse: How Societies Choose or Fail to Succeed. New York: Viking.Durham, William H. (1991) Co-evolution: Genes, Culture, and Human Diversity. Stanford: Stanford Uni-

versity Press.Engardio, Pek, Mark Clifford, and Michael Shari. (2003) Epidemics and Economics. Business-

Week (April 28).Fagan, Brian M. (2000) The Little Ice Age: How Climate Made History 1300-1850. New York: Basic

Books.Fidler, David P. (2004) SARS, Governance, and the Globalization of Disease. New York: Palgrave.Garrett, Laurie. (1994) The Coming Plague: Newly Emerging Diseases in a World Out of Balance. New

York: Farrar, Straus, and Giroux.Garrett, Laurie. (2005) The Next Pandemic. Foreign Affairs (July ⁄ August). Available at http: ⁄ ⁄ www.

foreignaffairs.org ⁄ 20050701faessay84401 ⁄ laurie-garrett.Geertz, Clifford. (1973) The Interpretation of Cultures. New York: Basic Books.Gomez-Dantes, Octavio. (2001) Health. In Managing Global Issues, edited by P.J. Simmons and Chan-

tal de Jonge Oudrat. Washington, DC: Brookings Institution Press.


Hallpike, C. (1986) The Principles of Social Evolution. Oxford: Clarendon Press.Harris, Marvin. (1979) Cultural Materialism: The Struggle for a Science of Culture. New York: Random

House.Hobhouse, Henry. (1989) Forces of Change. London: Sidgwick and Jackson Limited.Ladurie, Emmanuel L. (1971) Times of Feast, Times of Famine: A History of Climate since the Year 1000.

Garden City, NY: Doubleday.McKibbin, Warwick, and Alexandra Sidorenko. (2006) Global Macroeconomic Consequences of Pan-

demic Influenza. Sydney: Lowy Institute for International Policy.McMichael, Tony. (2001) Human Frontiers, Environments, and Disease. Cambridge: Cambridge Univer-

sity Press.McNeill, William. (1976) Plagues and Peoples. Garden City, NY: Anchor Press.Murray, C., A. Lopez, B. Chin, D. Feehan, and K. Hill. (2006) Estimation of Potential Global Pan-

demic Influenza Mortality on the Basis of Vital Registry Data from the 1918-20 Pandemic: AQuantitative Analysis. Lancet (December 23).

NIC. (2000) The Global Infectious Disease Threat and It’s Implications for the United States. Washington,DC: National Intelligence Council.

Ostler, Rosemarie. (1999) Disappearing Languages. The Futurist (August ⁄ September).Pirages, Dennis C, and Theresa M. DeGeest. (2004) Ecological Security: An Evolutionary Perspective on

Globalization. Lanham, MD: Rowman and Littlefield Publishers.Prystay, C (2003) SARS Squeezes Asia’s Travel Sector. Wall Street Journal (May 16).Tainter, Joseph. (1988) The Collapse of Complex Societies. Cambridge: Cambridge University Press.UNAIDS. (2006) Report on the Global AIDS Epidemic (Executive Summary). Geneva: UNAIDS.Wallace, Walter L. (1997) The Future of Ethnicity, Race, and Nationality. Westport, CT: Praeger.WHO. (2004) The World Health Report 2004. Geneva: World Health Organization.


nature, disease, and globalization: an evolutionary perspective

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