Epidemiology Agog

Louis R Godena louisgodena at ids.net
Fri Oct 11 15:36:26 MDT 1996


In the fourteenth century,  the plague destoyed between a quarter and a half
of the population of Europe,  North Africa and parts of Asia.    The loss of
65,000,000 halved China's population.    Until the seventeenth century,
epidemics commonly wiped out half of a city's population.    In contrast,
the most recent outbreak of plague--in India in 1994--caused few deaths and
was controlled in three weeks.    Its main adverse effects were on tourism
and exports.

Smallpox,   introduced by Cortes' arrival in Mexico,  reduced the indigenous
population from 30 million to 3 million. The Inca population in Peru
collapsed from 8 million to less than 1 million for the same reason.
Similar fates befell the native populations of North America,  Australia and
New Zealand.    Smallpox has now been banished from the planet.

Typhus was another scourge:  it accounted for most of the several million
deaths in the Irish potato famine,  was the main agent responsible for
pruning Napoleon's Grand Army of 500,000 to 35,000 and killed about
20,000,000 in the pandemic triggered by the First World War.    Typhus is
now preventable (soap,  insecticides and vaccines).

And the list goes on;  Asiatic flu,  cholera,  polio--diseases which in the
not too distant past killed hundreds of thousands or millions--are now
thought to be under control.    There has not been a confirmed case of polio
in the Americas in several years.    Much of the progress can be ascribed to
social reform,  better public health measures guided by common sense and
scientific understanding of the transmission of disease, and, to a lesser
extent,  the development of specific medical treatments.

Yet,  the epidemiology of the planet is considered today more precarious
than at virtually any time in the modern era (since 1789).    It is not just
the rapid spread of exotic killer viruses (between 25 and 40 million
Americans carry the human papilloma virus [HPV],  implicated in the
causation of cervical cancer),  but the discovery of possible links between
micro-organisms and diseases hitherto thought to be of non-infectious
origin: liver cancer,  neuro-degenerative conditions such as Alzheimer's
disease,  multiple sclerosis,   and rheumatoid arthritis.    Hepatitis B was
recently linked to liver cancer.    And the Ebola outbreaks in Africa and
Asia have dramatized just how fragile are local public health facilities in
an era of neo-liberal "rationalization" of scarce medical resources.    New
resistant strains of HIV have recently made their appearance in east Africa.

It is in fact the deteriorating state of the public health infrastructure
not only in the developing world but in the western countries especially
that has drawn a pall over the forecasts of forensic science at the turn of
this century. It,  together with ancillory isses such as environmental
degradation and the spread of drugs,  has recast the debate over the spread
of infectious disease from one of cautious optimism to one of resigned
despair.     The bi-annual summit meeting of the World Health Organization
in Brussels last week dramatized the growing concern over the spread of
particularly viral diseases and the growing rationalization of public health
under capitalism.     The present decreasing levels of public spending on
health and disease,  especially in those countries "restructuring" their
economies under the dictates of the International Monetary Fund,   invite a
potential public health disaster on a scale not seen since the fourteenth
century.

Louis Godena



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