1. The Unintended Health Consequences of Globalization Italo Subbarao DO,MBA Director Public Health Readiness Office Deputy Editor Journal of Disaster Medicine Center for Public Health Preparedness & Disaster Response

2. Why???...Ok What is Globalization • Globalization "is the closer integration of the countries and peoples of the world ...brought about by the enormous reduction of costs of transportation and communication, and the breaking down of artificial barriers to the flows of goods, services, capital, knowledge, and people across borders.” Joseph Stiglitz Noble Prize Economist

3. Globalization: The Flattening of the World • Global Economy • Dramatic Increases in Technological Efficiencies: Cheaper Goods and Services • Outsourcing: Radiologist doing evaluations from Australia • Increased Trade and Commerce • Communication • Virtual Communities (Shared Ideologies) • 24/7 News world

4. Globalization: Closing the Economic Gap between Developing and Developed Nations

5. The Rise of Asia in the Global Economy

6. Globalization’s Impact on Developing Countries…Too good to be true!! • Rapid Industrialization and Urbanization • Demand for Energy and Land • Profits maximized: No focus on standards and regulations • Demand for all populations to be involved in the “gold rush”

7. I thought globalization is good right???

8. Goal: Unintended Consequences of Globalization • Review Global Trends in Natural Disasters • Review the Health Impact of Climate Change • Review the Concern of Pandemic Influenza and Emerging Infections • Review the Risk of Global Terrorism • Case Study of the Virginia Tech Tragedy

9. Climate System

10. Greenhouse Effect

11. Global Warming

12. Carbon Dioxide10000 years before 2005

13. Methane10000 years before 2005

14. Nitrous Oxide10000 years before 2005

15. Greenhouse Gases • Carbon Dioxide 35% increase since industrial age • Combustion of Fossil Fuels • Deforestation • Methane 154% increase since industrial age • Animal (cattle and sheep) gas • Nitrous Oxide • Water Vapor

16. World Consumption

17. Climate Change Controversy • Nobody argues that the earth is getting warmer and that climate change is occurring. • Controversy is global warming part of the natural planetary cycle or does man have influence? • Other issue is whether curbing CO2 emissions now will have a real impact in the immediate future.

18. Curbing Carbon Emissions: No Easy Solution • Alternative Energy Non-Fossil Fuel Based • Wind, Solar, Nuclear • Ethanol Corn, Sugar Cane, Catalytic • Energy Efficiency • Carbon Emission Regulation: Carbon Tax

19. Kyoto Protocol: UN Agreement • Protocol signed by 167 countries: US and Australia notable exceptions • China and India have signed on • Cut greenhouse gas emissions by 5% less than 1990 emissions. • If unable can purchase carbon credits but are penalized in the future. • Treaty expires 2013

20. Unintended Consequences of Climate Change

21. Defining a Disaster Risk = Hazard * Vulnerability

22. Phases in Disaster Preparedness DISASTER

24. Societal Disruption • Infrastructure destruction • Hospitals • Primary Health Centers • Homes • Transportation

25. Criteria for a Natural Disaster • 10 or more people reported killed • 100 people reported affected • Declaration of a state of emergency • Call for international assistance • http://www.em-dat.net/

26. Natural Disasters http://www.em-dat.net/

27. Comparative Review of Natural Disasters http://www.em-dat.net/

28. Continental Comparisons http://www.em-dat.net/

29. Mortality and Population Affected http://www.em-dat.net/

31. Extreme Heat and Cold Waves: Populations susceptible • Elderly and Children • Those with Chronic Diseases • Lower Socioeconomic: Homeless

32. Climate Change???

34. What’s All The Hype About???

35. Infectious Disease and Globalization: • Urbanization (Developing Countries) • Overpopulation • Travel Projections • Climate Change Impact

36. Globalization and Urbanization: • 2006 UN Report: 1976 1/3rd of the population lived in cities • Today 50% of the worlds population lives in cities • Greatest growth is in developing countries: China and India

37. Overpopulation: Feed Me!!! • Pollution • Improper Waste Disposal • Depletion of Natural Resources • Overcrowding/ Slums: Mixing of Human and Animal populations • Increased Consumption

38. Travel projections until 2017

39. Influenza A • Orthomyxoviridae: • Single Stranded RNA Virus • Two proteins responsible for virulence • Hemagglutinin (HA) (1-16) • Neuraminadase (NA) (1-9) • Principal method of protection is seasonal immunization NA inhibitors are also efficacious Typical Seasonal Flu occurs during the winter season on average 36,000 deaths per year

40. Pandemic Influenza • Antigenic Shift: Occurs from genomic mixing of distinct virus strains with human strains. • Avian, Swine, etc. • New Strain of Influenza: • Humans will have no preexisting immunity • Efficacy of Antivirals: Unknown • No Vaccine will be available • Avian Influenza is not yet a Human Pandemic • Cannot Predict Level of Virulence

41. Historical Consequences

42. Overarching Objectives • Phase: Pre-Pandemic • Reduce opportunities for human infection • Strengthen Early Warning Systems • Phase: Emergence of a Pandemic • Contain or delay the spread at the source • Phase: Pandemic Declared and Spreading • Reduce morbidity, mortality, and social disruption • Conduct Research to guide Response

43. SARS: Window to a Pandemic • Emerging Respiratory Infection in a Globalized World • Travel and Commerce • Communication Alerts • High Mortality • High Secondary Infection Rate in Healthcare Workers • No Vaccine • Unknown Response to Antivirals

44. SARS Implementation Strategies : • Singapore: Patients with respiratory symptoms seen outside the Emergency Department • Toronto: EMS personnel restricted transport of patients with respiratory symptoms. • Once case definition present: High Index of Clinical Suspicion among Clinicians • Worked in Allentown

45. SARS Lessons Learned Developing: Overcrowding Developed: Travel Severe acute respiratory syndrome From Wikipedia, the free encyclopedia http://en.wikipedia.org/wiki/SARS

46. Avian Influenza

47. Greatest Growth: Asia/Pacific and Latin America

48. Human Resources • Overwhelming Patient Load • Care for Non-Infectious Patients ie. CVA, MI • Surge Capacity: Alternative Care Sites • Ethics: Ventilator Triage

50. Climate Change and Infectious Disease