Theorizing Global-Local Linkages in Global Health Studies: Theorizing Global-Local Linkages in Global Health Studies Craig R. Janes University of Colorado at Denver Craig.Janes@cudenver.edu


Disparate Views: Disparate Views The persons most at risk for emerging infectious diseases generally do not…have much of the benefit of scientific knowledge. We live in a world where infections pass easily across borders – social and geographic – while resources, including cumulative scientific knowledge, are blocked at customs -- Paul Farmer (1999: 54), Infections and Inequalities: The Modern Plagues The natural locus of disease is the natural locus of life – the family: gentle, spontaneous care, expressive of love and a common desire for a cure, assists nature in its struggle against the illness, and allows the illness itself to attain its own truth -- Michel Foucault (1973: 17), The Birth of the Clinic.


Local/Global Flows: Local/Global Flows Our research illustrates the effects on health of the flow of knowledge, ideas, policies, products, and technologies, as well as identity and cultural practices between the local and the global. Our findings highlight the vulnerability of the local to the global. Local communities experience the effects of globalization in different ways – through resistance and resilience as well as marginalization and alienation. Our analysis shows the importance of respecting local perspectives and traditions on well-being and healing – Statement of the New Century Scholars Program, November 6, 2002.


Slide4: Local Governance: Emerging models of global governance Changing role of the state NGOs Decentralization and Community Input/resiliency/responses Factors of Globalization: Trade Travel Migration Demographic transition Food security War, conflict, ethnic & sectarian violence Environmental degradation Technology Media/cultural flows Int’l civil society Figure 1: Conceptualizing the Articulation of the Local and the Global Risks to Health/ Healthy Responses: Direct epidemiologic consequences of globalization (both salutatory and pathogenic) Local- Culture Community Households Families


Emerging Antimicrobial Resistant Organisms: The Global Problem of Antibiotic Misuse: Emerging Antimicrobial Resistant Organisms: The Global Problem of Antibiotic Misuse Antibiotic resistant micro-organisms represent the largest proportion of so-called “emerging infections” in the world today


Tetracycline use in Burkina Faso: Tetracycline use in Burkina Faso It seems there is not a single market in the country where [“tupaye”] cannot be purchased. Even cigarette vendors & little girls sell it… In fact, “tupaye” means “it heals everything” & the evidence I obtained... indicates that it is according to its name for absolutely everything: from stomach aches to backaches, from toothaches to open wounds, headaches to malaria, diarrhoea, & so on. Capsule contents are poured into open wounds, emptied into cavities in the teeth, diluted in all sorts of liquids. Pradervand, Pierre. “Tupaye:” A Medical Wonder. Health Action International News 21:1-2, 1985.


Slide8: Causes of Antibiotic Misuse Local demands (“magic of the medicines”) Excessive clinical use by physicians Privatization Prescribing or selling by unskilled practitioners Over-the-counter availability Private pharmacy, Ulaanbaatar, Mongolia


State and Global Factors Contributing to Antibiotic Misuse: State and Global Factors Contributing to Antibiotic Misuse Inadequate or erratic drug supplies Political instability/corruption Poor quality antibiotics Actions of pharmaceutical companies


Slide11: Media Messages Regarding Inappropriate Antibiotic Use, “Minimizing Antibiotic Resistance in Colorado” Project


Trade, Migration, Air Conditioners and Mosquitoes: Dengue Fever along the U.S. Mexico Border: Trade, Migration, Air Conditioners and Mosquitoes: Dengue Fever along the U.S. Mexico Border Dengue fever: Mosquito-borne viral disease 80 million suffer disease annually Mortality may be high in developing countries Spread into temperate zones of the Americas Climate change Reduced public health efforts to control disease Political-economic changes North American Free Trade agreement Migration and urbanization along border Poverty, lack of services contribute to local ecology of disease


Tucson, AZ – northwest: Tucson, AZ – northwest


Nogales, AZ – adjacent to border: Nogales, AZ – adjacent to border


Local Resistance and Resilience: Local Resistance and Resilience Creative responses Resistance to global assaults, global “solutions” Haiti: support groups become micro-credit enterprises Mongolia: Rejection of global family planning policy


Conclusions: Conclusions The local is vulnerable to the global: “Small is may be beautiful, but it is also insignificant” Public health interventions must occur at all levels Policy fallacies: actions at one level determined by policy developed at another The principle determinants of health are social in origin and nature Governments, intergovernmental and nongovernmental organizations, private donors, multinational corporations, and local communities should assess each policy initiative according to its effects on the key social determinants of health: poverty, economic and ethnic inequities, vilence, war, environmental degradation, and access to health care services and technologies – NCS Statement, November 6, 2002.