The Unintended Health Consequences of Globalization: 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


Why???...Ok What is Globalization: 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


Globalization: The Flattening of the World: Globalization: The Flattening of the World


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


The Rise of Asia in the Global Economy: The Rise of Asia in the Global Economy


Globalization’s Impact on Developing Countries…Too good to be true!!: 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”


I thought globalization is good right??? : I thought globalization is good right???


Goal: Unintended Consequences of Globalization : 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


Climate System: Climate System


Greenhouse Effect: Greenhouse Effect


Global Warming: Global Warming


Carbon Dioxide10000 years before 2005: Carbon Dioxide 10000 years before 2005


Methane10000 years before 2005: Methane 10000 years before 2005


Nitrous Oxide10000 years before 2005: Nitrous Oxide 10000 years before 2005


Greenhouse Gases: 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


World Consumption: World Consumption


Climate Change Controversy: 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.


Curbing Carbon Emissions: No Easy Solution: 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


Kyoto Protocol: UN Agreement: 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


Unintended Consequences of Climate Change: Unintended Consequences of Climate Change


Defining a Disaster: Defining a Disaster Risk = Hazard * Vulnerability


Phases in Disaster Preparedness: Phases in Disaster Preparedness DISASTER


Societal Disruption: Societal Disruption Infrastructure destruction Hospitals Primary Health Centers Homes Transportation


Criteria for a Natural Disaster: 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/


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


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


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


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


Extreme Heat and Cold Waves: Populations susceptible: Extreme Heat and Cold Waves: Populations susceptible


Climate Change???: Climate Change???


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


Globalization and Urbanization:: 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


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


Travel projections until 2017: Travel projections until 2017


Influenza A: Influenza A


Pandemic Influenza: Pandemic Influenza


Historical Consequences: Historical Consequences


Overarching Objectives: Overarching Objectives


SARS: Window to a Pandemic : SARS: Window to a Pandemic


SARS Implementation Strategies :: SARS Implementation Strategies :


Slide45: Severe acute respiratory syndrome From Wikipedia, the free encyclopedia http://en.wikipedia.org/wiki/SARS


Greatest Growth: Asia/Pacific and Latin America: Greatest Growth: Asia/Pacific and Latin America


Climate Change and Infectious Disease: Climate Change and Infectious Disease


Climate Change???: Climate Change??? Thursday, 14 March 2007, 19,577 recorded cases of dengue were reported. The national average incidence rate is 325.8 per 100,000 inhabitants (Source: Mercosur and MSPBS). The dengue outbreak is concentrated in the capital city of Asunción Capital (incidence rate = 1166.6 per 100,000), . Climate in the form of continuous rainfall has played a major role in this outbreak.


Supersize Me!!!: Supersize Me!!!


Global Terrorism: Influence of Globalization: Global Terrorism: Influence of Globalization


Global Terrorism: Are we preparing for the right threats? : Global Terrorism: Are we preparing for the right threats?


Globalization and its Impact on Health: Globalization and its Impact on Health


Educational Framework for Disaster Medicine and Public Health Preparedness: Educational Framework for Disaster Medicine and Public Health Preparedness


Goals : Goals Create an educational framework that would meet the practical needs of all health system responders. Consistency and common lexicon among all learners and level of responders. Create a framework that would allow for scientific evaluation and assessment.


Methodology: Methodology Systematic Review (Jan. 2004-July 2007) peer reviewed, and unpublished (ASPR, CDC,DHS) Convened an Expert Panel Identified Commonality and Gaps: Ethics, Law, Mortuary, Risk Communication, Mental Health, Cultural Competence, Leadership.


Learning Matrix: Learning Matrix


Slide64: For each competency and responder category, learning objectives must be developed to accommodate persons in the target group who perform at different levels and in varying degrees based on their educational level, experience, professional role, and job function in disaster planning, mitigation, response, and recovery.


Slide65: For each competency and responder category, learning objectives must be developed to accommodate persons in the target group who perform at different levels and in varying degrees based on their educational level, experience, professional role, and job function in disaster planning, mitigation, response, and recovery.


Slide66: Competencies Bio Chem N/R 10 100 1,000 MD/DO RN Para R T B Geo-Climatic Time


Next Steps: Next Steps Development of Learning Objectives Development of Evaluation Measures Prospective Randomized/ Control Educational Trial (web-based vs. didactic).


Bombings: Blast Injury: Bombings: Blast Injury


Triage: Sorting patients…sort of. : Triage: Sorting patients…sort of.


Injury Severity: Injury Severity


Critical Mortality Rates: Identifying Preventable Deaths: Critical Mortality Rates: Identifying Preventable Deaths


Critical Mortality and Overtriage: Critical Mortality and Overtriage


Virginia Tech Case Study: You are a Level 3 Trauma Center: Virginia Tech Case Study: You are a Level 3 Trauma Center


Unable to Medevac: Unable to Medevac Triage broke down into two groups


Injury Severity: Injury Severity


Critical Mortality: Critical Mortality


Overtriage??? Not a Friend but is it a Foe?: Overtriage??? Not a Friend but is it a Foe?


Lessons Learned:Level I or not be ready!: Lessons Learned: Level I or not be ready!