Deadly Alliances: Death, Disease, and the Global Politics of Public Health

T he rancour surrounding the Bangkok AIDS summit of July 2004 has exposed a series of fundamental disagreements surrounding the global politics of public health. These tensions range from access to cheaper lifesaving drugs to disputes over the role of poverty and gender equality in the promotion of sexual health. The world is now experiencing the most profound public health challenge of the last forty years: we have witnessed the appearance of new diseases such as Ebola, SARS, and in particular, AIDS, combined with the alarming resurgence of diseases previously thought to have been under control, such as malaria and tuberculosis [1,2]. The AIDS pandemic in particular threatens to devastate entire regions and has already fundamentally altered the life expectancy and demographic profi le of many countries in sub-Saharan Africa. Billions of people lack access to adequate sanitation and safe drinking water (Figure 1), and the UN predicts that slums will become the dominant urban form within the next fi fteen years (Figure 2) [3,4,5]. Yet the very idea of " public health " sits uncomfortably alongside the current emphasis of bio-medical science on the molecular realm of DNA coding and the development of lucrative Western markets for new pharmaceutical products such as sildenafi l (Viagra). The needs of the majority—the global poor—scarcely feature within this tactical alliance between the biomedical sciences and corporate power. Since most people threatened by AIDS, tuberculosis, unsafe drinking water, and other health threats are poor, they have little or no infl uence over the global politics of public health. If we are to make sense of the current public health crisis, we need to explore interconnections between political, economic, and social developments that are ignored by the fragmentary emphasis of the biomedical sciences. The current impetus toward economic globalization is causing widespread social and economic disruption, ranging from wild currency fl uctuations to the systematic collapse of viable agricultural systems [6]. The imposition of austerity packages—widely referred to as structural adjustment programmes—in combination with the forcible extension of global markets for Western products is plunging millions of people into poverty and economic dependence. Existing primary health care services in much of the developing world and the former states of the Soviet Union have been drastically cut back, and services that were once freely available are now increasingly beyond the reach of the poor. And these harmful trends also extend even to the wealthiest global …