Lecture 2526: Disease And The International System

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Lecture 25-26 Disease And The International
System
1. Civilizations And Disease Pools 2. Economic
Development And Disease 3. AIDS A Global
Disease 4. War And Disease 5. War And The Spread
Of Disease 6. War And The Spread Of Influenza In
1918-19 7. War And Medicine 8. War And Lethality
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Disease Pools
1. Geographically Separated Civilizations 2. Each
Is A Disease Pool In Equilibrium 3. Introduction
Of New Disease -- Early Catastrophic Waves --
Adaptive Humans Rising Immunity Lowers Death
Rate 4. Adaptive Diseases Long Run Course of
Ebola 5. Long Run Equilibrium -- Disrupted by
Mutation Causes New Disease -- Disrupted by
Contact Between Civilizations
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Early Contacts
1. Roman Empire About 200 AD -- Antonine Plague
Of 165-180 AD -- Second Wave In 251 AD -- 5,000
Fatalities Per Day In Rome -- Triggers Military,
Tax, And Religious Changes 2. Justinian Revival
And The Plague (542-543 AD) -- Pneumonic
Plague -- Bubonic Plague -- Septicemic Plague
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Justinian Plague
1. Transmission Black Rats via Indian Ocean
Trade 2. 10,000 Die Per Day In Constantinople At
Peak 3. Weakens Justinian's Empire Aids The
Moslem Expansion 4. Plague Hits China At Same
Time 5. Plague Disappears From Europe About 767
AD 6. Convergence Of Disease Pools Africa,
China, And Europe A) Mongols Dont Die Off Or
Trigger Spread Plagues B) Africans Not Wiped Out
By Europeans
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The Black Death
1. Bubonic Plague Returns Permanently in the 14
Century 2. Pasteurella Pestis And Underground
Rodent Communities 3. Key Mongol Expansion
Spreads Disease A) Hits China In 1331 --
Population Drops from 123m to 65m
(1200-1393) -- Mongols Collapse 1368 B) Hits
Europe In 1346 -- 25-40 Of Population
Dies -- Shifts Relative Prices -- Triggers
Revision Of Customs Bizarre Behavior
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The New World
1. Contact Of Disease Pools 2. Astonishing Death
Rates 90 Of Huron Perish 3. Small Pox,
Measles, Plague All Hit At Once 4. Societies
Struggle To Cope With Change 5. Depopulation
Leads To Settlement Imperialism 6. Labor
Shortage Leads To Transatlantic Slave Trade
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Economic Development And Disease
1. Agricultural Revolution Leads To Cities High
Densities -- High Densities Encourage Spread Of
Disease 2. Commercial Revolution Extensive Trade
Links -- Spreads Disease More Widely 3.
Industrial Revolution (-) Higher Density
Disease Spreads Faster () Improved Sanitation
e.g., England Great Fire (1666) 4. Medical
Revolution Halts Many Diseases -- Early
Vaccines Antibiotics Invented In 1943
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AIDS A Global Disease
1. Acquired Immune Deficiency Syndrome (AIDS) 2.
Human Immunodeficiency Virus (HIV-1 Or HIV-2) 3.
Spread From U.S. And Sub-Saharan Africa Around
Globe 4. Spreads By Exchange Of Body Fluids
(Intercourse, Blood Transfusions, Dirty Needles,
Child Birth, Breast Feeding) 5. Triggers
Breakdown Of Immune System And Death
By Secondary Agent Such As Bacteria Or Virus 6.
Long Incubation Period Allows Spread
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Disease And Modernization
Trade And Transportation Links Spread Disease A)
Black Rats On Sailing Ships In 1300s B)
Influenza On Steam Ships And Rails In 1918-19 C)
HIV By Plane, Train, And Truck
Key Interdependence Makes Humans Very Vulnerable
Example Ebola Could Never Break Out
Globally Before The Advent Of The Airplane
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AIDs And Economic Development
1. Direct Cost Of Caring For The Sick In Enormous
Medical GNP per Year Cost capita Ratio ------
---------- ---------- -------- United
States 1993 33,168 22,240 149 France 1993 25,636
19,590 131 Honduras 1993 711 580 123 Tanzania 19
92 290 110 264 Source Mann and Tarantola 1996,
392.
2. Aggregate Direct Cost 50 Of Health Budget Of
Tanzania 3. Reallocation Of Resources Within
Societies 4. Disruption Of Households As Economic
Social Units
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AIDs And Economic Development
1. Aids Undermines Economic Productivity --
Uganda Commercial Bank 2. Industrialization Has
Spread Aids -- Urbanization -- Migrant
Workers a) Heterosexual Transmission Is The
Norm In Africa b) 35 Of Pregnant Women Test
Positive In Cities 3. Trade And Commerce e.g.,
The Aids Highway -- 70 Of Prostitutes In
Nairobi Have HIV in 1987
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AIDs And Economic Development
1. Huge Indirect Costs Attacks Young Adults 2.
Aids Reduces Investment -- Lower Domestic
Savings Rates -- Less International
Investment 3. Fall Of Communism Opens Door For
Aids In The East 4. Capitalism In China Has Led
To Drug Use And Prostitution
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Aggregate Impact
1. World Bank Estimates Tanzania Grow Rates --
3.9 Per Year Without Aids 2.8-3.3 With
AIDs -- Small Difference Means 15-25 Smaller In
2010 2. In Cameroon Growth Expected To Be Cut In
Half 3. International Response To Pandemic A)
Phase I Blame Each Other B) Phase II Attack
The Problem 1993 18.4b Spent
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A Complex System
DISEASE
WAR
MEDICAL ADVANCES
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War And Disease
Ratio Of Deaths To Disease To Deaths From
Injuries
Mexican-American War 27.80 U.S. Civil
War 21.29 Spanish-American War 16.65 World War
I 11.64 World War II 0.28 Korean War 0.23 Vietnam
War 0.24 Sources Gabriel And Metz 1992, 273
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War And Disease
1. First Crusade In 1098 2. Unification Of Spain
Siege Of Granada 1489-90 3. Thirty Years War
Nuremberg In 1643 4. Napoleons Attempt To Crush
Haitian Uprising 1801 5. Napoleons Russian
Campaign In 1812 6. Crimean War (1853-56) Died
of Died of Wounds Disease France 20,356 49,8
15 Britain 4,947 17,225 Russia 37,958 37,454
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War And The Spread Of Disease
1. Wars Bring People Together In Large Numbers 2.
Historically Armies Have Poor Sanitation 3. Troop
Movements Transmit Disease 4. Warfare Disrupts
Economy And Weakens Populations 5. Armies Are
Made Up Of Young Men Far From Home 6. War
Destroys Health And Sanitation Infrastructure 7.
Disintegration Of Feudal Armies Spreads War
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How many have heard of the Great
Influenza Pandemic of 1918?
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War And The Spread Of Influenza In 1918

• The Great Influenza Pandemic 1918-19
• -- 21 Million Dead Compared To 9 Million In WWI
• Occasionally Surfaces In The Media
• -- Swine Flu Panic In 1976
• -- Recent Finding Of Lung Tissue
• -- Avian Flu Virus 2003
• Influenza A Common Virus
• -- Kills Mostly Young And Old
• -- Rapid Mutation Means Few Have Immunity
• -- Tracking Identifying Vaccine Production
• Distribution

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Influenza And World War I
1. U.S. Mobilization In 1917-18 2. German Has
Upper Hand Race For U.S. Troops To Arrive 3.
Influenza Hits In September 1918 In Camp Devens,
MA 4. Troops Spread Disease To Civilians And
Front Deaths Chicago 14,014 New
York 33,387 Philadelphia 15,785
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American Expeditionary Force (AEF)
INFLUENZA PNEUMONIA DEATHS ------------ ------
------ ----------
SEPTEMBER 1918 37,935 3,560 2,500 OCTOBER
1918 38,655 7,008 5,092 NOVEMBER
1918 22,066 2,621 1,552 Source Crosby 1989.
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The Influenza Pandemic Of 1918

• 23,000 U.S. Soldiers Die Back In The U.S.
• 4,000 Die Per Week In Paris During Peace
  Conference
• 675,000 Americans Die In Pandemic
• At Least 21 Million Die World Wide

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War And Medicine
1. Medical Advances Impact On War A) Indirect
Through Disease -- Inoculation --
Sanitation B) Direct Through Treatment Of
Wounded Soldiers -- More Soldiers With Serious
Wounds Survive -- More Soldiers With Head
Wounds Survive -- Quick Treatment Field
Hospitals Ambulances
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Wars Impact On Medicine
1. Direct Military Funding Of Medical
Research 2. Indirect War Triggering Crisis
Which Needs Resolution -- e.g., Wounds From
Guns Versus Swords -- e.g., Physicians Versus
Surgeons In France
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War And Lethality
1. Lethality Of Weapons Rises Across Time 2. But
Percentage Of Total Soldiers Killed Declines 3.
Dupuy And Gabriel Metz Triggers Greater
Dispersion Napoleonic Wars 8 Mile Front And 20
Square Miles World War II 48 Mile Front And
2750 Square Miles 4. Argument Is Flawed
Calculation Is Too Crude A) Neglects Disease B)
Neglects Tooth-to-Tail Ratio
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