Elsevier

Health & Place

Volume 18, Issue 4, July 2012, Pages 726-736
Health & Place

H1N1, globalization and the epidemiology of inequality

https://doi.org/10.1016/j.healthplace.2011.09.001Get rights and content

Abstract

This paper examines the lessons learned from the 2009 H1N1 pandemic in relation to wider work on globalization and the epidemiology of inequality. The media attention and economic resources diverted to the threats posed by H1N1 were significant inequalities themselves when contrasted with weaker responses to more lethal threats posed by other diseases associated with global inequality. However, the multiple inequalities revealed by H1N1 itself in 2009 still provide important insights into the future of global health in the context of market-led globalization. These lessons relate to at least four main forms of inequality: (1) inequalities in blame for the outbreak in the media; (2) inequalities in risk management; (3) inequalities in access to medicines; and (4) inequalities encoded in the actual emergence of new flu viruses.

Section snippets

Inequalities in blame for the outbreak

“The outbreak narrative is a powerful story of ecological danger and epidemiological belonging, and as it entangles analyses of disease emergence and changing social and political formations, it affects the experience of both” (Wald, 2008: 33).

In her eloquent study of outbreak narratives literary critic Priscilla Wald shows how stories of disease emergence are generally told in ways that simultaneously and consequentially construct communities of insiders and outsiders. Contagions that start

Inequalities in risk management

“Severe disparities in public health can persist because of the array of technological, scientific and architectural innovations that enable wealthy households to insulate themselves from the environmental conditions of the poor. These public health inequalities – emboldened by the distortions of marketized public health and medical research – are creating the corporeal equivalents of gated communities” (Gandy, 2008a, Gandy, 2008b).

Matthew Gandy's argument based on research into health

Inequalities in access to medicines

Questions concerning production and distribution of resources such as vaccines and drugs during epidemics extend beyond underserved communities…. [The] current global regulatory mechanisms protecting pharmaceutical industries have driven prices of vaccines and antivirals up, diminished possibilities for collaborative production, and made it exceedingly difficult to manufacture cheaper generic versions. The result is that inequities in resource allocation occur between countries as well as

Inequalities encoded in the virus ecology

Factory practices provide what seems to be an amenable environment for the evolution of a variety of virulent influenzas, including pandemic strains. Swine flu H1N1, the most recent example arising early 2009 appears by definition industrial in origin. The closest ancestor for each of this H1N1's eight genomic segments is of swine origin. The segments have been identified as originating from different parts of the world: neuraminidase and the matrix protein from strains circulating in Eurasia,

Conclusions

Following Wallace, and yet also following Virchow whose exemplary innovations in the epidemiology of inequality began this article, we must note in conclusion that today's equivalents of hot stoves and Christmas apples – in short, all the diverse consumer goods, components and food coming out of the factories and factory farms of southern China – are no less connected to the production of disease. However, instead of ship hands suffering from cholera, today's victims of inequality-induced

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