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Global Health, Infectious Diseases, and Civil Society Networks

By Professor Ronald J. Deibert

Department of Political Science, University of Toronto

Ronald J. Deibert is assistant professor in the Department of Political Science at the University of Toronto, specializing in technology, media, and world politics. He is the author of Parchment, Printing, and Hypermedia: Communication in World Order Transformation, (NewYork: Columbia University Press, 1997).

A. Internet and Civil Society Activism

One of the major positive consequences of the development of the Internet and World-Wide Web has been the way it has facilitated the work of transnational social movements and civil society activism in a variety of issues of global governance (Deibert 1997; Mathew 1997). Traditionally the domain of states and state-elites, with citizens as mere "spectators", world politics has been invaded by citizen networks whose members see themselves as dynamic players or "participants" instead. For example, using the Internet as their information infrastructure, people across the world have teamed up to play a major role in the implementation of a landmines ban (Price 1998), the defeat of the Multilateral Agreement on Investments (Kobrin 1998), and numerous other cases in areas such as human rights, development, and the environment. Another issue-area that has recently witnessed the involvement of civil society networks is international health cooperation, and in particular the surveillance of newly emerging infectious diseases.

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B. Health as an international problem

For most people, health and health-related issues are purely a domestic public policy concern. Much obviously has been written about Canadian health policy, and even a great deal has been written about the use of new information technologies - such as the Internet and World-Wide Web - in the delivery of health services and information to Canadians (e.g., Chirrey, 1999; Jamieson 1996). Less well known, perhaps, is the extent to which health related issues have increasingly become international or global concerns. One of the most important international health issues concerns the spread of newly emerging infectious diseases, such as the global AIDS pandemic, the dengue virus, cholera, and tuberculosis, to name a few (Garrett 1996). Although these diseases may break out in localized areas in remote countries, the vastly expanding air and rail transportation networks that link the world into a "global village" mean that such diseases can travel rapidly to virtually any point on earth within days. Adding fuel to the fire is that outbreaks of emerging diseases tend to occur in already impoverished developing countries with poor existing health care infrastructures. Although the sequence of causes and effects are extended, it is now known that such diseases tax state infrastructures to the point of state collapse, which in turn undermines the social capacity of states to deal with basic issues of health care and governance (Pricesmith 1999). In a vicious cycle, fragile states contribute to environmental degradation and - in extreme cases - to civil war and violence, which together create conditions ripe for the further emergence of yet more infectious diseases, refugee flows, and even international war.

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C. Disease Surveillance on the Internet

While it is increasingly being recognized by many that emerging diseases are an international phenomenon, the global infrastructure dedicated to monitoring and responding to disease outbreaks is poorly equipped. As one report notes, "current surveillance capabilities are fragmentary, lack coordination, and are geared toward established diseases" (Morse 1996). Many governments are fearful of releasing information about disease outbreaks for security, economic, or cultural reasons. Policy coordination among many states is still in the embryonic stage. Only the U.S. military has constructed a global disease surveillance network, but the information derived from it is restricted to military personnel and is oriented towards security as opposed to health and development issues. International organizations, such as the World Health Organization, tend to be underfunded and overextended to meet the challenge of disease surveillance.

As in other areas of global politics, however, citizens networks have stepped into the breach where states and formal international organizations have failed to act. One of the most prominent of them is the Internet-based ProMED surveillance network. Created in 1993 as a project of the Federation of American Scientists, ProMED is an international collaborative network of human, animal, and plant disease specialists who share information about diseases, outbreaks, and scientific and medical assets around the world. At the heart of the ProMED network is ProMED-mail, an Internet-based listserv through which scientific and medical experts share their information. To give some example of the range of discussions, recent postings to the listserv have focused on attempts by Russian medical officials to control the spread of Hemorrhagic fever in Rostov, the causes of a 1984 outbreak of "Newcastle" disease in chickens in Great Britain, a discussion of the outbreak of the Nipah virus in Malaysia, and the quarantine of a province in Peru due to the outbreak of foot and mouth disease. The network has been responsible for the quick detection and rapid response to infectious disease outbreaks around the world. It has also helped generate the creation of similar networks, and helped further the collaboration among existing national and international health organizations.

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D. No Substitute for the Real Thing

Although the Internet has proved to be a vital information infrastructure for civil society activism in disease surveillance, it is important to be clear that the Internet itself and the information-sharing that goes on through ProMED cannot alone tackle the problems of international health. These tools help extend the network of concerned citizens and professionals, and bring quick action to bear on disease outbreaks around the world that would otherwise go unnoticed. But the network itself cannot in the long run take care of the development problems of Third World countries and the root societal and economic issues that give rise to disease outbreaks in the first place. To ameliorate these preconditions, much greater attention must be paid to the global inequalities of wealth between North and South, and the social and economic practices of both developed and developing countries that give rise to environmental degradation, poverty, and conflict. As in the other issue-areas of global politics, however, what the Internet can do is provide a vital link among concerned citizens, scientists, and professionals to help bridge the gap across countries in the area of global health governance.

E. References

Chirrey, Shawn, "Health Promotion and Information Technology," OHPE Bulletin 64.1

Deibert, Ronald J. Parchment, Printing, and Hypermedia: Communication in World Order Transformation, (New York: Columbia University Press, 1997).

Garrett, Laurie. "The Return of Infectious Disease," Foreign Affairs, (Jan/Feb 1996).

Jamieson, Rebekah (1996) "Canadian Community Health Centres and the Internet: Exploring the Challenges and Solutions" HealthNet Community Access Pilot c/o The Center for Health Information Infrastructure 1600 Scott Street, Suite 415 Ottawa, Ontario K1Y 4N7 Email

Kobrin, Stephen. "The MAI and the Clash of Globalizations," Foreign Policy, (Fall 1998), pp. 97-102.

Mathews, Jessica Tuchman, "Power Shift," Foreign Affairs, (Jan/Feb 1997), pp. 50-66.

Morse, Stephen, John Woodall and Barbara Hatch Rosenberg, "Global Monitoring of Emerging Diseases: Design for a Demonstration Program," Health Policy 38 (135-153)

Price, Richard, "Reversing the Gun Sights: Transnational Civil Society Targets Land Mines," International Organization, 52. 3 (Summer 1998), pp. 613-644.

Pricesmith, Andrew. The Health of Nations: Infectious Disease and Its Effects on State Capacity, Prosperity, and Stability. Doctoral Dissertation, Department of Political Science, The University of Toronto, 1999.

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F. Web Sites of Interest

1) Federation of American Scientist's ProMED Homepage

2)ProMED mail archives

3) Outbreak News from the World Health Organization

4) Program on Health and Global Affairs at the Centre for International Studies, University of Toronto

5) Joint United Nations Programme on HIV/AIDS