its effect on infectious disease transmission are summarized here; those addressing the need for improved surveillance of mobile populations are reported in Chapter 2.

Just as modern modes of transportation allow more people and products to travel around the world at a faster pace, they also open the airways to the transcontinental movement of infectious disease vectors. That mosquitoes can cross the ocean by riding in airplane wheel wells is a commonly cited example of this phenomenon and is one of several hypotheses proposed to explain the introduction of West Nile virus into New York City in 1999, the first known incidence of this disease in North America. Beyond such transport of disease vectors, controversial evidence suggests that global warming, much of which is generated by human activities, has caused or is causing changes in vector distributions worldwide and affecting the incidence rates of various tropical infectious diseases, such as malaria and dengue.

Consumers in much of the developed world expect constant access to a wide variety of high-quality, safe food products, regardless of the season or the product’s geographic origin. This demand for a global food market and the resulting transnational movement of food have important implications for foodborne infectious diseases. The global transport of food also raises concerns about the risk of the emergence of antibiotic resistance in humans. Food-producing animals are often given antibiotic drugs for important therapeutic, disease prevention, or production reasons; however, these drugs can cause microbes to become resistant to drugs used to treat human illness.

Although the movement of people and products may be the most conspicuous manifestation of the present era of globalization, the phenomenon’s main driving force is the global expansion of capitalism and the free-market system. Thus, it is useful to examine how the global flow of capital affects emerging and reemerging infectious diseases. The most direct effect results from the financing of environmental projects, such as dams and other water or land development efforts, that alter local vector ecologies and increase the potential for human exposure to infectious diseases. The movement of capital is often accompanied by movements or shifts in decision-making power, another manifestation of globalization with implications for infectious disease transmission.

The following sections address in turn each of these aspects of globalization and its implications for the transmission and spread of infectious disease. The last section summarizes the workshop presentation on the geographic spread of HIV/AIDS. As one participant argued, not only is the HIV/AIDS pandemic a devastating example of how global forces can cause or alter the emergence and spread of infectious disease, but, given its public health and economic impacts, it should probably also be a particular focus of any dialogue on global public health.



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