9.2: Background - Historical Global Health Crises

Learning Objectives

By the end of this section, you will be able to:

• Identify historical global health crises
• Differentiate how some global health crises have been confined to certain countries while others have spread around the world

Historical Pandemics

Global health crises are a cyclical part of history. The world has experienced a number of them, with the earliest documented in 430 BCE. A global pandemic is different, and is defined as a health crisis that can lead not only to illness, but also the possible death of individuals across the world. A global health crisis concerns illnesses that have the potential of spreading, but do not risk the death of a large number of individuals around the world.

The exposure to other cultures, usually through military conflict or trade, led to the possibility of large outbreaks of diseases. The first documented global pandemic was the Athenian Plague of 430 BCE, which caused people to have rashes, headaches, and abdominal cramps that could eventually lead to death in 7-8 days. In the case of Athens, it is estimated that 25 percent of the population died due to the plague. According to the contemporary historian Thucydides (who contracted and survived the disease), the plague began in Ethiopia, spread through Egypt and Libya, and eventually entered Athens through its port and spread through the city-state from there. Later. between 165-180 CE, the Antonine Plague occurred. Here it is believed that Roman troops carried the disease from their conflicts in the region of modern-day Iraq back into the empire. Infected individuals had rashes, hemorrhagic pustules, bloody diarrhea, and fever. It killed over 5 million people, which was about 25 percent of the population of the Roman Empire.  

We should also include the infamous Black Death, a bubonic plague caused by the yersinia pestis bacteria, that first spread across Asia, Europe, and Africa from 1346 to 1353. Individuals suffered from high fever, gangrene of the nose, ears, and extremities, and pneumonia, which was easily transmitted, and resulted in most people dying within 7-10 days of contracting the disease. The root cause of the Black Death is indicative of the need to evaluate global health disparities and the deplorable living conditions people experience. Initially, the plague spread due to rats carrying fleas (the vector, or living organism, that transmit the disease). Lower-income people in European cities lived in highly-congested areas with poor hygenic conditions (i.e. the perfect breeding grounds for rats). This helped the disease to spread rapidly, as well as made these individuals more susceptible to contracting it. Eventually, the disease also became airborne, which made the spread even more devastating. The Black Death is believed to be the worst global pandemic ever recorded, with a global death toll estimated to be around 200 million people. In Europe alone, it is believed that that about 60 percent of the population perished (Sampath et. al. 2021). It is harder to pin down the statistics for other global communities. 

As discussed in Chapter 2.2, the movement of disease that was a hallmark of the Columbian Exchange is also considered a global pandemic. With European movement into the Americas, diseases that once were limited in their spread to Afro-Eurasia, now could make the jump across the Atlantic Ocean, carried by the sailors, colonists and enslaved. Known as virgin soil epidemics, diseases such as malaria, influenza, measles, and the bubonic plague, just to name a few, infected the indigenous populations of the Americas, causing widespread death and allowing the eventual political, economic, and cultural victory of the Europeans. 

Modern Day Pandemics

With the pandemics discussed above, we primarily have to rely on the written word and often unscientific accounts and numbers to track symptoms, longevity and fatality numbers and rates. Modern pandemics are much easier to track and understand. Take for example modern cholera pandemics, which are clustered into seven phases, that have spanned between 1817 to the present. All major countries have been affected during the various phases. The first began in India and due to global trade, dispersed throughout Southeast Asia into the Middle East and Africa and eventually into Europe and North America. Over the course of these seven waves of cholera pandemics, over 1 million people have died. Additionally, 2.86 million cholera cases are still identified annually and approximately 1.3 billion people are at risk of being infected (Sampath et. al. 2021). There of course can still be data that is untrustworthy, either due to bad record keeping or the isolated nature of some of the effected populations, however there is no doubt that by studying the spread and effect of cholera in the modern world, we know much more about pandemics today than in the historical past. 

Another disease that is often the cause of global pandemics is influenza. The misnamed Spanish Flu (1918), which actually originated in Kansas, spread through the world via military deployment in the First World War. The pandemic hurt those who were under the age of 30, and shortened  life expectancy by 12 years (Sampath et. al. 2021). Individuals suffered from upper respiratory tract systems, such as a sore throat, cough, and fever. Similar to COVID-19, Americans reverted to wearing a mask, quarantining, and focused on personal hygiene to minimize the spread of the disease.

 

Figure 9.2.1: Georgia Tech Football Game in 1918 During the Spanish Flu, 1918 (Public Domain; Thomas Carter via Wikimedia Commons)

Other global health crises, such as the Asian Flu (H2N2) and the Hong Kong Flu had the potential to spread around the world, but did not. Both of these diseases did reach many industrialized countries through travel, however, they were not lethal. 

Current Pandemics

Currently, along with the above-mentioned cholera, we are living under two additional major pandemics, HIV/AIDS and COVID-19. Both of these pandemics have had devastating effects on a variety of countries, which is directly connected with global health care disparities. Since 1981, there have been 36 million people who have died from HIV or AIDS. For decades, contracting HIV or AIDS would lead to death, but due to medical discoveries, people can now live a long life with the disease. Additionally, mothers no longer have to worry about passing it to their child in utero and the spread of the disease can be prevented even if infected individuals are engaged in sexual activity. Yet, all of these medical advancements are extremely expensive. More developed countries, such as the United States, provided aid to countries to help tackle the devastating effects of AIDS/HIV on populations. In 2003, President George Bush created the President's Emergency Plan for AIDS Relief (PEPFAR) that provided treatment to 2 million people living in Africa south of the Sahara. This program, among others, has contributed to saving millions of lives, and show the importance of global cooperation in the realm of health. 

People are still being globally effected from the HIV/AIDS pandemic. As you can see from the United Nations report in 2022, 39 million people are still living with HIV/AIDS.

Table 9.2.1 World Health Organization Statistics of those Living with HIV

         

Name of Region	Number of People Living with HIV (estimate)
Africa	25.6 million
Americas	3.8 million
South-East Asian	3.9 million
Europe	3 million
Western Pacific	2.2 million
Eastern Mediterranean	490,000

Statistics are from the WHO (2023), HIV Data and Stats.

Just as AIDS/HIV revealed massive global health inequities around the world, COVID-19 revealed that global health disparities still exist. Communities that were underserved struggled to find the resources to tackle the disease. Thus, they determined that the best way to handle it was through the isolation of the public. However, even quarantining became a privilege, as some people had no place to quarantine. Additionally, some people’s livelihood is based on physical and social interaction. Therefore, people had two options - risk their lives to work or experience further financial distress through not working and isolating to prevent contracting COVID-19. These binary options further revealed how fiscally and physically fragile people are when it comes to withstanding a major health crisis. To exacerbate the disparity the already  overwhelmed medical community had to deal with the growing number of sick patients. Health systems around the world were suffering from the drastic increase of sick patients, while some countries were able to combat these issues through allocating more funds for medical equipment, personnel, and research, others were not.  

Global health pandemics and other health crises are inevitable. We need to realize what role we all play in protecting ourselves from fiscal and physical harm. As a global community, we have to ask, what role do we all play in protecting our fellow humans from experiencing preventable illnesses?