Public health: A worldwide concern

Medical groups must take the lead in addressing the global nature of infectious diseases.

Editorial. Oct. 23/30, 2000.

Globalization, a term frequently used by economists and policy wonks to describe the new order of economics and politics, is a development that has serious implications for the medical profession.

This was made unmistakably clear in recent weeks by American Medical Association President Randolph D. Smoak Jr., MD, in an address to the World Federation of Public Health Assns.

Speaking in Beijing, Dr. Smoak noted that rapid advances in transportation and communications technology had made possible a meeting that would have been impossible a few decades ago. "For many of us," he said, "it was almost no challenge to board airplanes and then fly halfway around the world."

However, he warned, "The organisms that we are talking about today travel every bit as easily." As an example, he noted that the West Nile virus that is causing considerable concern in the New York City area most likely arrived via an international flight, perhaps carried by an infected passenger or even a stowaway mosquito.

A recent report in Business Week buttressed Dr. Smoak's warning, emphasizing that the dangers to the animal population from such diseases as heartwater and mad cow disease are evidence of a "bioinvasion."

There are few shelters from this invasion, for humans or for animals. International travel is commonplace, both for business and pleasure. Commerce and industry recognize few borders today. It is not unusual to find a branch of a foreign manufacturing company in a small city in the United States; in fact, communities form task forces and assiduously woo such business for the jobs and tax revenue they bring.

But just as business and travel today are not constrained by international borders or vast oceans, so, too, do microorganisms and the epidemics they may produce move about freely -- not at the pace of a person, a horse, a ship or an automobile, but at near-supersonic speeds.

The result is a challenge for the world's medical profession. An outbreak of disease in a remote area of the world can move almost unimpeded to all corners of the globe.

Although much work remains, the medical profession is responding. In his Beijing address, Dr. Smoak outlined a number of initiatives that have been taken by the AMA to address the global nature of infectious disease today. One is the AMA's new international membership program, which allows physicians all over the world to benefit from telemedicine training.

The AMA also is the world's largest publisher of peer-reviewed medical research, with JAMA now published in 12 languages in 18 countries. Delegations from medical organizations all over the world visit the AMA on a regular basis, and information also is exchanged through the offices of the World Health Organization.

The AMA is investing considerable energy and resources in the Medicine and Public Health Initiative, which is building new bridges between private-sector physicians and the public health community.

The real challenges lie ahead, however. The medical community must put in place links that allow the exchange of information and skills as rapidly as new global technologies permit. Medical knowledge continues to expand at a rate that would have been considered breathtaking in years past, but this is not enough. Physicians and their allies around the world must ensure that the tools of health are available to all regions and all types of communities. As Dr. Smoak and others have pointed out, communicable diseases are not limited by geographic or political borders. Medical knowledge must attain the same international status.