Epidemiology in the era of globalization: Skills transfer or new skills?

Abstract

Background. Globalization carries information and technology opportunities and risks in widened inequalities, a resurgence of old health risks and reversal of health gains. Methods. The paper explores the implications for epidemiological work in southern Africa and through two case studies - occupational health and equity in health - profiles challenges faced in that region. Results. Occupational epidemiology is confronted by weak monitoring and regulatory systems, healthy worker effects, surveillance filters, and migration. Occupational disease determinants are masked by the combined effects of work, wider environmental risks, and high poverty-related disease. Health burdens associated with new production and trade patterns are thus largely unrecognized. Even when made visible, they may be ignored by economically vulnerable states and workers. Work on equity in health indicates the relevance of social and political determinants in the distribution of health resources. The shift of the cost burden of human immunodeficiency virus (HIV)/AIDS to poor communities and the weak public health response to HIV/AIDS suggest that economic and health reforms associated with globalization have both increased health inequalities and weakened social and political forces promoting equity and solidarity values in public health. Conclusions. Epidemiology can demystify disease sources and explain determinants in a manner that impacts on public policy and action. Under current conditions of globalization this implies addressing methodological challenges and enhancing uptake of evidence in policy processes. Given the intensifying political struggle around health resources, increased attention needs to be given to participatory forms of inquiry that strengthen the influence of poor communities and public interest values in health policy. © International Epidemiological Association 2004; all rights reserved.