S. Harris Ali

Global Cities and the Spread of Infectious Disease: The Case of Severe Acute Respiratory Syndrome (SARS) in Toronto, Canada

The outbreak of severe acute respiratory syndrome (SARS) in Toronto and other cities in 2003 showed a heightened sensitivity of places in the global economy to rapid changes brought on by the acceleration of social and ecological relationships. The spread of the SARS virus may be a predictable consequence of these processes. The paper investigates how processes of globalisation have affected the transmission and response to SARS within the context of the global cities network. Little work has been done on the relationship of global city formation and the spread of infectious disease. Arguing that this relationship may be central to understanding the intricate capillary structures of the globalised network, the paper focuses on how pathogens interact with economic, political and social factors. These relationships exist both in the network and in global cities themselves, thereby posing new issues for public health and epidemiological efforts at disease containment and tracking.

Climate Change, Vector-borne Disease and Interdisciplinary Research: Social Science Perspectives on an Environment and Health Controversy

Over the last two decades, the science of climate change’s theoretical impacts on vector-borne disease has generated controversy related to its methodological validity and relevance to disease control policy. Critical social science analysis, drawing on science and technology studies and the sociology of social movements, demonstrates consistency between this controversy and the theory that climate change is serving as a collective action frame for some health researchers. Within this frame, vector-borne disease data are interpreted as a symptom of climate change, with the need for further interdisiplinary research put forth as the logical and necessary next step. Reaction to this tendency on the part of a handful of vector-borne disease specialists exhibits characteristics of academic boundary work aimed at preserving the integrity of existing disciplinary boundaries. Possible reasons for this conflict include the leadership role for health professionals and disciplines in the envisioned interdiscipline, and disagreements over the appropriate scale of interventions to control vector-borne diseases. Analysis of the competing frames in this controversy also allows identification of excluded voices and themes, such as international political economic explanations for the health problems in question. A logical conclusion of this analysis, therefore, is the need for critical reflection on environment and health research and policy to achieve integration with considerations of global health equity.

The New Public Health Hegemony: Response to Severe Acute Respiratory Syndrome (SARS) in Toronto

The 2003 Severe Acute Respiratory Syndrome (SARS) outbreak presented a challenging period for public health in Toronto. Many old and new public health measures were implemented at local, national and global levels, in an attempt to control the outbreak of the disease. Among these, surveillance mechanisms dominated, which involved new epidemiological techniques and statistical profiling strategies. In this paper, Gramscis concept of hegemony is used to further understandings of public health governance during the outbreak of emerging infectious diseases. Specifically, the function of the discourse of ‘risk’ in public health governance is examined, along with public health as a ‘moral agent’ in the naturalization of specific public health measures. In addition, the pervasive discourse of ‘security’ is discussed in relation to current public health practices. These characteristics of public health are examined with consideration of their potential for propagating social exclusion and stigmatization of individuals and communities. The specific case of SARS in Toronto is used to examine the implications of public health as a mechanism for social control and reproduction rather than the promotion of equality in health throughout the population.

Disaster incubation, cumulative impacts and the urban/ex-urban/rural dynamic

Abstract This article explores environmental impacts and risks that can accumulate in rural and ex-urban areas and regions and their relation to urban and global development forces. Two Southern Ontario cases are examined: an area level water disaster and cumulative change at the regional level. The role of disaster incubation analysis and advanced environmental assessment tools are discussed in terms of their potential to contribute to more enlightened and effective assessment and planning processes. It is concluded that conventional approaches to EA and planning are characteristically deficient in addressing the full range of impacts and risks, and particularly those originating from pathogens, dispersed and insidious sources. Rigorous application of disaster incubation analysis and more advanced forms of EA has considerable potential to influence a different pattern of planning and decision making.

INCORPORATING THE ENVIRONMENTAL CONTEXT IN THE STUDY OF CANCER

The analysis in Section 2 of this chapter presents several lines of evidence that implicate the environment in cancer causation; specifically, findings from wildlife studies, cancer trend reports, immigrant studies, childhood cancer studies and twin studies are reviewed. Having established the general evidentiary basis for the cancer-environment linkage, in Section 3 we turn to a discussion of the current methodological difficulties in incorporating the environmental context in the study of cancer. The particular focus here is on exposure assessment — a key methodological limitation in studying the cancer-environment linkage. It is reasonable to expect that cancer cases arising from point source environmental exposure will tend to cluster geographically. For this reason the role of exposure assessment and other methodological issues in the context of cancer cluster investigations are considered. The case of the Woburn Massachusetts leukaemia cluster is reviewed to illustrate some of the pertinent issues involved. In Section 4, we move to a general discussion of the implications of cancer risk assessment methodologies for cancer policy and intervention. In light of the observational evidence concerning the cancer-environment link (Section 2), as well as the uncertainties involved in assessing the risks associated with environmental carcinogens (Section 3), it is suggested that the precautionary principle be adopted as a guiding principle for cancer policy and intervention. The precautionary principle calls for protective action, even when the evidence of harm remains inconclusive and the adoption of this principle seems warranted under the present technical and policy circumstances. The final section ends the chapter with some recommendations and concluding remarks.