discussion on access to and delivery of antiretroviral agents in sub-Saharan Africa, as summarized in Chapter 3.

As globalization creates new governance challenges with respect to infectious disease prevention and control, the role of international law in infectious disease control policy has been shifting in important but uncertain ways. The chapter includes a summary of presentations on the revised International Health Regulations (IHRs) and the changing role of international law.

The chapter ends with a summary of the discussion pertaining to the need to study and understand the emergence of infectious disease threats within the larger social and political context. Historically, study of the emergence of infectious diseases has been restricted to the realm of biology. The political ecology of disease provides a new conceptual framework for understanding the public health consequences of globalization, including, for example, investment decisions that lead to environmental alterations, changing vector ecologies, and increased risk of the emergence and spread of infectious diseases.


A significant change in the perception of international health has occurred over the past decade. If asked 10 years ago to think about where international health dollars were being spent, most people would probably have thought of charity or the work of Mother Theresa or Albert Schweitzer. Today, international health is no longer perceived as a costly charity endeavor. Rather, as noted above, it is increasingly being perceived as a cost-effective investment with national security implications. The political and economic instability of sub-Saharan African countries with high HIV infection rates, for example, threatens the potential for strong international trade partnerships and poses a serious national security risk to the United States.

Although the renewed interest in international public health can be attributed mainly to economic and national security concerns, numerous other factors are at play. One participant described this renewed interest as a convergence of economic, humanitarian, and other ideals and strategic interests, including the following:

  • Diplomacy—Public health is playing an increasingly important and constantly evolving role in international relations. Addressing the burden of


This section is based on the workshop presentations by Adeyi (2002), Gardner (2002), Gordon (2002), and Patz (2002).

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