the development of a general global infectious disease surveillance system are discussed in Chapter 3.)

Another notable feature of the changing global landscape is the increased perceived and actual threat of bioterrorism, particularly in the United States. In response, the Bush Administration has proposed an unprecedented amount of public health funding—approximately $6 billion—for defense against bioterrorism (biodefense). These funds are expected to have both direct and indirect benefits for the prevention and control of emerging and reemerging infectious diseases in general, whether intentionally or naturally introduced, by strengthening the public health community’s ability to make constructive changes in a way never before possible. The discussion of this topic is summarized here as well. (Presentations and discussions pertaining to increased spending on international health in general, including funds that are not necessarily U.S. biodefense–related, are summarized in Chapter 4.)

Finally, this chapter includes summaries of regional case studies presented by representatives of Russia and the European Union. Both provide important insights into the impact of globalization on public health in parts of the developed world outside of the United States. In the case of Russia, the collapse of the cold war political system has led to widespread social and public health problems manifested in multiple ways, most notably a rise in the numbers of people with HIV/AIDS and multidrug-resistant tuberculosis (TB). The current situation illustrates how even an educated population and a plenitude of natural resources cannot guarantee good public health if political and other leaders do not consider health a priority.

The situation in the European Union, on the other hand, may provide a useful model for understanding how the public health impacts of the movement of capital, resources, and people across former political boundaries can be managed. It is unclear, however, whether the European model can actually be applied to other, less unified areas of the world. Moreover, despite its successes, the region is still experiencing serious problems with respect to emerging infectious diseases, for example, among migrant populations.


Globalizing forces are expected to increase and exacerbate already tense relationships between rich and poor countries, as has been witnessed in the


This section is based on the workshop presentations by Gordon (2002), Leaning (2002), and LeDuc (2002).

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