Historical Origins of Global Health in Understanding Current Issues in Malaria

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Molly Reid

 Historical Origins of Global Health in Understanding Current Issues in Malaria

Powerful social forces among humans completely shape the way we interact with diseases found naturally in our environment. International Health as we know it now has arisen from a history of changes in social forces that led to devastating disease outcomes. Lifestyle, economic structure, city scheme, government, and class organization have all contributed to the human history of health.

I think one of the most fascinating examples of this is the case of Malaria and the development of quinine. I research Malaria, and I like to think about it as an organism trying to live a long time. Plasmodium needs the human host and mosquito vector to survive, so it would ideally never kill the host. In fact, the disease has been around almost as long as humans as a species has, and the two have lived relatively peacefully together for thousands of years. It’s when large scale social change occurred that Malaria started to be a problem. We see this when colonial Europeans began to make changes in regions of frequent (but not deadly) Malaria infection: “Rapid development, the building of cities and clearing of forests, and inadequate drainage and sewage disposal exacerbated malaria infection rates throughout the colonial world, starting in the Americas, from the 16^th century onward” (Birn, et al).

It was how close the colonial powers had people living that made malaria a problem, and Plasmodium has not since had enough time to slow down its infection rate to accommodate the newer arrangement. Africa was the “white man’s grave” because of malaria, and when the white man came into Africa and other “tropical” regions with natural infection rates and changed the way the Africans or South Americans or Southeast Asians lived, it became the curse of these people too (Birn et al).

This is the historical context of malaria research that still affects how International Health and individual organizations approach the issue today. Part of the funding comes simply from a European guilt about the origins of the devastating disease. Unfortunately, it seems impossible to return to the spread out pastoral structure which is the optimum for low malaria mortality. Additionally, the drugs that have been developed to treat the disease have changed the organism greatly. How much the parasite has become resistant varies greatly from place to place because treatment is in the hands of individual governments.

 This can be devastating because we sometimes forget that the parasite wants to live. It will obviously do anything to keep on living, just as we would. So when local politicians use promises of new drug regimes to help their people eradicate malaria to get put into power, they underestimate the ancient Plasmodium. Political interests, as well as well meaning but misguided aid campaigns, public health policies, and research efforts have all contributed to a very variable and sometimes quite grim resistant malaria outlook.

To visualize this, I have my favorite map ever made: http://www.pnas.org.offcampus.lib.washington.edu/content/106/45/18883.full
 

As you can see, some cities and some countries have a pack of resistant strains, whereas some only have a couple. The very identity of the parasite has been changed in these places because of human social organizations.

India, a former British colony from the 1820’s to 1950, now faces almost all of the chloroquine and amodiaquine resistant strains of malaria. This is a problem because there really are not very many drugs available to treat malaria in the first place, and India has few weapons remaining. As Birn et al argue, this problem’s colonial roots inform the way it can be approached in the international health arena.  In the description of a novel case of chloroquine resistant malaria in Northern India from, 1984, the unease of the situation is clear. “The patient stated that there was an awareness in Surat of a change in the type of malaria recently occurring there. This case demonstrated that malignant tertian malaria resistant to chloroquine can be acquired in Gujarar, an area hitherto considered free from this problem, and marks the further spread of this infection in the Indian sub-continent” (Mahoney, et al).

Until the late 20^th century, public health policy in India, backed by global health goliaths like WHO and others, was focused on malaria eradication. To accomplish this, they focused on acquiring and administering every drug there was. This was a mistake. India now faces these multiple drug resistant strains of malaria, and the real solutions have been left neglected. Now turning to the colonial history of malaria and India itself, public health policy there has started to look at solutions that stem from the community. Too-close living quarters and stagnant water are the aggravators of malaria endemic intensity. These conditions arose from response to British colonial and economic power, and can only be changed by more social change.

Our readings have focused on the origins of global health. They argue that what we have currently, as in the case of India, is a mess of different ideas and interests resulting in an array of complicated results. Governments have an economic interest in health, which has given rise to corporations with an economic interest in health. These powerful social forces working together can change the health of masses of people. This is a long way from public health origins in Imperialism and Industrialism, but these foundations can inform the ultimate goal of global health. I think, like in India’s cases, it is still possible to see how preserving lucrative trade is a priority in health and sanitation. The quick fixes of drugs allowed laborers to continue working, goods to remain uncontaminated, and business to go on as usual. Not to mention that the production and sale of pharmaceuticals is a trade in and of itself.

The myriad of disparate and interested voices which contribute to the global health arena all have the capacity to change the way people in the world live. Social change caused many of the health problems of today, and social change will solve them and this cycle may continue. It is just important to question the long term efficacy and cultural rootedness of global health initiatives.

Sources:

 Sâa, J. M., Twu, O., Hayton, K., Reyes, S., Fay, M. P., Ringwald, P., & Wellems, T. E. (November 10, 2009). Geographic patterns of Plasmodium falciparum drug resistance distinguished by differential responses to amodiaquine and chloroquine. Proceedings of the National Academy of Sciences of the United States of America, 106, 45.)

 Birn, A.-E., Pillay, Y., Holtz, T. H., & Basch, P. F. (2009). Textbook of international health: Global health in a dynamic world. New York: Oxford University Press. 

 Mahoney, M. P., Wright, P. A., Bhattacharjee, K. D., & Brown, J. (January 01, 1984). Chloroquine-resistant malaria in India. Lancet, 2, 8412.)