The Health of Nations: Infectious Disease, Environmental Change, and Their Effects on National Security and Development

Reviewed by: John S. Marr, MD, MPH

Disclosures

March 25, 2002

Introduction

By Andrew T. Price-Smith
The MIT Press
Copyright 2002
232 pages
ISBN 0-262-661123-3
$22.95 paperback

Interdisciplinary studies allow for an exchange of ideas between professions that otherwise might remain in their respective silos of expertise. Andrew T. Price-Smith's recent book, The Health of Nations: Infectious Disease, Environmental Change, and Their Effects on National Security and Development, is a good example of this type of exercise, analyzing emerging infectious diseases' effect on a nation's economy, growth, and security. Quoting Edward O. Wilson, the author hopes to achieve a "jumping together of knowledge as a result of the linking of facts and fact-based theory across disciplines to create a common ground work of explanations" -- or "consilience" -- through these endeavors (page 22).

Price-Smith, a professor of government and international affairs and environmental science and policy at the University of South Florida, applies his background to the broad spectrum of emerging infectious diseases. The downside of this type of interdisciplinary study, however, is that specialists in each group must be educated to another's language, vocabulary, and thinking while rereading information on their own area of knowledge, then deciding to accept the linkage between the 2.

The learning curves for each discipline are not bell-shaped, but highly skewed inclines followed by a plummeting into a familiar field of knowledge. Still, it is refreshing to see that the decade-old concept of emerging and re-emerging infectious diseases (ERIDs) is being used by a social scientist to analyze political and economic problems. The book also demonstrates the difference between the writing style and requirements between medical and social sciences. The former is tight and terse in word and citation; the latter is conversational, with many footnotes and references.

Indeed, the author acknowledges that the book is result of his PhD thesis, exploring the concept of ERIDs through a prism not yet explored by others in political and governmental circles. While his conclusion that ERIDs can and do affect government programs and national security is not a sui generis observation, he attempts to quantify the association.

Initially, Price-Smith uses well known national and global infectious disease problems (eg, TB, HIV, malaria) to not only demonstrate economic consequences to a particular country or region, but to demonstrate that their effects can be measurable and quantified. Tables and diagrams are offered to substantiate associations between a state's many "capacities" and the pressures exerted on them by ERIDs. Capacities include easily understood indicators like human capacity, as well as less familiar terms like coherence, resilience, reach-and-responsiveness, and legitimacy. While all of these terms are interesting (and well defined by the author), I wondered whether it was necessary to break down a state's overall "capacity" into all these rubrics when the overall premise is to demonstrate that ERIDs are economically bad news for everyone.

The third chapter, "Disease, Destitution and Development," lucidly discusses the various effects on a country as the result of ERIDs in a clear, concise, and organized fashion, without the journalistic histrionics of others who have mined the ERIDs midden. It is a fresh value-added contribution to the effect of ERIDs on the world's economy. Price-Smith has also done an excellent job in summarizing, tabulating, and updating the many ERIDs through 2002. In the last chapter, "Environmental Change and Disease Proliferation," his discussion of the causes of ERIDs is also on target -- climate change, extreme weather, El Niño oscillation, land use, biodiversity, and migration and trade; to this list of usual suspects, he adds ozone and "nonlinearity" -- a concept suggesting an unknowable perverse synergism of factors leading to an acceleration of adverse ERID events. Nonlinearity, unfortunately, is not measurable.

My challenge in reading this book was the author's necessary use of abbreviations (ERIDs, HIV/AIDS, TB, etc., notwithstanding), Pierson's correlation coefficient, and the selective use of country-specific and disease-specific data. Although each abbreviation is defined, at later points it is often difficult to understand a given point, such as "The global correlation between CAPIN and IM is -0.686*, significant to < 0.001, with r2 = 0.471. The association between LX and CAPIN is 0.682**, significant to < 0.001, with r2 = 0.465" (page 105). This book would have been much more readable if a glossary of abbreviated terms had been added.

Correlations are repeatedly used to substantiate positive and negative associations, such as Tables 2.20 (Tuberculosis vs. SC Indicators [United States]) (page 73), and Table 2.2 (State Capacity [SC] vs. tuberculosis incidence and prevalence [United States]) (page 74). (These correlations and others, while impressively statistically significant, do not necessarily substantiate a causal connection.) The 2 tables are based on data from 1950-1991 and from an unstated 15-year period. Actual TB incidence and prevalence rates do not appear in the tables, which makes it difficult to pinpoint real-life events that altered case counts (reclassification of "case"), the introduction of new drug therapies, loss of governmental block grants, and the effects of AIDS/immigration.

As stated above, Price-Smith has recapitulated a large body of information on ERIDs quite well. His footnotes are not excessive, and they are placed in the back of the book under "Notes," where he elaborates on the specific items. In the "Notes" section, he reinforces the points made in the text while offering additional citations and Web sites to the interested reader. There are minor errors in the text and "Notes," however. For example, Junin and Machupo are not subtypes of Ebola (page 4). Moreover, at least 1 tertiary, dubious note -- the suggestion that heart disease and multiple sclerosis may be due to infectious agents -- is based on "the evidence complied by Paul Ewald, see J. Hooper, 'A new germ theory,' Atlantic Monthly, February 1999, pp, 41-53," a hypothesis that has not gained general acceptance (page 8).

The overall premise of The Health of Nations is laudable. Price-Smith has attempted to quantify data on ERIDs and sociopolitical economic indicators in an attempt to demonstrate measurable effects heretofore qualitative in nature. Whether his work will attract and educate an audience of policy makers and planners is an open question. However, any attempt by a political scientist to call a closer attention to ERIDs from policy makers is welcome.

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