Respect for human rights is coming to be seen as a fundamental part of public health policies
The first major influence on health science on the eve of the twenty-first century is the phenomenon of globalization, the enormously expanding and intensifying movements of people, goods and ideas around the world. The Aids epidemic has accelerated an appreciation of global vulnerability to new disease pandemics.
Tourism is symbolic of the transnational character of the modern world, for it constitutes one of the world's largest industries and is inextricably linked with the history of infectious agents and epidemic disease. Mass tourism, with its characteristic heavy influxes during short periods, overloads sanitary infrastructures, and outbreaks of disease are most likely during these periods.
The Aids pandemic has been a shock, strongly challenging the old view of the world as composed of isolated communities and illustrating clearly the modern world's vulnerability to global spread of infectious agents. The pandemic is expanding relentlessly, and may well involve over 100 million people by the end of this decade. This says much about our limited collective capacity to deal with global health problems.
The emergence of new microbial threats to world health is inevitable, yet our ability to detect and respond to such threats with reasonable speed remains very limited, slow and haphazard. Current international health regulations are clearly based on an old, nation-state definition of "inter-national" rather than global health. A new global surveillance strategy must draw on a broader, ecological view of health and disease.
An ecological view of health
The definition of health itself is critical, for how we define a problem will determine what we do about it. The most widely used modern definition comes from the World Health Organization (WHO) and states that: "health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Through this definition, WHO has helped to move health thinking beyond a perspective which focused on diseases, disabilities and causes of death, to the more positive domain of "well-being". The definition highlights the importance of health promotion, described as "the process of enabling people to increase control over, and to improve, their health". Thus the modern concept of health emphasizes the broader, societal dimensions of health.
These changes in thinking about health have been complemented by changes in the practice of international health research. In HIV/Aids prevention, for example, global exchange of information has been unprecedented and useful. Inherent in this approach is the idea that when facing a problem like HIV/Aids, every society and environment may make useful contributions.
A second aspect of global learning involves how research is carried out. Early in the pandemic, international research was dominated by so-called "safari" or "parachute" research, in which scientists from industrialized countries arrived, took specimens and left to publish their results. These early projects were rarely collaborative in any meaningful sense and were part of a pattern inherited from colonial days. Increasingly, however, it became clear that both the ethics of good research and the capacity to answer the important questions depended on establishing genuine international collaboration.
The human rights revolution
As well as acquiring an increased capacity to think in integrated, ecological ways about health issues, the world in which health research is carried out has been changing in another critically important way. This involves the most hope-filled idea in the world today - that of human rights.
Among the fundamental characteristics of modern human rights are the following: they are rights of individuals; they inhere in individuals simply because they are human; they principally involve the relationship between the state and the individual; and they apply to all people around the world. …