ScanScan 1Scan 2Scan 3Scan 4Scan 5Scan 6Scan 7Scan 8Scan 9Scan 10Scan 11Scan 12Scan 13 Chapter 13 Global Health Challenges MANY INDIVIDUALS AND NONGOVERNMENTAL ORGANIZATIONS (NGOS) HELP FIGHT GLOBAL DISEASE. The Bill and Melinda Gates Foundation plays a key role in the war against malaria, AIDS, and other diseases. Melinda and Bill Gates met with doctors and patients at the Manhica Research Center and Hospital in an area of Mozambique heavily affected by malaria. Learning Objectives 1. 13.1Recall the causes and effects of noncommunicable diseases 2. 13.2Evaluate the role of global travel and trade in facilitating the globalization of infectious diseases 3. 13.3Outline the three developments that gave rise to the concept of human security 4. 13.4Describe the three epidemiologic transitions to better understand contemporary concerns about infectious diseases 5. 13.5Report the cause, spread, effects, and control measures of influenza and avian flu 6. 13.6Report the cause, spread, effects, and control measures of malaria 7. 13.7Recognize the causes and preventive measures of HIV 8. 13.8Report the origin, spread, effects, and control measures of SARS 9. 13.9Report the origin, spread, effects, and control measures of Ebola 10. 13.10Outline role of the WHO in preventing the spread of infectious diseases Noncommunicable diseases (NCDs) such as heart disease, cancer, diabetes, chronic respiratory disease, and mental illness in general and Alzheimer’s disease in particular are the leading causes of death and disability globally. Long associated with affluent Western standards of living, NCDs are now a global problem. While rich countries are better equipped to deal with chronic diseases, they are far more deadly in poor countries. Growing numbers of old people and the spread of middle-class lifestyles make NCDs more prevalent than infectious diseases. Globalization also contributes to the growth of NCDs by helping expand the global middle class and by promoting fast foods, sugary drinks, alcohol, smoking, processed foods, and sedentary lifestyles. A major global health threat that undermines efforts to cure diseases is the emergence of germs that are resistant to antibiotics. This is due mainly to the excessive use of antibiotics in medicine and agriculture. Infectious diseases are intertwined with numerous global issues and are inseparable from political, economic, and cultural components of globalization. Ethnic conflicts make populations vulnerable to infectious diseases. Fighting contributes to the collapse of public services, which means that many people die from what would ordinarily be treatable diseases, such as diarrhea and respiratory infections. Conflicts also create refugees, overcrowding, and unsanitary conditions, thereby creating environments conducive to the spread of infectious diseases. Environmental degradation and deforestation expose humans to a variety of infectious diseases. They also contribute to global warming and flooding,.

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Chapter 13 Global Health Challenges
MANY INDIVIDUALS AND NONGOVERNMENTAL

2. ORGANIZATIONS (NGOS) HELP FIGHT GLOBAL DISEASE.
The Bill and Melinda Gates Foundation plays a key role in the
war against malaria, AIDS, and other diseases. Melinda and Bill
Gates met with doctors and patients at the Manhica Research
Center and Hospital in an area of Mozambique heavily affected
by malaria.
Learning Objectives
1. 13.1Recall the causes and effects of noncommunicable
diseases
2. 13.2Evaluate the role of global travel and trade in facilitating
the globalization of infectious diseases
3. 13.3Outline the three developments that gave rise to the
concept of human security
4. 13.4Describe the three epidemiologic transitions to better
understand contemporary concerns about infectious diseases
5. 13.5Report the cause, spread, effects, and control measures
of influenza and avian flu
6. 13.6Report the cause, spread, effects, and control measures
of malaria
7. 13.7Recognize the causes and preventive measures of HIV
8. 13.8Report the origin, spread, effects, and control measures
of SARS
9. 13.9Report the origin, spread, effects, and control measures
of Ebola
10. 13.10Outline role of the WHO in preventing the spread of
infectious diseases
Noncommunicable diseases (NCDs) such as heart disease,
cancer, diabetes, chronic respiratory disease, and mental illness
in general and Alzheimer’s disease in particular are the leading
causes of death and disability globally. Long associated with
affluent Western standards of living, NCDs are now a global
problem. While rich countries are better equipped to deal with
chronic diseases, they are far more deadly in poor countries.
Growing numbers of old people and the spread of middle-class
lifestyles make NCDs more prevalent than infectious diseases.
Globalization also contributes to the growth of NCDs by

3. helping expand the global middle class and by promoting fast
foods, sugary drinks, alcohol, smoking, processed foods, and
sedentary lifestyles. A major global health threat that
undermines efforts to cure diseases is the emergence of germs
that are resistant to antibiotics. This is due mainly to the
excessive use of antibiotics in medicine and agriculture.
Infectious diseases are intertwined with numerous global issues
and are inseparable from political, economic, and cultural
components of globalization. Ethnic conflicts make populations
vulnerable to infectious diseases. Fighting contributes to the
collapse of public services, which means that many people die
from what would ordinarily be treatable diseases, such as
diarrhea and respiratory infections. Conflicts also create
refugees, overcrowding, and unsanitary conditions, thereby
creating environments conducive to the spread of infectious
diseases.
Environmental degradation and deforestation expose humans to
a variety of infectious diseases. They also contribute to global
warming and flooding, which facilitate the emergence of
infectious diseases. Rising temperatures in winter enable germs
to survive in large numbers, and flooded areas become potent
breeding grounds for mosquito-related diseases and cholera.
Rapid population growth and urbanization bring more people
closer together and into contact with infectious diseases. Trade
has long been a major facilitator of the spread of infectious
diseases. Consequently, trade suffers greatly when outbreaks
occur. In many ways, trade liberalization contributes to the
spread of infectious diseases by reducing the role of many
governments in providing essential basic health care and other
services. Infectious diseases have far-reaching social, economic,
demographic, security, and political consequences.
This chapter examines the globalization of noncommunicable
and infectious diseases, the concept of human security, and the
nature and spread of infectious diseases. The chapter discusses
global responses to the growth, persistence, and transmission of
infectious diseases. It concludes with a case study of obesity as

4. a global epidemic. The American Medical Association officially
classified obesity as a disease in 2013.13.1: Noncommunicable
Diseases (NCDs)
1. 13.1 Recall the causes and effects of noncommunicable
diseases
Modern medicine was primarily focused on curing and
preventing infectious diseases, precisely because they were the
leading causes of mortality and disability. The success of
modern medicine in eradicating and controlling many infectious
diseases combined with industrialization, urbanization, dietary
changes, economic prosperity, and changing lifestyles has
focused more attention on noncommunicable diseases (NCDs).
These diseases are not caused by infections. They require long-
term treatment and care and cause long-term harm.
Major NCDs are cancer, heart disease, diabetes, obesity,
Alzheimer’s disease, respiratory diseases, and other chronic
diseases. Depression and other mental health issues are
interrelated with NCDs. More than thirty-five million people die
each year from NCDs. Roughly 75 percent of all adult deaths
and half of all disability globally are caused by NCDs. Eighty
percent of these deaths occur in middle- and low-income
countries, and the death rate before the age of sixty for people
in the developing world is twice as high as it is for people in
rich countries.1 Rates of cancer and other NCDs are rising
sharply.13.1.1: The Impact of NCDs
NCDs have profound economic, social, and political
implications. They affect many issues discussed earlier. NCDs
increase poverty and drain financial resources of individuals,
families, and governments. Businesses are also affected.
Workers with NCDs usually miss work, underperform at work,
become disabled, and leave the workforce before they reach
retirement age. Chronic diseases require extensive medical care
and a variety of services that are very expensive. Payment for
treatment and care often reduces families to financial ruin,
trapping them in cycles of debt, impoverishment, and sickness.
Poor people are the most vulnerable to the negative effects of

5. economic costs associated with NCDs. Many lack economic
assistance and health insurance and often have to leave their
jobs to care for relatives. Some children are forced to leave
school to supplement their family’s income. Demographic
transitions in many countries, especially Western Europe, the
United States, Canada, and Japan, have reduced the proportion
of working-age adults while rapidly increasing the number of
older people who need care. Throughout the world, including
the United States, Canada, and Western Europe, women are the
indispensable caregivers. This means that many women leave
work and abandon opportunities for economic advancement and
diminish their chances of achieving gender equality. Diseases
such as Alzheimer’s disease require intensive and prolonged
care that is generally not provided by most national health care
systems. Furthermore, few families can afford the expense
associated with such care and must rely primarily on unpaid
informal care by the family. Many NCDs are the result of aging.
Governments are challenged to develop comprehensive and
sustainable long-term care plans and support for older people.
This inevitably leads to political struggles over the allocation of
scarce resources and the setting of national
priorities.213.1.2: Causes of NCDsGlobalization
Leading causes of NCDs include unhealthy diets, lack of
exercise, smoking, the harmful use of alcohol, affluence,
poverty, and pollution, especially black carbon, which is
discussed in Chapter 10. Globalization is playing a pivotal role
in the growth of NCDs. The spread of medicine and technology
to distant parts of the world to treat diseases directly
contributes to longevity, a major cause of NCDs. Globalization
also spreads Western lifestyles that enhance the development of
NCDs. Throughout the world, even in many small communities,
people have retreated from the outdoors and spend most of their
time with technological devices, especially the Internet and
television. Combined with rapid urbanization, these
technologies encourage sedentary lifestyles that contribute to
obesity, heart disease, and other NCDs. In a world that is

6. always busy, stress becomes toxic. Stress impairs the immune
system and is an underlying cause of many diseases, including
cancer. Global connectedness engenders chronic sleep deficits
which are implicated in many NCDs, including depression, heart
disease, chronic pain, diabetes, and cancer.
Globalization promotes free trade, which includes the spread of
fast food and processed foods even to remote parts of the world.
Profits, not proper nutrition, are the primary concern of global
food companies. Rising obesity rates around the world are
directly linked to the consumption of vast quantities of sugary
drinks. The Institute for Agriculture and Trade Policy in
Minnesota has shown that following the passage of the North
American Free Trade Agreement in 1994, discussed
in Chapter 8, there has been a more than 1,200 percent increase
in high fructose corn syrup exports from the United States to
Mexico. Mexico now has the highest obesity rates in the world.
Turkey tails, which are about 40 percent fat, are frequently
consumed in Samoa, which has strong ties with the United
States. Similarly, many Pacific islands close to New Zealand
have diets that include mutton flaps, which are mostly fat.
Consequently, Pacific islands have very high rates of
obesity.3Smoking
Smoking is the leading cause of NCDs and preventable
deaths. More than six million people die each year from tobacco
use, a number that is higher than all the deaths caused by
HIV/AIDS, tuberculosis, and malaria combined. With more than
300 million smokers, about one-third of the global total, China
has one million deaths each year from smoking. While rich
countries have sharply reduced smoking, countries in Central
and Eastern Europe, Asia, Africa, and Latin America are
experiencing a rise in tobacco use, due partly to aggressive
marketing efforts of tobacco companies. Tobacco use is the
leading cause of cancer, heart disease, and chronic respiratory
disease.Alcohol, Affluence, Poverty, and Pollution
Alcohol, a leading cause of NCDs in Eastern Europe, Central
Europe, Latin America, and the Caribbean, is the third leading

7. cause of deaths worldwide. Heavy drinking, especially when
combined with smoking, can cause cancers of the mouth, larynx,
pharynx, esophagus, liver, and breast. Affluence, often equated
with Westernization, has long been a leading cause of NCDs.
Some NCDs, such as colorectal and breast cancers, are still
more prevalent in rich countries than in the developing world.
Poverty also contributes to the increase in NCDs. People in
poorer countries tend to smoke more, are more obese, and have
higher blood pressure. Most poor countries lack adequate
medical care, and many diseases are not diagnosed early. Even
if a diagnosis is known, the disease often goes untreated. This
results in higher death rates from NCDs in poor countries than
in rich ones.4 Pollution is among the top seven leading causes
of NCDs and accounts for more than three million deaths
globally each year. Women and girls suffer most from indoor
pollution that comes from wood-burning stoves. Chronic
obstructive pulmonary disease and lung cancer increase with
greater industrialization. China, which has many factories and
relies mostly on coal for energy, heating, and cooking, has very
high levels of pollution, as we discussed in Chapter 10.
Pollution causes an estimated 1.2 million deaths in China and is
the fourth leading risk factor for deaths in China.13.1.3: Major
NCDsCancer
Cancer kills more than eight million people each year
globally. Approximately 70 percent of these deaths are in
developing countries. Cancers are caused by many different
things, including smoking, nutrition and diet, obesity, sunlight,
alcohol, and environment hazards such as chemicals and
pollution. Smoking is the leading cause of lung cancer, and
dietary intake can increase the risk of colon, breast, kidney,
prostate, and endometrial cancers. Patients with cancer in high-
income countries have twice the survival rates of people in
developing countries, due largely to the quality of medical care.
For example, many cases of breast cancer in middle- and low-
income countries are not diagnosed until it has reached stage 4,
the final stage, when it has invaded organs or bones and cannot

8. be cured. Enormous tumors develop. Stigma, poverty,
misinformation, and lack of knowledge are impediments to
getting medical treatment. In many parts of the developing
world, many people with cancer rely on useless herbs from
traditional healers. The unavailability of modern medical
technology that can help make sure that a lumpectomy is done
correctly often leads to unnecessary mastectomies.5Heart
Diseases
Heart disease, once concentrated in affluent societies, is
increasing in the developing world, especially among middle-
class individuals. Heart disease is the leading cause of death in
China, a country that has experienced unprecedented economic
growth and poverty reduction. As we have seen, many NCDs are
interrelated and are caused by many of the same things. Heart
disease is connected to high blood pressure, or hypertension.
Excess sodium in processed foods, fast food, and food prepared
at home is a key risk factor for hypertension. Heart disease is
also caused by diets that contribute to high blood cholesterol.
Other causes include obesity, physical inactivity, smoking, and
diabetes.Diabetes
Diabetes is rapidly growing globally as more people are able
to afford foods that contain large amounts of sugar. Sugar is
addictive and toxic. The consumption of large containers of
sugary drinks is mainly responsible for the rapid growth of
diabetes. The average individual in the United States and
Mexico consumes forty gallons of soft drinks a year. China,
with a rapidly growing middle class, has 114 million people
with diabetes, the highest proportion of the population (around
11.6 percent) in the world. Diabetes affects around 26 million
Americans, or 8.3 percent of the population. Type 2 diabetes is
by far the most common form of the disease and accounts for
about 95 percent of those over age twenty with diabetes. Type 2
diabetes usually begins later in life and is caused by lifestyle,
especially excessive sugar consumption. In contrast, Type 1
diabetes, or juvenile diabetes, usually begins early in life and is
an autoimmune disorder with genetic origins. Diabetes can have

9. many devastating health consequences. It is the seventh leading
cause of death in the United States. It is the dominant cause of
kidney failure, nontraumatic lower limb amputations, blindness,
heart disease, and stroke.Alzheimer’s Disease
Alzheimer’s disease is the most feared noncommunicable
disease because many individuals will get it if they get old, and
there is no cure for it. Alzheimer’s disease is the dominant
cause of dementia. The greatest risk for developing Alzheimer’s
disease is old age. This disease is growing rapidly as the
number of old people increases globally, as we discussed
in Chapter 11. More than thirty-five million people suffer from
Alzheimer’s disease globally. It is a degenerative disease that
poses severe challenges for the global community. Symptoms
include memory loss, cognitive impairment, difficulty
communicating, and mood changes.
There are three stages of Alzheimer’s disease
1. The early stages, during which those affected become
forgetful and have problems with orientation, making decisions,
and doing household work.
2. The middle stages, in which the symptoms from stage one get
worse. There is a greater need for personal care, which extends
to personal hygiene. Behavioral changes include wandering,
clinging, agitation, and aggression.
3. The final stages, in which individuals become unaware of
time and place; unable to recognize relatives, friends, or
familiar objects; unable to eat without help; severely restricted
in their mobility; and bedridden. Care, support, and supervision
needs are constant. Families are under severe stress and face
huge financial burdens.613.1.4: Global Responses to NCDs
Since many NCDs, with the exception of Alzheimer’s disease,
can be prevented or significantly diminished, there is an
emphasis on lowering the risks of getting them. Conventional
medical approaches that work well with infectious diseases are
less appropriate and less effective when dealing with NCDs.
Effective ways to reduce the growth of NCDs are to promote
healthy diets, encourage more physical activity, reduce stress,

10. and clean up the environment. These are essentially lifestyle
changes. To help treat these diseases, global pharmaceutical
companies such as GlaxoSmithKline and Merck provide
inexpensive drugs to people in developing countries.
Many governments are focusing on promoting healthier diets.
This means eating more fresh fruits and vegetables and whole
grains and limiting fast foods, processed foods, and sodium.
When Michael Bloomberg was mayor of New York City, he
stressed limiting the sale of large sugary drinks and reducing
the calories of food served in restaurants. Similar approaches
are being tried globally. Mexican president Enrique Peña Nieto,
for example, proposed a tax on the sale of all sugary drinks to
discourage their consumption. Bloomberg provided financial
support for Mexico’s National Institute of Public Health to
promote policies such as taxing soft drinks, controlling junk
food advertising targeted at children, and improving nutrition
labeling. Global fast food companies such as McDonald’s, KFC,
Taco Bell, and Pizza Hut are under increasing pressure to serve
more nutritious and healthy food.
Governments in Europe, Australia, the United States, Canada,
and elsewhere have implemented policies that restrict smoking
in public places. Australia has led the world by requiring
cigarette companies to place gruesome images of people who
have been harmed or disfigured by tobacco on plain dark brown
cigarette packages. Similarly, Uruguay requires tobacco
companies to cover 80 percent of their cigarette packages with
graphic pictures showing detrimental health consequences of
smoking. The Centers for Disease Control and Prevention
(CDC) has an advertising campaign that shows graphic images
of people harmed by smoking. The World Health Organization
(WHO), CDC, Johns Hopkins Bloomberg School of Public
Health, World Lung Foundation, Campaign for Tobacco Free
Kids, and several NGOs collaborate to reduce smoking.
The CDC’s Field Epidemiology Training Programs help health
professionals deal with NCDs in Brazil, China, Colombia,
Jordan, Tanzania, and Thailand. The emphasis is on prevention.

11. A global organization that works to prevent and treat NCDs is
the NCD Alliance, a partnership of the World Heart Federation,
International Diabetes Federation, Union for International
Cancer Control, and International Union Against Tuberculosis
and Lung Disease. Alzheimer’s Disease International is a global
federation of Alzheimer’s associations that support people with
Alzheimer’s disease. Its goal is to make dementia a global
health priority. Bupa is a leading health care group that focuses
on dementia care and treatment. The Global CEO Initiative on
Alzheimer’s Disease is an organization of private sector leaders
who partner with public leaders to provide treatment and care
for patients with Alzheimer’s disease and to support research to
find a cure for the disease.
13.2: Globalization of Infectious Diseases
1. 13.2 Evaluate the role of global travel and trade in
facilitating the globalization of infectious diseases
The rapid spread of globalization underscored links between
infectious diseases in poor countries and
Table 13.1 Deaths from Noncommunicable Diseases (NCDs) by
Country, 2012
In 2012, a total of 68 percent of global deaths were due to
noncommunicable diseases.
Adapted from Global Health Observatory (GHO) data on deaths
from NCDs, published in 2014 by the World Health
Organization, www.who.int/gho/ncd/mortality_morbidity/ncd_to
tal/en/ (retrieved May 2, 2015).
Top 10 Countries for NCD Deaths
NCD deaths per 100,000 population, both sexes
Turkmenistan
1,025
Guyana
1,024
Mongolia
967
Sierra Leone

12. 964
Kazakhstan
950
Mali
866
Armenia
848
Afghanistan
846
Uzbekistan
811
Fiji
804
United States
413
Bottom 10 Countries for NCD Deaths
NCD deaths per 100,000
Spain
323
Luxembourg
318
France
313
Israel
311
Italy
304
Australia
303
Republic of Korea
302
Switzerland
292
Singapore
265
Japan

13. 244
outbreaks of these diseases in rich countries. The most dramatic
development was the discovery of HIV/AIDS in the United
States, Western Europe, and other rich countries. Although
perceived initially as a disease limited primarily to
homosexuals, HIV/AIDS began to spread to the general
population through blood transfusions, intravenous drug usage,
and heterosexual practices. Furthermore, prominent people who
were suffering from the disease fought to put it on both
domestic and global agendas. Many of the diseases that were
believed to have been eradicated in rich countries re-emerged
and were placed on the global agenda. Two factors explain this
re-emergence: (1) growing resistance to common antibiotics and
(2) the devastating impact of new epidemics. The new
epidemics included cholera in Latin America, particularly in
Peru and Haiti; plague in India; the Ebola virus in Africa; and
the West Nile virus in the United States.
13.2.1: Global Travel and Communications
Human beings are the most efficient transmitters of diseases. In
the past, large proportions of populations were killed by plagues
as people traveled to distant places. The Plague of Justinian,
which occurred around 541 CE, devastated Europe. In the
twelfth and thirteenth centuries, the bubonic plague, known as
the Black Death, killed twenty-five million (or one of every
three) Europeans. The decimation of Native American
populations by European diseases is another example of how
travelers spread infectious diseases. More recently, China and
other Asian countries have spawned deadly infectious diseases
that have spread quickly to the rest of the world because of
travel and excellent global links. In 1968, the Hong Kong flu,
originating in South China, spread from Hong Kong to other
countries. About seven hundred thousand people died
worldwide. Following a devastating earthquake in 2010, Haiti
faced an outbreak of cholera that killed more than eight
thousand people. UN peacekeepers from Nepal brought the
deadly cholera strain to Haiti.

14. Trade also has been a major facilitator in the globalization of
infectious diseases. The bubonic plague (Black Death) was
transmitted to Europe through trade with Asia. Today, the rapid
expansion of trade with China exposes the world to many
diseases. The global trade in agricultural products has also
escalated the risk of the global transmission of diseases. Human
activities have profoundly affected the natural environment.
People have migrated to areas that bring them into contact with
animals and soils that play a role in the spread of infectious
diseases. Furthermore, gradual increases in the Earth’s
temperature (i.e., global warming) are conducive to the global
spread of diseases.
Conflicts have always contributed to the outbreak of disease and
often the spread of infectious diseases. Combatants are often
more likely to die from infectious diseases than from actual
fighting. It is estimated that more than two-thirds of the roughly
six hundred thousand deaths in the American Civil War were
caused by infectious diseases.7 Furthermore, the movement of
troops and mass migrations of civilians as a consequence of war
have contributed to the wider transmission of infectious
diseases. During the Spanish flu pandemic of 1918–1920, many
American soldiers who were transported on trains and troop
ships perished. On the battlefields of Vietnam and Iraq,
American troops suffered from infectious diseases, many of
which are drug resistant. Endemic ethnic conflicts in Africa
play a leading role in that continent’s struggle with infectious
diseases.
Conditions that influence people to leave one area to settle in
another initiate the downward spiral leading to infectious
diseases. The deterioration of health services, the destruction of
infrastructure, food shortages, and the lack of proper sanitation
make refugees susceptible to communicable diseases. The
poorest countries, like poor individuals, are generally more
vulnerable to contracting infectious diseases. Poverty is usually
a reliable incubator of disease. Overcrowding, malnutrition,
inadequate medical care, and unsanitary conditions facilitate the

15. growth and transmission of infectious diseases.
A growing problem that assists in the spread of infectious
diseases is overuse and misuse of antibiotics. The increasing
use of antibiotics in agricultural products has contributed to a
process of pathogenic natural selection, which promotes the
emergence of more virulent, resilient, resistant, and powerful
disease strains. The spread of infectious diseases has focused
attention on human security.
13.3: Human Security and Infectious Diseases
1. 13.3 Outline the three developments that gave rise to the
concept of human security
As we discussed in Chapter 1, the forces of globalization have
strengthened the concept and reality of global security, which
stresses a common and comprehensive security. The concept of
global security moves us beyond the narrow traditional view of
national security with its emphasis on military force and war to
emphasize the global dimensions of emerging threats and
problems and the need to achieve security with others. Within
the broader context of global security is the concept of human
security, derived from the globalist school of thought. Human
security focuses on the individual as the primary object of
security. It embraces a people-centered approach of anticipating
and coping with the multiple threats ordinary individuals face in
an increasingly globalized society. The emergence of the
concept of human security during the 1990s is attributed
to three developments: (1) the end of the Cold War, which
radically altered the global political and security environment;
(2) a better understanding of the everyday
insecurities experienced by the world’s poor, who comprise the
vast majority of the world’s population; and (3) the process of
globalization, which ushered in unprecedented changes and
uncertainty, thereby influencing a reevaluation of traditional
views of security.
13.4: Infectious Diseases
1. 13.4 Describe the three epidemiologic transitions to better

16. understand contemporary concerns about infectious diseases
The microbes (such as bacteria), viruses, parasites, and fungi
that are the agents of infectious diseases are integral
components of the natural and human environments. Throughout
recorded history, our ancestors have been extremely vulnerable
to, and mostly defenseless against, infectious
diseases. Pathogens (i.e., organisms capable of causing disease)
have routinely demolished societies. In many cases, there are
outbreaks of diseases; that is, essentially localized, endemic
occurrences. When infectious diseases spread to a relatively
large number of people, they are classified as epidemics.
Although epidemics generally impact populations
worldwide, pandemics are long-lasting, catastrophic, and truly
global in their consequences. Two factors that have always been
at the root of infectious disease threats to human populations
are (1) social, economic, and environmental conditions that
enable infectious diseases to exist among human hosts and (2)
various means of transmission to new populations. As our
ancestors developed agriculture and moved from isolated
villages to more densely populated areas, they were exposed to
more diseases.8 Altering the natural environment enables
microbes to infect humans. Humans are infected when they
come into contact with natural hosts (i.e., organisms that carry
diseases). The hosts are not negatively affected by the disease.
Transmission of infectious diseases can occur within a single
species or from one species to another. Humans often infect
other humans. But host animals also infect humans, a
transmission known as zoonosis. Infectious diseases are
transmitted through air, water, direct contact with the host’s
bodily fluids, and sexual activity, as well as through vectors
such as mosquitoes and other insects.
To better understand contemporary concerns about infectious
diseases, we will discuss the problem within the framework of
epidemiologic transition theory. Each transition is characterized
by “a unique pattern of diseases that is ultimately related to
modes of subsistence and social structure.”9 There are

17. basically three distinct epidemiologic transitions. The first
epidemiologic transition, as we mentioned earlier, occurred
when our ancestors established agricultural communities. Think
about sanitation problems in permanently settled areas and the
close interaction of humans and their domesticated animals.
Both of …
EDUC 742
PPOL 650
Reading Summary and Reflective Comments Form and
Instructions
For each assigned reading, summarize the main principles and
reflect on these principles in order to make the content
meaningful to you. This will ensure that you understand the
reading and its relationship to current events. The reflective
comments may draw on your experiences or information from
other readings. You must also critique ideas in light of a
biblical worldview. Approximate length of main principles
summaries must be 100–125 words each and must be in
paragraph form, and the reflective comments must be 150–200
words each. Submit the Reading Summary and Reflective
Comments by 11:59 p.m. (ET) on Sunday in Modules/Weeks 1–
7, adding the new entries each time.
Student:
Reading
Assignment
Main Principles
Reflective Comments
Reading Summary 1
Henderson

18. Payne
United States Constitution
Reading Summary 2
Henderson
Payne
U.N. Charter
Reading Summary 3
Henderson
Payne
Reading Summary 4
Henderson
Payne
Reading Summary 5
Henderson

19. Payne
Reading Summary 6
Payne
Reading Summary 7
Payne
Page 2 of 3
PPOL 650
Student:
5 Points
4 Points
3 Points
0–2 Points
Critical
Thinking
Rich in content:
full of thought, insight, and analysis. Ideas are critiqued in light
of a biblical worldview.
Substantial information:
a degree of thought, insight, and analysis has taken place.
Generally competent:
information is thin and commonplace.
Rudimentary and superficial:
no analysis or insight is displayed.
Connections
The summaries are reflective. Ideas are critiqued in light of a

20. biblical worldview. Clear connections to real-life situations.
New connections lack depth and/or detail.
Limited, if any, connections. Vague generalities.
No connections are made. Off topic.
Uniqueness
New ideas and connections display depth and detail.
New ideas and connections lack depth and/or detail.
Few, if any, new ideas or connections, simply restates or
summarizes.
No new ideas or connections are explained.
Timeliness
All required postings submitted, adding new entries each time.
Most required postings submitted, adding new entries each time.
Some postings submitted.
All required postings missing.
Stylistics
Few grammatical or stylistic errors. Reflections are 150–200
words. Summaries are 100–125 words. Written in paragraph
form.
Some grammatical or stylistic errors. Reflections are 150–200
words. Summaries are 100–125 words. Written in paragraph
form.
Obvious grammatical or stylistic errors that interfere with
content. Reflections and summaries have less than the required
amount of words.
Obvious grammatical or stylistic errors that make understanding
impossible. The required amounts of words are not met.
Total ____________________________/25
Reading Summary and Reflective Comments Grading Rubric