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It is likely that the factors that facilitated the global spread of the plague and the —, , and influenza pandemics that originated in China are even more forceful today.

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It follows that infectious disease risk mitigation is a product not only of the probability of emergence, but also of the probability that an outbreak will be propagated to other parts of the world. Design and implementation of risk mitigation strategies require an understanding of the factors affecting the probability that zoonoses will emerge, and the likely pattern of their spread McMichael ; Daszak et al.

With regard to China, in particular, this involves understanding the way that income growth, urbanization, and globalization interact with predisposing socioecological conditions including changes in the interface between wild and domestic species, and cultural practices surrounding the consumption of those species to alter the likelihood of emergence.

We also need an improved understanding of the role of more widespread processes in changing epidemiological environments. Climate change is expected to alter ecosystem processes and functioning in ways that will influence the emergence and reemergence of infectious diseases worldwide Morens et al. In China, climate change, including changes in the El Nino-Southern Oscillation ENSO , is expected to increase human vulnerability to a spectrum of infectious diseases such malaria, dengue, and Japanese encephalitis Bi et al.

Mitigating the infectious disease risks of climate change—both for vector-borne and directly transmissible zoonoses—requires a deeper understanding of how it interacts with urbanization and globalization to alter the vulnerability of human populations Tong et al. A second requirement for successful policy is to look beyond standard epidemiological measures for risk indicators.

For avian influenza, outbreaks among wild birds, poultry, and people reveal patterns that suggest new indicators Fig. Empirical studies have shown how both outbreaks were facilitated by similar socioecological changes as discussed in preceding sections. Because of this, it has been argued that wet markets could be used as an early-warning system to detect emerging zoonoses Webster , and that control measures could focus on the norms and incentives underlying human-to-animal interactions in the marketplace Goldman et al. A third requirement is to enable public health infrastructures to respond to a range of threat indicators.

SARS and HPAI, and the experiences of dealing with other zoonotic risks in recent years, have motivated Chinese policymakers to improve their capacity to respond to emerging infectious diseases. Responsiveness, information dissemination, and infectious disease surveillance have all improved since the initial SARS and H5N1 outbreaks Wang et al.

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Nonetheless, surveillance and the overall public health infrastructure still have several weaknesses, namely undercoverage of rural areas where zoonoses, particularly those borne by livestock, may originate , lack of training for health professionals in poorer areas, and a low per-capita level of funding Tong et al. Indeed, these weaknesses may have been reflected in the fact that management of zoonotic diseases has largely been ad hoc.

The reactions to HPAI outbreaks included widespread wet market closures and trade restrictions. While this limited the spread of H7N9 after its initial occurrence Webster ; He et al.

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Additionally, given the significant traditional values attached to wet markets and the live animal trade, policies of that kind may abrade cultural sensibilities. For instance, abrupt and prolonged closures of live animal markets may deprive people of a traditional venue for social interaction Goldman et al. Improving public awareness and knowledge has been one form of intervention, but more generally management has tended to take the form of response rather than prevention. But given the changing zoonotic risks, mitigation e.

A fourth requirement is to build the collective capacity to mitigate international risk. The U. Agency for International Development also has active programs in China assessing the risks of emerging zoonoses e.

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  5. Center for Disease Control, although as of only had graduated from the program Tong et al. As with domestic disease surveillance and management efforts, this has implications for the allocation of resources needed to support initiatives and institutions. Finally, the underlying research efforts to model risk at different spatial scales and inform policy need to include factors that affect not only the abundance of susceptible, latent, infectious, and recovered individuals, but also the likelihood of contact and transmission.

    There would be value in exploiting a class of models in economic epidemiology that addresses the decisions made by people and policymakers that affect the likelihood of both host contact and infectious disease transmission Perrings et al. Income growth, rising trade in goods and services, and the demographic and land-use changes caused by urbanization all affect private infectious disease risk management, and so should inform the public response.

    The development of infectious disease models for China that capture such risk factors would have the potential both to enhance management domestically, and to comprehend the risks from trade and travel links with the rest of the world. In certain respects, the nature of infectious disease risk mitigation is similar to the nature of climate change mitigation.

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    In both cases, there is a closing window for timely action. In both cases, too, the mitigation of global risk depends heavily on the efforts of a small number of countries, each of which has a disproportionate impact on global risk Pike et al. To that end, improving the management of infectious disease risk in China is a necessary, though not sufficient, condition for managing such risks globally. It has been argued that the world has been undergoing an epidemiological transition, in which rising incomes and the dissemination of improved technologies and good practices has shifted the burden of disease away from communicable toward noncommunicable diseases McKeown ; Sepulveda and Murray In part, this is because development generates greater resources for biosecurity and the prevention and treatment of infectious disease.

    There is ample evidence that an epidemiological transition is underway in China. Rising affluence has lessened the burden of infections that once were socially devastating, such as malaria and tuberculosis, but has increased noncommunicable diseases, such as cancer, heart disease, and obesity Yang et al.

    At the same time, globalization has increased the potential for domestic infections to be exported to countries where infectious diseases are still the greater part of the disease burden Bygbjerg Large developing countries such as India, Indonesia, and Nigeria have a similar set of predisposing socioecological risk factors to China—e.

    As the forces of economic modernization accelerate, so could the zoonotic risks that such countries face. Unlike China, many of these countries are still in the early stages of the epidemiological transition. While they are becoming more exposed to disease risk through the growth of trade and travel, they still experience many of the public health conditions that increase vulnerability to infections.

    A salient example is buffalopox, an emerging and reemerging zoonosis that has recorded many animal outbreaks and human cases in South Asia. The pathogen dynamics indicate a reasonably high level of transmissibility between livestock and people, and the forces of income growth, urbanization, and globalization could contribute to its further spread Singh et al.

    China is not the only emerging infectious disease hotspot, but it is among the most important. As the world continues to navigate a potentially new era for infectious diseases, the management of risk in China will be critical to the management of risk everywhere. Skip to main content Skip to sections.

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    Advertisement Hide. Download PDF. Economic growth, urbanization, globalization, and the risks of emerging infectious diseases in China: A review. Review First Online: 04 August Introduction Today, an increasingly urban and interconnected world faces growing threats from emerging infectious diseases McMichael ; Kapan et al. Increasing per-capita income has led to increasing per-capita meat consumption, and this has occurred more rapidly in China than in any other major economy. The pattern of consumption is also changing: while pork remains the main source of animal protein, chicken consumption and production are increasing more rapidly.

    Between and , the growth in poultry numbers was around ten times the growth in pig numbers Wang et al. Nor has the growth rate of these stocks slowed. By comparison, U. Open image in new window.

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    In China, this has expanded the interface of contact between humans, wildlife, and livestock. Urbanization and associated land-use changes, in conjunction with rising meat consumption, have brought reservoirs of wildlife diseases into closer contact with livestock and people Wang et al.

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    In particular, the emergence of HPAI strains has become more likely in southern China, where the growth of an increasingly affluent urban population has driven an increase in poultry production and land-use changes that brings humans, domesticated animals, and wildlife into closer contact Davis ; Wallace et al. The risk of pathogen spread from diseases contracted in wet markets is exacerbated by the concentration and interconnectedness of human populations associated with urbanization Fang et al. Wet markets in urban areas are now recognized to be the primary locus of infection for H7N9 Gilbert et al.

    The high density of people makes cities, particularly the large cities that have appeared rapidly in China, force multipliers of pathogen transmission Alirol et al. For instance, had the first SARS carrier reached the dense precincts of Durban, with its high incidence of AIDS, rather than the more ordered and hygienic environment of Toronto, the outcome may have been much worse Weiss and McMichael The archetypal modern pandemic—the one that remains a touchstone for thinking about global infectious disease risk—is the — Spanish Flu.

    The severity of this pandemic was in large part a result of the integration forced by global conflict. Recent forensic studies tracking mortality rates and other contemporary evidence suggest that, contrary to its name, this pandemic actually originated in China Langford ; Humphries Alirol, E. Getaz, B. Stoll, F. Chappuis, and L. Urbanisation and infectious diseases in a globalised world. The Lancet Infectious Diseases — CrossRef Google Scholar. Bai, L. Morton, and Q. Climate change and mosquito-borne diseases in China: A review. Globalization and Health 9: Benedict, C.

    Bubonic plague in nineteenth century China. Google Scholar. Bi, P. Parton, and S. Vector Borne Zoonotic Diseases 5: 95— Bradley, C. Urbanization and the ecology of wildlife diseases. Brahmbhatt, M. Avian and human pandemic influenza: Economic and social impacts. Geneva: World Health Organization. Bureau of Statistics of Guangdong Province. Guangdong statistical yearbook Beijing: China Statistics Press. Bygbjerg, I. Double burden of noncommunicable and infectious diseases in developing countries.

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