Trains, planes, and autoimmune diseases

How global transport spreads disease and what we can do about it

John Tang

Development, Trade and industry, Health | Asia, East Asia, The World

23 February 2016

When Japan became industrialised, along with the railways came death as disease was more easily spread. There are lessons from history for today’s policymakers tackling viruses such as Zika, John Tang writes.

Australia recently reported its first cases of the Zika virus infection, which followed closely on the World Health Organization’s declaration of an international public health emergency for the disease.

Zika has no vaccine and no treatment, is easily transmitted by mosquito bites, and may be associated with severe birth defects and autoimmune disorders in adults. Current efforts by governments around the world to tackle the emergency range from travel alerts and mosquito eradication to recommendations that women in affected countries delay pregnancy for up to two years.

The rapid spread of the disease should not be surprising, given the ease of travel and an integrated global market. At the same time, few dispute the benefits of improved transportation infrastructure and investment in developing countries.

For policymakers the advantages and disadvantages of economic growth often go hand-in-hand, and this is not a new phenomenon. My research on Japan’s industrialisation in the late Nineteenth Century testifies to the double-edged nature of development and its short-run impact on public health.

At a time when Japan was undergoing dramatic changes to its economy and institutions, allowing it to join the ranks of other industrialised nations during the first age of globalisation, the country also saw a significant rise in mortality rates. A major factor underlying this increase was the increasingly ubiquitous railroad, which was both a sign of modernisation and a carrier of disease, like air transport is today.

More on this: What more could India have done to stop the 2015 swine flu outbreak?

Introduced in Japan in the 1870s, railways spread throughout the country over the next three decades to create a national network, integrating previously isolated parts of the country to the major cities of Tokyo and Osaka, and then on to the rest of the world. And when the railways came, they came with death, with disease mortality due to the extension of railways accounting for approximately 5 per cent of total deaths per year between 1886 and 1893.

More striking is that annual death rates in areas with railways increased by 75 per cent in years following rail access, compared to years before access, and that the majority of these were from communicable diseases that could take advantage of increased mobility due to the railroad. These included the major killers of the time, such as cholera, typhoid, hepatitis, and upper-respiratory infections.

This connection between disease transmission and labour movement is not surprising; what is unusual is being able to identify transport access as a causal mechanism that allowed mortality to spread. The results even indicate that mortality rates are disproportionately higher for less populated areas once they are connected by rail, which is consistent with research about isolated communities lacking disease resistance and health infrastructure to combat increased disease exposure.

As with Zika today, in the Nineteenth Century medical treatment for most infectious diseases was lacking and governments did not adequately anticipate the need to invest in public health measures.

Until the mid 1890s, total government (central and local) spending on sanitation averaged 49,000 yen (US$433 in today’s currency) in nominal terms per year. This was in stark contrast with military spending, which averaged 33.5 million yen ($US292,000 in today’s currency) annually, or 27 per cent of the public expenditures. Even education was better funded at 9.3 million yen (US$79,599) per year. While the latter has clear long-term benefits for economic development, it would be difficult to argue that these outweigh the immediate and basic human needs of clean food and water. Other progressive steps would be to increase awareness of disease through public health campaigns, even if medical treatment was lacking, or identifying the vectors of contagion so affected communities could be better prepared.

A lesson from history this may be, but it highlights one potential adverse impact to industrialisation and market integration. Notwithstanding the desirability of greater access to jobs and lower prices from world markets, policymakers should nevertheless note the consequences of unbridled development if it exacts a significant human cost.

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Citation

Tang, J. (2016). Trains, planes, and autoimmune diseases - Policy Forum. [online] Policy Forum. Available at: http://www.policyforum.net/trains-planes-and-auto-immune-diseases/ 

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