Book Review
Risky Trade: Infectious disease in the era of global trade
Ann Marie Kimball
ISBN: 0 7456 4296 8; 2006; 212 pages; Hants, UK: Ashgate;
Hilary Bambrick
National Centre for Epidemiology and Population Health, Australian National University, ACT
Risky Trade is a thorough and engaging exploration of the impacts of international trade on infectious disease epidemiology. The information is detailed and dense, and sufficiently technical to satisfy those readers already involved in the field, while the writing style is lively and clear, ensuring accessibility for students and the lay reader.
Kimball uses many examples of past and present disease outbreaks to highlight how the movement of goods and people can have dire and far-reaching consequences. Some of these are widely known to be a consequence of trade, others less so, while some are merely speculative at this stage about what the future holds. Included, for example, is an in-depth discussion of the potential for burgeoning global trade to fuel the next influenza pandemic.
Increased distance, greater complexity, and the intensified competition that come with international trade, are themes which assert themselves throughout the book. For instance, the complexity of contemporary food production and trade pathways can make locating the source of an outbreak exceedingly difficult and slow. Kimball describes how increased economic pressures can also intensify problems with food safety. For example, she describes how global market forces in the 1980s drove the British ‘mad cow' epidemic by changing agricultural practices.
A somewhat slim but binding thread of the book, is social and economic disparity. In the case of a food-borne outbreak, Kimball describes the relatively limited capacity of poorer nations to recall contaminated products, and access to good health care (in the event of a global pandemic) favours those most able to pay. Kimball emphasises the need for poorer countries to be adequately involved in making trade rules, as they are often disproportionately affected when those rules are invoked.
The book contains a good summary of the role of the World Trade Organisation, with an appropriate level of background about the various rules governing international trade, and how they have already had an impact on health. The discussion includes some of the criticisms which have been aimed at the processes of negotiation and dispute settlement.
The book highlights how science and medical technologies fail to keep pace with trade-related disease outbreaks. Kimball describes the regulatory disputes and practical difficulties which arise from knowledge gaps about infectious diseases, particularly those that have emerged fairly recently; such as quantifying a risk when that risk is not yet well understood. Kimball articulates clearly that such uncertainties require a cautious approach. Establishing risk is especially difficult when infectious disease pathways are not obvious, such as with ‘stealth diseases': those with a long latency between infection and clinical disease (think HIV and variant Creutzfeldt-Jakob disease).
Risky Trade takes the reader beyond the banal and more usual ‘trade and health' focus on agricultural quarantine and food safety. Medical tourism (driven by increasing costs of medical care in richer countries and the inaccessibility of some procedures for the uninsured), and xeno-transplantation (the use of animal organs for transplantation) are introduced as emergent ‘hotbeds' for spreading infection.
While the book serves as a timely wake-up call for regulators to take account of the broader public health consequences of trade, not all of it focuses on the negative, with some discussion of some recent public health successes.
The book is well structured with clear objectives for each chapter, while links between the chapters ensure the book works together as a whole. The study questions at the end of each chapter would facilitate useful reflection by students on the main themes. The book's perspective is fairly global, although forgivably weighted towards a US regulatory perspective, given the author's experience and expertise.
One minor criticism is that some of the figures and tables are poorly presented, and do not do justice to the excellent and professional writing. For example, the text in a few of the tables is so small as to make them difficult to read - taking only half a portrait page where a full page in landscape would be preferable to accommodate the quantity of text - while some of the reproductions of figures are fuzzy or do not translate well to black-and-white. Use of inconsistent fonts and somewhat amateurish layout make some figures less appealing than they might be otherwise.
These slight annoyances do not, however, detract substantially from what is overall a very well-written and accessible book. You may never look at an alfalfa sprout the same way again.
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