This summer, the journal Nature Food published a study which is, in many ways, a microcosm of a key force shaping the future of global health: the US-China relationship. Notably, the study did not concern COVID-19. It was about soybeans. The study found that China’s retaliatory tariffs on US agriculture could “cause unintended increases in nitrogen and phosphorus pollution and blue water extraction in the United States as farmers shift from soybeans to more pollution-causing crops.” The study also looked at the potential global ripple effects of the trade dispute, suggesting that, if China’s soybean demands were diverted to Brazil, meeting them “may add additional pressures on phosphorus pollution and deforestation.” Given the extent to which our health depends on the condition of the natural world, these environmental consequences pose, in themselves, a threat to public health. More broadly, however, the force underlying them—simmering conflict between global superpowers—reflects an even deeper challenge to health in both the near- and long-term.
In many ways, these tensions are part of a larger story—that of globalization. Public health has long been engaged with this story, as globalization has increasingly helped shape the macrosocial determinants of health. As countries become more interconnected, their relations with each other have ever-greater influence on the determinants of health, both within and without their borders. Rising tensions between the US and China—fueled by a range of economic, cultural, and historical forces—have long been part of the conversation about globalization. But they have only recently factored into the conversation about health in a significant way. The emergence and spread of the pandemic are inseparable from the geopolitical concerns of the moment. There is an ongoing debate about the origins of the virus—whether it leaked from a lab in China or was zoonotic in origin. Tensions between the US and China are a key reason why this debate remains unresolved. From the start of the pandemic, the Chinese government has been reluctant to share information about the virus, and the hostile posture of the superpowers has helped maintain this status quo. This has had consequences for our ability to address the pandemic as it unfolds, and to prevent future contagions. It also has implications for how we think about globalization and health more broadly, in a “shrinking” world. Great power conflict reminds us that health does not occur in a vacuum, that it is shaped by global forces which are now coming to the fore in the actions of great powers.
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