Module/Week 7 PPOL 650 REFLECTIVE COMMENTS 7

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, 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 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 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. 2

13.1.2: Causes of NCDs

Globalization

 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 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. 3

Smoking

 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 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 NCDs

Cancer

 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 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. 5

Heart 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 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. 6

13.1.4: 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, 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. 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_total/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	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	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.

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 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 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 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 these situations provided favorable environments for the dispersal of infectious diseases. Cattle, goats, sheep, pigs, and fowl transmitted tuberculosis, anthrax, and other diseases. Large proportions of populations were routinely killed by plagues, especially as trade among communities increased and people traveled to distant places. An example of an early pandemic is the  Plague of Justinian , named after the Roman emperor, which devastated Europe around 541 CE. Increased trade and migration between Asia and Europe and the Medieval Warm Period of the twelfth and thirteenth centuries contributed to the proliferation of rats and fleas that transmitted bubonic plague. Believing that cats were witches, Europeans inadvertently helped spread the plague by killing cats. Known as the  Black Death , the bubonic plague killed roughly twenty-five million people, or one of every three Europeans. Individuals who manage to survive infectious diseases acquire immunity to them but can still transmit them to others. For example, most Europeans survived diseases such as tuberculosis and smallpox. West Africans lived with malaria and yellow fever. However, groups that lived in isolation from Europeans or Africans became quickly infected with their diseases when they came into contact with them. Millions of Native Americans were killed by diseases brought to the Americas by Europeans. 10  Many Europeans died of malaria and yellow fever in Africa, Asia, and the Americas.

Poverty and Migration help Spread Diseases Globally. A woman searches through trash in Mumbai, India.

The  second epidemiologic transition  coincided with the Industrial Revolution in Europe. Various inventions that accompanied the Industrial Revolution contributed to declining rates of infectious diseases. But overcrowding, environmental degradation, and unsanitary conditions led to the rebounding of cholera, smallpox, and tuberculosis. Developments in medical science and technology diminished epidemics not only in Europe but also in places affected by European migration, colonization, and commercial relations. We are now experiencing the  third epidemiologic transition . Just in the past three decades, we have seen an unprecedented emergence of new diseases and a re-emergence of infectious diseases that were thought to have been eliminated.

3.5: Influenza and Avian Flu

1. 13.5 Report the cause, spread, effects, and control measures of influenza and avian flu

Of all the major infectious diseases, influenza demands the unique and urgent attention of the global community because of its lethality and the speed with which it is transmitted. Of the more than fifteen hundred microbes known to cause disease in humans, influenza continues to dominate in terms of overall mortality. Every year, 5 to 10 percent of the American population gets the flu, and about 36,000 of them die. Even in normal times, an estimated 1.5 million people worldwide die from influenza infections or related complications each year.  Influenza , which is a viral infection of the respiratory tract, is very contagious and poses serious threats to children, the elderly, and individuals with compromised immune systems. It is estimated that three influenza pandemics in the twentieth century killed more than 50 million people. The  Spanish flu  pandemic of 1918–1920 is generally regarded as the most lethal plague in history, causing roughly 50 million deaths worldwide. Pandemics in 1957 and 1968, which originated in China and Hong Kong, together killed more than 2.5 million people. Given the efficiency with which flu is transmitted through air, close contact is not required for people to become infected. Furthermore, it is very difficult to identify and quarantine infected people who are spreading the disease.

Throughout the world, large commercial poultry farms, as well as the proliferation of chickens kept by families, have provided ideal conditions for the avian flu to spread. Furthermore, rapid population growth, especially in Asia, has given rise to densely populated urban areas. For example, during the 1968–1969 influenza pandemic, China had 790 million people and 12.3 million chickens and other poultry. China now has 1.3 billion people and more than 13 billion chickens. Poultry, pigs, and people living together or in close proximity enhance the transmission of avian flu from animals to humans. Although the avian flu (HSN1) caused 88 deaths out of a total of 165 cases globally, transmission from human to human had not occurred. The global community feared that the virus would undergo changes enabling it to  reassort  (i.e., mix genes with other human influenza viruses that are also present). This process can produce an entirely new viral strain, one that is capable of sustained human-to-human transmission.

Responding to the threat of a pandemic, governments, international organizations, and nongovernmental organizations (NGOs) concentrated on quarantine and the extensive culling of birds in affected areas. European countries were advised by the Animal Production and Health Division of the UN Food and Agriculture Organization to require travelers to fill out forms detailing their travel history and the agricultural products in their possession, which is the practice in the United States. Increased checks of airline passengers and their belongings were also regarded as effective countermeasures. Within rich countries, governments allocated resources to develop vaccines, primarily  Tamiflu , to deal with a pandemic.

13.6: Malaria

1. 13.6 Report the cause, spread, effects, and control measures of malaria

Malaria is found primarily in the tropics and is transmitted by mosquitoes. It is the most common vector-borne disease. The spread of human settlements and various activities in forested areas have led to increased contact with mosquitoes that carry the viruses that cause this disease. Global transportation and global warming have enabled malaria to spread and grow outside tropical areas. Discarded tires, bottles, cans, and other containers that collect water become fertile breeding grounds for mosquitoes. Humans contract malaria when bitten by female mosquitoes. Malarial parasites infect red blood cells, causing chills, fever, and often death. Of the estimated 300 million to 500 million people infected with malaria each year, roughly 1.5 million die from the disease.

Globally, Africa suffers the most from malaria. More than 90 percent of malaria deaths occur there, despite the relative ease with which the disease can be prevented and cured. In many ways, the prevalence of malaria in Africa is a manifestation of that continent’s endemic poverty. Malaria was once believed to be caused by swamp air. The role that mosquitoes play in transmitting the disease was not discovered until 1898. Several factors have contributed to the increase of malaria in different parts of the world. As population pressures have influenced farmers to cultivate areas bordering on swamps and as agroforestry has grown, mosquitoes have multiplied and have more opportunities to infect humans. The construction of dams and irrigation systems for agriculture has radically altered the natural environment and provided breeding places for mosquitoes. Natural disasters such as earthquakes often destroy sanitation facilities, cause severe flooding, and allow standing water to accumulate in which mosquitoes breed. Finally, global warming is widely believed to be responsible for increased rainfall and higher temperatures, which can result in flooding. These environmental conditions facilitate the spread of malaria.

Efforts to eradicate malaria began in 1898. In addition to draining swamps and removing standing water from around homes, insecticides and larvicides were used. Quinine was also used to treat infections. A major breakthrough in fighting malaria came after World War II when DDT was applied. DDT was first used in 1939 as an agricultural insecticide in Switzerland. However, it was during the war that its public health applications were discovered. The Allies used DDT to control typhus epidemics. Complete eradication of malaria was achieved in places such as the United States, southern Europe, Sri Lanka, and much of Brazil by massive DDT spraying. Success in reducing malaria problems influenced the World Health Organization (WHO) to initiate its  Global Malaria Campaign  in 1955 to intensify the use of DDT to control malaria. However, by the 1960s, malaria began to re-emerge in countries that had made significant progress in eliminating it because many countries were unable to continue the highly organized and costly spray program essential for success. Furthermore, widespread use of DDT engendered resistance to it at a time when more people were becoming aware of its danger to human health and the environment. As we discussed in  Chapter 10 , the toxicity of pesticides was stressed by Rachel Carson in her influential book Silent Spring. The WHO adopted a more comprehensive approach that included strengthening basic health services, focusing on the unique social and economic conditions in each region, and concentrating on treating patients with malaria. Known as the  horizontal approach , this new strategy emphasized control and containment, as opposed to complete eradication.

Rotarians worldwide have made eradicating malaria a major goal. The emphasis on bed nets was influenced by the growing ineffectiveness and health hazards of other approaches, such as indoor spraying and the use of chloroquine. Other organizations, such as the UN Children’s Fund (UNICEF), play a leading role in providing bed nets. An insecticide-treated bed net costs around $3. These bed nets are heavily subsidized or given away. A special initiative to eradicate malaria was launched in Zambia. Using $35 million donated by the  Bill and Melinda Gates Foundation , Zambia’s objective is to provide bed nets to 80 percent of its population. An additional $82 million was donated by international organizations and governments to supply the most effective malaria drugs to every public clinic and to pay for coordinated spraying programs across Zambia. Death rates from malaria have declined by around 60 percent in Zambia. In 2015, there was a significant breakthrough in efforts to control malaria. Clinical trials on the vaccine RTS,S prevented malaria in roughly one-third of the children receiving it. The vaccine’s efficacy would be increased when it is used along with other interventions such as bed nets. RTS,S was developed over two decades through a unique cooperative endeavor of organizations, including the Bill and Melinda Gates Foundation and the pharmaceutical company GlaxoSmithKline. 11

13.7: HIV/AIDS

1. 13.7 Recognize the causes and preventive measures of HIV

When AIDS was first recognized in 1981, the general assumption was that this deadly disease was essentially limited to homosexuals and West Africans. Today, however,  HIV/AIDS  has become a pandemic. More than thirty-three million people worldwide, 60 percent of them women, are infected. Roughly two million people die every year from AIDS. Although Africa remains the epicenter of the AIDS pandemic, home to roughly 70 percent of the people in the world who are living with HIV and experiencing 72 percent of the world’s AIDS-related deaths, the disease is rapidly growing in China, India, Russia, Latin America and the Caribbean, Eastern and Central Europe, and elsewhere. It is generally accepted that HIV evolved from the  simian immunodeficiency virus  (SIV) found in chimpanzees in southwestern Africa. It is believed that individuals acquired the disease from exposure to blood in the process of handling the meat of a chimpanzee that carried the virus. Compared with other infectious diseases, HIV/AIDS—while devastating—is transmitted in very specific ways and is thus more controllable. The virus is passed from one individual to another through the exchange of bodily fluids during sexual intercourse, through blood transfusions, from mother to fetus, through intravenous drug use, and through other activities in which infected blood is transmitted from one person to another. Early symptoms of HIV infection include chronic fatigue or weakness, noticeable and sustained weight loss, extensive and persistent swelling of the lymph glands, routine diarrhea, and sustained deterioration of the central nervous system.

Globalization is a major factor contributing to the spread of HIV/AIDS. As global tourism continues to grow and people venture to all corners of the world, they increase their risk of contracting infectious diseases.  Sex tourism , which involves traveling to specific countries to participate in the local sex industry, is a potent source of infectious diseases, especially HIV/AIDS. Furthermore,

Africa is at the Epicenter of the Aids Pandemic, but the Disease is Growing Around the Globe. Nurses distribute free condoms during an AIDS awareness event on a street in China.

as we discussed in  Chapter12 , the growth in human trafficking and the sex trade in many parts of the world helps spread HIV/AIDS. Poverty, ethnic conflicts, and wars facilitate the transmission of HIV/AIDS.

13.7.1: Global Responses to AIDS

Condom usage is a relatively inexpensive and effective approach to reducing the risk of infection and transmission of HIV. Governments, NGOs, and international organizations support condom distribution programs, although this practice remains controversial for some groups that stress abstinence. Given the reality of increased human sexuality, using condoms will undoubtedly be the dominant and practical approach to fighting HIV/AIDS. Thailand provides an example of how governments have integrated condom usage into an overall strategy to impede the spread of the disease. Thailand began mandatory HIV testing of high-risk individuals, such as homosexuals, commercial sex workers, and intravenous drug users. It also implemented the  100 Percent Condom Program . The principal objectives of the program are to protect 100 percent of commercial sex acts through mandatory condom usage in brothels and to diminish the commercial sex trade through sustained educational efforts. Free condoms are distributed to sex workers, who are instructed to use them or face several penalties. The commercial sex business is closely monitored by the government to ensure compliance.

Medical advances and a deeper understanding of HIV/AIDS—in addition to the fact that the disease was concentrated among high-risk groups—enabled rich countries to make significant progress in decreasing the transmission of the virus. Antiretroviral drug therapies, though expensive, allowed many patients with HIV/AIDS to continue living relatively normal lives. Deaths from the disease have declined in most developed countries, although both HIV/AIDS and mortality rates have increased among the poor in these societies, especially among African Americans. Despite opposition by pharmaceutical companies concerned about intellectual property rights, Brazil, Argentina, Costa Rica, Cuba, and Uruguay took the unprecedented approach of providing government-subsidized antiretroviral medications to patients with HIV/AIDS, thereby setting global precedents for widespread access to AIDS medications. Brazil, in particular, has made it legal for government laboratories to ignore drug patents in order to produce low-cost generic drugs to stop the spread of the disease. As we discussed in  Chapter 12 , Holland and Australia have implemented policies to reduce the spread of HIV/AIDS by providing supplies of clean needles and treatment for drug addicts.

Although the United States has been involved in the global efforts to reduce HIV infections, a significant change in U.S. policy was initiated by Franklin Graham, founder of  Samaritan’s Purse , an evangelical charity based in South Carolina. Bringing together evangelical Protestants and Catholic leaders, as well as overseas missionaries who worked in countries devastated by HIV/AIDS, Graham focused national attention on the problem. Perceptions of the disease as affecting primarily heterosexuals, as opposed to only homosexuals, enabled many conservatives to take action instead of disregarding the pandemic because they believed it was God’s punishment of homosexuals. President George W. Bush, influenced by Graham and the evangelicals, announced the Emergency Plan for AIDS Relief and committed $25 billion over five years to preventing HIV infections and treating patients. 12  However, political pressure from conservatives influenced the U.S. government to allocate a third of the money to abstinence-promoting programs and to avoid spending money on sterile syringes and needles for intravenous drug users. Essentially, the U.S. government adopted Uganda’s  ABC (Abstinence, Be Faithful, and Use Condoms) program , which helped significantly reduce the prevalence of HIV/AIDS in that country. The William J. Clinton Presidential Foundation HIV/AIDS Initiative concluded an agreement with generic drug manufacturers to lower the price of triple combination antiretroviral drug regimens to less than $140 per patient per year. The Clinton Foundation has concentrated its efforts against HIV/AIDS in Mozambique, Rwanda, Tanzania, South Africa, and several Caribbean states.

The WHO and U.S. government agencies—including the Food and Drug Administration (FDA) and the Alcohol, Drug Abuse, and Mental Health Administration—convened the First International AIDS Conference in Atlanta, Georgia, in 1984. This was followed by the initiation of the WHO’s Special Program on HIV/AIDS in 1985, which set the objective of reducing the growth of HIV/AIDS globally and to lessen the disease’s impact on the countries most seriously affected. Concerned about HIV/AIDS patients’ inability to afford drugs to treat the disease, members of the World Trade Organization (WTO) ratified the  Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS)  in 1994. TRIPS included a provision to allow states to waive patent protections without authorization from the patent holder in national emergencies for noncommercial use. A major breakthrough in the fight against the pandemic came in 1996 when the  Joint United Nations Program on AIDS (UNAIDS)  was founded. UNAIDS’s main objective is to be the leading advocate for global action against HIV/AIDS. Several organizations, reflecting UNAIDS’s comprehensive approach to the problem, participate in the program. These include UNICEF; the UN Development Program; the UN Population Fund; the UN Educational, Scientific, and Cultural Organization (UNESCO); the World Bank; the UN Office on Drugs and Crime; and the International Labor Organization. These organizations have been joined by the eight leading industrial countries (known as the G-8), various NGOs, and pharmaceutical companies (such as Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Merck, and F. Hoffmann-LaRoche). Pharmaceutical companies discounted their antiretroviral medications and allowed countries to manufacture drugs inexpensively for patients in poor countries. In 2014, the twentieth International AIDS Conference was held in Melbourne, Australia. AIDS experts noted that HIV rates were at a twenty-year high, with most cases in Africa. However, the experts were optimistic that with adequate funding from the global community for further research, an AIDS-free world is within reach.

13.8: SARS

1. 13.8 Report the origin, spread, effects, and control measures of SARS

SARS emerged in China’s Guangdong Province in late 2002. The virus that caused SARS was transmitted from the civet cat to individuals handling and consuming the animal’s meat. This highly contagious disease is spread when individuals come into contact with droplets from an infected person’s coughing or sneezing. The symptoms of SARS are high fever, chills, muscle aches, and a dry cough. The vast majority of individuals infected with SARS improve without having to undergo extensive medical treatment. However, between 10 and 20 percent of those who contract the disease require breathing assistance from a mechanical ventilator for an extended period of time. Many of them eventually die.

The transmission of the disease globally began when twelve guests in the Metropole Hotel in Hong Kong contracted it from an infected physician from Zhongshan University. Unaware that they were infected, these guests carried the disease to Singapore, Vietnam, Canada, Ireland, and the United States. More than eight hundred cases of SARS worldwide are believed to have originated with this one  superspreader . Global communications helped spread the most recent information about SARS, thereby heightening global awareness of the deadly virus and generating pressure on governments, especially that of China, to take action to prevent its spread globally. Global communications also enabled the scientific community to engage in unprecedented cooperation to control the virus.

Governments responded quickly. Vietnam—which had the first documented case of SARS, even though SARS originated in southern China—implemented detection and prevention measures immediately. These included (1) prompt identification of people with SARS, their movements, and their contacts; (2) appropriate protection of medical personnel treating these patients; (3) isolation of suspected SARS cases; (4) exit screening of international travelers; and (5) timely and accurate reporting and sharing information with others. 13  Canada, the United States, and other countries took similar actions. The WHO also responded promptly by sending investigative teams to Guangdong, the first Chinese city to experience SARS. Also, WHO personnel visited Beijing and pressured government officials to give an accurate assessment of the SARS problem and to improve its reporting system. Roughly sixty teams of public health officials and experts were recruited from the United States, Britain, Germany, France, and other countries to assist with efforts to control the spread of infections in areas affected by SARS. Several factors contributed to this rapid global response. First, the disease was greatly feared, partly in light of the threat of biological weapons. Public health officials did not want to repeat the slow global response that had allowed HIV/AIDS to grow. WHO leadership plus the success of medical researchers resulted in solutions to the disease.The global response to SARS marks a radical departure from earlier responses to infectious diseases and has become a model for dealing with potential pandemics.

13.9: EBOLA

1. 13.9 Report the origin, spread, effects, and control measures of Ebola

The outbreak of Ebola in Guinea and its spread to the neighboring countries of Liberia and Sierra Leone was declared a global emergency by the WHO in 2014. Ebola has killed more than eleven thousand known victims. Although these three countries became the epicenter of the Ebola epidemic, the disease also spread to Nigeria. Discovered in 1976 in the Democratic Republic of Congo, near the Ebola River, Ebola is one of the world’s deadliest viruses, with fatality rates as high as 90 percent in some communities. Ebola comes into the human community via fruit bats, a delicacy in Central and West Africa, and by people consuming the meat of wild animals infected by these bats. Ebola causes vomiting, diarrhea, and hemorrhagic fever that induces bleeding. It is highly contagious among humans and is transmitted by exposure to bodily fluids of those infected, including corpses that are being buried. Although experimental drugs have been given to some patients with Ebola, there is no cure for Ebola. It is contained by quarantining infected individuals and monitoring those who have been in close contact with them, particularly family members and caregivers.

Sierra Leone, Liberia, and Nigeria declared national emergencies to limit the spread of Ebola. These West African countries implemented prevention measures that included restricting travel and quarantining some communities. Several airlines terminated flights to the affected countries, the United States withdrew Peace Corps volunteers from West Africa, and several companies and organizations reduced operations and allowed employees to leave. The WHO responded by allocating $100 million to stop transmission of Ebola by improving surveillance of the virus, protecting health care workers, and helping individuals understand how to avoid being infected. The World Bank and the African Development Bank disbursed $260 million to Guinea, Liberia, and Sierra Leone to strengthen their very weak health care systems. Johnson & Johnson and GlaxoSmithKline agreed to cooperate to develop an Ebola vaccine and to produce millions of doses quickly. The European Union contributed $250 million to develop new Ebola vaccines, drugs, and diagnostic tests.

13.10: Global Responses to Infectious Diseases

1. 13.10 Outline role of the WHO in preventing the spread of infectious diseases

As early as 1851, European countries convened the  International Sanitation Conference  in an effort to prevent the spread of infectious diseases from developing countries to Europe, primarily through travel and trade. Significant improvements in sanitation, nutrition, and medical technology in Europe have reduced outbreaks of infectious diseases. But Europe remained vulnerable to the importation of diseases. Shortly after the United Nations was founded, the WHO was created as a specialized agency to develop international rules concerning infectious disease control. Under the International Health Regulations developed by WHO, countries are required to report outbreaks of yellow fever, cholera, plague, and other diseases. This information is disseminated to other countries, and surveillance strategies are implemented to help prevent transmission. Countries are also required to provide safe drinking water, food, and disposal of refuse, wastewater, and other things dangerous to health at their airports and ports. The International Health Regulations also require countries to provide health services, equipment, and services for isolating infected persons and for disinfecting, disinsecting, and deratting ships and aircraft. The U.S.  Centers for Disease Control and Prevention (CDC) , based in Atlanta, Georgia, also plays a leading role in preventing and controlling the transmission of infectious diseases into the United States. Both the CDC and WHO emphasize the importance of research and the development of medicines to prevent the emergence and spread of infectious diseases.

As we have seen, an important component of the global response to the emergence and re-emergence of infectious diseases is stressing preventive measures. These include protecting and chlorinating water supplies, disposing of human feces in a sanitary manner and maintaining fly-proof latrines, paying special attention to cleanliness in food preparation and food handling, stressing the importance of frequent hand washing, and eliminating potential mosquito breeding sites. Routine preventive immunization programs have effectively reduced outbreaks of many infectious diseases.

Case Study Obesity: A Global Epidemic

Obesity is now a global epidemic. Obesity and overweight are generally defined as excessive fat accumulation that has serious health consequences. Obesity and overweight are the fifth leading cause of death globally. The World Health Organization (WHO) has warned that obesity puts populations at risk for developing noncommunicable diseases (NCDs), which have been declared a global epidemic. Obesity is an underlying cause of infertility in women and impotence in men. Globally, obesity rates have doubled since 1980. More than 1.5 billion adults and 43 million children, mostly in the developing world, are obese or overweight. More women are obese or overweight than men worldwide. With the exception of Mexico, rich countries have the highest percentage of obese and overweight persons. Mexico leads the overall list, with almost one-third of its population obese or overweight. America is a close second, with 24 percent, followed by Britain with 23 percent, Slovakia with 22.4 percent, Greece with 22 percent, and Australia with 21.7 percent.

There are many causes of obesity and overweight. As part of our ancestors’ evolutionary adaptation to food scarcity, human beings store calories when food is available. A gestating mother’s environment directly influences her children’s weight in later life. Children born to parents who did not have adequate diets during pregnancy tend to have higher rates of obesity. The children of starving mothers, anticipating starvation during their own lives, tend to hoard calories. As food remains abundant, they tend to overeat and gain weight. Brighter lights contribute to obesity by confusing the body’s biological clock, which signals when we should eat and sleep. Contemporary lifestyles deprive many individuals of adequate sleep, and an increasing amount of time is spent watching television and on the computer.

Cultural globalization, increased food supplies, declining population growth rates, and urbanization are major causes of obesity. Cultural globalization has led to the homogenization of lifestyles, diets, and an automobile culture globally. The hectic pace of life influences people to eat fast foods that have lots of sugar, fat, and salt. Overcrowding and crime in urban areas contribute to a decline in exercise. The availability of high-calorie snacks and soft drinks guarantee the growth of the obesity epidemic.

Solutions to obesity and overweight are well known, though difficult to achieve in a world with constant advertising and global competition among food companies for market share. While individuals are ultimately responsible for their behavior, losing weight requires support from families and communities. Food consumption is an essential component of culture. Consequently, greater efforts must be made at a societal level to promote proper nutrition and smaller food portions. Global and local food companies could help by reducing the fat and sugar content of food and be more responsible in marketing products to children. By decreasing sedentary activities and increasing exercise as part of a daily routine, individuals can gradually help reduce obesity and overweight. Wellness programs in workplaces, hiking and walking trails, and communities designed to encourage walking and biking instead of driving could make a difference. Finally, working with children to make them aware of the benefits of proper nutrition and physical activity will slow the growth of the obesity and overweight epidemic.

Summary

This chapter focuses on the impact of NCDs: the causes of NCDs, major NCDs (such as cancer, heart disease, diabetes, and Alzheimer’s disease), and global responses to NCDs. It also examines the globalization of infectious diseases; rapid increases in global travel, trade, and migration; growing use of illegal drugs; human trafficking for sexual purposes; rapid population growth; environmental changes; widespread poverty; and inadequate medical resources—all factors that have facilitated the global spread of infectious diseases. These diseases pose significant threats to humans as well as to global security. By discussing infectious diseases—such as influenza, avian flu, malaria, HIV/AIDS, and SARS—we were able to see the social, economic, and political challenges these diseases pose and the ease with which they are spread globally. We discussed various responses to the globalization of infectious diseases. The case of SARS demonstrates that rapid transportation and instantaneous communications have raised global awareness of how quickly infectious diseases are transmitted worldwide. The global response to SARS is widely regarded as a model for how to deal with emerging as well as current infectious diseases. Some organizations, such as the WHO, play a pivotal role in reducing the expansion of infectious diseases. NGOs as well as individuals are also actively involved in fighting pandemics. However, many governments have inadequate resources to deal with NCDs and infectious diseases. Furthermore, countries have different priorities. Cultural values and practices also complicate global efforts to prevent the emergence and spread of diseases. This chapter discusses the newly identified epidemics of obesity and noncommunicable diseases (NCDs), which are related to each other. Global organizations are targeting these preventable diseases that cause 63 percent of all deaths and increase poverty worldwide.

Discussion Questions

1. Discuss the causes and effects of the global obesity epidemic. How does obesity relate to the global epidemic of noncommunicable diseases (NCDs)?

2. Discuss the role of the WHO in preventing the spread of infectious diseases.

3. Discuss the factors that facilitate the spread of HIV/AIDS and various efforts to deal with this pandemic.

4. Discuss the leading causes of noncommunicable diseases.

5. Discuss how conflicts, global warming, and poverty contribute to the emergence and spread of infectious diseases.

 Chapter 14 Cultural Clashes and Conflict Resolution

In Afghanistan, Americans Have Fought an Unconventional War Against a Nonstate Actor, the Taliban. U.S. Army Private Robert Montgomery, on joint patrol with Afghan security forces in Kandahar Province, exchanged the thumbs-up sign with an Afghan boy.

Learning Objectives

1. 14.1Report that ideas of culture may be used to diminish tensions or to encourage conflict

2. 14.2Evaluate Huntington’s thesis on the clash of civilizations with specific reference to U.S. relations with Muslim countries

3. 14.3Examine how cultural distance and threatened national interests are the causes behind clashes among nations

4. 14.4Review the global issues of the causes of ethnic and religious conflicts

5. 14.5Report the phenomenon of religious violence

6. 14.6Describe the four interrelated approaches to resolving cultural conflicts

Some groups and individuals promote globalization as a positive force to advance their own interests, whereas others perceive globalization as threatening. Global integration is increasing while, simultaneously, national cohesion is weakening as smaller groups seek increased political and cultural autonomy. Progress toward global order and security is accompanied by persistent outbreaks of violent conflicts and insecurity. Globalization challenges traditional certainties, conservative values, and parochialism; it also erodes identities based on nationality, geographic location, religion, social status, and ethnicity. Insecurity gives rise to global, international, and domestic conflicts. That these clashes occur at different levels (global, international, regional, national, and local) and often operate interdependently manifests the complexity of global society. Benjamin R. Barber, for example, envisions two possible global futures: (1) the McDonaldization or interdependence of the world and (2) a  jihad  (or struggle) in the name of a hundred narrowly conceived faiths against every kind of interdependence. 1  Barber’s view of a jihad is essentially synonymous with  ethnic conflicts . Another perspective, best articulated by Samuel P. Huntington, is that the world is divided into distinct civilizations that inevitably clash. 2  This rigid distinction among civilizations is widely rejected by scholars and policymakers.

This chapter examines the role of culture in global conflicts, focusing on civilization clashes, international conflicts, and ethnic conflicts. It discusses efforts to resolve cultural conflicts. As the case study of the war in Afghanistan shows, America’s longest war is not with another state; rather, it is with a nonstate actor, the Taliban.

14.1: Cultural Influences on Conflicts

1. 14.1 Report that ideas of culture may be used to diminish tensions or to encourage conflict

Culture and nationalism have generally been closely intertwined. In fact, culture has been synonymous with nations, races, and ethnic groups. Nations have traditionally been defined in terms of their common identity, values, customs, languages, and geographic boundaries. How nations’ ethnic groups interact and resolve disagreements is determined largely by the cultural reservoirs or the lack of them. A  cultural reservoir  may be defined as an accumulation of goodwill and understanding that emanates from a common set of values, beliefs, attitudes, historical experiences, and racial and ethnic links. Leaders usually draw upon cultural similarities to diminish tensions and, conversely, upon cultural differences and hatreds to promote conflict.

A distinction can be made between  material culture  (i.e., the tangible products of human society) and  nonmaterial culture  (i.e., the intangible products of society, such as values and rules of right and wrong behavior). Nonmaterial culture is comprised of the learned ideational aspects of human society. 3  In most countries, culture is generally equated with civilization. The clash-of-civilizations theory adopts this definition of culture.  Culture  is generally defined as a set of shared learned values, beliefs, perceptions, attitudes, modes of living, customs, and symbols.

One of the first questions we tend to ask someone who appears to be different is: Where are you from? This question, though routine, goes to the heart of identity and belonging. Do you belong to this society? Are you foreign? All societies, directly and indirectly, promote their values as positive and desirable while, simultaneously, devaluing those of other societies. This behavior is referred to as  ethnocentrism . Positive images of one’s society are developed and reinforced by rewards for conformity. Ken Booth, for example, contends that each society views itself as the center of the world, perceives and interprets other societies within its peculiar frame of reference, and invariably judges them to be inferior. 4  The more culturally distinct the other society is perceived to be, the more inferior it is often deemed to be and thus suitable for negative treatment. This perception is at the heart of ethnic conflicts and international wars.

14.2: Clashing Civilizations

1. 14.2 Evaluate Huntington’s thesis on the clash of civilizations with specific reference to U.S. relations with Muslim countries

According to the clash-of-civilizations perspective, global conflicts occur due to cultural differences. Although nation-states will continue to be the most powerful actors in global affairs, civilizations will be the dividing lines. A  civilization  is broadly defined as a cultural entity that, despite variations within it, is distinct from another civilization. For example, despite differences between Spain and Britain, they belong to the same Western civilization and are distinguished from Arab or Chinese civilizations. Huntington states that “a civilization is the highest cultural grouping of people and the broadest level of cultural identity people have short of that which distinguished humans from other species. It is defined by common objective elements, such as language, history, religion, customs, institutions, and by the subjective self-identification of people.” 5  From Huntington’s perspective, there are eight major civilizations: Western, Confucian, Japanese, Islamic, Hindu, Slavic-Orthodox, Latin American, and African. The clash-of-civilizations theory stresses conflict instead of cooperation among civilizations.

Many scholars have criticized the clash-of-civilizations perspective. For example, Fouad Ajami argues, “Huntington has found his civilization whole and intact, watertight under an eternal sky.” 6  Similarly, Stanley Hoffmann criticized Huntington’s concept of what constitutes a civilization as being hazy. From Hoffmann’s perspective, Huntington “failed to take into account sufficiently conflicts within each so-called civilization.” 7  Civilizational bonds have not restrained countries from competing with each other for power. Furthermore, civilizations are products of cultural cross-fertilization. Their members are complex, and the lines separating civilizations are often blurred and messy. For example, music by Haydn, Mozart, and Beethoven has Turkish origins. The Ottomans used giant war drums and cannons to frighten their enemies on the battlefield and to terrify the population in places like Vienna, Austria. Eventually, Western Europeans adopted many Turkish cultural practices, including military music for its marching bands. Haydn wrote his Military Symphony, and Mozart composed the piano sonata Rondo Alla Turca under the influence of Turkish music. 8

Religion, a foundation of civilizations, is regarded by Huntington as essentially pure and unaffected by other religions. The mixing of religions is as old as human civilization. As Susanne Rudolph observes, “Religious communities are among the oldest of the transnationals. Sufi orders, Catholic missionaries, and Buddhist monks carried word and practice across vast spaces before those places became nation-states. Religious communities have become vigorous creators of an emergent transnational civil society.” 9

14.2.1: The West and the Muslim World

At the heart of the theory of the inevitability of cultural clashes between the West and the Muslim world is the assumption that the two civilizations are inherently incompatible and hostile. But Western perceptions of Islam, like perceptions in general, are rooted in selective historical memories. Cooperation and similarities between these cultures are overlooked or downplayed while historical conflicts are stressed. Despite the Muslim conquest of part of Spain in the eighth century, Muslims were largely tolerant of Jews and Christians, regarding them as  Dhimmis  (i.e., people of the Book who also believed in one God, the God of Abraham). The advent of the Crusades in 1096 aided the foundation for the clashes between the West and Islam. The Crusades became a potent experience that continues to influence many Muslims’ perceptions of the West and their own self-perceptions. The Crusaders’ brutality symbolized Western hatred not only of Muslims but also of Islam.

A small number of European Christians regularly made pilgrimages to the Holy Land (then Palestine) starting in the fourth century without encountering systematic or widespread violence. However, in 1009, the Egyptian caliph (religious ruler) Hakim ordered the destruction of the Holy Sepulcher in Jerusalem (where Christians believed that Jesus was buried). This action engendered increased conflicts between Christian pilgrims and Muslims in Syria and Palestine. Hoping to unite European Christians, who were engaged in incessant feudal warfare against each other, and to terminate attacks on pilgrims,  Pope Urban II  (in 1095) called on European Christians to proclaim their faith by taking military action to force the infidels (primarily Muslims) out of Jerusalem. The First Crusade (1096–1099) represented unprecedented European cooperation as well as Europe’s emergence from the Dark Ages. There were nine Crusades. The final Crusade (1271–1272) was followed by the Muslim reconquest of the last Christian stronghold in the Islamic world in 1291. Armstrong states, “The Christianity of the Angles, the Saxons, and the Franks was rudimentary. They were aggressive and martial people and they wanted an aggressive religion.” 10  Crusaders, believing that Jews had killed Christ, slaughtered Jews in communities along the Rhine Valley and elsewhere on their three-thousand-mile journey to fight Muslims, about whom they were largely unaware. Believing that they were God’s Chosen People, the Crusaders were unrestrained in their cruelty. When they conquered Jerusalem in 1099, “they fell on the Jewish and Muslim inhabitants with the zeal of Joshua and massacred them with a brutality that shocked even their contemporaries.” 11  The ability of the less culturally sophisticated European Christians to plunder and defile Islam’s holy sites, including the  Dome of the Rock  in Jerusalem, has been interpreted by many Muslims as a consequence of their religious shortcomings. Contemporary Muslim grievances are often linked to the Crusades. Believing that Islam continues to be attacked by the West, many Muslims feel an obligation to engage in jihad (or struggle) against unbelievers.

14.2.2: The United States and Islam

Deeply shocked by massive terrorist attacks by al-Qaeda in the United States, many Americans asked why Muslims hated them. To answer this question, many U.S. politicians, scholars, and commentators retrieved the clash-of-civilizations theory and downplayed analysis of complex causes of terrorism. President Bush declared on September 15, 2001, that “this crusade, this war on terrorism is going to take a while,” thereby stunning many Muslims. For Muslims, a crusade evokes a highly emotional historical experience that laid the foundation for their interactions with the West. Furthermore, the clash-of-civilizations theory, with its assumption of a monolithic Islamic civilization, frustrated many Muslims who are aware of the diversity within the Islamic world and who also face terrorist threats from the Islamic extremists. The clash-of-civilization theme was reiterated by Bush in 2006 on the fifth anniversary of the September 11 attack when he asserted that the United States was in a struggle for civilization. Although cultural differences have contributed to conflicts between the United States and particular Muslim countries, specific national interests were by far the most important influences. The first significant clash was between a fledgling United States and the  Barbary States , or North Africa (Tunisia, Algeria, Morocco, and Libya or Tripolitania). As part of its wars with Spain, the Ottoman Empire, which controlled the Barbary States, encouraged piracy against Spain. Barbary pirates enslaved Europeans and Americans and demanded tribute (payment) from European and American commercial interests. U.S. president Thomas Jefferson eventually tried to end this piracy by sending U.S. marines “to the shores of Tripoli” (1801–1805).

The United States maintained a neutral approach to the region until the Six-Day War of 1967. As American petroleum companies became more deeply involved in the Middle East and as Britain reduced its role in the region after World War II, the United States developed closer relations with strategically important Islamic countries. Consequently, America was also increasingly perceived by many Muslims as colonial Europe’s replacement. Muslims’ perceptions of American indifference to Palestinian suffering as well as increasing globalization influence contemporary U.S. relations with the Muslim world. Globalization, especially American culture, both attracts and repels. Globalization reinforces connections between some Muslims and the United States while, simultaneously, undermining traditional society, compounding inequality, and generating feelings of alienation and insecurity.

The rise of militant Islam coincides with the growth of Islamic fundamentalists, whom many believe are engaged in an apocalyptic struggle with Western infidels. Some Islamic militants believe that by attacking the United States, viewed as a strong supporter of Israel, they will eventually reconquer Jerusalem from Israel or even destroy Israel itself. But Islamic militancy is also linked to U.S. involvement in Muslim countries. For example, American actions in Iran contributed to contemporary conflicts between the West and Islam. When Iranian students discovered from declassified U.S. Central Intelligence Agency documents in 1978 America’s role in the 1953 overthrow of Iran’s Prime Minister Mohammad Mossadeq, they engaged in mass demonstrations against the United States and the Iranian government, led by  Shah Muhammad Reza . Widespread opposition to the shah culminated in the Islamic Revolution, which forced the shah out of Iran in 1979 and facilitated Ayatollah Khomeini’s return to Iran from exile in France. American diplomats were taken hostage, and demonstrators occupied the American embassy. Although secularists who supported the revolution wanted to develop democracy in Iran, the Ayatollah’s followers were able to create an Islamic political system.

Ironically, peace between Egypt and Israel also fueled the emergence of extremist Islamic groups in Egypt, such as  Egyptian Islamic Jihad , which was responsible for the assassination of Egypt’s President Anwar Sadat in 1981. Sadat was killed because he signed the Camp David Accords with Israel and because of Egypt’s close links with the United States. Egyptian Islamic Jihad was strengthened by Muslims who went to Afghanistan to fight with the  mujahedeen  (i.e., holy warriors) to resist Soviet occupation of that country. When the Soviets invaded Afghanistan in 1979, the United States provided military assistance to the mujahedeen. Osama bin Laden, from Saudi Arabia, also joined the mujahedeen. Assisted by veterans from Afghanistan’s war, Egyptian Islamic Jihad carried out a series of bombings against U.S. targets, including American embassies in Kenya and Tanzania in 1998, and cooperated with al-Qaeda, led by bin Laden.

Sources of Muslim hatred of the United States are found within many Islamic countries. Many Arab governments are authoritarian and have used their considerable economic resources from petroleum to preserve the status quo. As we have seen, these governments now face popular uprisings. Barry Rubin argues that Muslim hatred of America is “largely the product of self-interested manipulation by groups that use anti-Americanism as a foil to distract public attention from other, far more serious problems within those societies.” 12  It is generally agreed that the spread of Islamic fundamentalism is, to some extent, a product of deteriorating economic conditions, growing economic inequality, rapid population growth, rural-to-urban migration, and declining social services, health care, and educational opportunities. Furthermore, the increasing Westernization of these countries is perceived by traditionalists as undermining Islam, the foundation of their societies. America is viewed as corrupting these countries’ elites and humiliating Muslims. America’s invasion of Iraq, widely perceived as an effort to consolidate its power in the Middle East, has heightened Arab anti-Americanism. Photographs of Americans abusing Iraqi prisoners at the  Abu Ghraib  prison in Iraq served to confirm Muslim perceptions of the United States. The acts of brutality, sadism, and dehumanization that occurred at Abu Ghraib demonstrated to Muslims that America regarded them as culturally distant and excludable from moral considerations that govern its own society.

14.3: Clashes Among Nations

1. 14.3 Examine how cultural distance and threatened national interests are the causes behind clashes among nations

Clashes among nations within the same civilization are common realities of international relations. For example, France and Britain sharpened their national identities through constant conflict with each other. Linda Colley contends, “Britain was an invention forged above all by war. Time and time again, war with France brought Britons, whether they hailed from Wales or Scotland or England, into confrontation with an obviously hostile other and encouraged them to define themselves collectively against it.” 13  The consolidation of diverse cultural groupings within England, France, Spain, and Germany was an essential component of the rise of national identity and nationalism. Growing nationalism culminated in clashes with the Catholic Church and the Holy Roman Empire. This clash within Western civilization elevated states above civilizations. Following the conclusion of the Peace of Westphalia in 1648, which marked the birth of the nation-state, European countries routinely engaged in wars to settle boundary disputes, underscoring not only the territoriality of states but also their preoccupation with who belongs to them. Two world wars were not only clashes among nations but also wars among countries sharing what is seen as a common civilization.

A combination of cultural distance and threatened national interests makes international conflicts more likely, partly because negotiations with distant others are generally downplayed or rejected. Two wars between the United States and Iraq (in 1991 and 2003) demonstrate this point. Many Americans lack close relationships with Arabs, and few are knowledgeable of Arab history and culture. Few believe that they share many common cultural values with Arabs. Instead, Americans generally rely on negative stereotypes when dealing with them. The Arab oil embargo in 1973–1974 etched a negative view of Arabs in American minds, which was reinforced by the terrorist attacks on the United States. Often Arabs are perceived as dangerous, untrustworthy, immoral, undemocratic, barbaric, and primitive. 14  Iraq’s leader, Saddam Hussein, reinforced these stereotypes. But American cultural values also played a significant role in conflicts with Iraq. In both wars, disputes with Iraq were framed in terms of good versus evil. The United States also viewed the wars as transformative: the destruction of Saddam Hussein would bring peace and democracy to the Middle East and resolve the Palestinian-Israeli conflict.

The United States’ reliance on force to resolve conflicts and its handling of international relations reinforced negative views held by the global community against it. This anti-Americanism is found among close European allies, in rich and poor countries, and in Christian as well as Islamic countries, a reality that directly challenges the clash-of-civilizations theory. Historically, countries threatened by a hegemonic power usually form alliances to balance that power, as we saw in  Chapter 2 . Fareed Zakaria argues that “by crudely asserting U.S. power and disregarding international institutions and alliances, the Bush administration pulled the curtain on decades of diplomacy and revealed that the United States’ constraints are self-imposed.” 15  From the European perspective, American power must be constrained. As Robert Jervis put it, “They fear a world in which their values and interests are served only at Washington’s sufferance.” 16  But great powers often experience a sense of permanent insecurity. Their quest for the illusive absolute security makes other countries feel less secure, which often engenders conflicts. By strongly supporting the United Nations and multilateral action to resolve disputes, the United States reduced global opposition to its overwhelming power. Conversely, America’s unilateral exercise of military might created fears among Europeans and others who perceive the United Nations as playing an essential role in promoting global governance. Furthermore, as America grows more nationalistic, Europeans are concentrating on building European political and economic cooperation.

International conflicts that are influenced by cultural differences and divergent national interests are also prevalent in Asia. China’s rapid economic expansion and growing U.S. dependence on imports from China have engendered both cooperation and conflict between the two countries. China is widely perceived as a rising power that is competing with America for global hegemony. Its strong economy attracts advanced technology from around the world, which enables it to improve its military capabilities. Japan’s historical rivalry with China is reinvigorated by Japan’s economic problems, the transfer of some of its manufacturing industries to China, and China’s assertiveness in claims to islands in the South China Sea. Nationalism in both China and Japan is resurging, even as economic cooperation between them strengthens. North Korea’s decision to test nuclear devices further reinforced Japan’s nationalism and security concerns. But as the case study of the war in Afghanistan shows, wars among nations are rare, whereas conflicts between states and nonstate actors are increasing.

14.4: Ethnic Conflicts

1. 14.4 Review the global issues of the causes of ethnic and religious conflicts

Horrific bloodshed in the Democratic Republic of the Congo, Rwanda, Bosnia, Sudan, Iraq, Chechnya, and elsewhere is widely publicized by the global media. The proliferation of humanitarian organizations and other nonstate actors has also helped to make the world more aware of ethnic conflicts. As our discussion of global terrorism in  Chapter 5  demonstrates, European countries, such as Spain, are challenged by groups that claim separate ethnic identities. In fact, as Europe moves toward greater unification, minority groups—such as

Table 14.1 Ethnic Conflicts

Country	Estimated Deaths	Description of Conflict
Nigeria	1 million (1966–1970)	Ibo region declared independence, calling itself Biafra
Angola	600,000 (1975–2002)	Civil war following independence from Portugal
East Timor	307,000 (1975–2000)	Struggle for independence against Indonesian occupation
Sri Lanka	70,000 (1983–2009)	Tamils fighting the Sinhalese government for a separate state
Iraq	45,000 Kurds and Shiites (1983–1992)	Suppression of rebellion against Saddam Hussein
Sudan (Darfur)	2 million (1983–2009)	Arab/Muslim North fighting Christian and animist South
Turkey	40,000 (1984–2009)	Kurdish groups fighting for autonomy
Sierra Leone	15,000 (1992–2000)	Attempt to overthrow the government
Burundi	250,000 (1993–1999)	Tutsis and Hutus fought after the president, a Hutu, was assassinated.
Yugoslavia	400,000 (1994)	Serbs against Muslims and Croats
Rwanda	800,000 (1994)	Hutus slaughtered Tutsis and moderate Hutus
Congo (Zaire)	5.4 million (1997)	Overthrow of Mobutu Sese Seko

Catalans, Basques, Corsicans, Scots, and Flemish—are seeking more autonomy. However, most of these ethnic or nationalist groups are not violent. Although the brutality and intractability of many ethnic conflicts tend to reinforce perceptions of escalating ethnic wars, there has actually been a decline in their number. 17

14.4.1: Ethnicity and Ethnic Identity

Tribalism, ethnicity, and ethnic nationalism are terms that are often used interchangeably.  Tribalism  is usually regarded as an anachronistic term that refers to groups of indigenous people. Most scholars prefer to refer to these groups as ethnic groups. Sometimes ethnic groups are located across the artificially created boundaries of several countries. Ethnic groups within states as well as those that straddle national boundaries may aspire to create their own country. To achieve this, they develop a strong sense of nationalism. For example, the  Kurds , an ethnic group that has nationalistic aspirations, are scattered among Turkey, Iraq, Iran, Syria, and parts of the former Soviet Union. Most ethnic groups attempt to achieve more political and cultural autonomy within the boundaries of existing states.

An ethnic group is composed of individuals who generally have a sense of common identity based on a common set of historical experiences, national sentiments, religious beliefs, geographic location, language and culture, and, in countries such as the United States, largely arbitrary racial categories.  Ethnicity  is a subjective perception of who belongs to a particular group. Ethnicity serves as a rallying point for mobilizing ethnic group members to compete for economic resources, positions in government and social and economic organizations, and social and religious status. An essential component of ethnicity is a strong sense of identity.  Identity  may be defined as a concept of the self, a selection of physical, psychological, emotional, or social attributes of particular individuals. There are different types of identity. Those include ethnic, religious, geographic, and linguistic identities. Identity provides a framework within which people construct reality and determine their positions on a wide range of issues. Members of different ethnic groups are predisposed to hold certain stereotypes about each other and to act on the basis of these assumptions.

Identity is generally about drawing sharp distinctions among groups and building boundaries that separate one group from another. It contributes to developing a feeling of “us versus them,” insiders versus outsiders. We treat members of our own group differently from members of another group. Discrimination on the basis of ethnic identity is a common problem worldwide. Instead of seeing discrimination as being inherently wrong and unfair, it becomes the norm.  Ethnic pluralism  (i.e., ethnic diversity) is the presence of many different groups within a specific geographic boundary. Several factors contribute to ethnic pluralism:

1. Conquest and annexation

2. The decision by colonial powers to put different ethnic groups together in newly created countries

3. The deliberate attempts by colonizers and others to divide people to control them

4. Migration

14.4.2: The Causes of Ethnic Conflict

Although conflicts between ethnic groups are often perceived as the result of “ancient hatreds,” most ethnic conflicts are very complex and have little to do with ancient animosities. In all societies, generational change and economic and social developments generally modify ancient hatreds. Contemporary ethnic conflicts have more immediate causes. Although the Scots and the English fought each other for centuries, these ancient hatreds do not influence them to fight today. Most ethnic wars occur in poor countries that have weak political institutions. Paul Collier has found that once a country achieves a per capita income similar to those of rich countries, its risk of ethnic conflict is negligible. The potential for conflict is concentrated in the poorest countries with declining economies and a heavy reliance on natural resources for a large share of national income.

Another cause of ethnic conflict is the deliberate manipulation of negative perceptions by leaders to mobilize group support for their own individual political, economic, and social objectives. Leaders rely on the emotional intensity and loyalty of ethnic group members. They know that distrust can be instrumental in fueling fears and that fears usually override logical, objective thinking. Consequently, despite misgivings individuals may have about engaging in or condoning violence against another group, these fears and an emotional commitment to their own group generally influence ethnic group members to follow their leaders.

Competition among groups for scarce economic resources is a major cause of ethnic violence. Growing economic disparities, resulting from economic development, may increase the fears and insecurities of those ethnic groups that are disadvantaged. On the other hand, ethnic conflict may emanate from attempts by an ethnic group to monopolize scarce resources. In Nigeria, for example, the  Ibos  fought to create a separate country (called Biafra) partly because of their experience with violence and discrimination and because they did not want to share the wealth from petroleum found in their region of the country. The discovery of oil in the Sudan has contributed to a humanitarian crisis in Darfur.

Forces of globalization help destroy boundaries essential to ethnic group solidarity and identity. Many leaders’ power is threatened, a development that often influences them to promote ethnic identity more zealously. Weak political institutions contribute to ethnic conflicts, especially when countries are experiencing economic, cultural, and technological transformation. The inabilities of political institutions to effectively regulate change and provide mechanisms through which differences can be managed frequently contribute to ethnic violence.

Systematic and widespread frustration of human needs may culminate in outbreaks of ethnic violence. Tensions are heightened by perceptions of favoritism toward other groups, compared with disadvantages suffered by the particular ethnic group. Ethnic group members are mobilized to articulate their grievances and to seek solutions to them. In many cases, violence is seen as the most effective instrument to get the government to respond favorably to their demands. This, in turn, influences the government to respond with violence against the ethnic group. Finally, the proliferation of automatic weapons, especially AK-47s, is a significant contributor to ethnic conflicts around the world. While it may be argued that these weapons do not cause conflict, their availability increases the potential for deadly clashes among ethnic groups or the use of violence by ethnic groups against governments, as we discussed in  Chapter 6 . Automatic weapons including AK-47s were used to kill and wound hundreds of civilians in the November 13, 2015 massacre in Paris, for which Muslim terrorists claimed credit.

14.4.3: Ethnic Clashes

Although ethnic violence is clearly more prevalent in poor countries, developed countries are also experiencing ethnic tensions and renewed ethnic nationalism. Since the end of the Cold War and the fall of the Berlin Wall, there has been a resurgence of anti-Semitism in Europe,

A Resurgence of Anti-Semitism in Europe Shows that Developed Countries are Experiencing Ethnic Tensions. A tribute grew in front of the Hyper Cacher kosher supermarket in Paris, where four Jewish hostages were killed and 15 other hostages were taken in the wake of the Charlie Hebdo terrorist killings two days earlier. The French president described the 2015 episode as a “terrifying act of anti-Semitism.”

especially in France. Mark Strauss states that “not since  Kristallnacht , the Nazi-led pogrom [violent campaign] against German Jews in 1938, have so many European synagogues and Jewish schools been desecrated.” 18  One of the oldest hatreds in Europe, anti-Semitism is strongest in Alsace, France, a region that has strong cultural ties to Germany. This traditionally German-speaking area was annexed by Germany in 1871, following the Franco-Prussian War, and remained under German control until the French conquered it in World War I. Alsace became a Nazi stronghold in the 1930s, and many Alsatians joined the Nationalist Socialist Party (Nazi Party) when Alsace was annexed by Adolf Hitler in 1940. The worst German atrocity in France against the Jews was the massacre at Oradour in Alsace in 1944. This historical affiliation with Nazism was rekindled by the rise of the  National Front , an extremely conservative political movement. Both Jews and Muslims are targets of violence. Under the leadership of Marine Le Pen, the National Front is attempting to change perceptions of it as a far-right extremist anti-Semitic party. It is opposed to immigration, Islam, and illegal Roma encampments.

Anti-Semitism has risen sharply across Europe, especially following Israel’s devastating military campaign against the Palestinians in Gaza in 2014. A growing number of Jews have been raped, beaten, and murdered in France, Belgium, Denmark, and elsewhere in Europe. Muslims commit most of the violence against Jews, which, ironically, contributes to growing anti-Muslim and anti-immigration views in Europe. In January 2015, Muslim extremists killed four Jews at a kosher supermarket in Paris two days after the Charlie Hebdo massacre discussed in  Chapter 5 . Responding to increasing anti-Semitism, many Jews are leaving Europe and going mainly to Israel, a development encouraged by the Israeli government. 19

The political landscape in Europe in regard to Muslims will be affected by the November 13, 2015 terrorist attack on Paris, for which the terrorist organization Islamic State of Iraq and Syria (ISIS), claimed credit. The growing number of Muslims in countries across Europe has been perceived as a threat to cultural institutions. This perception of threat has escalated with the rise of Islamic terrorism such as the Paris massacre and other terrorist attacks on France, the United States, Spain, and Britain. Other countries in Europe have been concerned about demographic changes brought about by the great influx of Muslim immigrants, whom they see as making Islam a part of the previously predominantly Christian European culture. Religious symbols, especially the Muslim headscarf, have been politicized. France, stressing the separation of church and state, has been the most aggressive European country in terms of banning headscarves in public schools.

Canada and the United States, two of the world’s most ethnically diverse countries, have managed to reduce ethnic violence by bringing various ethnic minorities into the democratic process and by outlawing discrimination. Canada was confronted with separatist movements in Quebec until recently. Quebec, colonized and settled by the French, was conquered by the British in 1759. The  Treaty of Paris  in 1763 officially transferred Quebec from France to Britain, making it part of British Canada. Many people in Quebec maintained close ties with France and nurtured French culture and language. Generational change, economic interdependence, political reforms, and increased immigration to Quebec combined to lessen nationalistic aspirations. However, the growing numbers of Muslims in Canada, as well as that country’s strong commitment to multiculturalism, have created new ethnic tensions. Autonomy granted to various Native American groups has inspired other ethnic groups to seek more cultural autonomy. Muslims, for example, point to Jews and their ability to use Jewish laws to govern their communities and argue that  sharia law  (Islamic law) should govern Muslim communities.

Ethnic conflicts in the former Yugoslavia produced widespread military confrontation in which ethnic identity literally became a matter of life and death. These conflicts also underscored how cultural links with various countries influenced both military actions and efforts to terminate the bloodshed. The Croats have historically been the most thoroughly integrated into European civilization, largely as a consequence of their domination by Austria-Hungary and Venice. Serbs identify with Eastern Orthodox countries, such as Greece and Russia, and the Muslims, though they are also Europeans and Slavic, are regarded as remnants of the Ottoman Empire and identify with Turkey and other Islamic countries. Composed of six republics—Bosnia-Herzegovina, Croatia, Macedonia, Montenegro, Serbia, and Slovenia—and the two provinces of Kosovo and Vojvodina, Yugoslavia was an artificial nation-state held together by  Marshall Josip Tito’s  domineering personality and the League of Communists of Yugoslavia (LCY) until Tito’s death in 1980 and the fall of Communism in the late 1980s. As Yugoslavia’s disintegration became obvious, the Republic of Serbia intensified its efforts to arrest Yugoslavia’s fragmentation and to continue Serbia’s dominance. Bosnia’s Serbs, led by  Radovan Karadzic , favored increased centralization, whereas the Muslims and Croats opted for a loose confederation. Acting on their fears of each other and remembering historical experiences, Croats and Serbs began to dismember Bosnia. Muslims, aware that Bosnia had been divided between Croatia and Serbia prior to World War II, resisted reabsorption into those states. Serbia clearly intended to use its superior military might to fashion Greater Serbia out of Croatia and Bosnia.  Slobodan Milosevic , president of Yugoslavia (who was later tried for war crimes at the International Criminal Court at the Hague), boasted that the Serbs were on the threshold of “the final solution.”

Although Muslims and Croats engaged in their own campaigns of  ethnic cleansing , the Serbs were primarily responsible for genocide, and Muslims were the principal victims. After depriving Muslims of their jobs and property, the Serbs began to destroy their villages and cities and forced them to leave, thereby creating the greatest refugee crisis in Europe since World War II. Many refugees were shipped out of northern Bosnia in sealed freight trains, a practice reminiscent of Nazi Germany’s treatment of the Jews. Atrocities included the massacre of villagers; the torture, rape, and killing of prisoners; the use of Muslims as human shields; and the taking of hostages. Many civilians, imprisoned in forty-five concentration camps, were executed. Serbian gunmen raped more than fifty thousand Muslim women and children as part of their program of ethnic cleansing and as a weapon of war. Echoing Nazi Germany’s plan to exterminate the Jews and eliminate all traces of Jewish culture, Serb nationalists attempted to destroy the Muslims’ culture. Mosques, central to Muslims’ identity and society, were principal targets. Historical monuments and libraries that were depositories for more than five centuries of Muslim culture were reduced to rubble.

Ethnic conflicts in Rwanda also demonstrate how ethnic differences are socially constructed and how deadly the consequences of policies exaggerating and emphasizing small differences can be. Genocide in Rwanda, the Congo, and Sudan illustrate that the decline in the number of ethnic conflicts globally is largely irrelevant to Africa, the continent most marginalized from globalization. As we discussed earlier, the world’s poorest countries, most of which are in Africa, are the most vulnerable to prolonged and widespread ethnic violence. Africa also has a very large number of ethnic groups, many of which live together in artificially created countries. When the Germans conquered what is now Rwanda in 1899, they encountered two main groups: the  Hutus , who comprised the majority of the population, and the  Tutsis , a small group of cattle herders who ruled the area. Many smaller groups spoke the same language and shared the same culture. Years of intermarriage made it difficult to neatly separate them into distinct ethnic groups. The Germans relied primarily on the ruling Tutsis to help them control the territory. They designated the Tutsis as the superior group, a perception reinforced by the Belgians who gained control of Rwanda in 1916, following Germany’s defeat in World War I. Germany’s and Turkey’s colonies became mandates under the League of Nations. Finding it difficult to distinguish Hutus from Tutsis, the Belgians issued mandatory identity cards to all Rwandans, placing each person into a fixed ethnic category. Eventually the Tutsis, who received preferential treatment from the Belgians, believed that they were indeed superior to the Hutus. However, Belgian missionaries, believing in equality and social progress, helped disadvantaged Hutus obtain education. Educated Hutus,

WHAT DOES THIS PHOTO CONVEY ABOUT ETHNIC CONFLICT? A YOUNG ETHNIC ALBANIAN BOY CARRIES HIS SISTER AS THEY LOOK THROUGH BARBED WIRE AT A REFUGEE CAMP. Almost a million ethnic Albanians fled or were expelled from Kosovo.

facing discrimination, challenged the system that gave Tutsis significant advantages and advocated ethnic separation. In 1959, the Hutus rebelled and killed more than twenty thousand Tutsis. When Rwanda became independent in 1962, the Hutu majority gained political control.

Ethnic rivalries escalated in 1990 when the Hutus’ power was challenged by the Rwanda Patriotic Front army, which was composed of Tutsis. To restore a measure of peace and stability, moderate Hutus agreed to share power with the Tutsis. Hutu extremists responded by killing both Tutsis and moderate Hutus. When a plane carrying Rwanda’s President Juvenal Habyarimana, a Hutu, crashed on April 6, 1994, ethnic violence erupted with a force that stunned the global community. Believing that Tutsis were responsible for destroying the plane, Hutus circulated lists of names of those favoring democracy and national reconciliation. They set up roadblocks, demanded identity cards, and systematically killed Tutsis. Students were slaughtered by their teachers, neighbors killed neighbors, and clergymen participated in the genocide. In many cases, husbands killed their families and then committed suicide to avoid a more terrible death. About eight hundred thousand people were slaughtered in thirteen weeks of fighting in Rwanda. In the aftermath of this genocide, Rwandan authorities decided to outlaw ethnic identity.

14.5: Religious Violence

1. 14.5 Report the phenomenon of religious violence

Religious violence has escalated since the fall of dictatorial regimes in Iraq, Egypt, and Myanmar (Burma) and the civil war in Syria. Attempts to transition to democracy, along with historical fears and contemporary economic and demographic issues, underlie many religious conflicts. As authoritarian leaders lost power and control over the population, which they had held together through intimidation and coercion, religious groups that lived in relative harmony quickly embraced an explosive mixture of nationalism and religious hatred. Emerging democracies have largely failed to establish order and to protect religious minorities from violence by religious majorities. Violence has spread to other countries that share religious beliefs with different sides in conflicts. Although many of these clashes have historical roots, such as the schism between Sunnis and Shiites over the issue of succession to leadership of Muslims following the Prophet Muhammad’s death or British colonial policies toward the Muslim minority in Burma (now Myanmar), they are mainly driven by individuals who are exploiting history to achieve their own political, economic, and cultural objectives.

Following the relatively sudden demise of Hosni Mubarak’s authoritarian regime, Egypt descended into lawlessness and violence. Egypt’s new leader, Mohamed Morsi, and his supporters in the Muslim Brotherhood failed to develop a post-Mubarak agenda that could unite Egyptians. Instead, Islamist hard-liners derided opposition groups as enemies of Egypt and fanned the flames of hatred against the Shiite and Coptic Christian minorities. Violence against Christians grew after Morsi was overthrown by the military, which had the support of millions of Egyptians who had protested against Morsi and had demanded his removal from power. Many of Morsi’s supporters believe that Christians helped to bring about the military coup and that they are part of a global anti-Muslim conspiracy. Muslims destroyed at least forty-seven churches and monasteries. At least seven Christians were killed. Sunni extremists have terrified the tiny Shiite minority (less than 1 percent of the population), and at least four of them were killed.

What began as a popular uprising to remove Syria’s authoritarian ruler, Bashar Assad, from office and bring about a transition to democracy soon degenerated into a brutal civil war in which sectarian violence became a dominant component. Assad is a member of the minority Alawites, a Shiite sect. The majority of Syrians and those who oppose the Assad regime are Sunnis. Roughly 220,000 Syrians have been killed, including more than 10,000 children. Thousands of the casualties, including children, were tortured to death. Sunni countries such as Saudi Arabia, Qatar, and Turkey support the opposition, while Iran and Hezbollah in Lebanon support Assad. Reverberations of the Syrian civil war can be felt throughout the Middle East, especially in neighboring Iraq. Gruesome suicide bombings of Shiites occur almost daily and are carried out by Sunni Muslims led by al-Qaeda.

Britain brought Indians, many of them Muslims, to Burma (Myanmar) during its colonial rule to work in the civil service and to join the army. Eventually, they controlled much of the country’s finance and commerce, thereby fueling resentment among the Buddhists. Muslims, Christians, and Hindus are tiny minorities. These groups lived together peacefully under the country’s harsh authoritarian military rule. Myanmar’s remarkable and rapid transition to democracy under military control, discussed in  Chapter 4 , unleashed unprecedented religious violence that was inflicted on Muslims by Buddhists. More than 200 Muslims have been killed and more than 150,000 made homeless. Many have become refugees. Extremist Buddhists believe that Muslims are having too many children and that they will dilute the country’s Buddhist character.

In contrast to northern Nigeria, discussed in  Chapter  5 , where the dominant Muslim majority engages in widespread violence against the Christian minority, in the Central African Republic, Christians carried out what have been called pregenocidal atrocities against the Muslim minority. The gruesome sectarian violence, including indiscriminate killings, torture, summary executions, and cannibalism, forced more than half a million Muslims to flee to neighboring Chad and Cameroon. Muslims initiated the violence when they killed, raped, and robbed Christians on their way from the predominantly Muslim northern part of the country to seize power in Bangui, the capital, in the predominantly Christian southern part of the country. When the Muslims were eventually defeated by Christian militias who regained power, Christians unleashed an unprecedented wave of bloodshed against Muslims.

Religious violence in Iraq is intertwined with terrorism conducted by  ISIS (Islamic State of Iraq and Greater Syria) , which is affiliated with al-Qaeda. ISIS controls Sunni areas of Iraq bordering Jordan and Syria. When ISIS vowed to exterminate the Iraqi non-Muslim Yazidi minority sect and Christians, many of whom sought refuge in the parched Sinjar Mountains, where they were trapped, the United States and Britain responded to this humanitarian crisis with airdrops of water, food, and other essential supplies to the Yazidis and the Christians. The United States built a broad coalition of countries to conduct airstrikes against ISIS. The United States, Britain, Australia, and France also supplied weapons to Iraq’s Kurds to enable them to prevent ISIS from conquering Kurdish areas and to recapture territory it seized, including the strategic Mosul dam.

ISIS escalated its gruesome murders, primarily beheadings, of hostages from the United States, Britain, France, Iraq, Syria, Jordan, Japan, and elsewhere. It used graphic videos on social media of the murders to publicize its brutality as part of its global campaign of terror and to recruit members, especially from Western Europe, the United States, and Australia. Claiming to practice purified teachings of the Prophet Muhammad, ISIS destroyed Shiite, Sufi, and Christian religious sites as well as Iraqi statues and sculptures from the seventh century BCE, regarding them as symbols of idolatry. Religious terrorism and global terrorism are discussed in  Chapter 5 . 20

14.6: Resolving Cultural Conflicts

1. 14.6 Describe the four interrelated approaches to resolving cultural conflicts

In many ways, globalization was widely perceived as instrumental in creating a more harmonious world. Global markets and the promotion of democracy were believed to diminish violent clashes. Although the realization of Immanuel Kant’s vision of perpetual peace seemed distant, many political scientists and others observed that democratic norms that emphasize compromise, persuasion, peaceful competition, the protection of minority rights, and so on would move the global community closer to Kant’s vision. The end of the Cold War and increasing globalization contributed to a stronger global emphasis on peacefully resolving conflicts. NGOs, such as the Carter Center in Atlanta and the Crisis Management Initiative in Helsinki, play leading roles in conflict resolution. Their unconventional approach to negotiation is known as  track II diplomacy . We will examine four interrelated approaches to conflict resolution: (1) negotiation, (2) peacekeeping (which includes humanitarian intervention), (3) peacemaking, and (4) peacebuilding.

14.6.1: Negotiation

Negotiation is back-and-forth communication to reconcile contradictory positions and conflicting interests in order to reach an agreement acceptable to the parties involved. Negotiation is principally concerned with helping one’s opponent make a particular decision. An important impetus for advancing proposals and making concessions and compromises is that there are common interests that can be secured through cooperation. 21  Each side must be willing to make those adjustments that are essential to reaching a compromise, thereby creating what Roger Fisher and William Ury in Getting to Yes call a win-win situation (where both sides gain) instead of taking a zero-sum approach (where one side wins and the other loses). But negotiation is not entirely separated from the use of coercion or violence. Most conflicts cannot be resolved by relying on either negotiation or the threat of force. Negotiations involve both  carrots  (inducements) and sticks (punishments).

Raymond Cohen stresses that cultural values directly influence negotiation strategies and the success of negotiations in Negotiating Across Cultures. When individuals, countries, and ethnic groups focus primarily on their underlying interests and objectives, they have a better chance of resolving disputes than if they allow their emotions and beliefs to dominate. Learning the other side’s real interests necessitates a careful and patient probing of the needs, hopes, fears, perceptions, and cultural values that form their sense of what is threatening or vital to protecting their identity. This requires willingness on the negotiator’s part to listen actively to the other side and to put himself or herself in the other side’s shoes, as it were. Active listening involves trying to hear and absorb the other side’s views of the facts as distinct from one’s own, to seek further clarification through questioning, and to process the information received in terms of the larger context of the situation and the issues of the movement. In addition to active listening, negotiators must develop formulas or  trade-offs . A trade-off is essentially an exchange to address the fears and interests of those involved. An example of a trade-off is the 1967  UN Security Council Resolution 242 , which attempted to resolve the Middle East conflict by exchanging land for peace. Israel would withdraw its armed forces from territories it had conquered and occupied in exchange for the Arabs’ termination of belligerency against Israel and recognition of Israel’s sovereignty and territorial boundaries.

Numerous barriers impede successfully negotiating cultural conflicts. Perceptions often complicate negotiations between parties that have very different cultures. Information and facts that contradict our perceptions and images of ourselves and others are usually ignored or overlooked. Stereotypes impede the negotiating process between nations and ethnic groups that are culturally distant by fostering negative interpretations of motives behind actions that could be viewed as positive developments. Public opinion is also important. If citizens or ethnic group members believe that force is an effective and desirable means of dealing with disputes, leaders are likely to consider military action against the opponent. A society or group that perceives compromise as a sign of weakness is likely to produce leaders who devalue negotiations with adversaries. Similarly, leaders and policymakers who perceive the world as hostile and conflict ridden and who believe that only military force provides real security are generally likely to reject or downplay negotiations.

14.6.2: Peacekeeping and Humanitarian Intervention

Increasingly, the United Nations and regional organizations intervene militarily to end international and interethnic violence or to prevent it from escalating. This is called  peacekeeping . A principal objective is to create an environment that is conducive to both humanitarian operations and negotiations. Peacekeeping missions are generally supported by the global community as well as the combatants. Nonstate actors—such as Amnesty International, Catholic Relief Services, Oxfam, and the International Committee of the Red Cross—cooperate with the United Nations and regional organizations. However, the global community is often slow in responding to ethnic conflicts. Humanitarian intervention is closely related to the doctrine of  responsibility to protect (R2P)  civilians in conflicts, as discussed in  Chapter 3 . The NATO intervention in Libya against the Qaddafi regime reinforced global acceptance of the necessity for humanitarian intervention. However, failure to protect civilians in Syria’s brutal civil war undermines this doctrine. An issue raised in humanitarian intervention is the concept of a  just war . A just war must meet certain criteria:

1. Support a just cause

2. Be just in intent

3. Be of last resort

4. Have limited objectives

5. Be proportional

6. Be declared by legitimate authorities

7. Not involve noncombatants

14.6.3: Peacemaking

Peacemaking , which generally occurs after peacekeeping has made significant progress, involves the intervention of neutral third parties. Their objective is to get the combatants to reach a political settlement through negotiations. These intermediaries rely on certain methods such as arbitration, mediation, and facilitation.  Arbitration  refers to “binding, authoritative third-party intervention in which conflict parties agree to hand the determination of a final settlement to outsiders.” 22   Mediation  is a process of facilitating communication between combatants to encourage them to brainstorm, invent options for mutual gains, and try to see the other side’s perception of reality and legitimate concerns, as well as help them understand difficulties that might prevent the other side from meeting their demands. Mediators generally have some leverage over parties to a conflict and are generally seen as impartial.  Facilitation  is a cooperative, nonhierarchal, and noncoercive approach to conflict resolution. Facilitation attempts to get those involved in conflict to see the problem as a shared problem that requires cooperation to be solved. The third party’s objective is to get the adversaries to engage in joint decision making to reach a settlement that is self-sustaining. 23

14.6.4: Peacebuilding

Peacebuilding  is a long-term process of implementing peaceful social change through economic development and reforms, political reforms, and territorial compromises. Peacebuilding concentrates on improving conditions for a country’s population or an ethnic group’s members. By making economic reform, more equal distribution of economic opportunities, and economic development leading priorities, governments of ethnically torn countries can end the cycle of conflict. Ongoing violence in Afghanistan and the civil war in Iraq are widely perceived as partly due to the failure of the United States to provide essential economic change and help people with basic human security needs. Paul Collier observes that the postconflict period is a good time to reform because vested interests are loosened up. 24  Diaspora organizations can play a major role in the economic recovery of their original countries by providing money, skills, and valuable connections. Political reforms, including transitions to democracy, and power-sharing arrangements can be helpful. However, equating holding elections with democracy is a fallacy that is usually counterproductive. Building democracy takes time. This is clearly demonstrated by the failure of U.S. efforts to promote democracy in Iraq by stressing holding elections.  Power-sharing arrangements  divide political power among different ethnic groups. However, unless periodic adjustments are made to reflect changing demographics, these arrangements tend to disintegrate and ethnic conflicts erupt. In Lebanon, for example, government positions and political power were divided between the Maronite Christians and Sunni Muslims. But the power-sharing arrangement was not changed to reflect the rapid growth of the Muslim population. The country was plunged into a brutal civil war from 1975 to 1990. Israel’s invasion of Lebanon in 2006 weakened the Lebanese government and exacerbated tensions among the various ethnic and religious groups. Federalism (i.e., the sharing of power between the central government and states, provinces, or regions) helps solve ethnic conflicts. Ethnic groups can enjoy a degree of autonomy while remaining within the existing country. Finally,  partition  (i.e., the forming of a separate and independent country from an ethnic group) is generally regarded as a last resort. Many Kurds in Iraq and Turkey have advocated creating separate states to solve ethnic conflicts. As ethnic violence escalated in Iraq, many Shiites advocated dividing the country along ethnic lines. Elections and political compromises among the ethnic groups kept Iraq unified. Bitter conflicts between North Sudan and South Sudan were resolved by dividing Africa’s largest state. In a referendum held in January 2011 under UN auspices, South Sudanese voted for an independent country. 25  States are extremely reluctant to agree to partition, as America’s Civil War clearly demonstrates.

Case Study War in Afghanistan

War, a central component of international relations, has traditionally been fought between states. America’s longest war is not with another state but is instead a war against a nonstate actor, a terrorist group. Since the beginning of the war in 2001, the United States and its allies in the U.S.-led International Security Assistance Force (ISAF), which has roughly 150,000 troops, have lost hundreds of lives each year and have spent hundreds of billions of dollars (about $7 billion a month).

Afghanistan, historically at the center of the “great game” among the leading military powers for influence in Central Asia, was invaded by the Soviet Union in 1979. Responding to Soviet aggression in the larger context of the Cold War, the United States imposed ineffective sanctions against the Soviet Union and increased military support to Pakistan. The United States, regarding the Afghan resistance movement (known as the mujahedeen, or holy warriors) as freedom fighters, provided them with military aid to counteract Soviet military superiority. Muslims from other countries, including Osama bin Laden (from Saudi Arabia), joined the mujahedeen. The effectiveness and brutality of the mujahedeen forced the Soviets to withdraw in 1989. Afghanistan disintegrated into a civil war during which the Taliban, which emerged from the freedom fighters, gained control of the country and provided a safe haven for bin Laden and his fighters. On September 11, 2001, terrorists from al-Qaeda, headed by bin Laden, hijacked four U.S. passenger jets loaded with fuel and used them as missiles to bomb the World Trade Center in New York as well as the Pentagon, the center of American military might, in Arlington, Virginia, just outside Washington, D.C.

On October 7, 2001, the United States, with British support, began Operation Enduring Freedom with a massive bombing campaign in Afghanistan after the Taliban refused to surrender bin Laden and to close al-Qaeda’s training bases and terrorist network. Supported by the United States, the Northern Alliance (the Afghan opposition) captured Kabul and drove the Taliban from urban areas. America announced the end of major combat operations on May 1, 2003. However, driven largely by hubris and the arrogance of power, America launched a pre-emptive war against Iraq in March 2003, thereby diverting resources and attention away from Afghanistan and destroying the global support it had for the war against the Taliban and al-Qaeda.

America’s inability to defeat the Taliban is due in part to its failure to focus on Afghanistan’s endemic weaknesses that gave rise to the Taliban. The United States and its allies did not invest enough resources in improving government institutions, the justice system, the army and police, and local governance. 26  The government in Afghanistan is deeply corrupt.

Recognizing that the war against a nonstate actor is unwinnable, the United States decided to withdraw its troops in 2014. Given this reality, greater emphasis must be given to empowering the Afghans to govern themselves. A major step toward this goal is focusing on capacity development, enhancing the capabilities and performance of civilian institutions of governance. Another solution is to support political decentralization by allowing local leaders to take greater responsibilities for their communities. In light of its vital interests in Afghanistan, America must remain engaged and continue to work with the Afghans and develop arrangements such as joint basing. This means that America would help Afghans in various military operations. Finally, there needs to be a shift away from the concept of traditional war to a comprehensive counterterrorism strategy in the Pashtun area of Afghanistan, which is a Taliban stronghold. Efforts to reach a negotiated settlement with members of the Taliban must be strengthened. Nation-building strategies could be continued in the rest of the country. 27

Summary

Various periods of globalization have contributed to the cross-fertilization of cultures as well as to cultural clashes. This chapter focused on how the contemporary period of globalization is creating cultural homogenization and hybridization even as scholars and others believe that the world is divided into clashing civilizations. As we have seen throughout history, most violent conflicts have occurred within civilizations, within regions, and among groups within the same country. We saw that culture and nationalism have often been closely intertwined. We discussed the problem of ethnocentrism as a major factor in civilizational, international, and ethnic conflicts. We challenged the dominant perspective that Western states and the Muslim world are inherently incompatible and hostile. However, the political, economic, and cultural forces of globalization heighten insecurities among states, groups, and individuals.

This chapter examined ethnic conflicts, several causes of ethnic conflicts, some of the reasons for the decline in ethnic wars, and growing religious violence. The rising costs of ethnic conflicts, active global promotion of democracy, global concerns about human rights, and increased global efforts to find peaceful solutions to conflicts have contributed to the decline or limitation of many ethnic wars. Nevertheless, many leaders continue to manipulate ethnic differences to achieve their various objectives. Finally, we examined global and regional efforts to end conflicts. These include negotiation, peacekeeping, peacemaking, and peacebuilding.

Discussion Questions

1. How does globalization affect ethnicity, nationalism, and cultural clashes?

2. Can you give a short background on the Hutu-Tutsi ethnic conflict that resulted in the Rwandan genocide?

3. Discuss the four approaches to resolving cultural conflicts presented in this chapter.

4. Discuss the growth of religious violence. Give examples.

5. With specific reference to U.S. relations with Muslim countries, critically evaluate Huntington’s thesis on the clash of civilizations.