Infectious diseases remain a persistent problem in many poor countries globally and, certainly, affluent countries are not immune to extreme suffering and death from communicable diseases. While the COVID-19 pandemic represents a salient example, “new” disease outbreaks, such as monkeypox (mpox), Zika, Ebola and HIV/AIDS are increasingly making news headlines and posing serious threats to human health globally. Infectious diseases have long been considered “diseases of the poor,” as these pathogens spread easily in crowded conditions, among malnourished populations and among people who lack adequate access to clean water, proper sanitation and other basic public health elements (e.g., Braveman, Egerter, and Williams 2011). While recent examples demonstrate that infectious diseases can infect people in affluent countries as well as impoverished ones, it is clear that the emergence of new infections and persistent suffering from communicable diseases remains concentrated in the Global South (e.g., WHO 2020).

In the field of public health, increased attention toward the social determinants of health sheds light on how various social conditions, such as level of education or income, working conditions and job security, food insecurity, housing, discrimination and access to affordable health services, impact the health of communities and individuals (e.g., Braveman, Egerte, and Williams 2011). While this framework importantly goes beyond biomedical explanations of health, it fails to consider the larger structural factors that impact the commonly articulated social determinants. Indeed, transformations such as colonialism and the establishment and continued expansion of the capitalist world-economy have greatly influenced how income, wealth and social determinants are distributed and used across and within countries. We must engage macro-level theory in order to truly understand the patterns in disease taking shape globally today.

Immanuel Wallerstein's (1974, 2004) articulation of world-systems analysis (WSA) offers meaningful insights on current global health dynamics. Although rarely referring to health or disease directly, his theorization on global inequality and development, including crucial elements such as unequal exchange, has keen relevance for patterns in infectious disease. Reflecting the significance of Wallerstein's articulations, a growing body of scholarship draws on WSA to explain important trends, including in infectious disease outcomes like HIV/AIDS, malaria and tuberculosis (TB), as well as the emergence of new zoonotic diseases (e.g., Austin 2015, 2021; Coburn et al. 2017; Maynard and Ong 2016; Maynard, Shircliff, and Restivo 2012).