Introduction
Crises are a feature of the modern era. Financial crises, climate crises, refugee crises, energy crises, humanitarian crises or health crises create a strong demand for reflection on crises in different geographical areas, human (and non-human) communities, economic sectors and time periods. Health crises are a particular type of crisis affecting the lives of modern people. Although they relate to the area of public health due to their multiple consequences and the means used to combat them, such as limiting contact between people and a threat to safety, they significantly affect all spheres of social and economic life. Alongside the major problems of the present day, such as wealth disparity, uneven economic development, problems of war and peace, environmental protection, demographic pressure, and the dangers of the development of artificial intelligence, these are one of the main points of the agenda for consideration of the present and future scenarios. The increased interest in the issue of health crises was triggered by the recently ended COVID-19 pandemic, which turned out to be a health crisis (COVID-19 crisis) with particularly significant social and economic consequences.
The aim of the study is to characterise the phenomenon of health crises as a challenge faced by contemporary societies and to indicate the importance of such phenomena from the perspective of understanding the present and building scenarios for the future.
The study consists of three parts. The first part is devoted to the issues of defining the concept of crisis and the problems connected with the use of the term ‘crisis’ and the study of crises. The second part explains the concept of health crisis and presents the major health crises in human history, analysing the social and economic consequences of the health crises of the 20th and 21st century. The third part of the study looks at the health and non-health consequences of the COVID-19 crisis. The study closes with conclusions resulting from the analysis.
The concept of crisis
According to the Polish dictionary, the word ‘crisis’ means a ‘situation that is unfavourable for someone or something’. In colloquial terms, crisis is ‘a difficult situation’ that exists or may occur (Szymczak, 1978). The term is also understood as a turning point in the course of events, a decisive moment, a breakthrough period, a stage or event followed by change. The term ‘crisis’ is also used for the description of ‘extraordinary conditions’ to indicate a moment experienced individually or collectively when the usual course of life is challenged and when the state of affairs regarded as normal until then begins to be perceived as no longer tenable. The concept of crisis is also understood as a ‘moment of disruption of normal processes’, ‘a breakdown of the existing stable structure of reality’, or ‘a state of decomposition and disintegration’. As we can see, the concept of crisis is used in a number of very different senses, thereby being difficult to understand clearly and to apply precisely.
The origins of the term ‘crisis’ can be traced back to ancient Greece, where the word Kρισις (krisis) meant a judgement made to refer to a decision regarding an illness or proceedings. It was also used in the political sphere in the sense of a crucial moment that required a decision (Barrios, 2017). For the ancient Greeks, the concept had a relatively limited meaning in the sphere of law, medicine and theology. It imposed a choice between stark alternatives: good or evil, life or death, salvation or damnation (Koselleck, 1988; Koselleck, 2006). Related meanings of the term also included the formation of judgement, making the concept the etymological foundation of the subsequent eighteenth-century term ‘criticism’, which indicates that the concepts of crisis and criticism are closely interrelated (Barrios, 2017). The concept of crisis is also referred to by the terms ‘critic’, i.e. someone who judges, and ‘critical state’, i.e. a state that can end well or badly, whose outcome is essentially uncertain, such as a person’s medical condition, which can go either way and can end differently (Davies, 2020).
The Middle Ages saw the evolution in the meaning of the term ‘crisis’, which assumed a more theological, Judeo-Christian sense. It began to be associated with the final judgement, the awaited moment that marks the end of history and the beginning of a new era, after which things will never be the same. This meaning became a broader cultural background against which eighteenth-century historians began to perceive the crisis as a moment of transition between eras, which were understood as time periods qualitatively different from each other.
At the end of the 19th century, the concept of crisis, in the sense outlined above, i.e. epochal change, became the basis on which some representatives of the social sciences began to build theories of social evolution. This interpretation is clearly evident, for example, in Karl Marx’s theory of social development, where socio-economic crises result from the inherent contradiction of capitalism occurring between labour and capital and ultimately lead to a transition to a new idealised communist socio-economic formation. According to some commentators, this interpretation is a sign of the transposition of well-established Christian theological narratives of salvation to the secular sphere (Koselleck, 2006; Roitman, 2012).
Nowadays, due to the historically grounded multiplicity of meanings and the general nature of the term ‘crisis’, this concept usually occurs in combination with a term defining the type of crisis. Therefore, we can speak of housing crisis, worldview crisis, fuel crisis, refugee crisis, energy crisis and many other crises that arise depending on the issue under analysis. In medicine, the term ‘crisis’ stands for the most severe phase of illness equated with the concept of a breakthrough, which is understood as a sudden abrupt turning point of the illness with a rapid reduction of fever and cessation of other disease symptoms. In politics, it is used in the context of parliamentary democracy when referring to a government crisis (parliamentary crisis), or a constitutional crisis, where the former describes the situation caused by the collapse of the government as a result of a parliamentary vote of no confidence1, and the latter is used to describe a conflict between authorities (Radziewicz, 2020). In economics, the term ‘crisis’ is used with regard to an economic crisis understood as a major breakdown of the economic growth process (in economic history, crisis defined in this way is first mentioned in relation to medieval Europe in the 14th century (Szpak, 2003), and in economic theory the term denotes a phase of the business cycle characterised by a significant reduction in the volume of production, an increase in unemployment, a decrease of income and the deepening differentiation in the sphere of the population’s living conditions. (Czech et al., 2020; Kalinski, Zalesko, 2009). In the context of state finances, it means a financial crisis or debt crisis (Acharya, Richardson, 2009)2. Financial crisis is understood as an episode of rapid change in financial markets involving a shortage of liquidity or even insolvency of some market participants and interventions by public sector authorities aimed at preventing this (Bordo et al., 2001).
In the social sciences, the types of crisis under analysis also include a crisis of values or international crisis. Sociologists analyse the identity crisis of human communities (Popiołek, Bańka, 2010), psychologists speak of personal crisis as a type of situation difficult for an individual or psychological crisis and its types such as suicidal crisis, psychological crisis, burnout crisis, identity crisis and crisis related to the choice of sexual orientation (Pilecka, 2004). In the social sciences, the concept of crisis is also used in the sense of a general crisis of society (Teusz, Teusz, 2023) or a crisis of culture (Karpiński, 2024). In relation to religion and religious worship, religious scholars use the concept of a crisis of faith (beliefs) and, more specifically, a crisis of Christianity (Ziemiński, 2014). In the context of protection of the natural environment and the dangers of its overexploitation, environmentalists use the concept of ecological crisis (Dobrzański, 1999). We can also encounter the term ‘crisis of institutions’ and, in relation to economic and political change, the term ‘transformational crisis’ (Chmielak, 2009). In philosophy, the concepts of ideological–axiomatic crisis (Kowalczyk, 2011), the crisis of analytical philosophy (Piłat, 2005) or the crisis of metaphysics (Chromik, 2012) are used. Philosophers also analyse the crisis of humanity (Husserl, 1993). In relation to the sphere of tourism alone, the concept of crisis is used in the following senses: tourism crisis, tourism industry crisis, tourism management crisis, tourism demand crisis, tourism recovery crisis, tourism confidence crisis, tourist communication crisis, tourism destination crisis, crisis tourism sector, or terrorism-related tourism crisis3.
Taking the multiplicity of uses of the term ‘crisis’ into account, the authors studying the history and meaning of concepts highlight the intricacies of the use of the term, its semantic blur, or semantic ambiguity, and its evident overuse. They also point out the lack of a comprehensive theory explaining the phenomenon of crisis (unlike similar concepts in the social sciences, e.g. the phenomenon of conflict, for which a comprehensive theory has been developed) that would allow it to be understood comprehensively. According to the commentators, the aforementioned features of the term ‘crisis’ indicate ‘a threat to the value of this term as an analytical tool in the social sciences and humanities’. It is also stressed that ‘since the nineteenth century there has been an enormous quantitative expansion of the variety of meanings of the concept of crisis, but this has contributed little to its clarity and precision’ (Koselleck, 2006, p. 397).
At the same time, it is pointed out that, due to its ‘unique cultural history’ and characteristics such as future orientation, epochal transformation and utopian liberation, this concept is not only a noun denoting a state or event but carries a strong emotional charge. This threatens its objective use, which under current conditions reduces the analysis of the situation to the question: what went wrong? Consequently, crisis is understood as ‘a state of disorganisation and lack of ways to cope with the circumstances’ (Piotrowicz, 2010, p. 24)4. It is also pointed out that ‘the high emotional charge attached to the concept distances the observer from the everyday practices that cause situations of this kind, reducing the chance of preventing the occurrence of such phenomena and constituting a distraction from the practices that contribute to them’(Barrios, 2017, p. 153); consequently, the concept is actually used as a tool to stabilise the existing structures and reduce the possibility of collective mobilisation leading to the elimination of the unfavourable situation described by this concept (Masco, 2017).
The aforementioned limitations of using the term ‘crisis’ must be taken into account in the context of using this concept to discuss health crises.
Health crises
Health crisis is the socially dangerous uncontrolled spread of a disease, usually in the form of an epidemic or pandemic5. According to the definition of a health crisis adopted by the World Health Organisation (WHO), it is ‘any disease-related event that exceeds the coping capacity of the affected community’ (WHO, 2008). In this sense, the concept of health crisis is equated with the concept of public health crisis, which stands for a public health condition characterised by the following features:
‘high incidence of the disease (condition),
high mortality resulting from it (the common condition of a mild disease is not regarded as a health crisis), and
the in effectiveness of the treatment received by carriers of the disease or the lack of possibility to use effective treatment’ (Enriquez-Sarano et al., 2019, p. 447).
When understood in this way, health crises are not a new phenomenon for the world. For millennia, epidemics and pandemics of various diseases, originally described as pestilences, the causes of which were most often interpreted as God’s punishment for people’s sins, have shaped human history by having a significant transformative impact on societies and their ability to adapt to external change. Global epidemics have occurred many times in the past and have often changed the course of history.
The appearance of the first epidemics is linked to the human transition from a nomadic to sedentary lifestyle as early as the Neolithic period. The new lifestyle and higher population density than in the case of hunting tribes meant that people were more vulnerable to infectious disease epidemics in those days (Cameron, 2010). The most famous epidemics that changed the course of history include the typhoid epidemic in the 5th century B.C., which hastened the fall of Athens, the epidemic of the plague of Justinian in the 6th and 7th century, which is believed to have started in 541 A.D. (Milewski, 2021; Banaś, 2021), which affected the Eastern Roman (Byzantine) Empire, Mediterranean Europe, Gaul (areas corresponding to present-day France, Belgium and northern Italy, the British Isles and Persia), whose presence and recurrent waves were recorded in various regions until the middle of the 8th century A.D., causing significant depopulation (Szpak, 2003), the plague epidemic in the 14th century, which is associated with the end of the Middle Ages and contributed to the collapse of feudalism in Europe, the smallpox virus in the 16th and 17th century, which caused the collapse of the Aztec and Inca empires and facilitated the colonisation of the western hemisphere, and the cholera plague of 1817.
The most famous pandemic was the giant plague of the mid-14th century brought on ships from Asia to Europe referred to as the ‘Black Death’. In 1348, the disease spread rapidly along the main trade routes, taking its heaviest toll in large and small cities. Within two years, it wrought havoc across Europe, from Sicily and Portugal to Norway and from Moscow to Iceland. Between 1348 and 1350, more than a third of Europe’s population died (Skodlarski, 2012). In some large urban centres, more than half the population died. This epidemic evolved into an endemic disease that recurred every 10–15 years for the rest of the century (Cameron, 2010). Europe’s population declined from 73 million in 1300 to 45 million in 1400 (Szpak, 2003).
The epidemic was one of the main reasons for the sudden halt in Europe’s economic expansion and the most dramatic episode related to the crisis of the medieval economy. The plague halted the first period of population growth, which had begun in the 9th or 10th century, probably reaching a maximum in the 12th century (Cameron, 2010). It led to the exacerbation of social tensions and conflicts. The price and pay gaps rapidly widened. With a rapid decline in the urban population and the consequent reduction in demand, the prices of grain and other food products fell sharply; on the other hand, there was a wage increase in due to the shortage of labour. The first reaction of the ruling groups was to introduce wage control. This move met with a harsh reaction from the already hostile villagers and other hired labourers, who evaded this control as much as they could and incited revolts if firm steps were taken to make them obey. In the second half of the 14th century, riots, rebellions and civil wars broke out in all European countries (Cameron, 2010). Although the bubonic plague of the 14th century caused terrible devastation, it paved the way for a period of renewed growth and development with the advent of the 15th century.
In the first half of the 17th century, a series of crop failures, new outbreaks of plague and other infectious diseases as well as the extent of warfare and related atrocities resulted in a stunted population growth. In several regions of Europe, notably Spain, Germany and Poland, the population actually declined at certain times or throughout the 17th century.
It is difficult to understand colonial conquests and the phenomenon of globalisation without considering the transmission of Old World diseases that took the lives of many indigenous peoples in the Americas, Australia and the Pacific. The disease that largely contributed to the e xtinction of the Indians of the Americas and the Caribbean people (75% of the Aztec population, 95% of the Inca population) who had contact with the Europeans and the virus brought with them for the first time was smallpox. A Spanish priest wrote from Mexico: ‘as the Indians knew no cure for the disease, they died in clusters, died like bugs’ (more extensively: Crosby, 2015). ‘At the time of Columbus’ discoveries, the indigenous population was around 25 million (some researchers estimate it was much higher), but the devastating diseases reduced it to just a few million by the end of the 16th century’ (Cameron, 2010, p. 120).
Despite significant civilisation progress and general improvement of the quality of health care, the modern man has not managed to effectively eliminate the phenomenon of health crises. They are at least as dangerous as they used to be. This condition is primarily influenced by human activity. Analysing the causes of the health crises that haunt humanity today, we can find out that they result from the simultaneous occurrence of several processes. One of these is the high degree of urbanisation of modern societies. Epidemic risks arise from the growing trend of settlement in urban areas6.
The modern world is now more urbanised than ever, with more than half of the modern population living in large urban centres. The higher concentration of the population significantly increases the possibility of disease spread. It is no coincidence that the highest risk of infection is recorded among populations living and working in major urban centres and those who are more mobile. The highest incidence rates are recorded in large urban centres and in regions with the highest population density (Golinowska, Zabdyr-Jamroz, 2020). In contrast, the places least vulnerable to the emergence of infectious diseases include regions that are ‘less developed with an abundance of greenery, sparsely populated, less attractive for tourists and economy, less strongly connected to the outside world, located in peripheral areas with no airports and many other transport connections, where culturally determined social distance exists and people are not spatially mobile’ (Polak, 2021, p. 60). This indicates the importance of the context of the emergence of health crises, regardless of the quality of public health interventions. At the same time, urban centres with huge groups of people that are most vulnerable to disease outbreaks are much more interconnected than ever, thanks to the development of different forms of transport, globalisation and intensively developed tourism. Thanks to the well-developed transport infrastructure, the passenger – and, consequently, any disease carried by them – can move from one end of the world to the other in a single day. The simultaneous encroachment of humans into the world of wildlife and the destruction of millions of hectares of natural habitats by them disturb biodiversity, making humans more vulnerable to animal pathogens that spread rapidly upon getting into urban populations. Today, it is not the presence of a pathogen but humans and their various activities, especially those associated with movement, that are most responsible for the spread of infectious diseases. An infection that occurs in some remote region of the world regarded as peripheral can quickly move further due to the intensification of global transport and intercontinental travel (Larska et al., 2022).
Table 1 presents the major health crises of the 20th and 21st century.
Table 1
Major health crises of the 20th and 21st century
| Years | Health crisis | Number of cases and deaths | Characteristics |
|---|---|---|---|
| 1918–1920 | Spanish flu (called also the Great Influenza). An illness caused by the H1N1 type A virus. The name ‘influenza’, meaning influence, was invented by Italians who attributed the origin of the infection to the influence of stars. The Polish word ‘grypa’ comes from the Russian word ‘hrip’, which means snoring or chuckling. The term ‘Spanish’ is related to the information provided about the disease. | 500 million cases of disease. An estimated 50 million people worldwide died of Spanish flu (Johnson, Mueller, 2002). | The first great health crisis of the 20th century, which affected a third of the world’s population at the time and claimed the number of victims exceeding those of the First World War. During the First World War, when the epidemic occurred, Spain was the only country that did not censor information about the disease, so the public initially believed this country to be its source. The COVID-19 pandemic is often compared to this disease because of its enormous size and the countermeasures used to prevent its spread, such as wearing masks and keeping a social distance. |
| 1956–1958 | Asian flu caused by the AH2N2 virus. The disease started in the Chinese province of Guizhou, hence its Asian name. | Between 1 and 4 million deaths. It matched the Spanish flu in numbers, but it had a significantly lower death rate thanks to a vaccine developed in 1957. | From China, where the first outbreaks were reported, the disease spread first southwards, reaching Singapore, Hong Kong and India and then the UK and the USA. The Asian flu crisis is estimated to have contributed to a decrease of global GDP by up to 3.5% (WHO, 2009). |
| from 1961 until now | Cholera (an acute and very dangerous infectious disease of the gastrointestinal tract caused by the bacterium Vibriochlerae, sometimes referred to as the ‘blue death’ due to the bluish shade of the sick people’s bodies. The disease causes severe gastroenteritis. Infection usually occurs through the ingestion of food or water containing the bacterium. In extreme cases, mortality can reach up to 20% of infected people (Orłowski, 2023). | In the 19th and 20th century, the disease spread worldwide seven times, starting with the first cholera pandemic in 1817 (Jaroń, 2021). There are currently around 1.4 billion people worldwideliving in areas where the disease has occurred in three out of the last five years. In countries affected by cholera, about 2.8 million people contract it annually and about 90,000 die (Ali et al., 2012). | The seventh cholera pandemic began in South Asia in 1961 and has continued until today (Deen et al., 2020). In the 21st century, cholera cases were reported, e.g., in Zimbabwe (2008–2009), Haiti (2010-now due to difficult sanitary conditions caused by the earthquake and flood taking place in this region), Yemen (2016-now - the total number of suspected cholera cases reported in Yemen from October 2016 till March 2021 exceeded 2 million) (WHO, 2021). In September 2023, the World Health Organisation reported the double increase of cholera cases worldwide. According to the official announcement, 470,000 cases were reported in 2022. This is a significant increase towards the previous year, when 220,000 cases of the disease were reported. According to the organisation’s experts, however, the figures are significantly underestimated due to the misreporting and concealing of disease cases. Apparently only 5 to 10% of cases are reported. It is suggested that the real number of cases may reach 4 million. According to the WHO’s analysts, the cholera epidemic lasts in a number of countries around the world: Afghanistan, Cameroon, the Democratic Republic of Congo, Malawi, Nigeria, Somalia and Syria (Orłowski, 2023). According to data from November 2023, the balance of the epidemic in Zimbabwe’s capital Harare totalled around 7,000 infected persons and more than 50 deaths. According to the Red Cross, the disease is spreading rapidly and is likely to go beyond the country’s borders soon. The neighbouring countries - Malawi, Mozambique and South Africa - are putting security measures in place and preparing for such an eventuality (Zdrojewski, 2023). |
| 1968–1970 | Hong Kong Flu. The disease originated from a mutated virus that had been responsible for causing the Asian flu. | Between 0.5 and 2 million deaths (in its new incarnation, the disease was less fatal). | The disease is believed to be the first disease whose massive spread has been linked to air travel. This is how it found its way to Europe, starting from Western European countries. At the beginning of 1969, it reached Poland - first Warsaw and Poznań, and then the south of the country. The disease is estimated to have caused an up to 1.5% decrease of the global GDP. |
| from 19817 until now. | AIDS (Acquired Immuno-deficiency Syndrome). A disease caused by the HIV virus (Human immuno deficiency Virus) identified in 1983. There are two related viruses that cause AIDS: the more common and more deadly HIV-1, which is found worldwide, and the rarer and less lethal HIV-2, found in West Africa. | 75 million cases, 35 million deaths (mainly in Africa). In 2020, 1.5 million people were diagnosed with HIV infection, of whom 680 000 died. (National AIDS Centre,2024). | The disease is present in almost every country and ‘has caused more widespread fear and anxiety than any other health crisis in the 20th century’ (Feldman, Miller, 1998, p. XXV). One of its characteristics is slow development in the human body. It takes ten or even twenty years from the infection to the death of the infected person. Because HIV destroys the immune system of the infected person, infected people are susceptible to serious diseases caused by even the most common microorganisms. AIDS has developed particularly dangerously in Africa, where it has affected a higher proportion of women and children than in North America and Europe. No AIDS vaccine has been developed so far, but a new class of drugs used against the disease prolongs the lives of most people taking them. Reduced life expectancy in African countries as a result of AIDS is associated with an estimated 1.5% reduction in economic growth. |
| 2002–2003 | Severe Acute Respiratory Syndrome (SARS) - a form of atypical inflammation caused by the coronavirus transmitted by bats and grackles. | 8,437 cases in 30 countries and 813 deaths, concentrated in Asia, with the highest number of victims in China (WHO, 2024). | The disease first appeared in the southern Chinese province of Guandong at the end of 2002. Its cases were reported also in other areas of the continent (Taiwan, Singapore, Hong Kong, Vietnam, Indonesia, Japan) and, outside the Southeast Asian countries, in Canada. In total, the virus spread to 37 countries. Little is still known about the contagiousness of the virus, which has a death rate of 14–15%. In connection with the disease, the WHO’s experts proposed restrictions on air travel and stays in places of collective residence (hotels) (WHO, 2003). The estimated global cost of the disease for global economy is USD 100 billion, including USD 48 billion in China. |
| from 2009 until now8 | Swine flu - a disease caused by the mutated AH1N1 influenza virus, originally found only in pigs and known since the 1930s. After coming into contact with both the normal influenza virus and the avian influenza virus in the patient zero’s body, the virus mutated into a new dangerous pathogen that can be transmitted to humans (Nowak-Kreyer, 2020). | Around 500,000 deaths. The exact number of cases and victims remains unknown, because shortly after the beginning of the swine flu pandemic, the WHO instructed that only the most severe or least typical cases be recorded, justifying such actions by the exponentially increasing number of infections (Nowak- Kreyer, 2020). | The disease first appeared in Mexico, then moved to California and then to other US states and more countries, including Europe. The economic impact of the swine flu outbreak in Mexico, where the first cases of the disease were identified, is estimated at USD 3.2 billion (0.3% of GDP). In Poland, the swine flu pandemic was associated with a political storm, as Poland was the only European country that did not purchase the vaccine. The WHO’s decisions regarding the registration of disease cases, as well as the case of a vaccine purchased by many countries and soon rendered unnecessary due to the rapid acquisition of population immunity, undermined confidence in this organisation and contributed to the growth of anti-vaccine movements. It was suspected that swine flu either did not actually exist at all, or that it had been a much milder disease than officially reported from the beginning, and that the announcement of the pandemic was intended to overshadow the social unrest in the US associated with the 2008 crisis. Pharmaceutical companies were also accused of stirring up panic deliberately in order to make money from selling vaccines. |
| from 2012 until now | Middle-East Respiratory Syndrome (MERS-CoV) Disease transmitted by camels and humans. | High death rate of 35%. | The virus emerged in Arab countries in the Middle East in 2012. Infections occurred in health care facilities (mainly hospitals), which enabled relatively quick treatment measures and stopped further infections. The outbreak of MERS-CoV in Korea in 2015 caused losses estimated at USD 2.6 billion in tourism alone. Advice on the disease is given to persons making a hajj and an umrah pilgrimage to Saudi Arabia. |
| from 2013 until now | Ebola (haemorrhagic fever) - a disease caused by a virus transmitted to humans by wild animals and spread by human-to-human transmission (WHO, 2021a). | 28,600 cases and 11,325deaths (probably underestimated figures). Death rate of 25 to 90% (WHO, 2021a). | A disease known in African countries since the 1960s. The first mass cases were reported in 1976 in the Democratic Republic of Congo in the Ebola River Valley, from which the virus and the disease took their name (Stachoń, 2021). The 2013 epidemic started in Guinea and spread very quickly to neighbouring African countries: mainly Liberia and Sierra Leone. Ebola reached the USA in September 2014 and Spain in October of the same year. The disease mainly covers areas in West Africa, Guinea, Liberia, Sierra Leone and Congo. Estimated economic losses caused by the disease in West Africa amount to up to 30 billion of lost GDP. |
| from 2015 until now | Zika (a flavivirus transmitted by Aedes Egypti mosquitoes). | Unknown number of cases, few deaths (if any) The disease is primarily known because it can cause microcephaly in infants whose mothers are infected with it. | According to an estimate by the World Bank, the short-term impact of the disease outbreak in Latin America and the Caribbean in 2016 was approximately USD 3.5 billion, especially with regard to the hosting of major sporting events |
| from 2016 until now | Dengue fever9. | The first recorded case probably corresponding to dengue is described by a Chinese medical encyclopaedia from the times of the Jin dynasty reigning between 265 and 420 A.D. It refers to ‘water poisoning’ associated with flying insects. Early descriptions of the disease date back to 1779, and the viral aetiology and the transmission of the disease was clarified in the early 20th century. Dengue has become a global problem since World War II. The incidence of the disease has increased dramatically since the 1960s. Between 50 and 100 million people were infected annually (Wikipedia, Dengue fever, 2024). Approximately 25,000 deaths per year are now reported worldwide due to the disease (Opozda, 2023). Symptoms of the disease include fever, headache, myalgia and arthralgia and a characteristic rash similar to the one that occurs in measles. Because of haemorrhagic fever, 30% of disease cases end in death (Opozda, 2023). | ‘Dengue is the most important vector-borne viral disease in humans and probably more important than malaria worldwide in terms of incidence and economic impact’ (Gubler, 2012, p. 743). It is a tropical disease that assumed a global scale in 2016. It occurs endemically in more than 110 countries, mainly in Southern Asia and Central Africa, as well as in the Southern United States. Half of the world’s population is now endangered by the disease due to global warming (Wikipedia, Dengue fever, 2024). The total annual cost of the disease in 2013 was estimated at USD 89 billion. The World Health Organisation (WHO) warned that the number of dengue cases may hit a record high in 2023. |
| Hepatitis E virus | The WHO estimates that there are about 20 million HEV infections each year, of which about 3 million are diagnosed. Around 70,000 people worldwide die due to the disease each year (Rajewski et al., 2017). | The disease is contracted after eating raw or undercooked meat or other products containing the blood and liver of pigs (figatellu in France) or wild boar and deer (Japanese shikasashi) (Larska et al., 2022). | |
| from 2019 until now | COVID-19 (coronavirus) Disease caused by the SARS- CoV-2 virus. | The number of confirmed infections worldwide is 607 million, with nearly 7 million deaths. | The virus causing the disease has a huge population infection rate (reproduction rate: 2.0-3.0), which implies a much faster infection rate than in the case of MERS or SARS, but a lower death rate. The economic losses associated with the disease represent, depending on the country, a decrease in GDP even by more than 10%. Support packages for economic entities resulting from the periodic inability of businesses to operate have resulted in a huge public debt, the repayment of which will burden the development of many economies in the future; therefore, the return to the prepandemic economic growth will not be easy and will take many years. |
| 2022 until now | Monkeypox - a contagious animal disease caused by the MPXV virus. The disease takes its name from the first discovery of the virus in laboratory monkeys: Javan macaques and rhesus monkeys in a Danish laboratory in Copenhagen in 1958. The name remains valid even though rodents are the reservoir and source of the Orthopoxvirus causing it in humans (Larska et al., 2022). | The number of cases in the European Union reached 321 by May 2022; globally, outside Africa, where the disease is endemic, 557 infection cases occurred (Larska et al., 2022). | The first case of the disease in Europe was confirmed on 7th May 2022 in Great Britain. Since then, the disease has emerged in more than 20 countries around the world, excluding Africa, where it occurs endemically. The disease manifests itself through swollen lymph nodes, difficulty in swallowing, fever and chills, and a burn-like rash. Since 2016, cases of monkeypox have been reported in nine African countries where African rodents carrying the virus are present, including Sierra Leone, Liberia, the Central African Republic, the Republic of Congo and Nigeria. Currently, non-African cases of the disease occur in the form of outbreaks involving dozens of people each. At present, the WHO does not recommend travel restrictions due to the disease. |
COVID-19 crisis
The recently ended COVID-19 crisis, also called ‘pandemic crisis’ (Rokicka, 2022) or ‘coronacrisis’ (Krzystofek, 2021), is a health crisis that claimed a total of nearly 7 million lives worldwide10 and had significant economic and social consequences. The end of the COVID-19 crisis triggered the process of ‘historicising’ it, i.e. recognising it as a phenomenon that can be subjected to historical analysis. Given the short time that has elapsed since the end of the crisis, its full assessment is extremely difficult. It stems from the problems that are usually related to the description of events of recent history and the excessively short time from the occurrence of the phenomenon that makes its objective evaluation hardly possible, specified as the ‘lack of an adequate historical perspective’, which causes historians of recent times to complain about the pressure of the current situation relating to the relationship between history and politics and that they are dealing with processes that have not yet been completed (Leczyk, 1998).
The first cases of acute infectious disease of the respiratory system caused by a SARS-CoV-2virus infection, known as COVID-19, which marked the beginning of the related crisis, were reported in central China in the city of Wuhan in the province of Hubeiin November 2019. After the spread of the disease to many parts of the world, the WHO declared a public health emergency with an international reach on 30th January 2020 and declared COVID-19 a pandemic11 on 11th March 2020.
In the most general way, the COVID-19 crisis is described as a crisis of economised societies rooted in a growth paradigm (Ötsch, 2020). It is interpreted as the result of a cross between broader urbanisation processes, signs of globalisation, environmental change, agribusiness and contemporary capitalism. It has many features in common with previous health crises, but it is characterised by certain specific features and circumstances. It differed from previous similar crises, including the threat of SARS infection, in its duration and the speed and scale of the spread of the virus causing the disease (Rossi et al., 2020). For the first time in history, the pandemic covered literally the entire world. It is enough to quote one example: schooling (in classrooms) was discontinued in 192 countries. Such a situation had never happened before. The wars called global did not even cover half of the globe (Krzysztofek, 2021). The most distinctive features of the COVID-19 crisis are considered to be its ‘global and massive scale, multidimensional and interconnected impacts challenging current values and systems leading to global recession and depression’ (Sigala, 2020, p. 312)12.
The observation of the socio-economic reality during the COVID-19 crisis and, above all, the accompanying scale of the collapse of the global economy indicate that it became not only a health crisis but also the biggest cause of the collapse of global economy after the Great Depression of the 1930s (Baldwin, Weder di Mauro, 2020)13. The double-digit unemployment rate in countries such as the USA, China, Australia, Germany and Great Britain had been unthinkable just a year before the COVID-19 crisis, and in 2020, just a few months after its emergence, it became a reality.
Due to significant economic consequences, business closures, wage cuts, mass job losses and huge economic losses, the COVID-19 crisis has become known as ‘the most expensive disease in the history of the world’ (Orłowski, 2020). Its cost in terms of lost production and public health expenditure is estimated at the astronomical amount of USD 16 trillion (Gomoła, 2023). The huge economic cost of the COVID-19 crisis was largely due to the model used for combating in in most countries, which was based on restrictions on mobility through the use of quarantine and strict limitations on the freedom of movement and assembly. Despite the enormous progress of humanity, including but not limited to medicine, most of the methods used for combating the COVID-19 crisis are those used for combating previous health crises, with far-reaching economic and social consequences. As the disease was transmitted by airborne droplets through direct human-to-human contact, one of the primary measures used for stopping its spread was to close borders and impose sanctions for violations of movement and social contact prohibitions. This occurred through the introduction of a lockdown by national governments, i.e. the requirement for people to remain in their places of residence because of particular risk arising from movement (What is a lockdown? Definition, 2020). Global travel bans, policies based on the ‘stay at home’ slogan and assembly bans affected around 90% of the global population (Czech et al., 2020).
The deep economic crisis resulting from the freezing of the economy and transport was particularly visible in countries where subsistence production accounted for only a small percentage of the economy and those whose economies were based on tourism. The invention and launch of the vaccine, which occurred much earlier than initially expected, did not change this situation fundamentally14.
The specificity of the COVID-19 crisis, in comparison to the Great Economic Crisis of the 1930s to which it is often compared, is that it particularly affected certain areas of the economy. Industries producing physical products, especially labour-intensive firms, were forced to minimise operations or close temporarily, while sectors producing and providing information products and services started to get better15. While travel services were particularly affected by the crisis due to limited mobility, banking services developed and medical and courier services intensified their activities at the same time16. The uneven consequences of the COVID-19 crisis became also apparent from the perspective of company size. While small companies, especially service companies such as restaurants, where direct contact with customers was necessary, had to get rid of employees, Amazon announced the recruitment of additional 100,000 employees (Davies, 2020), ranking as the second largest global company in 2022 (fortune.com/global500, 2024).
Constraints on direct interpersonal contacts have contributed significantly to the broader use of digital technologies. Their comprehensive use has largely become a remedy for mitigating the effects of the crisis (Kamiński, 2021; Kamiński 2023). This resulted in the overall acceleration of the digitalisation of societies, which has brought a number of broader consequences, such as: transformations in the sphere of e-commerce (Czech et al., 2020), the prevalence of remote working (Radziukiewicz, 2021), or remote education (Ptaszek et al., 2020) with their broad social consequences.
Because of the reduced internal mobility of citizens as well as the closure of borders by most countries, the COVID-19 pandemic hit international trade very hard in terms of supply, negatively affecting the value of export of European Union countries (Czech et al., 2020). In the short term, the coronavirus reduced consumption and production levels and led to an increase of unemployment. In the long term, it brought about inflation and the destabilisation of public finance, mainly the strongly growing debt of central and local government institutions, which directly and indirectly limited long-term opportunities to create economic growth and development (Nazarczuk et al., 2022).
Although the impact of the COVID-19 crisis was geographically very diverse, depending on such factors as the quality and capacity of the health system, the age structure of the population, the density of employment, or the speed with which state institutions responded to the crisis, especially in its first period, it shook the foundations of the consumption-based capitalist economic system on a global scale and undermined the sense of security of the Western civilisation. Prior to the COVID-19 crisis, it was taken for granted in Western countries that basic needs of consumers would be easily satisfied by the wide availability of different products, and consumers were spoilt for choice. Although consumers’ needs were still satisfied in these countries, the COVID-19 crisis seriously undermined consumers’ sense of security through emerging shortages of basic products, and they clearly saw their ability to meet their needs in a different way. Many consumers, especially young ones, were confronted with a shortage situation for the first time. No previous health crisis had been able to undermine consumption – a pillar of the capitalist system – on such a significant scale.
The diverse impact of the COVID-19 crisis emerged not only on the part of industries and companies but also on the part of customers. ‘Certain demographic groups, known as digital immigrants and marauders, are the segments that have been hit hardest by the pandemic.... However, digital natives may perceive this new reality as something beneficial’ (Kotler et al., 2021, p. 92). The varied impact of the COVID-19 crisis on different segments of customers and market players is presented in Table 2.
Table 2
Impact of the COVID-19 crisis on different segments of customers and market players
| Strong blow | Weak blow | |
|---|---|---|
| Customers segment | ||
| Companies segment |
One of the consequences of the COVID-19 crisis was the adoption of a number of regulations increasing control over citizens, limiting their rights and introducing unprecedented powers for the authorities. In many cases, the COVID-19 emergency was the basis for circumventing the standards of proper legislation and departing from the ‘norms of good law’, which caused serious concern among lawyers (Izdebski, 2021). Audit activities carried out after the COVID-19 pandemic by the Supreme Chamber of Control (NIK) indicate that some regulations introduced in response to the COVID-19 outbreak were incompatible with the Constitution of the Republic of Poland17 . The control of patient health knowledge by the state became particularly distinct (Nocuń, Rojek-Socha, 2023; Szymacha, Szymacha, 2022). In many cases, new regulations adopted not only in Poland but also in many other countries were imposed in a manner that constituted a strong blow to the existing foundations of Western democracy and the associated civil liberties. Since democratic countries did worse, at least in the first period of the crisis, and suffered more damage than less democratic countries, the COVID-19 crisis provided a strong impetus to revise the way of functioning of modern societies towards making them more authoritarian.
The fight against the pandemic prompted the development and implementation of many procedures, which were developed at a truly express pace 18. The need to act quickly and the emerging possibility of ignoring the existing procedures resulted in unprecedented breaches of the law. The best-known example are the EU’s unclear vaccine ordering procedures and the mistakes made by the EC during the negotiation of contracts with Pfizer – one of its vaccine suppliers (Klinger, Wójcicka, 2022).
The COVID-19 coronavirus pandemic exposed the weaknesses and inadequacies of social models prevailing in many countries. Countries without universal access to health care recorded very high illness and death figures, primarily among the poorest citizens (Marczewski, 2020). In many countries, epidemic challenges changed the balance of power on the political scene, making some politicians more recognisable and bringing them fresh popularity while pushing others to the bottom of trust rankings (Marczewski, 2020).
The COVID-19 crisis undoubtedly contributed to the fact that the world has also changed significantly on an international scale, especially from the perspective of its previous openness and departure from liberal principles. It has become less open and less free, which particularly manifests itself in the closure of borders and a considerable restriction on the freedom of travel. In this context, we can perceive the impact of the COVID-19 crisis on the weakening of the existing liberal international order and globalisation19.
Because of differences in the assessment of threats, the COVID-19 crisis seriously undermined the cohesion of the European Union. The lack of a decisive response from the EU’s authorities in its initial period gave the impression of total helplessness in the face of the emerging crisis. Many member states, particularly Italy, felt left behind, which led to an intense debate on the sense of existence of the European Union in its current form.
The COVID-19 crisis also had a significant impact on the perception of the role of the scientific world. The helplessness of science in the face of the crisis, especially in its first period, shook the foundations of the concept of the knowledge-based society (Polak, 2021). The dissonance of opinions about the crisis went well beyond the natural revision of scientific views occurring in a situation of research progress. “Bombarded ... with an overabundance of information, much of which was contradictory, society became more and more confused’ (Duszynski et al., 2020, p. 8). Although in the very first days of the crisis, the major actors responsible for informing modern societies concluded an agreement under which they undertook to oppose the presentation of false information in connection with the COVID-19 pandemic20, many contradictory opinions circulated about it. The cognitive chaos resulting from many contradictory opinions, including those uttered by epidemiologists and virologists, became known as ‘epistemological smog’ among sociologists (Krzystofek, 2021). (‘A large amount of information, including false or misleading information during the outbreak of a disease’, was called an ‘infodemic’ by the WHO21). At the same time, there was a distinct lack of reliable information activities coordinated by the state or supranational institutions and based on well-thought-out and well-reasoned social campaigns. This resulted in successive reports not always being taken seriously, which caused impatience, changing decisions22 and irrational action not only by citizens but also by state authorities23.
High public uncertainty about how the disease spread, its symptoms (the asymptomatic form), its end (the conditions that had to be met for collective immunity), its risk groups (in the early period of crisis, it was emphasised that COVID-19 did not affect children), and the importance of concomitant diseases combined with not always fully thought-out ways of preventing it fuelled public anxiety and facilitated fear management (Krzysztofek, 2021).
Summary
Health crises have intrinsically accompanied people since the dawn of time, being one of the main causes of death for people around the world, having a significant impact on various areas of social life. Due to environmental changes and increasing levels of urbanisation, it can be assumed that the threat of health crises will increase and the world will be affected by new health crises. The warming climate is causing a bigger threat of tropical diseases than before in the parts of the world that have not been exposed to them so far, including Europe and Poland.
The health crises presented in the study, including the case of the COVID-19 crisis analysed in the article, shows that health crises are highly significant not only for public health, but also broad social non-health consequences. Actions taken to combat health crises, including those aimed at combating the COVID-19 pandemic that are outlined in this paper, had serious social, political and economic consequences that are still felt today. The coronavirus pandemic showed market participants, policy makers and the general public that health crises can have a direct global disruptive economic impact on an unprecedented scale. The COVID-19 crisis has had multifaceted consequences ranging from changes in the functioning of the health system, such as the obligation of medical professionals to provide information on medical events and e-advice, to the widespread introduction of remote working and related regulations. Moreover, it also had a decisive impact on the acceleration of the digitalisation of economy with its related positive and negative consequences. It became the main reason of the inflation and an occasion for numerous abuses, and led to significant changes in the political sphere, allowing authoritarian decisions to be taken and democratic societies to be managed with the use of fear.
In view of the enormous importance of crises in the modern world and the high probability of the occurrence of such phenomena, it seems necessary to develop the crisis theory, including health crises, and to deepen our understanding of them in many aspects through basic research on the issue in order to make it more useful for their analysis than currently. Their results should contribute, above all, to their better recognition, lower unpredictability of many processes and their use for reforms that would improve the functioning of societies and prepare them to face such phenomena. The health policy of the countries responsible for preventing crises should take into account the real probability of such phenomena to a greater extent than before.
In view of the increasing threat of health crises and their significant impact on various aspects of functioning of societies, not only on a national but also international scale, students of not only medical but also social sciences should be familiarised with this issue. The issues that seem most important for understanding health crises are: their origins, history, nature, manifestations, economic and social consequences, ways of managing crisis phenomena, security constraints, the importance of health crises from the perspective of the formation of social trust, the impact on social communication, risk perception and behavioural change, the impact of health crises on the varied transformation of societies. To ensure that students are provided with unquestionable content, the broadly understood issues of health crises should be subjected to further scientific analysis and in-depth discussion. Thus, there is a strong need for their further research.
Knowledge communicated about health crises must necessarily be interdisciplinary knowledge. This requires research collaboration between representatives of many fields of science: the field of health sciences, particularly public health; the humanities in the field of history, particularly the history of medicine and economic history; and the social sciences, including the identification of economic and social consequences of such phenomena in order to understand better the broad causes and consequences of health crises. Since safety, security and peace of mind are basic conditions for the normal functioning of organisations of all kinds, especially companies, and personal safety is very important from an individual and economic perspective, it is also necessary to open up knowledge on health crises more widely to the achievements of management and security sciences, both on the national and international level. Political science can also make an important contribution to the understanding of health crises, particularly with regard to analysing democratic processes and the context of the delegation of power of states to supranational institutions in relation to the occurrence of such phenomena.
The analysis of health crises carried out in the presented study also proves that the impossibility of empirical analysis of all phenomena relating to the COVID-19 crisis brings the knowledge on health crises closer to social philosophy than empirical science. It may also change the focus of the existing health crisis research, which has been oriented towards a specific event so far, which means that it should be given a general character.
