AQA GEOG1: The Geography of Health
Global patterns of health, morbidity and mortality:
health in world affairs.
The study of one infectious disease (e.g. malaria, HIV/
AIDS) its global distribution and its impact on health,
economic development and lifestyle.
The study of one non-communicable disease (e.g.
coronary disease, cancer) its global distribution and
its impact on health, economic development and
lifestyle.
Food and health – malnutrition, periodic famine,
Obesity.
Contrasting health care approaches in countries at
different stages of development.
Health matters in a globalising world economy –
transnational corporations and pharmaceutical
research, production and distribution; tobacco
transnationals.
Regional variations in health and morbidity in the UK.
Factors affecting regional variations in health and
morbidity – age structure, income and occupation
type, education, environment and pollution.
Age, gender, wealth and their influence on access to
facilities for exercise, health care, and good nutrition.
A local case study on the implications of the above
for the provision of health care systems.
Health is a state of complete physical, mental and social wellbeing, not merely the absence of disease and infirmity.
Mortality is the death of people. It is measured by a number of indices including crude death rate, infant mortality, case mortality and attack rate.
Morbidity is illness and the reporting of disease.
We can use health indicators to understand the patterns that exist globally in terms of health, mortality and morbidity.
Global patterns of Mortality
Global Patterns of Morbidity
Morbidity indicators include prevalence (the total number of cases in a population at a particular time) and incidence (number of new cases in a population during a particular time period). Global patterns of morbidity differ depending on the type of disease. Infectious communicable diseases are most common in LEDCs, whereas in MEDCs, non-communicable diseases of affluence are most common.
Global patterns of Health: Life Expectancy
In general, life expectancy is greatest in MEDCs such as UK, USA and Australia. It is lowest in LEDCS, like those of Sub Saharan Africa.
There are some exceptions: China – 73.8 years – and Vietnam – 72.7 years have a low GNP per capita but a long life expectancy.
Factors affecting life expectancy:
Nutrition – under nutrition and malnutrition are underlying factors in more than half of child deaths in LEDCs. People are more likely to catch an infectious disease with a lowered resistance due to poor diet.
Clean Water and Sanitation – each year 1.8 million people die from Diahorreal diseases including cholera and 88% of these diseases are linked to unsafe water supplies and inadequate hygiene. 1.3 million people die every year from malaria, and part of the problem is poor management of water.
Health Services - imbalance in the distribution of health professionals around the world; in countries like America, there are about 23 doctors per 1000 people; in some parts of Africa, this number is as low as 2. The level of government spending per capita is also important; 2 million children under the age of 5 die from pneumonia each year, and it costs only 15p per head to treat. Due to lack of funding from the government, treatment is not possible.
Health in World Affairs - the geography of health can make an important contribution to future national plans and policies;
o Advising on planning for healthcare staffing in Sub Saharan African countries devastated by the HIV/AIDS crisis
o Analysing the global correlation between income and welfare
o Monitoring the effects of climate change on the emergence of new infectious diseases
o Investigating the optimum pattern of healthcare provision in primary healthcare trusts
o Collaborative efforts between worldwide organisations like the WHO (World Health Organisation) and governments to help to eradicate and prevent disease – for example running a vaccination programme paid for by wealthy countries to eradicate polio in developing countries.
An Infectious Disease: HIV/AIDS
HIV is the human immunodeficiency virus, which causes Acquired Immunodeficiency Syndrome. It is a slow retrovirus which invades the white blood cells and reproduces itself inside them. The body can no longer defend itself against infection, so people may die from an everyday infection like flu.
HIV is spread through exchange of bodily fluids during sexual intercourse, contaminated needles in intravenous drug use, contaminated blood transfusions and across the placenta during pregnancy.
There are three distribution patterns of HIV;
1. Areas which began to see a spread of HIV in the 1970s amongst the homosexual and drug using communities. This includes North America, Western Europe, Australia and parts of Latin America.
2. Countries where the spread has been due to heterosexual contact and then through mother-to-child transmission; this includes all of Sub Saharan Africa.
3. Regions where the disease appeared in the late 1980s, brought by travellers and in blood imported for transfusions. This includes Eastern Europe, USSR, Asia, the Middle East and Northern Africa.
Impacts on Health, Economic Development and Lifestyle
AIDS in Botswana, Sub Saharan Africa
o 24% of the 1.6 million population are infected with HIV.
o Life expectancy has dipped below 40 for the first time since 1950, and in 2006 stood at 34 years. Without the AIDS pandemic, it is expected that the life expectancy would have been 74 years.
o The economy is shrinking because AIDS is destroying the workforce; it is predicted that the economy will be one third smaller by 2021 than it would have been without AIDS.
AIDS in Thailand
Towards the end of the 20th century, Thailand had the most serious AIDS problem in Asia, with infection rates amongst prostitutes reaching 30% by the 1990s. The numbers in Thailand were so high due to low condom use and a high rate of pre marital and extramarital sex with sex workers. In 1995, 5,000 HIV positive babies were born. The Thai government responded in a positive way; a ‘100% condom programme’ was launched in 1991; the National AIDS committee was set up which devised media advertising campaigns. Commercial sex workers were targeted with a supply of 60 million free condoms every year. HIV rates in Thailand are now in decline.
The link between HIV/AIDS and Global Poverty - LEDCs cannot afford to provide the infrastructure and resources to make health and education available to everyone. This means that these countries are particularly vulnerable. A lack of education makes it harder for people to protect themselves from the virus; poverty means that people may not have access to condoms; women may not have the power to say no to sex, and some may be forced to sell sex to survive; having unprotected sex leads to HIV infection; hospital treatment is expensive and HIV testing not widely available; people who aren’t treated die; more orphaned children are left without parents; family income drops; children are kept from school to work or care for family – and this restarts the vicious cycle, and the lack of education spreads.
A non-communicable disease: Coronary Heart Disease
CHD is a disease caused by atheromous plaques blocking the coronary arteries reducing blood flow and meaning that the heart does not receive adequate oxygen.
Coronary heart disease is a disease of affluence; it is more common in wealthier countries. Factors associated with these diseases are:
o Increased use of cars
o Less strenuous physical activity
o Easy accessibility to large amounts of low cost food
o More high fat and high salt foods in diet
o More processed foods commercially provided
o More sedentary work
o Greater use of alcohol and tobacco
Impacts of CHD on Health, Economic Development and Lifestyle
Comparing Coronary Heart Disease in the UK and India
UK (MEDC) / INDIA (LEDC)Social Causes / Wide use of tobacco and alcohol. Unhealthy lifestyles – high fat diets and little physical activity. / Slum areas of poor housing not conducive to good health. High fat traditional cooking (fatty butter Ghi). Development and industrialisation leads people to adopt a more Western lifestyle. Increasing life expectancy.
Economic Causes / Poorer areas of the UK with high levels of deprivation have greater incidences of obesity - greater access to convenience foods and lack of access to health facilities like leisure centres. / Existence of a major class divide – working class cannot afford to eat well have poor western-style convenience food. Slum areas in cities like Mumbai have very poor socio-economic conditions. Lack of education about the importance of good diet and lifestyle as many cannot afford to pay for schooling.
Food and Health
Malnutrition is defined as a condition resulting from some form of dietary deficiency. This many be because the quantity of food is too low, not giving enough calories per day, or because there are important nutrients absent. Malnutrition weakens immunity and makes people vulnerable to diseases. It may also lead to deficiency diseases such as beriberi or anaemia. Some people refer to this as undernourishment.
Famine is a period of time in which there is such a shortage of food that populations starve and death is caused. Famines are caused by a combination of natural events and human management. Many people who suffer in famine do not do so due to a lack of food; they lack the resources or other entitlements needed to obtain food. Famine is largely due to the failure of institutions, organisations and policies – not just the failure of markets and farmers. Famines in Africa can be explained in a long term context; they occur when poverty interacts with human policies (relating to economy, agriculture or demography). These interactions make some segments of society and some regions very vulnerable to minor changes in climate. Famine on a large scale can be a result of one or more of the following: cause
cause
The Sahel has been the region of the world most prone to repeated widespread famine. Drought in Ethiopia and Somalia has also been an issue:
In 2000, rains failed leading to a severe drought which affected 43% of the population:
People moved with their livestock in search of water and fresh pasture. As a result of these unusual migrations, too much pressure was put on the land. The lack of food and water lead to thousands of deaths amongst the population, as well as cattle, sheep and goats. Milk became scarce and food prices began to rise. Thousands of families headed for the cities and many camps for these internally displaced peoples had to be set up.
Obesity – “abnormal or excessive fat accumulation that may impair health.” The WHO defines obese as a BMI equal to or more than 30. The figures from the WHO indicate that in 2005:
o 1.6 billion adults were overweight
o At least 400 million adults were obese
o 20 million + children under the age of 5 were overweight
Health Care Approaches
Emergent – INDIA, BRAZIL, SOUTH AFRICA, BANGLADESH
Health care is viewed as an item of personal consumption. Physicians operate as solo entrepreneurs and facilities are privately owned. The state’s role in healthcare is minimal. Remote areas are developing mobile clinics and health workers who can treat common ailments, give inoculations and advice of basic hygiene, like in Tamil Nadu, India.
Pluralistic – USA
Healthcare is viewed as a consumer product provided by independent doctors. The consumer pays for all treatment, including surgery, hospitalisation and doctor’s fees. Many people have insurance to pay for treatment. US Federal Government established Medicaid for the poor and Medicare for the poor elderly.
Insurance Social Security – FRANCE, SPAIN, JAPAN
The entire population pays compulsory health insurance, and the amount is based on the income of the individual. A premium is deducted form employee’s pay automatically. The patient pays all medical bills and then claims up to 85% of it back. The state’s role in healthcare is evident but indirect.
National Health Service – UK, CANADA
Healthcare is a state supported service. Funding is provided by national government taxation and in the UK, it equates to approximately £1,980 for every man woman and child. At the point of use, health care is free for everyone. The aim of the NHS is to provide citizens with equal access to healthcare regardless of wealth. The state’s role is central and direct.
Socialised – CUBA, CHINA
Healthcare is a state provided service. Physicians are state employed and facilities are entirely publically owned. Payments for services are entirely indirect and the state’s role in healthcare is total. In Cuba, for a population of 11 million, there are over 30,000 family doctors and 10,000 dentists, as well as 21 medical schools providing free training.
Comparing Cuba and the USA - Cuba spends much less than USA on healthcare, yet the life expectancies are identical – 78.3 years. This may be because of Cuba’s more proactive approach reducing the cost for future treatment; every family receives a visit once a year from a doctor, emphasising the importance of a healthy lifestyle. Also, because healthcare in Cuba is free, everyone has equal access treatment, which is not the case in the USA.
Country / Healthcare Approach / Positives / NegativesCuba / Socialised / Free medical and dental care; home visits once every year; 2nd highest life expectancy in the Caribbean; 21 medical schools provide free training. / Huge pressure on government resources at times of economic decline; reported as being intrusive.
USA / Pluralistic / Medicare and Medicaid provide care for poor and poor elderly. Richer Americans see the benefit of paying for healthcare, in that quality is higher. / Many people in USA have poor health because they cannot afford health care and checkups. People are sometimes desperate for surgery before addressing problems.
Health Matters in a Globalising World Economy