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Health has 2 distinct but related facets in Geography:

the incidence of disease


the provision of healthcare

What is health?
Negative definition
the absence of disease, disability or
illness
But health is more than not being ill
Positive definition
a state of well-being
Health is also
culturally determined
a fundamental human right

What is health?
Health is a state of complete
physical, mental and social well-being,
not merely the absence of disease or
infirmity. 1946

Match the key word to the definition..


HEALTH
MORBIDITY
MORTALITY

ATTACK RATE

FANT MORTALITY

ASE-MORTALITY

The number of cases of a disease diagnosed in an


area, divided by the total population, over the
period of an epidemic.
The death of people. It is measured by a number
of indices including death rate, infant mortality,
case mortality and attack rate.
The number of deaths per 1,000 people in 1 year
A state of complete physical, mental and social
well-being and not merely the absence of diseases
and infirmity. (WHO, 1946)
The number of people dying from a disease divided
by the number of those diagnosed as having the
disease.
The number of deaths of children under the age of
1 year expressed per 1,000 live births per year. It
is a useful barometer of social and environmental
conditions and is sensitive to changes in either.
Illness and the reporting of disease. In the UK
2001 census respondents were asked how well they
felt and whether they had a limiting long-term
illness. Some diseases are so infectious that by
law they must be reported e.g. plague and cholera.

RUDE DEATH RATE

What is health?
Health is a state of complete
physical, mental and social well-being,
not merely the absence of disease or
infirmity. 1946

Types of indicators
Mortality the number of people who die
Morbidity the number of people who
are ill
Well-being how well people feel

Leading causes of mortality


Causes of death in
developing countries

Number of
deaths

Causes of death in
developed countries

Number of
deaths

HIV-AIDS

2,678,000

Ischaemic heart disease

3,512,000

Lower respiratory
infections

2,643,000

Stroke

3,346,000

Ischaemic heart disease

2,484,000

Chronic obstructive
pulmonary disease

1,829,000

Diarrhea

1,793,000

Lower respiratory
infections

1,180,000

Cerebrovascular disease

1,381,000

Lung cancer

938,000

Childhood diseases

1,217,000

Car accident

669,000

Malaria

1,103,000

Stomach cancer

657,000

Tuberculosis

1,021,000

High blood pressure

635,000

Chronic obstructive
pulmonary disease

748,000

Tuberculosis

571,000

Measles

674,000

Suicide

499,000

Mortality
Crude death rate number of deaths
per year in 1,000 people
Infant mortality rate number of
infants under one year old who die each
year, for every 1,000 babies born

Morbidity
Prevalence
The number of people who have disease
at a particular time
Incidence
The number of new cases occurring
within a set time period

Leading causes of death worldwide

countries

% of deaths caused
by infections, perinatal,
maternal and deficiency
diseases

% of deaths caused by
degenerative diseases

Richest 20%

85

Poorest 20%

59

32

ActionAid

Medical conditions causing morbidity

The World Health Organisation measures morbidity in


DALYs (daily adjusted life years), the amount of health
lost due to a disease or condition.

Main risk factors


contributing to disease and
morbidity

Mortality
Life expectancy the average
number
of years a newborn child is expected to
live assuming conditions remain
constant

World Life Expectancy


This map shows the total years of life expected to be lived by the current
population, based on the life expectancy of children born in 2002.

The longest life expectancy at birth is in Japan, at 81 years 6 months.


The shortest life expectancy is in Zambia, at 32 years 8 months.
The world average life expectancy is 67 years.

Death rate

Global Patterns of Health,


Disease and Death
Health is better in Wealthier countries
Global morbidity patterns are different
depending on the type of disease
Mortality patterns depend on morbidity
and the ability to treat morbidity
Health and disease are world issues

Summary table for selected


countries

Factors affecting health

Poverty
Education, especially of girls
Contraception
Environment
State and society/civil breakdown
Availability of health care
Gender

Determinants of Health

AIDS

What is AIDS?
Acquired Immunodeficiency
Syndrome
Destructs bodys immune system
Aids is caused by the virus HIV
HIV is Human Immunodeficiency Virus

Most severe manifestation of HIV

The history
1959: AIDS first identified in the Belgian
Congo
1978: Gay men in US show first signs of
AIDS
1982: term AIDS used for first time
1983: Institute Pasteur finds the HIV
virus
1985: The FDA approves the first HIV

Symptoms
Flu-like symptoms
No symptoms
Fever, Fatigue, Diarrhea, Skin Rashes,
Night Sweats, Loss of appetite
Other possible affects include
Opportunistic infections, cancers, pneumonia,
and tuberculosis

Global Summary

Adults and children estimated to


be living
with HIV as of end 2005
Western & Central Eastern Europe
& Central Asia
Europe

720 000

North America

1.2 million

[650 000 1.8 million]

Caribbean

1.6 million

[570 000 890 000] [990 000 2.3 million]East Asia

North Africa & Middle East

300 000

[200 000 510 000]

Latin America

1.8 million

[1.4 2.4 million]

510 000

[230 000 1.4 million]

Sub-Saharan Africa

25.8 million

[23.8 28.9 million]

870 000

[440 000 1.4 million]

South & South-East Asia

7.4 million

[4.5 11.0 million]

Oceania

74 000

[45 000 120 000]

Total: 40.3 (36.7 45.3) million

Country Level

Swaziland
38.8%
Botswana
37.3
Lesotho
28.9
Zimbabwe
24.6
S. Africa
21.5
Namibia
21.3
Zambia
16.5
Malawi
14.2
CAR
13.5
Mozambique 12.2

S. Africa 5,300,000
India 5,100,000
Nigeria
3,600,000
Zimbabwe
1,800,000
Tanzania 1,600,000
Ethiopia 1,500,000
Mozambique1,300,000
Kenya
1,200,000
DRC
1,100,000
USA
950,000

Sub-Saharan Africa 25.8 million


infected
66% OF THE PEOPLE
WITH HIV LIVE HERE.

AIDS HAS LEFT


BEHIND OVER 13
MILLION
ORPHANS

57% OF THE INFECTED


ADULTS ARE WOMEN
HERE AIDS IS THE
LEADING CAUSE
OF DEATH

2.4 MILLION ESTIMATED


DEATHS AT THE END OF
2005

SWAZILAND HAS THE HIGHEST


PREVALENCE OF HIV IN THE
WORLD. 38.8% OF THE ADULT
POPULATION INFECTED.

Voluntary counselling and


testing
The majority of people living with HIV in
low and middle income countries are not
aware of their HIV infection.
Increased provision of treatment and care
services will help motivate people to be
tested.
This, in turn, requires increased availability
of voluntary counselling and testing (VCT)
services. VCT stands at the heart of
prevention and treatment.

Antiretroviral (ARV)
Treatment
Behavioural counselling and provision of
condoms, clean needles and syringes must be
made available to people.
After testing positive, people living with HIV can
be offered care, treatment and support services,
including ARV if necessary.
Counselling and other services aimed at
prevention of secondary transmission, as well as
the provision of ARV to prevent mother-to-child
transmission, are an essential component of
follow-up services for individuals who test
positive.
Effective prevention programming and treatment,
care and support services therefore go hand-inhand.

Impacts
The impact of AIDS is devastating to the
economies of low and middle income countries
with high HIV prevalence.
These countries, already suffering from heavy
debt burdens, low productivity and weak
infrastructures are being further impoverished by
the scourge of AIDS.
There is strong evidence that investment in HIVrelated treatment and care can reduce
hospitalisations and other direct and indirect
costs of HIV/AIDS.
Brazil has completed a number of economic
analyses demonstrating significant cost-savings
and expenditures avoided since the introduction
of universal coverage of HIV-related treatments,

Impacts
Destruction of social capital
Knowledge base of society
Production sectors: agriculture,
industry

Weakening of institutions
Civil service, judiciary, armed forces,
education, health
Inhibition of private sector growth

Wider, deeper poverty

Impacts
HIV treatment allows savings due to
avoidance of hospitalisations and lower
incidence of opportunistic infections.
In addition to prolonging the lives of
countless teachers, health workers,
farmers, students and other precious
human capital, it makes sense for
countries to invest in health care in
general, and HIV treatment specifically,
because access to care and treatment is a
human right.

Age in years

Projected population structure with and


without the AIDS epidemic, Botswana 2020
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0

Projected population
structure in 2020

Males

140 120 100 80

Females

60

40

20

20

40

60

Population (thousands)
Source: US Census Bureau, World Population Profile 2000

80 100 120 140

Deficits due to AIDS

Women
Women are infected up to 10 times
more easily than men
Social and economic factors increase
womens vulnerability
In RSA 75% of 15-24 years olds
infected are women, globally 47% of
total infections are in women
Women bear the social and economic
burden of the epidemic

Comprehensive care

Comprehensive care for people living with HIV/AIDS


includes, but is not limited to, the following:

Available, accessible, voluntary counselling and testing


services
Antiretroviral therapy (ARV)
Prevention and treatment of tuberculosis and other
opportunistic infections
Prevention and treatment of sexually transmitted infections
Palliative care to reduce the suffering of infected people
Prevention of further HIV transmission, through existing
technologies (e.g. male and female condoms, antiretrovirals for
the prevention of mother-to-child transmission, clean needles
and syringes) and investment in future technologies (e.g.
vaccines and microbicides) as well as behaviour change
Family planning
Good nutrition
Reduction of the stigma associated with HIV/AIDS

There is no cure

Treatment programmes vary


Different approaches are being used to help fund
access to care and treatment in low and middle
income countries. These include:
Universal, free-of-charge, access to treatment
programmes through the public sector (the approach
used by Brazil and a number of other Latin American
countries),
Direct government subsidies to patients (the approach
used by Chile, Cote dIvoire, Gabon, Mali, Romania,
Senegal and Trinidad and Tobago),
Out-of-pocket purchasing by patients after large-volume
purchases at reduced prices by governments (the
approach being used by Uganda).

Costs
It is clear, however, that the vast majority
of people living with HIV and in need of
treatment will not be able to afford to
cover the costs of their care.
Countries that have maximised treatment
access have done so through universal
access.
HIV care will need to be provided at a price
that is proportionate to local purchasing
power and for many people, in many
communities, in many countries, that
means HIV care and treatment must be
free

Potential AIDS treatment costs as a


percent of the Ministry of Health
Budget
70
70%
% of
of MOH
MOH Budget
Budget
60
60
50
50
40
40
30
30
20
20
10
10
00

Ethiopia 2014

Source: Stover & Bollinger, 1999

Kenya 2005

Zimbabwe 2005

Benefits
Treatment brings many wider benefits and its
effects on national development are also
substantial.
What makes AIDS uniquely destructive is that it
targets adults in the prime of their lives as
workers, parents and caregivers.
Treating HIV:

Saves children from ophanhood,


Keeps households intact
Keeps businesses intact
Maintains social cohesion
Enhances the return on social investments in sectors
such as education and rural development
Boosts economic growth
Enhances national security

Prevention better than..


Prevention can help stave off such threats
in the future, but people, societies,
economies and nations are at risk today
and the risk stems primarily from the likely
impact of millions of premature deaths
within the next decade among those
already infected.
Moreover, those countries with the highest
rates of infection are at disproportionately
greater risk, which makes treatment there
all the more important.

Water issues
Where drought conditions exist,
access to clean water is reduced,
further increasing the risk of infection
for adults, children and infants,
particularly those on formula feeding.
Clean water supplies and adequate
food must be part of an overall HIV
treatment, care and support package

Food issues
For much of the worlds population living
with HIV, the need for food remains an
overwhelming priority.
People living with HIV and AIDS need
substantial nutritional inputs (up to 50%
more protein) to fortify their compromised
immune systems.
Those suffering from hunger, famine
and/or nutritional deficits are more likely
to fall ill with opportunistic infections and
are less likely to be able to recover from
them.
Malnutrition is also one of the major
clinical manifestations of HIV disease.

HIV/AIDS affects rural areas


69% of the population of the most
affected countries lives in rural areas
AIDS affects economic sectors with
mobile/ migratory workers
(agriculture, mining)
AIDS-related traditional practices are
more prevalent in rural areas
AIDS-affected urban dwellers often
return to rural areas

Case study Zambia


Extracts from a Report for The
University of Nottingham School of
Nursing, May 2003
This report describes my experiences
whilst on a five-week placement in
the Southern Province of Zambia as
part of my nursing degree The
focus of my placement was to see
the work of SAPEP an HIV/AIDS
project

Southern Province of
Zambia
SAPEP is a non-governmental
organisation which works in two rural
districts in Zambias Southern Province,
surrounding the towns of Monze and
Mazabuka.
The project used to be funded by the
government Family Health Trust. The
project was under-funded and has been
funded by PEPAIDS, a British-based
charity, since December 2002.
SAPEP employs two District Co-ordinators,
one in Monze and one in Mazabuka.
Their districts are divided into 20 Zones,
each with a part-time Zone Co-ordinator

Anti-AIDS Clubs.
Anti-AIDS Clubs had been running in Zambia
since 1991.
SAPEP took over in 2002
The Club Leaders organise activities
Competitions
drama/role-plays about HIV/AIDS transmission situations
Sport has proved to be a very effective way of reaching
the youth and giving health education, because it
attracts a large audience.

They also liaise with local health clinics, hospitals


and schools.
Youth Friendly Corners are run in rural health
clinics, where young people can go for advice and
discuss sex and HIV, which are usually taboo
subjects in Zambian society.

Reducing the stigma


There is a huge stigma surrounding
HIV/AIDS in Zambia. Issues around sex are
not discussed. Heterosexual intercourse is
responsible for the vast majority of HIV
infections in Zambia.
Zambian women have an extremely low
status in society.
Women have no power within relationships
to refuse sex, insist on condom use or
demand that their partners be faithful.
This is one of the most crucial reasons for
the spread of AIDS in Zambia, and in Africa
as a whole.

Cultural issues
Some practices and beliefs have a
direct effect on the transmission of
HIV.
For instance, it is believed that men
can cure sexually transmitted
diseases by having sex with a virgin
Family and tribal elders are also
expected to initiate young girls into
womanhood, through sexual
intercourse.

Poverty
For many people each day is, literally, a struggle for
survival.
Many women and young girls are forced into
prostitution, which obviously contributes to the
spread of HIV.
I visited three different areas in Monze with homebased care services. The majority of the patients we
visited had AIDS they were dying without any
food or pain relief.
For many people, AIDS meant their family had no
source of income as the sole earner was sick.
There were countless orphans who had lost both
parents to AIDS.
One woman I met had seven grandchildren to look
after, her own children having died from AIDS.

Geography
of an
Infectious
Disease:

HIV/AIDs

Some key facts!

35.7 million adults and 2.1 million children are living


with it.

This year also saw 2.9 million deaths from it.

50% of people who get AIDS at 25 years old die


before their 35th birthday.

At the end of 2003, the epidemic had left behind 15


million orphans.

In 2003, an estimated 700,000 children aged 14 or


younger became infected.

An estimated 49,500 adults were living with the


disease in the UK at the end of 2002, nearly a third
of whom were undiagnosed.

The overwhelming majority of people with the


disease, some 95% of the global total, live in the
developing world.

The area in Africa south of the Sahara desert is by far the


worst-affected in the world, as it is home to over 60% of all
people living with the disease.

What is it?
AIDS =
acquired
immunodeficiency
syndrome
It is caused by
the human
immunodeficie
ncy
The virus
spread of
(HIV).
HIV..

See sheets

Describe the global


distribution of HIV/AIDS

Describe the global


distribution of HIV/AIDS

The global
KEY FACTS: hazard

In 2005 over 43 million people lived with


HIV.
In 2006, 3 million people died of AIDS; 5
million more were infected.
Sub-Saharan Africa is the worst affected
region: it has 10% of the global
population but 70% of the worlds HIV
cases.
75% of all women with HIV live in sub-

Evidence of frequency and


scale is hard to determine
accurately. Why?

A Disease Largely of
Poverty
Among all low- and middle-income
countries, HIV prevalence is strongly
correlated with falling protein
consumption, falling calorie
consumption, unequal distribution of
national income and, to a lesser extent,
labor migration.
Poverty not only creates the biological
conditions for greater susceptibility to

For wealthier people in industrialized countries, there is a better chance


to afford the very expensive treatment that is available.
However, for the vast majority of HIV and AIDS sufferers in the
developing countries, such treatment is not available. The spread and
epidemic of AIDS is also largely a result of poverty and debt conditions.
Although there are numerous factors in the spread of HIV/AIDS, it is
largely recognised as a disease of poverty, hitting hardest where people
are marginalised and suffering economic hardship, increasing their
vulnerability to HIV infection, and reinforcing conditions where the
scourge of HIV/AIDS can flourish.

Deadly Conditions? Examining the relationship between debt relief polic


ies and HIV/AIDS
, Medact and the World Development Movement, September 1999

Causes of the
Epidemic.
Background
about
AIDS/HIV.

Aids/HIV in
Africa.
Strategies to
tackle the
epidemic.

Impacts on
African
Communities.

CHD Your heart

CHD What is it?


CHD begins when cholesterol, fatty material, and calcium
build up in the arteries. When this occurs in the arteries that
supply the heart, this buildup, or plaque, causes the arteries
to narrow, so that oxygen delivery to the heart is reduced.
The reduction in oxygen delivery to the heart can create
chest pain, also called angina.
The link between heart disease and heart attack
When plaque builds up to the point that it ruptures, it causes
a blood clot to form in the coronary artery. The blood clot
blocks blood from flowing to the heart muscle, leading to a
heart attack. In a worst-case scenario, sudden cardiac
arrest or fatal rhythm disturbance can occur.

CHD What is it?

CHD the effects - Heart disease begins when


cholesterol, fatty material, and
calcium build up in the arteries, a process known
as atherosclerosis

CHD Risk Factors


smoking,
high blood pressure
(hypertension),
high cholesterol,
diabetes,
family history of
CHD,
peripheral artery
disease
Obesity
lack of exercise,
high-fat diet.

CHD - Symptoms
Some people experience
shortness of breath or chest
pain and make it to the
hospital in time to be treated.
Besides chest pain (angina)
and shortness of breath,
other occasional symptoms
include jaw pain, sweating,
and nausea.

For others, cardiac arrest can be


the first symptom they
experience, and is deadly unless
treated immediately

CHD - Diagnosis
Doctors use a variety of tests to
detect heart disease.
One common test is the
electrocardiogram (ECG)
Symptoms of CHD tend to show
up when the person is exercising
because that's when the heart
needs a higher level of oxygen
delivery. However, for a person
with heart disease, the coronary
arteries can't deliver the amount
of oxygenated blood needed
because of the coronary artery
blockage. That's why stress tests
require the patient to perform a
strenuous activity under a
doctor's supervision, such as
walking or running on a treadmill.

CHD diagnosis Identifying the


location of the blocked arteries:
Angiography

CHD Treatment Angioplasty


and stent insertion

(Normally done within 24 hours of positive ECG result under


local anaesthetic)

CHD - Treatment
Bypass Graft if the blockages are too extensive
then artificial arteries are created that bypass the
affected areas. This open heart surgery is done under
general anaesthetic.

CHD - Treatment
Medication is always necessary to manage CHD. This
is normally:
1.Statins lowers cholesterol
2.ACE inhibitors & beta blockers Reduce stress on
the heart
3.Aspirin thins the blood.

CHD Impact upon


Individuals

Medical advances have reduced the impact


greatly in recent years. The effect of CHD will
depend upon whether the person knows they
have it, and whether it can be surgically
treated.
Before treatment, the symptoms already
mentioned can lead to difficulties with exercise
even walking short distances.
After treatment the main impact is having to
take various medication with possible side
effects and for some the psychological effect
of having a heart attack or nearly dying.

Disease prevention
You can reduce
the risk of
developing
CHD by
exercising,
eating
healthily, and
not smoking.

Global morbidity as a
result of CHD

Homework
Research and find out about the recent Cholera
epidemic in S. Africa.
How is it being spread, contained, treated etc.
To what extent is the level of development in
Zimbabwe contributing to the outbreak?

BELL WORK

In the UK it is estimated that in 2007,


60.8% of adults and 31.1% of children
were overweight or obese.

BELL WORK
In 2010,
an
estimat
ed 925
million
people
were
sufferin
g from
hunger.

BELL WORK

Children as
young as 3 are
being treated
for obesity

BELL WORK

In 2008, nearly 9
million children died
before they reached
their fifth birthday.
One third of these
deaths are due
directly or indirectly

BELL WORK

Why?

Globally, we produce enough to feed everyone 2,700 calories


per day, yet 30m people die every year from starvation and
800m suffer from chronic malnutrition. Its a big FAT
contradiction!!

Dietary Energy Supply

Food and
Health
MALNUTRITION
FAMINE
OBESITY

T.A.G.S.
Thinking Skill:
Assessment for learning:
Geographical Skill(s)/Skills for Life:
Success Criteria (Learning Outcomes for the lesson):
LEARNING OUTCOMES:
1)
2)
3)

What
What
What

are malnutrition and famine?


causes them and what impacts do they have?
are the solutions to famine?

Lesson Overview
Class
Case Studies
Differentiation
Personalised
Learning
Use of TA
SMSC
Literacy/Numeracy
Bell Work
New Information
Clarify Understanding
Apply
Plenary
Homework

KEY WORDS FOR TODAYS LESSON


Periodic Famine

Malnutrition

Undernourishment
Stunting
Overnourishment

Develops when the body doesnt get the right


amount of the vitamins, minerals, and other
nutrients it needs to maintain healthy tissues and
organ function.
Reflects shortness-for-age; an indicator of chronic
malnutrition and calculated by comparing the
height-for-age of a child with a reference
population of healthy children
The regional failure of food production or distribution
systems, leading to increased mortality due to
starvation and associated disease

The excessive consumption of food which can


increase the risk of developing health problems.
The status of people whose food intake does not
include enough calories (energy) to meet
minimum physiological needs.

KEY WORDS FOR TODAYS LESSON


Malnutrition

Stunting

Periodic Famine
Overnourishment
Undernourishment

Develops when the body doesnt get the right


amount of the vitamins, minerals, and other
nutrients it needs to maintain healthy tissues and
organ function.
Reflects shortness-for-age; an indicator of chronic
malnutrition and calculated by comparing the
height-for-age of a child with a reference
population of healthy children.
The regional failure of food production or distribution
systems, leading to increased mortality due to
starvation and associated disease.

The excessive consumption of food which can


increase the risk of developing health problems.
The status of people whose food intake does not
include enough calories (energy) to meet
minimum physiological needs.

MALNUTRITION
Going without proper food can lead to serious
health implications:
Marasmus
(protein energy
malnutrition) by a
lack of protein and
energy with sufferers
appearing skeletally
thin.

BeriBeri
by vitamin B1
deficiency. It causes
severe fatigue and
cardiovascular
complications.

MALNUTRITION
Xeropthalmia by vitamin
A deficiency. It is a
leading cause of blindness
in LEDCs.

Pellagra by vitamin
B3 deficiency.

Anaemia is caused
by iron
deficiency and a
decrease

MALNUTRITION

Rickets
Is caused by a lack
of vitamin D. Leads
to a softening of
the bones leading
to fractures and
deformity.

Scurvy
is caused by vitamin C
deficiency. It leads to
spots on the skin,
spongy gums and
bleeding from the
mucous membranes.
Teeth may also fall
out. It has affected
sailors in the past.

DISTRIBUTION OF WORLD HUNGER

TASK write a detailed description


of the distribution of global under-

HOMEWORK TASK 1
We are going to look at 2 case studies on
malnutrition UK and Niger. You need to have
3 highlighters and you must read through
the article and highlight:
Causes
Impacts
Solutions
Top Tip:
If you would rather create case study
summaries so you have a revision aid for exam
time then I would agree that this would be a
great idea as large articles can often be very
overwhelming at exam time. In addition, putting
in the hard work now will mean you have less to
do for your revision preparation.

FAMINE
Famine contains three elements: food shortage,
starvation and excess mortality.
It has a greater effect on the most
vulnerable in society as they have
low status, limited land and weak
purchasing and bargaining power.
Famine is caused by many complex factors
including: poor climatic and environmental
conditions, population growth, market failure or war.
The difference between famine and food crisis
is whether there is enough food aid to keep
starving people alive. If there is not then people die
and then there is a famine.

FAMINE
Famines are not always widespread. They can be
localised and can affect only one group or social class.
In areas affected by famine it is not uncommon to see
food available in markets and some agricultural
produce being exported.
Large scale famines occur as a result of the
following factors:
Drought which limits water supply when the rains
fail.
A population increase greater than the rate of
food production (e.g. sudden influx of refugees).
A rapid rise in the price of food stuffs and
animals this happens when the quality of farmland
and grazing declines, this leads to panic buying
making the situation even worse.

FAMINE CAUSES AND


SOLUTIONS
1) Read the information
on the stickers. Some of
them have 2 parts so
identify which 2 stickers
go together
2) Colour them in the correct
colour and for homework
- stick them in the correct
place on the worksheet:
Causes of Famine
Solutions to Famine
Long Term Solutions
to Famine
Problems with
Famine Relief

Did you know


The majority of food aid is
delivered on a continuous
basis as programme or
project aid.
It has been argued that
this is actually a way for
Northern countries to get
rid of extra food, and that
it encourages dependency,
changes eating habits,
allows Northern countries
to exert influence over
Southern countries, keeps
prices at an artificially low
level and drives food
producers in developing

HOMEWORK TASK 2
Using the following resources:
Video:
http://www.youtube.com/watch?v=JJD880K1rYU
(or type into google/youtube endless famine,
Ethiopia, the video is about 18 mins long). You
must watch the whole video and make notes on
specific facts and figures which will then inform
your case study.
The brown textbook P.290
Action Aid Document
Independent internet research (optional)
You are to create a case study on famine in

Ethiopia.

Obesity

Definition
An excess of body fat which is
greater than 20%
The most common method of
measuring obesity is calculating an
individuals Body Mass Index (BMI).
This is calculated by dividing a
persons weight measurement (in
kilograms) by the square of their
height (in metres)

Latest UK figures (2010)


62.8% of adults (aged 16 or over)
were overweight or obese
30.3% of children (aged 2-15) were
overweight or obese
26.1% of all adults and 16% of all
children were obese

Predictions
A report, published in October 2007,
predicted that if no action was taken:
60% of men, 50% of women and 25%
of children in Britain would be obese
by 2050.
Without action 41-48% of men and
35-43% of women could be obese by
2030.

Dangers
Obesity can have a severe impact on
peoples health, increasing the risk of
type 2 diabetes, some cancers, and
heart and liver disease.
There is also a significant burden on
the NHS direct costs caused by
obesity are now estimated to be 5.1
billion per year (2013).

An Obese man is:


five times more likely to develop type
2 diabetes
three times more likely to develop
cancer of the colon
more than two and a half times more
likely to develop high blood pressure
a major risk factor for stroke and
heart disease

An Obese woman is:


almost 13 times more likely to
develop type 2 diabetes
more than four times more likely to
develop high blood pressure
more than three times more likely to
have a heart attack

Measures
Leading soft drinks brands Lucozade,
Ribena and J20 are among the latest
brands to sign up to the
Responsibility Deals calorie reductio
n pledge
as part of the governments drive to
curb obesity levels.

Measures
Jan 2013 campagn from Change4life
exposes hidden facts about everday
foods.
Tv advert reveals that there is 17
cubes of sugar in a bottle of cola,
More than a wine glass full of fat in a
large pizza is to be shown on TV.

Measures
The government has announced
(March 2013) new funding for school
sport and PE worth 150m a year for
the next two years.
This is to promote an interest in sport
and healthy lifestyles for the future.
Part of Olympic legacy measures

Contrasting health care


approaches in countries at
different stage of development

Countries to be studied:
Peru
USA
Cuba

What data belongs to which


country?

Egypt
Suriname
Finland
Australia
Argentina
Gambia
USA
Jamaica
Pakisatn

Average
life
expectan
cy

Maternal
deaths/1
00,000liv
e births

Child
mortality
rate

Diabetes
%

HIV/Aids
% of 1549 year
olds

Healthca
re
spending
% of GDP

Doctors
per 1000
people

70

110

39

1.9

1.9

3.6

75

82

16

5.4

5.4

4.3

30

79

0.1

7.2

5.7

32

81

6.2

0.1

6.4

25

71

87

20

7.2

1.5

2.7

64

500

100

8.5

0.1

0.7

78

17

8.0

0.6

6.8

26

57

137

2.2

2.2

2.4

3.2

70

84

33

9.8

<0.1

2.5

Answers

Average life
expectancy
Suriname
Argentina
Finland
Australia
Jamaica
Pakistan
USA
Gambia
Egypt

70
75
79
81
71
64
78
57
70

Maternal
deaths/100
live births
110
82
6
8
87
500
17
137
84

Child
mortality rate

Diabetes %

39
16
4
6
20
100
8
2.2
33

1.9
5.4
0.1
6.2
7.2
8.5
8.0
2.2
9.8

HIV/Aids % of
15-49 year
olds
1.9
5.4
7.2
0.1
1.5
0.1
0.6
2.4
<0.1

Healthcare
spending %
of GDP
3.6
4.3
5.7
6.4
2.7
0.7
6.8
3.2
2.5

Doctors per
1000 people
5
30
32
25
9
7
26
1
5

What is health care?


Together make a list of five things
that you think should be covered
under the term health care

http://www.slideshare.net/kgphipps/geography-of-heal
th

Photos to stimulate your thinking on health care

Key components of a health care


system:
Five key aspects are:

Equality
Equality
Equality
Equality
Equality

of
of
of
of
of

public spending
final real income
access
cost
outcome

What evidence can we find to compare


expenditure on health care, existing
health care schemes and health care
outcomes?
Study the 5 graphs you have been
given.
As a group write a summary
describing the patterns between
spending on health care and health
outcomes.

Fig 1: Wealth and health expenditure are


correlated (2009)

http://www.who.int/mediacentre/factsheets/fs319/en/#

Fig 2: Correlation between expenditure on health and outcomes


(2009)

Figure 3: DALYs lost by World Bank income region projected 2005


Note: The Disability-Adjusted Life Year (DALY) is a unit measuring the amount
of health lost due to disease or condition.

Figure 4:

http://ucatlas.ucsc.edu/spend.php

Figure 5:

Comparing health care of countries


at different stage of development.
As a group think of at least 5 indicators
we can use to compare expenditure
and outcomes for health care.
Use the atlas or the internet to find
this data for;
Peru, USA, Cuba, UK.

Health matters in a globalising world


economy
transnational corporations and pharmaceutical
research, production and distribution

UK Trademark
Generic
A

B
Bactroban
mupirocin
Becloforte
beclomethasone
dipropionate
Becodisks
beclomethasone
dipropionate
Beconase Aq. Nasal Spra
y

Adartrel
ropinirole hydrochloride
Alkeran
melphalan
Altargo
retapamulin
Amoxil
amoxicillin
Andropatch
testosterone
Anectine
beclomethasone
suxamethonium chloride
dipropionate
Arixtra
Becotide Inhaler
fondaparinux sodium
beclomethasone
Atriance
dipropionate
nelarabine
Betnovate
Augmentin
betamethasone valerate
amoxicillin/clavulanate potassium
Avamys
C
fluticasone furoate
Avandamet
Cicatrin
rosiglitazone/metformin HCl neomycin sulphate
Avandia
Combivir
rosiglitazone maleate
zidovudine and

D
Daraprim
pyrimethamine
Dermovate
clobetasol propionate
Digibind
digoxin antibody fab
fragments
Doralese Tiltabs
indoramin
hydrochloride
E
Efcortelan
hydrocortisone
Epivir
lamivudine
Eumovate
clobetasone butyrate

What is the
difference?

The Name Game

A pharmaceutical company discovers a new generic drug to treat or


prevent a condition,
They put it through a series of clinical trials in order to gain approval for
marketing from the Medicines and Healthcare products Regulatory Agency
(MHRA).
the MHRA approves the drug and gives it a licence.
the pharmaceutical company can then market the generic medicine under
a brand name.
The company then has exclusive rights to market the medicine for the
licensed uses for a certain period of time, usually about 10 to 12 years.
This is known as a patent, and allows the drug company to recoup the
costs of research and development of the new medicine, before other drug
companies are allowed to produce it as well.
Other drug companies are likely to be able to produce and sell the
medicine at a cheaper rate, because the research and development has
already been done.
Once a patent expires, other drug companies then have the right to
manufacture and market the generic drug. However, they must market it
under a different brand name, or under its generic name.

For example, sildenafil (Viagra) is still under patent and so


can currently only be marketed by Pfizer to treat
impotence. Once the patent expires, we can expect to see
other other pharmaceutical companies marketing
potentially cheaper versions of the generic medicine
sildenafil, either under different brand names, or simply as
the generic sildenafil.

Ibuprofen on the other hand is a much older medicine and can


already be bought under various different brand names, eg
Nurofen (made by Reckitt Benckiser), and Anadin ultra
(made by Wyeth Consumer Healthcare), to name but a few.
All of these contain ibuprofen as the generic medicine.
Ibuprofen can also be bought simply as ibuprofen tablets,
made by various different manufacturers who market it
without a brand name.

Why buy branded?


Why buy generic?

Branded vs. generic

Generic drugs are cheaper. The


NHS could save up to 85 million
by prescribing generic statin
drugs to patients with high
cholesterol.
A which report sites medicines
such as paracetamol and
ibuprofen can be bought for a
fraction of the price of branded
medicines if shoppers seek out
less prominent labels.
It cites Panadol, which costs 1.85
for 16 tablets but contains the
same amount of the active
ingredient as Sainsbury's ownbrand paracetamol, which costs
26p for the same size pack.
Drug manufactures put large
amounts of money into research
and development of new and
existing drugs and need to
recuperate this through sales.

Epilepsy medication: Anecdotal


studies and small scale research
report that switching epilepsy
suffers from branded medicine to
generic medicine can mean
seizures return.
The placebo effect. Marketing
makes people think branded
drugs work better, so they believe
they do.

Definitions
Generics
Off patent medicine
Transnationals
Globalisation
Lobbying

The process by which people, their ideas and their activities


(economic, social and political) in previously relatively
separated parts of the world become interconnected,
integrated, drawn to the same social space at the same
historical time.

Globalisation

Globalisation:
the integration of economic social
cultural and political systems across
geographical boundaries.
Increasing economic and social
systems across geographical
boundaries.
It refers to increasing economic
integration of countries especially in
terms of trade and the movement of
capital.

Globalisation:True or false

True1.
True2.
True3.

Two thirds of international trade is accounted for


by just 500 corporations.
Of the worlds 100 largest economies, 50 are
TNCs.
Global wealth doubled from $14 trillion to $28
trillion in one decade.
to the World Bank, this wealth has
alse4. According
reduced global poverty.
True5. Unilevers corporate sales were $49.7 billion in
1994. In the same year, the GDP of Egypt was
$43.9 billion.
alse6. About forty countries today are poorer than
True they were twenty years ago.
7. In a single day under globalization, poor
lose nearly $2 billion due to
True countries
international trade,
8. 30,000 children die from preventable

Pharmaceutical companies

How is health globalized?


Spider diagram your ideas.
Think about TNCs
Think about your Niger, UK studies
Think about your HIV/AIDS work
Think about your crisis plan for H5N1

Key points

Health workers move between countries


NGOs e.g. doctors without borders
World health organisation, UN
TNCs like GSK research and distribution
Infectious diseases crossing borders bird
flu and HIV AIDS, which means crisis plans
have to be put together.
Sharing of research
Panorama sharing information on
unreliable drugs
Exports and imports of medicines

Globalisation
It refers to increasing economic
integration of countries especially in
terms of trade and the movement of
capital.

How does the pharmaceutical industry


create drugs?

A pharmaceutical company creates a new drug to treat or


prevent a condition. This is called a generic drug (generic
= chemical name).
They put it through a series of clinical trials in order to gain
approval to sell the drug
The pharmaceutical company can then market the drug
under a brand name branded drug.
The company then has exclusive rights to market the
medicine for a certain period of time, usually 10 - 12 years.
This is known as a patent, allowing the drug company to
set the price and recoup the costs of research and
development of the new medicine.
Once a patent expires, other drug companies then have
the right to manufacture and market the generic drug.
These are usually sold much cheaper, because the
research and development has already been done.

How do TNCs develop new


drugs?
It is estimated that new drug costs $500
million to bring to market.
Most money is spent targeting diseases of
affluence as MEDCs can pay high sums for
treatments.
This figure includes the R&D in labs, clinical
trials, marketing (especially to doctors) etc.
Patents make it illegal to copy the drug and
for rival companies to make a generic
version for 20years.

Medical exports
Worldmapper.org

Earning from exports of Medicines and medical equipment. Territories


in Western Europe receive 74% of all earnings from exports of
medicines. These territories account for 91% of net medicine exports
(US$).
Non-European net exporters include China, India, Mexico and
Singapore. India is a major source of medicines. Indian medicines are
sold more cheaply than European medicines, therefore Indias export
earnings are lower, so India appears smaller on this map.

Medical imports

Nearly 90% of the territories mapped are net medicine importers. There
is huge variation in the spending per person on imported medicines.
The highest spending per person is in Luxembourg, where US$ 406 is
spent on net imports of medicines per person, per year.
At the other extreme, in Tajikistan, only 9 US cents are spent per person
on net imports of medicines. This does not necessarily mean that there
is very little medicine in Tajikistan, because there might also be
domestic production of medicines and even exports of these. But for
this territory that is not significant.

What might this map show?

Research and development

Research and development

1. Describe the distribution of research and development.


2. Explain how some countries will benefit and others will
suffer. Use the words Patent, generic and Transnational
in your answer.

Research and development


In 2002, US$289 billion was spent on
research and development in the United
States; in the same year there was
practically no research and development
spending in Angola. It is thus unsurprising
that the number of patents granted and
the value of royalty and license fees
received are also vastly different between
these places.

Many people, most of them in tropical


countries of the Third World, die of
preventable, curable diseases. Malaria,
tuberculosis, acute lower-respiratory
infectionsin 1998, these claimed 6.1
million lives. People died because the
drugs to treat those illnesses are
nonexistent or are no longer effective.
They died because it doesnt pay to keep
them alive.
Ken Silverstein,
Millions for Viagra, Pennies for Diseases of
the Poor
, The Nation, July 19, 1999

Pharmaceutical companies: heroes


or villains?
GSK is directly responsible for numerous deaths due to its
patents held, and drug pricing strategies
GSK is at the forefront of developing immunisations and
treatments for diseases in developing countries. Profits are
ploughed back in to research. HIV AIDS treatments are sold
at cost in many countries
GSK share price is declining, they are not reaching the
expected 55p and profits are slightly down from the 22.7
billion made last year.

Who might have said the statement, does it make GSK a


hero or a villain?

GSK hero or villain?


Discuss with your partner what
conclusion you came to.

Task
Make sure you have at least 3 points
for each perspective.
Write a conclusion to your argument
justifying why you think GSK is a hero
or a villain.

The Tobacco Industry and


Health

To describe the effects on health of smoking


cigarettes
To describe the current patterns of cigarette
consumption
To explain how and why these patterns are changes
To outline how Tobacco TNCs are looking to expand
markets and profits by targeting LEDCs.

Female Smokers

There are women who smoke living in every territory in the world. But the
proportion of women who smoke varies from 1% in Azerbaijan to 47% in
Guinea. Of the total world female population over the age of 15 years,
10% are smokers. Some girls start to smoke before they reach the age of
15.

Male smokers

Worldwide there are four times more men that smoke than women. In
2002 there were 941 million male smokers, which was 43% of all men
aged over 15 years old. The largest population of male smokers lives in
China - where men are more likely to smoke than not to smoke. Even
Puerto Rico and Sweden, with the lowest percentages of men who smoke
still have 17% who are smokers.

How many cigarettes are smoked


each year?
5.5 trillion
5,500,000,000,000
There are
believed to be 1.1
billion smokers in
the world, 800
million of them in
developing
countries.

Whats in that cigarette?

Cigarette smoke contains about 4,000 chemical agents, including over 60


carcinogens including substances, such as carbon monoxide, tar, arsenic,
cyanide, benzene, formaldehyde, methanol, acetylene, ammonia, lead.

Effects of smoking on human


health

http://news.bbc.co.uk/1/hi/health/medical_notes/473673.stm
Use this website to annotate the body to show the effects of smoking

Effects of smoking on your health

Smoking is a greater cause of death and disability than any single


disease, says the World Health Organisation.
According to their figures, it is responsible for approximately five
million deaths worldwide every year.
Tobacco smoking is a known or probable cause of approximately 25
diseases, and even the WHO says that its impact on world health is
not fully assessed.
5X more likely to have a heart attack
Increased risk of stoke
Men are 22X likely to get lung cancer
Smoking also increases the risk of oral, uterine, liver, kidney,
bladder, stomach, and cervical cancers, and leukaemia.
Another health problem associated with tobacco is emphysema,
which, when combined with chronic bronchitis, produces chronic
obstructive pulmonary disease.
Smoking in pregnancy greatly increases the risk of miscarriage, is
associated with lower birthweight babies, and inhibited child
development.
Smoking by parents following the birth is linked to sudden infant
death syndrome, or cot death, and higher rates of infant respiratory
illness, such as bronchitis, colds, and pneumonia.

Health Risks
Heart attacks and strokes. Smokers
are five times more likely to have a
heart attack than non-smokers.
Smoking also increases the risk of
having a stroke
Lung problems. Men who smoke
increase their chances of dying from
lung cancer by more than 22 times.
For women the giure is 12 times.

Health Risks
Cancer. Smoking increases the risk of
oral, uterine, liver, kidney, bladder,
stomach and cervical cancers, and
leukaemia.
Smoking and young people. People
who start smoking aged 11-15 are 3
times more likely to die a premature
death than someone who takes up
smoking at the age of 20

Healthy Lung vs. Smokers


Lung

Who imposed the worlds 1st


smoking ban?
The Nazi party banned smoking in
its offices, hospitals, universities and
post offices and broadcast anti
smoking campaigns until 1945.

Smoking Bans in MEDCsan example of public health


policy

South Africa 1993

California and New York 1998


Japan 2002
Sweden 2005
EU wide ban on Advertising 2005
Spain 2006
Denmark, UK 2007
France, Netherlands, India, Romania, Greece, Bulgaria 2008
Hungary 2009

In most countries a ban on smoking in public places has


led to smokers reducing consumption by 15% and
increasing their chances of giving up by 84%.

Bar graph showing annual


tobacco consumption in grams

As a result of smoking and advertising bans


markets in MEDCs have declined and
tobacco TNCs have started to look to
LEDCs and emerging economies (eg.
China) to guarantee new smoking addicts
and guaranteed profits.
What do you think of this?
Are tobacco TNCs: drug dealers/
providing consumer choice/ causing
manslaughter/?
Is it ethical to exploit LEDCs or is it just
the way business works?

Map showing the proportion of


men who smoke in each country

Source:worldmapper.org

World map showing location and %


of males who smoke.

Source: WHO 2008

Tobacco TNCs

USA

India

Smoking bans are in place


in public places for many
cities and states. EG New
York banned smoking in
bars, clubs and restaurants
in 2003

A ban on smoking in all


public places in October
2008 and cigarette sales
to children banned. India
has 900,000 smoking
related deaths every year

Tackling
Smoking
China
May 2008 smoking
banned in most public
places in the lead up to
the Olympic Games.
Part of a move to
encourage healthier
lifestyles.

Australia
Smoking banned in
most public places,
including Bondi Beach.
The cities of Freemantle
and Perth have banned
smoking in outside
dining areas.

Case Study BAT (British


American Tobacco)
Main brands: Dunhill, Kent, Lucky
Strike, Pall Mall, Vogue, Rothmans,
Peter Stuyvesant, Benson & Hedges.
Annual revenue: 33,921 million
(2008)
Cigarette factories in 44 countries

BBC2 This World documentary 2008:


Bannatyne takes on Big Tobacco

Duncan Bannatyne

Taking on the tobacco


industry
:: Download Bannatyne Takes on Toba
cco for Free. WatchBannatyne Takes
on Tobacco Online with Other Docume
ntary Films and Free Movies. ::

Using Case Study information


outline two ways in which tobacco
TNCs are impacting on the lives of
people in the developing world
(8marks)
L1 (1-4) simple description of effects
L2 (5-8) more detailed description with
specific case student detail of
countries and a TNC

Websites for further


reading:

http://www.globalissues.org/article/533/tobacco
http://www.ash.org.uk/
ASH is an anti smoking pressure group
www.forestonline.org/
A pro smoking pressure group
www.bat.com
British American Tobacco
http://www.who.int/tobacco/resources/publicati
ons/tobacco_atlas/en/index.html
World Health Organisation tobacco atlas a very
in depth look at global patterns and the
tobacco industry.

Factors affecting regional variations in health


and morbidity
Learning Objectives
All will be able to give reasons for regional variations in
health and morbidity.
Most will be able to find relationships between these
factors.
"Northerners dying of ignorance and chips
Edwina Currie, ex-MP
During her short time at the Department of Health, Mrs Currie has courted
controversy with her outspoken opinions.
She upset northerners when she claimed they were dying of "ignorance and
chips".
And she was branded patronising and callous for advising the elderly to broach
the winter months with a pair of long-johns.
One of her most controversial remarks was on the subject of Aids.
She said: "Good Christian people who would not dream of misbehaving will not
catch Aids."

CHD in the UK

People in S-E group 1 are


more likely to have children
of higher birth weight than
those in S-E group 8.
Age
structur
eP.288

Income

Those suburban
middle-class
residents with access
to facilities such as
gyms and health
clubs are healthier.
Environm
ent and
pollution
An increase in
childhood leukaemia
in the west linked to

Factors
affecting
regional
variations in
health and
morbidity

Barker
P.304
Smith
Yellow
sheet
Red sheet
(2nd side)
Include
locations

Educati
on
Those who are
more educated
are also those in

Diseases of
ageing are
more likely to
be found in
areas where
populations are
ageing (e.g.
Alzheimers in
Eastbourne.)
Not working is
linked to poor
health.

Occupatio
n type
Stress at work
is linked to
heart disease.
Older people have
respiratory problems....
Manufacturing industry
in inner cities in the

Practice exam question


June 2009 8c

Factors affecting regional variations in health


and morbidity
1. Read through the article
2. Write 5 sentences to summarise key points in
the article. Remember, we are thinking about
factors that affecting health in the UK.
3. Go back to your group and share the information
you have found.
4. Create a mind-map of factors that affect health
and morbidity.

Factors affecting access to healthcare


Key Questions
1. What is primary healthcare?
2. In your local area how do age, gender and
wealth affect access to exercise facilities, health
care and good nutrition?
3. Local case study: what are the implications of
the above for the provision of health care systems
in your area?

Primary Care Trusts (PCTs)

Started 1948

Has been more difficult to manage as time has gone on (costs have
risen as people living longer and medical advances increasing)
Year 2000 Government produced NHS Plan
Creation of primary care trusts (PCTs)
This is the care provided by the people you see when you first have a
health problem e.g. doctors, pharmacists, dentists, opticians
NHS Direct

All of the above are managed by local PCT. Control about 80% of
NHS budget

Nutrition

AGE

WEALTH

GENDER

Healthcare

Exercise Facilities

Nutrition

AGE

Different attitudes to
nutrition over time?
Healthy Schools
Jamie Oliver?
Meals on Wheels
service

Better nutrition the


wealthier you are?

WEALTH

What supermarkets
do we have?

Healthcare
West Berkshire = ageing,
therefore specific facilities
given priority
Cervical Cancer? Targets
particular age groups
Teenage pregnancies
Private health care e.g.
BUPA
No waiting lists
arguably better
treatment?

Exercise Facilities
Less accessible for elderly (less
mobile). Facilities cater for those
with cars more and more
Less accessible for under 16s
cost, local area may have ack of
fields, some gyms have
restrictions

Wealthier can afford gym


membership
Wealthier more mobile to access
exercise facilities
Employed full time = easier access
Northcroft (more family orientated),
Regency, Canons (Nuffield Health)
LA Fitness

GENDER

Different attitudes to
food and diet

Contraceptive clinics
Sexually transmitted
diseases, teenage
pregnancies, breast
screening services
aimed at specific gender

Men have easier access than


women - childcare

So what does the evidence say?


What is access to these things like
in the West Midlands?

http://www.westberks.gov.uk/index.aspx?articleid=8406

1.Define the term Primary Care Trust


2. Briefly describe the provision of health care
in your own local area
3. Identify two charitable organisations that
play an important role in health care
provision

Private Healthcare and


Charities
What do private healthcare organisations
offer?
Give an example of such an organisation
Why is this not accessible to all?
What role do charities have?
Give several examples
Pg 308 Core text

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