Some of the highest crude death rates are found in the less developed countries, particularly in sub-Saharan Africa. Liberia, Niger, Sierra Leone, Zambia and Zimbabwe all have death rates of 20 or more per 1,000. However, some of the lowest mortality rates are also found in countries at the lower end of the development range, for example Kuwait (2 per 1,000), Bahrain (3 per 1,000) and Mexico (5 per 1,000).
Infant mortality is falling across the world, but there are still wide variations between nations- 142 infant deaths per 1,000 births in Liberia, compared to 3 per 1,000 in Finland. Areas with high rates of infant mortality have high rates of mortality overall.
HIV/AIDS is having a major impact on mortality around the world but especially in sub-Saharan Africa. More than 40 million people are now living with HIV/AIDS, over 25 million of them in sub-Saharan Africa. In Swaziland, Botswana, Lesotho and Zimbabwe, over 20% of the total population of the country are affected. Asia is also badly affected and of the 7 million HIV/AIDS victims in south/southeast Asia, over 5 million live in India. It is estimated, however, that infection rates have begun to decline in a number of countries.
Influenza is caused by a virus that attacks the upper respiratory tract- the nose, throat and bronchi and sometimes also the lings. The infection usually lasts for about a week. It is characterised by sudden onset of high fever, headache and severe malaise, non-productive cough and sore throat. Most people recover within 1-2 weeks without requiring any medical treatment.
In the very young, the elderly and people suffering from chronic medical conditions such as lung disease, diabetes, cancer, kidney or heart problems, influenza poses a serious risk. In these high-risk people, the infection may lead to severe complications, pneumonia and death
Influenza spreads around the world in seasonal epidemics and imposes a considerable economic burden in the form of hospital and other healthcare costs and lost productivity. In annual influenza epidemics 5-15% of the population are affected with upper respiratory tract infections. Hospitalisation and deaths mainly occur in high risk groups.
Although difficult to access, these annual epidemics are thought to result in between 3 and 5 million cases of severe illness and between 250,000 and 500,000 deaths every year around the world. Most deaths currently associated with influenza in industrialised countries occur among those over 65 years of ages.
Much less is known about the impact of influenza in the developing world. However, influenza outbreaks in the tropics, where viral transmission normally continues year-round, tend to have high attack and case-mortality rates. For example, during an influenza outbreak in Madagascar in 2002, more than 27,000 cases were reported in 3 months and 800 deaths occurred despite rapid intervention. An investigation of the outbreak, coordinated by the World Health Organisation (WHO), found that there were severe health consequences in poorly nourished populations with limited access to adequate healthcare.
Three times in the last century, influenza viruses have undergone major genetic changes resulting in global pandemics and large tolls in terms of both disease and deaths. The most infamous pandemic was 'Spanish Flu' which affected large parts of the world population and is thought to have killed at least 40 million people in 1918-19. Two other influenza pandemics occurred in 195 ('Asian influenza') and 1968 ('Hong Kong influenza') and caused significant morbidity and mortality globally. In contrast to current influenza epidemics, these pandemic had severe outcomes among healthy younger persons, although not on such a dramatic scale as the 'Spanish flu' where the death rate was highest among health young adults. Limited outbreaks of a new influenza subtype (H5N1) directly transmitted from birds to humans occurred in Hong Kong special administrative Region of China in 1997 and 2003 and there have been fears that this could cause a Pandemic.
Today, the virus is spread in the following ways:
1. Exchange of bodily fluids during sexual intercourse.
2. Contaminated needles in intravenous drug use.
3. Contaminated blood transfusions.
4. From mother to child during pregnancy.
Evidence shows that the disease started in small high-risk groups such as gay men, drug users and prostitutes, and then spread into the population as a whole. This meant that in the early stages of the disease in developed countries, AIDS was regarded by many as a 'gay plague'. The heterosexual community took little notice of it and education about safe sex was disregarded. In developing countries, mainly in Africa, the transfer of the virus was more commonly through heterosexual sex, but this was not known in most of the developed world. Three distinct patterns of distribution therefore developed.
PATTERN 1: This covers areas which began to see a spread of HIV in the late 1970s, first among the homosexual, bisexual and drug-using communities and later in the general population. This includes North America, western Europe, Australia and some parts of Latin America.
PATTERN 2: This covers those countries where the spread has been essentially through heterosexual contact. This includes the bulk of sub-Saharan Africa, where more women than men are infected (in the proportion of 60:40). In 2005, over 0.5 million children were infected as a result of mother-to-child transmission.
PATTERN 3: This covers those regions where the disease appeared later (in the 1980s) and was brought in by travellers and sometimes by blood imported for transfusions. This includes eastern Europe (including the former USSR), Asia, the middle east and north Africa.
By 2006, it was estimated that over 39 million people worldwide were living with HIV or full-blown AIDS. In every global region, the number of people living with HIV is rising. The steepest rises have been in east Asia, central Asia and eastern Europe, but the situation is most serious in sub-Saharan Africa. Over 62% of people living with HIV/AIDS (24.7 million people) in 2006 were in the countries of sub-Saharan Africa. It has been estimated that 6% of the adult population of Sub-Saharan Africa is HIV- positive. The area has over 13 million infect women, which represents 76% of all women in the world living with HIV. Ten countries have 10% or more of their adult population infected, including Swaziland and South Africa. By 2020, the UN has estimated that 70 million people in the world will have died from AIDS.
1. Trying to find a vaccine- the hope of this seems remote, but research is continuing, particularly in trying to find groups that might possess some degree of natural immunity through their white cells.
2. Prolonging life through drugs- such drugs are available but expensive: a typical course of AZT cost US$10,000 a year per individual in 2000, but costs are now much lower at $300 for generic drugs such as Nevirapine. This is still beyond the reach of mots govts in less developed countries. In 2001, however, a court case against the South African govt by a group of multinational pharmaceutical companies was dropped because of massive public pressure on the companies. This means that the South African govt can now manufacture and import cheap generic versions of antiretroviral drugs instead of having to buy the expensive brand-name products. In 2003, South Africa announced that it would make available free HAART (Highly active antiretroviral therapy) treatment to everyone who was HIV-positive. In 2005, 17% of those needing HAART around the world were receiving it, funded by donations from Western countries. Some people argue that this is leading to complacency, as HAART is not a cure.
3. Plotting the course of an outbreak, making it possible to predict the future spread of the disease and identifying areas where resources should be concentrated.
4. Screening blood for HIV antibodies before it is used for transfusions in developed countries, leading to a negligible risk of infection. This was not always the case. Blood plasma products, such as fator eight (for haemophiliacs), are now treated to remove the virus.
5. Education and advertising- education is seen as the main way in which HIV/AIDS infection can be combated in sub-Saharan Africa. However, this assumes that humans are rational and their behaviour is under individual control. Often, due to social norms and prejudices, they are not. Education is aimed at increasing the use of condoms, but, in Africa in particular, they are not popular. In developed countries, education and advertising have been aimed at vulnerable groups such as homosexuals and intravenous drug users to try and prevent the spread of the disease. Raising the profile of the disease in schools through sex education has been a major feature in the UK government programme. Other campaigns in the UK have include free needles for drug users, free condoms, and warnings to travellers about their sexual behaviour in foreign countries.
6. Caring for victims and families, which involves charities such as the Terrence Higgins Trust and London Lighthouse in the UK.
It is now believed that the spread of HIV/AIDS is rooted in problems of poverty, food and livelihood insecurity, sociocultural inequality, and poor support services and infrastructure. Although responses to HIV/AIDS have grown and improved over the past decade, they still do not match the scale or pace of a steadily worsening epidemic. Indeed, in a report published in 2005, UNAIDS said that 'the AIDS epidemic continues to outstrip global efforts to contain it'.
Over 300 risk factors have been associated with CHD. Many of these are significant in all populations. In MEDCs, there are 5 major risk factors:
1. Tobacco use
2. Alcohol use
3. High blood pressure
4. High cholesterol
In developing countries with low mortality, such as China, the same risk factors apply, with the additional risks of under nutrition and communicable diseases. In developing countries with high mortality, such as those of Sub-Saharan Africa, low vegetable and fruit intake are also important factors. Some major risks are modifiable in that they can be prevented, treated and controlled. There are considerable health benefits at all ages, for both men and women, in stopping smoking, reducing cholesterol levels and blood pressure, eating a healthy diet and increasing physical activity.
Significant health gains in the treatment of heart disease can be made within a short period of time through public health and treatment intervention. Governments are stewards of health resources and have a fundamental responsibility to protect the health of citizens. They can do this by educating the public, making treatments affordable and available and advising patients on healthy-living practices. Some examples of prevention strategies are:
1. In the UK, dieticians promote the benefits for heart health of eating oily fish, more fruit and vegetables, and less saturated fat.
2. In Finland, community-based interventions, including health educations and nutrition labelling, have led to population-wide reductions in cholesterol levels closely followed by a sharp decline in heart disease.
3. In Japan, govt-led health education campaigns and increased treatment of high blood pressure have reduced blood-pressure levels in the population.
4. In New Zealand, the introduction of recognisable logos for healthy foods has led many companies to reformulate their products. The benefits include greatly reduced salt content in processed foods.
5. In Mauritius, a change from palm oil to soya oil for cooking has brought down cholesterol levels, but obesity has been unaffected.
Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. BMI is a simple index of weight for height that is commonly used in classifying overweight and obesity in adult populations and individuals. It is define as the weight in kilograms divided by the square of the height in metres.
The WHO defines 'overweight' as a BMI equal to or more than 25 and 'obesity' as a BMI equal to or more than 30. These cut-off points provide a benchmark for individual assessment, but there is evidence that the risk of chronic disease in some populations, such as people in Asia, increases progressively with a BMI of 22 and over.
The new WHO Child Growth Standards, launched in April 2006, include BMI charts for infants and young children up to age 5. However, measuring overweight and obesity in children aged 5-14 years is challenging because a standard definition of childhood obesity is not applied worldwide. The WHO is currently developing an international growth reference for school-age children and adolescents
WHO's global figures indicate that in 2005:
1. Approximately 1.6 billion adults were overweight.
2. At least 400 million adults were obese.
3. At least 20 million children under the age of 5 years were overweight. Childhood obesity is a big problem in the USA where over 35% of children are overweight.
WHO further projects that, by 2015, approximately 2.3 billion adults will be overweight and more than 700 million will be obese. Overweight and obesity were once considered to be problems of high-income countries, but are dramatically on the rise in low and middle income countries, particularly in urban areas.
Overweight and obesity can have serious health consequences. Risk increases progressively as BMI increases. Raised BMI is a major factor for chronic disease such as:
1. Cardiovascular disease (mainly heart disease and strokes)- already, the worlds number one cause of death, killing 17 million people each year.
2. Diabetes, which has rapidly become a global epidemic. WHO projects that diabetes deaths will increase by more than 50% worldwide in the next 10 years.
3. Musculoskeletal disorders, especially osteoarthritis.
4. Some cancers (endometrial, breast and colon).
Childhood obesity is also associated with a higher chance of premature death and disability in adulthood. Life expectancy is reduced by an average of 14 years for obese smokers compared with non-smokers of normal weight.
More than 60% of adults in the USA are overweight or obese. Triple-width coffins, capable of holding a 300kg body, are in increasing demand. There are 70 million overweight people in China and the South Pacific now has some of the worlds highest rates of obesity.
Many low and middle income countries are now facing a 'double burden' of disease. While they continue to deal with the problems of infectious disease and undernutrition, they are at the same time experiencing a rapid upsurge in chronic disease risk factors such as obesity and overweight, particularly in urban settings.
It is not uncommon to find undernutrition and obesity existing side by side in the same country, the same community and even the same household. This double burden is caused by inadequate prenatal, infant and childhood nutrition followed by lack of physical activity and exposure to high-fat, energy-dense, micronutrient-poor foods.
A transnational corporation is a company that operates in at least two countries. It is common for TNCs to have a hierarchical structure, with head quarters and R&D department in the country of origin, and manufacturing plants overseas. As the organisation becomes more global , regional headquarters and R&D departments may develop in the manufacturing areas. TNCs take on many different forms and cover a wide range of companies involved in the following primary, secondary (manufacturing) and tertiary (service) activities:
1. Resource extraction, particularly in the mining sector, for materials such as oil and gas.
2. Manufacturing in three main sectors:
(a) High tech industries such as pharmaceuticals
(b) Large volume consumer goods such as motor vehicles
(c) Mass produced consumer goods such as cigarettes, branded goods.
3. Services such as banking/finance, advertising, freight transport, hotels and fast-food operations.
TNCs are the driving force behind economic globalisation. As the rules regulating the movement of goods and investment have been relaxed and the sources and destinations of investment have become more diverse, such companies have extended their reach. There are now few parts of the world where influence of TNCs is not felt and in many areas they are a powerful influence on the local economy. TNCs tend to be involved in a web of collaborative relationships with other companies across the globe.
1. TNCs control and coordinate economic activities in different countries and develop trade within and between units of the same corporation in different countries.
2. TNCs can exploit differences in the availability of capital, and costs of labour, land and building.
3. TNCs can locate to take advantage or govt policies in other countries, such as reduced tax levels, subsidies/grants or less strict environmental controls. They can get around trade barriers by locating production within the markets where they want to sell.
4. The large size and scale of operations of TNCs means they can achieve economies of scale, allowing them to reduce costs, finance new investment and compete in global markets.
5. Large companies have a wider choice when locating a new plant, although governments may try to influence decisions as part of regional policy or a desire to protect home markets. Governments are often keen to attract TNCs because inward investment creates jobs and boosts exports which assist the trade balance. TNCs have the power to trade off one country against another in order to achieve the best deal.
6. Within a country, TNCs have the financial resources to research several potential sites and take advantage of best communications, access to labour, cost of land and building, and government subsidies.
Branded drugs are unusual among consumer goods in the developed world in that their consumers tend to have little choice in the drug they purchase and use. Patients tend to use what their doctor prescribes for them. Therefore, the industry heavily targets doctors with its marketing, providing free samples of drugs, giving away everyday items (pens, calendars etc.), advertising in medical journals and arranging visits of sales representative to surgeries and offices.
Another criticism aimed at pharmaceutical companies and WHO is that they tend to treat the symptoms rather than the root cause of the problem. For example, iron folate, a vitamin supplement, is on WHO's list of essential drugs. It is included because of its ability to prevent anaemia in pregnant women, a common problem in both the underdeveloped and developed world. However, a similar compound, with the same anaemia-preventing properties, is found in leafy green vegetables. It is possible that encouraging the growth of these vegetables would be more valid than promoting vitamin supplements.
Philip Morris, R.J. Reynolds and British American Tobacco (BAT), the world's largest non-state owned tobacco producing TNCs, own or lease plants in more than 60 countries. These three companies have a total revenue of more than US$70 billion, a sum greater than the combined GDP of Costa Rica, Lithuania, Senegal, Sri Lanka, Uganda and Zimbabwe.
Of the 1.2 billion smokers in the world, 800 million are in the developing world. Countries where consumption is growing the fastest are also among the world's poorest, and it is these countries that the major tobacco TNCs are targeting with their advertising and marketing campaigns. China's increase in tobacco consumption has been the most dramatic. Nearly 70% of Chinese men smoke, compared with just 4% of Chinese women. This means that China alone accounts for 300 million smokers, almost the same number as in all the developed world.
Tobacco TNCs are turning to developing countries not only to expand their markets but also as a source of cheaper tobacco. The danger with this is that tobacco cultivation will replace food crops. In Kenya, food production in tobacco-growing districts has decreased as farmers have shifted from food crops to tobacco. BAT is the largest agribusiness company in Kenya, contracting over 17,000 farmers to cultivate tobacco in an area of around 15,000 hectares. The situation is similar in Brazil, the world's largest exporter of tobacco. Brazilian tobacco is primarily used by Philip Morris to make less expensive brands. Cigarettes made with tobacco grown in the USA cost twice as much.
Like many other international companies, tobacco TNCs are shifting production overseas to take advantage of cheaper labour costs. They have all started production in Asian countries. For example, R.J. Reynolds has a factory in Vietnam which is used to supply German and Canadian markets. Damon, one of the world's largest tobacco- leaf dealers, also has an office in Vietnam, where is is developing new crop varieties for what it hopes to be a growing market. Vietnam sells most of its tobacco for less than US$3 per KG.
Life expectancy in the UK is increasing. Across the country as a whole, men aged 65 can expect to live a further 16.6 years and women a further 19.4 years if mortality rates remain the same as they were in 2005. Women continue to live longer than men, but the gap is decreasing. In 1985, there was a difference of 4 years between male and female life expectancy at age 65 in the UK. By 2005 this had narrowed to 2.8 years.
There are slight variations in life expectancy between the constituent countries of the UK, as shown in the table (in textbook, page 301). English men and women have the highest life expectancy at age 65, at 16.8 and 19.6 years respectively. Scotland at 15.5 and 18.4 years respectively, has the lowest life expectancy at this age.
There are also more local variations. The southeast, southwest and east of England have the highest life expectancies. Scotland, the North East and the North West of England have the lowest.
All ten local authorities with the highest male life expectancy at birth rate are in England: five in the southeast, three in the east of England and one each in the southwest and London. Eight of the ten local authorities with the lowest male life expectancies are in Scotland. Glasgow City (69.9 years) is the only area in the UK where life expectancy at birth is less than 70 years. Kensington and Chelsea is the local authority with the highest male life expectancy. A similar situation exists for female life expectancy.
A considerable amount of research has been conducted into regional variations in morbidity in the UK. The purpose of this research is to try to identify patterns of morbidity and the factors that contribute to these patterns, with a view to targeting elements of healthcare to combat them. The results are far from clear; variations exist for some aspects of morbidity but not for others. The links between factors such as age, income, occupation, education and environment and types of morbidity are also difficult to establish. They tend to be based on speculative association rather than clearly established causal links.
The research so far has shown that, at a country level:
1. Scotland has the highest rates of lung cancer, heart diseases, strokes and alcohol and drug-related problems.
2. Wales has the highest incidence of breast, prostate and bowel cancer.
3. Northern Ireland has the highest rate of respiratory diseases.
4. England has the lowest rates for most of these.
At regional level within England, a north-south divide in health is evident in some cases but not in others. Regions in the north have a higher mortality from heart disease, strokes and lung cancer. London has the highest rates for infectious and respiratory diseases. Alcohol related problems to not show a regional pattern. There is little variation in the incidence of bowel cancer, whereas breast and prostate cancer rates are higher in the south than in the north. Age appears to be a factor for some aspects of morbidity. For example, in London heart disease incidence at ages 45-64 is below average, whereas the incidence of strokes for this age group is high.
A central finding of the research is that differences between countries and regions of the UK are less important than the wide differences that exist within the regions. Urban areas tend to have higher levels of morbidity. Deprivation is often given as the main reason for this, but many areas of deprivation exist in rural parts.
Environment is also cited as a facto. The relationship between the weather and various aspects of health has been studied in great detail. Relationships have been found between:
1. Temperature, heart disease and pneumonia, but these are more associated with seasonal variations of temperature than regional variations.
2. Rainfall and heart disease, which may impact on regional variations.
Seasonality of mortality has declined in the UK since the 1960s, possibly due to the increased use of central heating. Air pollution was responsible for high morbidity and mortality from respiratory diseases before this period, and has declined.
Other smaller-scale aspects of the environment have an influence on morbidity. The impact of background radiation may be a factor in some diseases. For example, some rocks in the south-west of England contain high amounts of radon, and the radioactivity from this is thought to be responsible for a higher risk of lung cancer in the area. Issues of water quality are significant. Hard water is found in the south and east, soft water in the north and west . A consistent relationship has been shown between soft water and high levels of heart disease. Deficiencies and excesses of certain trace elements in water a known to be harmful. Excesses of nickel, cadmium, mercury and lead are hazardous and high concentrations of aluminium in water have been suggested as an explanation for the geographic distribution of Alzheimer's disease.
HOW ITS FUNDED:
Healthcare in the USA is almost entirely private and is based on the free market and survival of the richest models. Individuals must choose a health insurance package that covers certain types of treatments and pay a monthly or yearly fee for that insurance. The cost of health insurance varies based on the package a person has. On average, healthcare for a family of four costs around $10,000 per year (about ½ the yearly wage of a Walmart employee). The health care services themselves receive little in terms of funding from the government, instead relying on payments from people for treatment.
HOW IT WORKS
Much like the French system, people can receive general treatments from a physician or receive specialist treatment at a hospital without the need for a referral. The treatment that a person can receive, however, is limited to the health insurance package that they are paying for.
WHO CAN ACCESS IT
As mentioned above, provided a person is paying enough for their insurance, they can access any health care services. If a person doesn't have the right insurance package for their treatment though, or if the person just doesn't have insurance, they must either pay the full price of the treatment upfront, beg for help from a charity or just do without the treatment. For people without insurance, a service called Medicaid provides very basic treatment from the state however it's very limited in terms of what treatment people can access. Medicare is a service that provides health insurance to those over the age of 65, again, paid for by the state.
The health of people in the Wirral varies greatly both within the area and when compared to the rest of England.
Many health statistics are worse than their average throughout England. For example, Wirral's average life expectancy for men & women is lower than the national average. In addition, the number of people who eat 'healthy food' in the Wirral is less than the national average.
Conversely, many statistics are also better than the national average's. The number of adults who smoke cigarettes, for example, is less than the national average. In addition, the number of people who are obese is also lower than the national average.
There are inequalities in the Wirral in terms of employment, environmental and deprivation and these inequalities have different effects on the health of people in different areas of the Wirral. People in the north & east of the Wirral, for example, generally have lower health standards due to a more deprived lifestyle. Conversely, people in the west of the Wirral in areas such as Caldy & Hoylake, have better healthcare and longer life expectancies due to a higher standard of living and a (generally) higher income.
The Wirral Strategic Partnership has prioritised health inequalities including smoking, alcohol abuse, employment, teenage pregnancies and child obesity.