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Terms in this set (53)

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'.
Most famine results from a combination of natural events and human mismanagement. Some authorities refer to famine as a decline in the access to food, rather than to there not being enough food.
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 products being exported.

The decline of food availability is said to be the result of deterioration in the entitlements of certain sectors of society. Poorer people have limited access to food as a consequence of weaker purchasing and bargaining powers. They have low status, menial occupations and limited land ownership.

Famines on a large scale occur as a result of one or more of the following factors:
1. Drought- lack of rainfall causes soil and groundwater sources to decline, which ultimately leads to a reduction in the supply of water. The soil moisture will not meet the needs of particular plants and agricultural crops, creating serious problems for areas that depend on farming, both arable and pastoral.
2. A population increase greater than the rate of crop (food) production- this often occurs in areas where there is a sudden influx of refugees fleeing a war zone or an area of civil unrest. It can also occur as people migrate from one drought zone to another.
3. A rapid rise in the price of food stuffs and/or animals- this can occur when the quality of farmland and grazing land declines (often during a drought). It is further compounded by a breakdown in the local economy and marketing systems. Control mechanisms react too slowly and inflationary price rises fuel panic buying, which rapidly leads to shortages of basic foodstuffs.
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 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.
The NHS is a publicly funded healthcare system that is payed for by the government via taxes. The NHS accounts for around 16.5% of the UK government's total spending.

People are able to choose a GP of their own liking and can swap and change GPs whenever they wish. Despite this, many GPs will only accept patients from a small catchment area, so in reality, there's a lot less choice in a person's GP. The GP acts as an access point to the NHS's specialist services. When a patient has a medical problem they can book an appointment with a GP who will then see the patient and attempt to diagnose them with a condition. Once the patient has been diagnosed, or if he/she can't be diagnosed, the patient is referred to a relevant department within a hospital or specialist treatment centre so that they can receive the care that they need.

Obviously the GP method won't work during an emergency which is where the A&E (Accident & Emergency) department comes into play. All hospital's have an A&E department and it is a walk in department for people who have suddenly fallen critically ill. People can receive specialist treatment from an A&E department without a referral from their GP.

Anybody can access the NHS health service, even those who don't pay their national insurance tax such as immigrants. The only difficulty arrises when someone without an address tries to use the service. In order to obtain a GP, a person must have an address, so a homeless individual's medical care would be limited to the A&E section of hospital's only. The person would be unable to receive any follow up care after treatment in A&E due to their lack of a GP.
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.

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.

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.