Geog 1 Health BEREN MILES Course Outline G

Geog 1 - Health BEREN MILES

Course Outline • • G 5. 1: Introduction to health issues G 5. 2: infections and disease G 5. 3: HIV/AIDS - Zambia and SSA G 5. 4: Diseases of affluence (CHD and Obesity) • G 5. 5: Famine - Somalia • G 5. 6: Healthcare systems - Emergent – HCS in LEDCs - Pluralistic - US - Insurance – France - NHS – UK - Socialised – Cuba - Dual - Singapore G 5. 7: Health and The DTM G 5. 8: Transnational corporations (TNCs) - Pharmaceutical: GSK - Other: British American Tobacco G 5. 9: Health variations in the UK - New Forest and Southampton

Water Waste Alcohol Medication – TNCS Quality Access to Healthcare Medicine / Drugs Sanitation Health LEDCS/ MEDC Food Preventable Disease - HIV/AIDS Obesity Malnutrition Healthy Eating

Introduction to Health Issues - Key Words • Health – a state of complete physical, mental and social well being and not merely the absence of diseases and infirmity (WHO 1946) • Morbidity – Illness or any diseased state, disability, or conation of poor health from any cause. Can be used to refer to the existence of disease, or the extent that a health condition affects a patient. • Mortality – Death, or susceptibility to death. • Determining factors – things that could affect your health: Age, Sex, lifestyle, community/social aspects, food, environment, living and working conditions. • Epidemiological transition model – tracks the types of illness throughout the stages of development.

Millennium Development Goals The eight Millennium Development Goals (MDGs) – range from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education, all by the target date of 2015. Source

Health differences from MEDC to LEDC Water-bourne parasites Bilharzia snail Mosquito Blackfly Guinea worm Malaria Yellow fever River Blindness Poor Hygiene Poor Diet Typhoid Cholera Dysentery Trachoma Hepatitis Lack of protein Lack of vitamins

Health differences from MEDC to LEDC MEDC Degenerative diseases Diseases of affluences Heart disease Cancers Mental disorders Arthritis Alzheimer's and dementia Respiratory

Infectious Disease • Infectious diseases are caused by pathogenic microorganism, such as bacteria, viruses, parasites, or fungi. The diseases can be spread directly or indirectly from one person to another. Area SSA Total Infections 24. 7 million Deaths 2. 1 million New Infections 2. 8 million South/ SE Asia 7. 8 million 860000 590000 Latin America 1. 7 million 65000 140000 E. Eurpe and Asia 750000 84000 270000 East Asia 750000 43000 100000 Europe 740000 12000 22000 North America 1. 4 million 18000 43000 N. Africa + middle East 460000 36000 68000 Carribean 250000 19000 27000 Oceania 81 000 4000 7100

AIDS- Zambia Case Study - People don’t want to have sex with “plastic” and so the disease is spread. - Men have many wives - No sex Education - Stigma - outcast - 16 million die each year - 26 Million living with AIDS - 50% have underlying AIDS - Fluid/ fluid contact spread disease HEALTH NIGHT MARE - 200, 000 in a hospital but only 273 beds - Poor sanitation – often run out of gloves - Loss of Professionals – Teachers, Doctors, Police - Working age hit (20 -30 y/o)

Diseases of affluence In MEDCs and developing countries infectious disease has largely been tackled and controlled. Instead there is a new type of disease to fight – Disease of affluence – these tend to be due to people living to long or de to people overindulging and having poor lifestyle choices.

Obesity - Case Study • 30% UK is obese • 50% USA • Abnormal or excessive fat accumulation that may impair health • BMI = Weight(kg) / Height (m 2) • Overweight BMI = 25+ • Obese = 30 + • 2005: 1. 6 billion adults were overweight • 400 million were clinically obese • 2015: 700 million (WHO) • At least 2 million children under 5 were overweight • 35% of children in the USA are overweight

Cardiovascular disease (CVD) – Case Study • Responsible for 30% of global deaths • 16 million deaths worldwide • Highest areas : Russia, China, India • It is expected that in 2030 23. 6 million will die from CVDs • 60% of CVD’s occur in developing countries • Influenced by lifestyle

UK and CVD -CASE STUDY - Nearly 75% of NHS time is taken up by Diseases of Affluence - Treat affects rather than prevent it - 10 000 on impatient care in 2006 - 2967 on impatient stroke - Costs the NHS £ 238 pp

Types of CVD • There are four main types of CVD. They are: 1. coronary heart disease 2. stroke 3. peripheral arterial disease 4. aortic disease

Famine • What are the causes and impacts of famine and obesity? • Malnutrition – Lack of nutrients – Can be due to famine (LEDC) or eating the wrong things (obesity MEDC) • Periodic famine – a time of so little food that people will starve to death • Links to MGD 1: end poverty and hunger • There is enough food in the world for everyone to have 2700 cal/day

Food distribution • The areas affected by hunger and malnutrition are likely to be in SSA and Asia. • MEDC’s often have too much food and end up throwing it away Famine • Can occur due to natural events but also due to human management • Lack of resources often goes with lack of food and poverty

Sahel region of Africa - 1984 • 1/3 severely malnutrition • ½ people don’t have food • 40, 000 no food, no transport • People were living in the open with freezing temperatures • “out of control” • 7000 people packed in to sheds dying of malnutrition • 37+ died each day at the camp

Somalia • Britain withdrew from Somalia in 1960 • In 2011 a famine happened • Up until this point causes of the famine had been things like, unstable government, clan militias • Somalia has been ranked as one of the worlds poorest most violent countries • Since 2006 the country faced an insurgence led by Al Shubab – Extreme Islamism group • The Shabab have blocked foreign aid

Health Care Approaches G 5. 6 2 types of Care: • Primary Care – First line of care (paramedics, GP, A&E, dentists, opticians) • Secondary Care – referred to from primary care (specialist in-patients) • Some primary care can cost in the UK e. g. pharmacies, dentists, opticians. Secondary care is usually free. • Types of Health care • Comparing health care approaches

Types of Healthcare approach Type of Healthcare Main Characteristic Examples Emergent Healthcare is a personal consumption Physicians are solo entrepreneurs Direct payment from Patient to Physicians No state role within healthcare LEDC’s Bangladesh/Brazil/India/ Kenya Pluralistic Consumer product Private and public ownership State role is minimal USA Insurance Social Security Healthcare is an insured product much like car insurance Payment is indirect State role is evident but indirect France Japan Spain National Health Service (NHS) State Supported Facilities are publicly owned State role is central and direct UK Canada Socialised State provided public service Physicians are state employed Professional associations are weak or non- existent Facilities are completely public owned Payments for services are entirely indirect State role is total China Cuba Dual Funded by both private and public sectors Singapore

Comparing H/C Systems

Comparison – Cuba Vs USA Cuba • 18% (2012) of GDP on H/C – highest in the world • 8. 6% of GDP (2012) • Highest private sector expenditure • LE: 77 • IMR: 6. 1/1000 (2014) • LE: 77. 4 years (2009) • Pluralistic Approach • IMR: 4. 7 (2014) • Dr to patient 1: 159 • Socialised • State provided service • State employs 17651 Doctors • All payments are indirect • State has total control

CUBA Vs UK UK Cuba • GDP/ Capita: USD: 40972 (2011) • GDP/ Capita : USD: 6051 (2011) • 9. 4% of GDP (2012) • 8. 6% of GDP (2012) • IMR 4. 4 (2014) • IMR: 4. 7 (2014) • LE: 80. 4 • LE: 78. 2 • Doctors/1000: 2. 8 • Dr to patient 1: 159 • NHS • Socialised • State funded • State provided service • Tax funded • State employs 17651 Doctors • Some direct payments (dentist) • All payments are indirect • State has total control

France and UK • France was ranked 1 st in the world for best health after a report in 2000 • IMR: 3. 3/1000 • Healthcare expenditure: 11. 7% • %65+: 18. 3% • Doctors/1000: 3. 2 • Life Expectancy: 81. 6 • Insurance/ Social Security system • Health care is a product provided by insurance companies • UK was ranked 18 th in the same report • GDP/ Capita: USD: 40972 (2011) • 9. 4% of GDP (2012) • IMR 4. 4 (2014) • LE: 80. 4 • Doctors/1000: 2. 8 • NHS • State funded – (free on the door) • Tax funded • Some direct payments (dentist)

Links between the DTM and Health

CHD Famine Stage 1 Stage 2 In stage 1 and 2 countries CHD is likely to be undetected and therefore people may die without even knowing they have it. Also CHD comes from the lifestyle you lead, people in these areas do not have the unhealthy lifestyle associated with CHD Stage 3 Stage 4 Stage 5 Stage 3 is often where the Again people in stage 4 have People in S 5 countries change occur in these the lifestyle previously are encouraged to have developing countries the lifestyle associated with CHD. That of healthier lifestyle and to is often that of tobacco use as inactivity from reliance on cars have better treatment well as high stress and high and therefore people may due to better facilities blood pressure the longevity of become diabetic and may be however the average ag people is also increasing in this stressed from work all these of this population is high area which is another factor that attribute to higher risk of CHD. which could lead to affects CHD is the biggest killer in the people being less likely t UK. However on the whole survive CHD affects Stage 3 more than stage 4 due to medical facilities. Stage 1 is likely to have less famine as tribes and such like usually rely on subsistence farming. Famine in stage 1 may only affected one area unlike in stage 2 where a famine can affect the whole country. Famine tends to be more common in LEDC’s and unlike CHD has natural causes as well as human causes. Poorer countries have less of a system to cope with famine and often this Famine is less likely in the other Stage 4 and 5 are unlikely to experience famine except i stages of the DTM and is caused extreme circumstances. due to either unfair poverty within a country – e. g china or due to extreme weather During this task I found that conditions. often stage 3 is the bridge between stage 4 and 5 and stage 1 and 2. Stage 1 and 2 tend to be similar just as 4 and

TNC’s and their impact on Health – G 5. 8 How do they impact world health ? • How they treat employees • How they market their products • How they sell their products • What products they choose to research and development • Who has the access to the global health market • A TNC is a company that operates in at least 2 countries. Usually the HQ and R+D departments are in the country of origin and manufacturing is in plants overseas.

Glaxo Smith Kline (GSK) – Big Pharma TNC Biggest UK – Based Pharma TNC Supply ¼ of World Vaccines Employs 100, 000+ people in 117 countries 15, 000 Work in research Mission: To improve the quality of human life 2006 – donated 155 million Albendazone tablets. 3 priority diseases AIDS/HIV Spends £ 500 million/ year on research Disease of affluence get more money invested due to higher demand • Designer drugs • • •

Smoking and British America Tobacco • Smoking is a greater cause of death and disability than any single disease (WHO) • Smoking can cause 25 diseases! • Men who smoke are 22 times more likely to get lung cancer! BAT: • Have cigarette factories in 44 Countries • Revenue: £ 33921 Million (2008) • Main Brands: Kent, Dunhill, Vogue • Between 2000 -2007 the sale of cigarettes increased from 85 billion to 161 billion (nearly double in 7 years) • Each year BAT purchases about 460000 tonnes of tobacco • 80% from developing countries • 250000 farmer from emerging economies • The company has a CSR in tobacco production • This programme covers improving agriculture, soil and water conversation and health and safety

G 5. 9 – Health variations in the UK The health of people in New Forest is generally better than the England average. Deprivation is lower than average, however about 3, 800 children live in poverty. Life expectancy for both men and women is higher than the England average. Life expectancy is 5. 3 years lower for men in the most deprived areas of New Forest than in the least deprived areas. Over the last 10 years, all cause mortality rates have fallen. Early death rates from cancer and from heart disease and stroke have fallen and are better than the England average. In Year 6, 13. 1% of children are classified as obese, better than the average for England. The level of alcohol-specific hospital stays among those under 18 is worse than average. Teenage pregnancy and breast feeding are better than the England average. The estimated level of adult physical activity is better than the England average. The rate of road injuries and deaths is worse than the England average. Rates of hip fractures, sexually transmitted infections, smoking related deaths and hospital stays for alcohol related harm are better than the England average. The rates of malignant melanoma and hospital stays for self-harm are worse than average. Priorities in New Forest include older people, alcohol misuse and long term conditions. NEW FOREST VS SOUTHAMPTON

Southampton • • Population 240, 000 The health of people in Southampton is mixed compared with the England average. Deprivation is higher than average and about 11, 200 children live in poverty. Life expectancy for both men and women is similar to the England average. Life expectancy is 8. 0 years lower for men and 3. 4 years lower for women in the most deprived areas of Southampton than in the least deprived areas. • Over the last 10 years, all cause mortality rates have fallen. Early death rates from cancer and from heart disease and stroke have fallen. • About 19. 8% of Year 6 children are classified as obese. Levels of teenage pregnancy, GCSE attainment, alcohol-specific hospital stays (-18) and smoking in pregnancy are worse than the England average. • The estimated level of adult 'healthy eating' is worse than the England average. The estimated level of adult obesity is better than the England average. • Rates of sexually transmitted infections and smoking related deaths are worse than the England average. Rates of hip fractures and hospital stays for alcohol related harm are better than the England average. • Priorities in Southampton include violent crime, drug and alcohol misuse and obesity.