Global patterns of health, morbidity and mortality:



AQA GEOG1: The Geography of Health

Global patterns of health, morbidity and mortality:

health in world affairs.

The study of one infectious disease (e.g. malaria, HIV/

AIDS) its global distribution and its impact on health,

economic development and lifestyle.

The study of one non-communicable disease (e.g.

coronary disease, cancer) its global distribution and

its impact on health, economic development and

lifestyle.

Food and health – malnutrition, periodic famine,

Obesity.

Contrasting health care approaches in countries at

different stages of development.

Health matters in a globalising world economy –

transnational corporations and pharmaceutical

research, production and distribution; tobacco

transnationals.

Regional variations in health and morbidity in the UK.

Factors affecting regional variations in health and

morbidity – age structure, income and occupation

type, education, environment and pollution.

Age, gender, wealth and their influence on access to

facilities for exercise, health care, and good nutrition.

A local case study on the implications of the above

for the provision of health care systems.

Health is a state of complete physical, mental and social wellbeing, not merely the absence of disease and infirmity.

Mortality is the death of people. It is measured by a number of indices including crude death rate, infant mortality, case mortality and attack rate.

Morbidity is illness and the reporting of disease.

We can use health indicators to understand the patterns that exist globally in terms of health, mortality and morbidity.

Global patterns of Mortality

Global Patterns of Morbidity

Morbidity indicators include prevalence (the total number of cases in a population at a particular time) and incidence (number of new cases in a population during a particular time period). Global patterns of morbidity differ depending on the type of disease. Infectious communicable diseases are most common in LEDCs, whereas in MEDCs, non-communicable diseases of affluence are most common.

Global patterns of Health: Life Expectancy

In general, life expectancy is greatest in MEDCs such as UK, USA and Australia. It is lowest in LEDCS, like those of Sub Saharan Africa.

There are some exceptions: China – 73.8 years – and Vietnam – 72.7 years have a low GNP per capita but a long life expectancy.

Factors affecting life expectancy:

Nutrition – under nutrition and malnutrition are underlying factors in more than half of child deaths in LEDCs. People are more likely to catch an infectious disease with a lowered resistance due to poor diet.

Clean Water and Sanitation – each year 1.8 million people die from Diahorreal diseases including cholera and 88% of these diseases are linked to unsafe water supplies and inadequate hygiene. 1.3 million people die every year from malaria, and part of the problem is poor management of water.

Health Services - imbalance in the distribution of health professionals around the world; in countries like America, there are about 23 doctors per 1000 people; in some parts of Africa, this number is as low as 2. The level of government spending per capita is also important; 2 million children under the age of 5 die from pneumonia each year, and it costs only 15p per head to treat. Due to lack of funding from the government, treatment is not possible.

Health in World Affairs - the geography of health can make an important contribution to future national plans and policies;

o Advising on planning for healthcare staffing in Sub Saharan African countries devastated by the HIV/AIDS crisis

o Analysing the global correlation between income and welfare

o Monitoring the effects of climate change on the emergence of new infectious diseases

o Investigating the optimum pattern of healthcare provision in primary healthcare trusts

o Collaborative efforts between worldwide organisations like the WHO (World Health Organisation) and governments to help to eradicate and prevent disease – for example running a vaccination programme paid for by wealthy countries to eradicate polio in developing countries.

An Infectious Disease: HIV/AIDS

HIV is the human immunodeficiency virus, which causes Acquired Immunodeficiency Syndrome. It is a slow retrovirus which invades the white blood cells and reproduces itself inside them. The body can no longer defend itself against infection, so people may die from an everyday infection like flu.

HIV is spread through exchange of bodily fluids during sexual intercourse, contaminated needles in intravenous drug use, contaminated blood transfusions and across the placenta during pregnancy.

There are three distribution patterns of HIV;

1. Areas which began to see a spread of HIV in the 1970s amongst the homosexual and drug using communities. This includes North America, Western Europe, Australia and parts of Latin America.

2. Countries where the spread has been due to heterosexual contact and then through mother-to-child transmission; this includes all of Sub Saharan Africa.

3. Regions where the disease appeared in the late 1980s, brought by travellers and in blood imported for transfusions. This includes Eastern Europe, USSR, Asia, the Middle East and Northern Africa.

Impacts on Health, Economic Development and Lifestyle

AIDS in Botswana, Sub Saharan Africa

o 24% of the 1.6 million population are infected with HIV.

o Life expectancy has dipped below 40 for the first time since 1950, and in 2006 stood at 34 years. Without the AIDS pandemic, it is expected that the life expectancy would have been 74 years.

o The economy is shrinking because AIDS is destroying the workforce; it is predicted that the economy will be one third smaller by 2021 than it would have been without AIDS.

AIDS in Thailand

Towards the end of the 20th century, Thailand had the most serious AIDS problem in Asia, with infection rates amongst prostitutes reaching 30% by the 1990s. The numbers in Thailand were so high due to low condom use and a high rate of pre marital and extramarital sex with sex workers. In 1995, 5,000 HIV positive babies were born. The Thai government responded in a positive way; a ‘100% condom programme’ was launched in 1991; the National AIDS committee was set up which devised media advertising campaigns. Commercial sex workers were targeted with a supply of 60 million free condoms every year. HIV rates in Thailand are now in decline.

The link between HIV/AIDS and Global Poverty - LEDCs cannot afford to provide the infrastructure and resources to make health and education available to everyone. This means that these countries are particularly vulnerable. A lack of education makes it harder for people to protect themselves from the virus; poverty means that people may not have access to condoms; women may not have the power to say no to sex, and some may be forced to sell sex to survive; having unprotected sex leads to HIV infection; hospital treatment is expensive and HIV testing not widely available; people who aren’t treated die; more orphaned children are left without parents; family income drops; children are kept from school to work or care for family – and this restarts the vicious cycle, and the lack of education spreads.

A non-communicable disease: Coronary Heart Disease

CHD is a disease caused by atheromous plaques blocking the coronary arteries reducing blood flow and meaning that the heart does not receive adequate oxygen.

Coronary heart disease is a disease of affluence; it is more common in wealthier countries. Factors associated with these diseases are:

o Increased use of cars

o Less strenuous physical activity

o Easy accessibility to large amounts of low cost food

o More high fat and high salt foods in diet

o More processed foods commercially provided

o More sedentary work

o Greater use of alcohol and tobacco

Impacts of CHD on Health, Economic Development and Lifestyle

Comparing Coronary Heart Disease in the UK and India

| |UK (MEDC) |INDIA (LEDC) |

|Social Causes |Wide use of tobacco and alcohol. |Slum areas of poor housing not conducive to good health. High fat |

| |Unhealthy lifestyles – high fat diets |traditional cooking (fatty butter Ghi). Development and |

| |and little physical activity. |industrialisation leads people to adopt a more Western lifestyle. |

| | |Increasing life expectancy. |

|Economic Causes |Poorer areas of the UK with high levels|Existence of a major class divide – working class cannot afford to eat|

| |of deprivation have greater incidences |well have poor western-style convenience food. Slum areas in cities |

| |of obesity - greater access to |like Mumbai have very poor socio-economic conditions. Lack of |

| |convenience foods and lack of access to|education about the importance of good diet and lifestyle as many |

| |health facilities like leisure centres.|cannot afford to pay for schooling. |

Food and Health

Malnutrition is defined as a condition resulting from some form of dietary deficiency. This many be because the quantity of food is too low, not giving enough calories per day, or because there are important nutrients absent. Malnutrition weakens immunity and makes people vulnerable to diseases. It may also lead to deficiency diseases such as beriberi or anaemia. Some people refer to this as undernourishment.

Famine is a period of time in which there is such a shortage of food that populations starve and death is caused. Famines are caused by a combination of natural events and human management. Many people who suffer in famine do not do so due to a lack of food; they lack the resources or other entitlements needed to obtain food. Famine is largely due to the failure of institutions, organisations and policies – not just the failure of markets and farmers. Famines in Africa can be explained in a long term context; they occur when poverty interacts with human policies (relating to economy, agriculture or demography). These interactions make some segments of society and some regions very vulnerable to minor changes in climate. Famine on a large scale can be a result of one or more of the following: cause

cause

The Sahel has been the region of the world most prone to repeated widespread famine. Drought in Ethiopia and Somalia has also been an issue:

In 2000, rains failed leading to a severe drought which affected 43% of the population:

People moved with their livestock in search of water and fresh pasture. As a result of these unusual migrations, too much pressure was put on the land. The lack of food and water lead to thousands of deaths amongst the population, as well as cattle, sheep and goats. Milk became scarce and food prices began to rise. Thousands of families headed for the cities and many camps for these internally displaced peoples had to be set up.

Obesity – “abnormal or excessive fat accumulation that may impair health.” The WHO defines obese as a BMI equal to or more than 30. The figures from the WHO indicate that in 2005:

o 1.6 billion adults were overweight

o At least 400 million adults were obese

o 20 million + children under the age of 5 were overweight

Health Care Approaches

Emergent – INDIA, BRAZIL, SOUTH AFRICA, BANGLADESH

Health care is viewed as an item of personal consumption. Physicians operate as solo entrepreneurs and facilities are privately owned. The state’s role in healthcare is minimal. Remote areas are developing mobile clinics and health workers who can treat common ailments, give inoculations and advice of basic hygiene, like in Tamil Nadu, India.

Pluralistic – USA

Healthcare is viewed as a consumer product provided by independent doctors. The consumer pays for all treatment, including surgery, hospitalisation and doctor’s fees. Many people have insurance to pay for treatment. US Federal Government established Medicaid for the poor and Medicare for the poor elderly.

Insurance Social Security – FRANCE, SPAIN, JAPAN

The entire population pays compulsory health insurance, and the amount is based on the income of the individual. A premium is deducted form employee’s pay automatically. The patient pays all medical bills and then claims up to 85% of it back. The state’s role in healthcare is evident but indirect.

National Health Service – UK, CANADA

Healthcare is a state supported service. Funding is provided by national government taxation and in the UK, it equates to approximately £1,980 for every man woman and child. At the point of use, health care is free for everyone. The aim of the NHS is to provide citizens with equal access to healthcare regardless of wealth. The state’s role is central and direct.

Socialised – CUBA, CHINA

Healthcare is a state provided service. Physicians are state employed and facilities are entirely publically owned. Payments for services are entirely indirect and the state’s role in healthcare is total. In Cuba, for a population of 11 million, there are over 30,000 family doctors and 10,000 dentists, as well as 21 medical schools providing free training.

Comparing Cuba and the USA - Cuba spends much less than USA on healthcare, yet the life expectancies are identical – 78.3 years. This may be because of Cuba’s more proactive approach reducing the cost for future treatment; every family receives a visit once a year from a doctor, emphasising the importance of a healthy lifestyle. Also, because healthcare in Cuba is free, everyone has equal access treatment, which is not the case in the USA.

|Country |Healthcare Approach |Positives |Negatives |

|Cuba |Socialised |Free medical and dental care; home |Huge pressure on government |

| | |visits once every year; 2nd highest |resources at times of economic |

| | |life expectancy in the Caribbean; 21 |decline; reported as being |

| | |medical schools provide free training. |intrusive. |

|USA |Pluralistic |Medicare and Medicaid provide care for |Many people in USA have poor health |

| | |poor and poor elderly. Richer Americans|because they cannot afford health |

| | |see the benefit of paying for |care and checkups. People are |

| | |healthcare, in that quality is higher. |sometimes desperate for surgery |

| | | |before addressing problems. |

Health Matters in a Globalising World Economy

Transnational Corporations are companies which operate in at least two countries. TNCs are the driving force behind globalisation and there are now very few parts of the world where the influence of TNCs is not felt. Often, TNCs have a powerful influence on the local economy and politics. TNCs have a role to play in global health;

o How they treat employees – the wages they pay, their safety standard and the health care that they provide. The Namdeb Diamond Corporation runs a HIV/AIDS awareness programme in Namibia and provides HIV positive employees with treatment.

o How they market products – like tobacco and fatty foods. There are concerns that fast food advertising aimed at children from companies like McDonalds may contribute to long term unhealthy lifestyle choices and obesity.

o How they sell products – the sale of tobacco and medical supplies and their costs; many African countries must rely on generosity of overseas governments and companies to subsidise drugs because they cannot afford them.

o Which products are chosen to be researched and developed – Kraft Foods are developing a new food that kills intestinal worms aimed at Africa, Asia and South America where this is a big health problem.

Pharmaceutical Transnationals – are successful examples of globalisation. Johnson and Johnson has more than 190 operating companies in 52 countries, selling products to 175 countries. These companies affect world health because they can choose which drugs to develop and what prices to charge.

In terms of research and production, there is more money in wealthier countries, so pharmaceutical companies often choose to research and produce more drugs for diseases that mainly affect wealthier countries, like for cancer, CHD and high blood pressure. Often, research into tropical diseases affecting hundreds of millions of people in less developed countries receives only a small proportion of the sum spent on cancer research. Marketing plays a large role in drug sales; companies target doctors with free samples and promotional items like pens and mouse mats to encourage them to prescribe their drugs. In terms of distribution and sales; pharmaceutical companies have exclusive rights to a drug for 20 years – they are seen as intellectual property, and so no generic drugs can be made in that period. Any price can be set for these drugs, because they can’t be obtained from anywhere else, and prices are often high as companies attempt to reclaim money spent on research and development. Poorer countries may be unable to afford these branded drugs, which leads to a decline in their health. In order to restore this imbalance, many pharmaceutical companies will make deals with wealthier countries in which they will supply free or cheaper drugs to developing countries. Some companies will invest profits made into research on diseases affecting less developed countries.

Tobacco Corporations

1.2 billion People in the world smoke. 800 million of these are in developing countries. China’s increase in smoking population has been most dramatic; nearly 70% of Chinese men smoke - China alone has 300 million smokers. Tobacco related illnesses kill 4 million people every year, and this is rising, because as poorer countries develop longer life expectancies, there is enough time for diseases like lung cancer and CHD to develop.

In 2003, the World Health Organisation developed a treaty called the Framework Convention on Tobacco Control. The treaty protects public health by restricting advertising, ensuring they are labelled correctly and regulating who they are sold to. There are concerns that tobacco companies are targeting countries that have not signed up to the convention. In these countries, there are fewer restrictions, and companies can exploit the population’s lack of knowledge of tobacco related illnesses.

Tobacco TNCs are also turning to developing countries as a source of cheaper tobacco. Tobacco cultivation often replaces food crops – this has happened in Kenya. BAT is the largest agribusiness in Kenya, employing over 17,000 farmers. This tobacco is used to make cheaper brands of cigarette.

INDIA – BRITHISH AMERICAN TOBACCO has targeted the expanding market in India. There are 5 million children under 15 years of age who are already addicted to tobacco. BAT engages in campaigns to convert tobacco users, particularly the young, to cigarette smoking.

Regional Variations in Health and Morbidity in the UK

Life expectancy – England has the highest life expectancy of all UK countries with 81.2 years for females, and Scotland has the lowest life expectancy of the UK; 8 out of the 10 worst local authorities for male life expectancies are in Scotland. Glasgow has the lowest life expectancy of the entire UK, at 69.9 years (the only area in the UK with a life expectancy lower than 70). In England, there is a North South divide, with the North having longer life expectancies than the South. Women in the North East and North West live over 2 years less than those in the South East or South West. The proportion of men in the North East who assess their health as not good is approaching double that in the South East.

Morbidity – The patterns of morbidity in the UK follow a similar pattern to life expectancy. Cancer rates are higher in the North than in the South; lung cancer rates in women in Scotland are 50% higher than the rest of the UK, and in the South West, these rates are 40% lower than the rest of the UK. Rural areas tend to be healthier than urban – the East, South East and South West are more rural and have higher life expectancies than the North West and North East, which are more urban. London is very mixed – with both the least healthy (Newham) and most healthy (Kensington and Chelsea) in the UK. There are anomalies however; 5 year olds in the West Midlands have half the average number of decayed, missing or filled teeth than elsewhere in the North; this is attributed to fluorine being added to Birmingham’s water and a focus on children’s dental care in the region.

Factors affecting regional variations

Age structure; Older people are more likely to suffer from age related or degenerative diseases, such as cancer and heart disease. Some areas of the UK have high numbers of elderly people because they choose to retire there (for example, Devon and St. Anne’s)

Income; there is a strong correlation between how much is earned and how healthy the population is. In general, wealthier people have better access to exercise facilities and health care and are more educated about health issues. Those of lower economic status are more likely to smoke and this creates the pattern of lung cancer. Linking Deprivation with morbidity - Average household incomes are 70% of those in the best health areas. There are 3.6 times as many people not working in the worst health areas compared to the best health areas.

Occupation type; men in social class 5 (unskilled and unemployed) have higher mortality rates than those in social class 1 (professional and managerial). People with manual jobs are 3 times more likely to suffer from poor health than those who do non-manual jobs. This is because people who do non manual jobs have a lower risk of being exposed to hazardous substances or having accidents. People who do non manual jobs however are more likely to suffer from stress and mental health problems.

Education; Areas with poor health have GCSE failure rates more than 1.5 times higher than the areas of best health. The better educated an individual is, the more likely they are to choose a healthier lifestyle.

Environment and Pollution; In areas where there is lots of pollution and little open space, morbidity is higher. London for example has a particularly high mortality rate from respiratory diseases; this is thought to be caused by the poor air quality of the city. Other environmental factors such as the quality of housing, whether central heating is fitted, have an influence on health; pneumonia is associated with cold damp housing, often due to a lack of heating. Water is also thought to influence health; hard water is found in the south and east and soft water is found in the north and west. A consistent relationship has been shown between soft water and high levels of heart disease. Areas of dense population where overcrowding is an issue can have issues with a rapid spread of disease.

Gender, wealth and age – their influence on access to health care, good nutrition and exercise facilities

| |Nutrition |Healthcare |Exercise facilities |

|Age |Younger generation has a |Some facilities may be given |Less accessible for the elderly|

| |different attitude to nutrition|priority according to the |as they are less mobile. |

| |– larger amount of saturated |demographic of the area; if |Facilities are often located |

| |fat filled convenience food. |there are large numbers of |for easy access with cars, not |

| | |elderly, facilities for them |necessarily public transport. |

| | |will be given priority. |Some gyms may have restrictions|

| | | |making it more difficult for |

| | | |young people to access. |

|Wealth |Can wealthier people afford |Wealthier people can afford to |Wealthy can afford gym |

| |better quality food? No need to|pay for private healthcare, |membership and are more mobile |

| |depend on low quality |where treatment may be of |to access these facilities. |

| |convenience food. |better quality and where there | |

| | |is no waiting time. | |

|Gender |Men and women may have |Many services aimed |Women are less likely to |

| |different attitudes to food; |specifically at women; breast |participate in sport, 18.5%, |

| |generally women are more |screening and cervical cancer |compared to 23.7% of men. |

| |conscious of fats present in |screening, pregnancy care. |Childcare may restrict a |

| |diet. | |woman’s access to exercise |

| | | |facilities. |

Implications for the provision of healthcare

o An area with a large proportion of elderly will need specialised hospital wards to care for the growing population of elderly people with ill health. They may need to implement programmes for screening for age related diseases, such as cancer or heart disease. More residential homes and carers will be needed. There may be a need for more mobile health services to cope with the increasingly immobilised elderly population, particularly in rural areas.

o Ares with large numbers of young people may need extra services for antenatal care and child hood clinics and inoculations.

A local case study – Healthcare in the Wirral

Four NHS trusts provide services for the people of the Wirral.

o Wirral Primary Care Trust

o Wirral Hospital NHS Trust

o Cheshire and Wirral Partnership NHS Trust

o Clatterbridge Centre for Oncology NHS foundation Trust

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This map shows infant mortality rates.

99% of infant deaths are in LEDCS, and 40% were in Sub Saharan Africa.

Mortality rates are much higher in LEDCs because malnutrition reduces the body’s ability to fight disease and there is poor access to healthcare so diseases cannot be treated.

Countries with high infant mortality rates have high mortality rates in general. HIV AIDS is having a huge impact on mortality around the world, but especially in sub-Saharan Africa. Over 25 million people in this region are living with HIV AIDS. In Botswana, Lesotho and Zimbabwe, 20% of the population are affected.

In LEDCs, the 4 main causes of morbidity are HIV/AIDS, Diahorreal diseases, Malaria and Tuberculosis. These are linked to;

o Malnutrition - being underweight reducing body’s ability to fight disease

o poor standards of living – indoor smoke from solid fuels and lack of clean water and sanitation

o Lack of knowledge and health education - about how to stop the spread of disease.

o Overcrowded conditions

o Disease vectors such as mosquitoes

In MEDCs, the main causes of morbidity are non communicable diseases associated with old age and affluence; examples include Alzheimer’s disease, osteoarthritis, breast cancer and diabetes. The risk factors are linked to lifestyle; blood pressure, stress, physical inactivity, tobacco, alcohol, being overweight, high cholesterol levels, low fruit and vegetable intake.

Sub Saharan Africa:

Congo – 48.1 years

Mali – 49.2 years

Zimbabwe – 42.2 years

Developed World:

UK – 79.7 years

Australia – 81.8 years

Iceland- 81.8 years

Japan – 82.8 years

USA – 78.3 years

Influenza – spreads around the world is seasonal epidemics which impose a serious economic burden in the form of health care and loss of productivity. In industrialised countries most deaths occur among those over 65 years of age. In the developing world, particularly in the tropics, influenza transmission normally occurs all year round, tending to have high attack and case mortality rates. Global pandemics occur a few times each century – the most recent in 1968 (Hong Kong Influenza).

Yellow fever – a viral disease that is transmitted by mosquitoes in tropical regions. The virus is endemic in tropical regions of Africa and the Americas. The viral presence can amplify in regular epidemics.

Factors helping the spread of the epidemic:

Mobile populations – people travelling for work and pleasure

Lack of education on sex and hygiene

Problems with distribution of condoms, of affording them and overcoming reluctance among men to use them

High proportions of people die from AIDS due to:

Lack of antiretroviral drugs at affordable prices

Reluctance to be tested means that treatment is late onset.

Lack of resistance to opportunistic infections because poverty limits their diet

Poor living conditions make people more vulnerable to diseases like TB.

Health

It is estimated that up to 39 million people are living with HIV/AIDS worldwide. 66% of the people living with AIDS are in Sub Saharan Africa, and over 70% of global deaths from HIV occur there. In Botswana and Zimbabwe, life expectancy has now dropped below 40 years do to the HIV epidemic. The United Nations estimates that by 2020, 70 million people will have dies from AIDS.

Economic Development:

HIV strikes mature adults at an age when they are potentially most productive, so their potential contribution to the economy is lost. HIV strikes all types of people – including wealthy and educated, and this often means a waste of investment in education and training. Many children are left orphaned and unable to continue their education which reduced their value to the workforce.

Lifestyle: loss of income earning opportunities for families; diversion of effort and income into care and medicine, and the withdrawal of children from school, because of lack of money and because they are needed for agricultural work; food shortages; strain on local resources due to large numbers of orphans.

Cases of CHD are increasing in poor and newly industrialising countries because of increasing life expectancies and changes in culture – more people adopting Western diets and lifestyle – like fast food and smoking. A lack of education about the risks of smoking, as well as the inability to afford drugs (like aspirin) and surgery contribute to this.

In more developed countries, incidence and deaths form CHD are declining; this is due to the improved prevention, diagnosis and treatment of the disease. A better awareness of the risks of cigarette smoking has also helped.

Lifestyle: People must change their lifestyles: taking regular physical activity, eating a low fat and salt diet and monitoring medication. Pressure is put onto families to care for the individual and any children they may have.

Economic Development: There are economic costs to both the individual and the government: to the individual, losing pay due to time off work, and the cost of treatment and prescription drugs. To the society; there is a loss of productivity due to more employees off work due to illness; more people on incapacity benefit putting pressure on government resources; cost of healthcare to the government for surgery and after care. The Medicare cost of treatments for CHD in people aged 65+ was $76 million in 2000 in the USA.

Health – shortness of breath, fatigue, swelling of the feet and legs, angina – pains in chest and shoulder, arrhythmia, depression and anxiety. DALYs are an indicator of the number of healthy years of life lost, and for CHD, the disease burden is projected to rise from 47 million DALYs in 1990 to 82 million DALYs in 2020. Since 1990, more people have died from CHD than from any other cause.

Drought – lack of rainfall causes soil and groundwater sources to decline which ultimately leads to a reduction in the supply of water. The soil will not need the needs of agricultural crops, creating problems for those who rely on farming, both arable and pastoral.

A population increase greater than the rate of food production – an influx of refugees fleeing war zones or areas of civil unrest. People may migrate from one drought zone to another putting increased pressure on the new land.

A rapid rise in the price of food stuff and animals – if quality of land declines due to drought, compounded by a breakdown in local economy, causes inflationary price rises and panic buying, rapidly leading to shortage of food.

Famine relief is a short term aid that takes the form of distributing food. It is usually carried out by non governmental organisations, charities, like Oxfam and the Red Cross, and government. Much of this is temporary in nature and is given out with caution as not to result in over dependence. Famine relief is often difficult to deliver due to: lack of infrastructure (few ports, airports or roads); cost of providing relief must be raised through charitable donations; coordination between agencies and governments is often difficult in areas of civil unrest.

Causes of Obesity

o Energy imbalance between calories consumed and calories expended

o Global shift in diet towards intake of energy dense foods that are high in fat and sugar

o A trend towards decreased physical activity due to the increased sedentary nature of many forms of work, changing modes of transportation and increasing urbanisation.

Health Consequences of Obesity

o Cardiovascular Diseases – heart disease – world’s number one cause of death

o Diabetes – a global epidemic

o Musculoskeletal disorders – osteoarthritis

o Some cancers – breast, colon, endometrial

Reducing obesity – at both an individual and governmental level.

Individuals can reduce calorie intake and exercise more. Governments must commit to shaping a healthy environment and making healthier lifestyle choices affordable and accessible.

Case Study: GlaxoSmithKline – the biggest UK based pharmaceutical TNC, and the 2nd largest in the world. They produce almost 4 million packs of medicines each year, including 25% of the world’s vaccines. As well as producing drugs for wealthy countries, like Pravastatin for CHD, it produces other for poorer countries, like polio vaccines. In 2006, 206 million tablets of their HIV treatment were shipped to developing countries as well as 155 million Albendazole tablets to eliminate elephantiasis.

Sandwell is part of the West Midlands conurbation. It is an inner city area which suffers from high morbidity. It also suffers from deprivation, it being the 4th most deprived district outside of London. There are four main factors of inner city living that have influenced Sandwell’s high levels of morbidity: the closure of primary and manufacturing industries (coal mining, metal working and chemical industries) has meant that there are high levels of unemployment, so people have less money to spend in improving their quality of life. Secondly, the industries in Sandwell have left a legacy of ill health in their manual labourers. The industries had unhealthy working conditions and diseases like asbestosis are common. Thirdly, the quality of housing is low, lacking adequate heating which lead to problems of damp, which is not conducive to good health. Finally, this deprived inner city area is an unpopular place in which to live, so health authorities struggle to attract general practitioners to work there, leaving existing doctors to deal with too many patients, making it difficult to deal with health needs. Migration has also contributed to increasing morbidity: out migration of young well qualified professionals leaves older residents who have the highest morbidity behind. In migration of migrants who have just arrived in the UK contributes because they may have difficulty in communicating in English, making it difficult for doctors to treat them.

In Sandwell…

In the early 1990s, the primary care trust decided to adopt a new approach to providing health and social services in Tipton, one of the deprived areas in Sandwell. The broad aim was to try to improve lifestyle of residents so as to reduce mortality rates. The trust worked with a large general practice and a community development project to improve access to a number of health services by providing a new centre where a range of services could be accessed under one roof. This centre was Neptune Health Park. Within this there is a sure start centre, aiming to tackle child deprivation by coordinating initiatives to improve pre-school education, childcare and health. Next to the health park, there is also a housing development, Swallow Fields. It is specifically designed for the over 55s, who will have access to lifestyle coordinators and emergency aid. The Health service has also put into place two initiatives to improve health and fitness. “Sandwell Stride” and “Walk to Beijing” encourage regular physical activity, in a effort to reduce blood pressure and minimise obesity. The PCT also run a stop smoking service which is aimed at young smokers, because in 2003, 11% of 11-15 years olds were smokers in Sandwell.

Wirral PCT is responsible for deciding on the health service needs of the population. It provides primary care and community services and commissions secondary care from the other three trusts. The primary care provided includes doctors, dentists, pharmacists and health visitors.

Wirral Hospital NHS Trust is responsible for most operations and major specialist treatment. This may occur when a patient is referred to the trust by their GP or brought into the A and E department. Arrowe Park is the best known part of this hospital trust.

Cheshire and Wirral Partnership NHS Trust - the PCT commissions specialist mental health, learning disability and drug and alcohol services from the partnership trust for the people of the Wirral.

Clatterbridge Centre for Oncology NHS Foundation Trust specialist regional cancer centre providing cancer services to patients across the North West.

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