Download et al - School

Development & Health
Development & Health
Across the developing world
mortality* & morbidity* rates
are much higher than in the
developed world.
Poverty and lack of
development are significant
contributing factors to this
picture.
In examining the impact of
health issues on development
and the impact that
development can have on
health issues it is worthwhile
considering a few globally
significant diseases:
Malaria, TB & HIV/AIDS
The focus of this presentation
will be HIV/AIDS.
The major causes of mortality & morbidity in the
developed world are attributable to lifestyle
(Cancer, Heart disease etc). In the developing
world the majority of people die as a
consequence of exposure to communicable
disease or malnutrition.
*Mortality = Death
*Morbidity = Disease
Variation in Infant Mortality Rates 1960 - 2000
Progress is being made but at a slow rate. The impact of poor health care
provision and lack of accessibility in Sub-Saharan Africa is still significant
with many countries seeing over 150 out of every 1000 children born dying
before the age of 5. In the UK this figure is 5 per 1000!
Malaria is one of the planet's deadliest diseases and one of the leading causes of sickness and death in the
developing world. According to the World Health Organization there are 300 to 500 million clinical cases of malaria
each year resulting in 1.5 to 2.7 million deaths.
Children aged one to four are the most vulnerable to infection and death. Malaria is responsible for as many as half
the deaths of African children under the age of five. The disease kills more than one million children - 2,800 per day each year in Africa alone. In regions of intense transmission, 40% of toddlers may die of acute malaria.
About 40% of the world's population - about two billion people - are at risk in about 90 countries and territories. 80 to
90% of malaria deaths occur in sub-Saharan Africa where 90% of the infected people live.
Sub-Saharan Africa is the region with the highest malaria infection rate. Here alone, the disease kills at least one
million people each year. According to some estimates, 275 million out of a total of 530 million people have malaria
parasites in their blood, although they may not develop symptoms.
Of the four human malaria strains, Plasmodium falciparum is the most common and deadly form. It is responsible
for about 95% of malaria deaths worldwide and has a mortality rate of 1-3%.
In the early 1960s, only 10% the world's population was at risk of contracting malaria. This rose to 40% as
mosquitoes developed resistance to pesticides and malaria parasites developed resistance to treatment drugs.
Malaria is now spreading to areas previously free of the disease.
Malaria kills 8,000 Brazilians yearly - more than AIDS and cholera combined.
There were 483 reported cases of malaria in Canada in 1993, according to Health Canada and approximately 431
in 1994. The Centers for Disease Control and Prevention in the United States received reports of 910 cases of
malaria in 1992 and seven of those cases were acquired there. In 1970, reported malaria cases in the U.S. were
4,247 with more than 4,000 of the total being U.S. military personnel.
According to material from Third World Network Features, in Africa alone, direct and indirect costs of malaria
amounted to US $800 million in 1987 and are expected to reach US $1.8 billion annually by 1995.
Sources : The Malaria Control Programme, World Health Organization, Third World Network Features, Health Canada, The Centers for Disease
Control and Prevention,
Infection and transmission
Tuberculosis (TB) is a contagious disease. Like the common cold, it spreads through the air. Only people who are sick with TB
in their lungs are infectious. When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the
air. A person needs only to inhale a small number of these to be infected.
Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year. However,
people infected with TB bacilli will not necessarily become sick with the disease. The immune system "walls off" the TB bacilli
which, protected by a thick waxy coat, can lie dormant for years. When someone's immune system is weakened, the chances
of becoming sick are greater.
Someone in the world is newly infected with TB bacilli every second.
Overall, one-third of the world's population is currently infected with the TB bacillus.
5-10% of people who are infected with TB bacilli (but who are not infected with HIV) become sick or infectious at
some time during their life. People with HIV and TB infection are much more likely to develop TB.
Global and regional incidence
The World Health Organization (WHO) estimates that the largest number of new TB cases in 2004 occurred in WHO's SouthEast Asia Region, which accounted for 33% of incident cases globally. However, the estimated incidence per capita in subSaharan Africa is nearly twice that of the South-East Asia Region, at nearly 400 cases per 100 000 population.
It is estimated that 1.7 million deaths resulted from TB in 2004. Both the highest number of deaths and the highest mortality per
capita are in the WHO Africa region, where HIV has led to rapid growth of the TB epidemic, and increases the likelihood of
dying from TB.
In 2004, estimated per capita TB incidence was stable or falling in five out of six WHO regions, but growing at 0.6% per year
globally. The exception is the African region, where TB incidence was still rising, in line with the spread of HIV. However, the
number of cases notified from the African region is increasing more slowly each year, probably because the HIV epidemics in
African countries are also slowing. In eastern Europe (mostly countries of the former Soviet Union), incidence per capita
increased during the 1990s, but peaked around 2001, and has since fallen.
Global incidence of TB
The global HIV/AIDS
epidemic
The Global Picture
An African Disease?
Spread of HIV in Africa 1988 -2003
How do we account for these two ‘spikes’?
Why are women so much more vulnerable to HIV than men?
Impact of HIV/AIDS on the
Population & Economy
“It is difficult to predict what effect AIDS
might have on population growth rates,
but because the death rate from AIDS is
highest amongst children and young
adults, it could have a serious effect on
future developments in certain
countries”
Myers (1994)
Treatment, Prevention &
Education
Future?
Progress & potential obstacles
Any attempts to mitigate against the impact of HIV/AIDS may come
against a variety of sources of resistance or difficulty in their
implementation. Some of these are illustrated below:
Conflict, instability
and poverty are all
significant
contributory factors
in Africa’s
HIV/AIDS
epidemic.
Trade & vulnerability
to global commodity
fluctuations
represent a
significant ‘barrier’ to
HIV/AIDS prevention
& treatment.
Preventative
education & health
initiatives are
expensive, as are
the costs associated
with treatment and
care of those
infected (despite the
fact that ARV’s are
coming down in
price, the sheer
quantities required
are very expensive).
So the Sociology then!
Different sociological perspectives will
address the issues of global health
inequalities by asking 3 key questions:
1. Who is affected?
2. Who or what is top blame?
3. How can things be changed or improved?
Consider then what each of the following perspectives
would think about the issues of health & development.
● Modernisation theorists
● Dependency theorists
● Feminists
● Marxists
High rates of infection
due to ‘traditional’ cultural
values, practices &
behaviours
Failure to invest in
industrialisation limits
resources to combat
disease
Failure to adopt
Western medical
practices contributes to
higher death rates
amongst those infected
Modernisation
Theory
(Rostow (1971), Friedman
et al)
Investment in health
care from the
revenues generated
by participation in
process of economic
globalisation
Western technologies
and practices should
be adopted
Colonialism and
Neo-colonialism
have produced the
health inequalities
witnessed today
Diseases introduced through
colonialism and spread by
introduction of transport
networks for the extraction of
raw materials & resources
Global economic system
is unfair and ‘rigged’
against developing
countries making them
vulnerable to exploitation
Dependency
Theory
(Hayter, Frank (1981)
et al)
Loss of trained health
professionals (doctors &
nurses) to developed
world further evidence of
exploitation
Reliance on
“cash-crops” to
service crippling
debts can
exacerbate
problems of
malnutrition
Failure to ‘share’ medical
technologies with
developing countries
example of
Underdevelopment
High tech ‘Western’ medical
technologies should not be a
priority for developing countries
Concentration on
improvements to basic health
care provision that impacts on
a greater proportion of the
population should be the
priority for developing countries
Marxists
(Navarro (1976, Harris (1987)
et al)
Health care professionals should be
encouraged to stay in the developing
world where their skills have the
potential to achieve a greater benefit
for more people
Developing world countries
should avoid becoming
dependent upon trade with
the developed world as the
capitalist system will never
be altered to provide
greater equity
Need to raise status of
women in the
developing world
Improve basic provision of
sanitation, access to clean
water etc in rural areas where
high numbers of women are
often ‘trapped’
Concentrate on
improving education of
population as this will
impact significantly on
women
Ensure equity in provision
& access to health care
programmes and facilities
Feminists
(Foster-Carter (1984),
Bumiller (1991) et al)
Empower
more women
to take control
of their own,
and their
families, health
Increase education
& access to family
planning advice
and make
contraceptives
(particularly
condoms) more
easily accessible
Tackle issues surrounding
prostitution rather than adopting
an ‘ostrich’ approach
Other Developing Countries
India
With an estimated 4.58 million HIV positive cases, India has the second
largest number of people in the world living with HIV. This accounts for 11.4
per cent of global HIV infections.
The epidemic is unevenly distributed across India, with just six states
accounting for 80 per cent of the estimated cases: Andhra Pradesh,
Karnataka, Maharashtra, Manipur, Nagaland and Tamil Nadu. In these states,
the HIV prevalence rate among women attending antenatal clinics exceeds 1
per cent – an indication that the epidemic has spread from high-risk groups,
such as sex workers and injecting drug users, to the general population.
The main mode of HIV transmission is through sexual contact. The exception
is in the north-eastern states of Manipur and Nagaland, where injecting drug
use accounts for the majority of the transmission.
Awareness and knowledge of prevention are crucial to checking the spread of
HIV. In 2001 a behaviour surveillance survey (BSS) conducted by the
National AIDS Control Organisation (NACO) indicated increased levels of
awareness but also revealed that very few people correctly understood how
to prevent transmission
http://www.unicef.org/india/hiv_aids.html
Fewer than half of all people interviewed were aware of the two important
methods of prevention of transmission: consistent condom use and sexual
relationships with faithful and uninfected partners. Awareness is especially
low amongst women. The survey found that while 70 per cent of men were
aware of the protective value of a condom, only 48 per cent of women knew
about this. The epidemic is shifting towards women and young people, with
women accounting for 25 per cent of all HIV infections. Low levels of
awareness, spiralling violence within the home and limited access to healthcare are also responsible for the growing incidence of HIV/AIDS amongst
women. Stigma and discrimination continue to be among the biggest barriers
to prevention, care and treatment.
China