There are a number of ways in which the increasing socio-economic development of a nation can help improve the health of the population.
1.There is a correlation between mortality rates in the developing countries, especially amongst children, and the level of education of the parents of the children. For example, in Morocco, a mother who has completed 4-6 years of schooling, their child is 45% less likely to have died by the age of 2, compared with child’s mother who has had no school (Book 3, Page 54). Education improves the overall knowledge of looking after oneself and others, but also enables people to gain higher income levels, and thus, acquire purchasing power to buy the goods (if available), which will help them improve their quality of life.
2.Food provisions are a necessity to maintaining a healthy population. There are many facets to food, mainly the distribution and supply of food, and the quality and nutritional ingredients of food. Food needs to be of good, sustainable quality so that it provides people with the basic supply of vitamins and minerals to live, and has to be easily accessible so that everyone in the nation can benefit. Developed countries have pioneered the way of preserving food for longer (i.e. use of plastics), and developing countries have benefited from this, but the developed world has also introduced new fear factors regarding food such as contamination (BSE, Salmonella etc) and additives, and, the long term effects of such advancements is beginning to materialise (Book 3, Page 306-307). Developing nations need to maintain a balance of growth, by producing enough food for the nations own consumption, but also growing food for exportation, which will improve their GNP and their overall growth as a nation.
3.Reducing the gap between the social classes will provide a better overall health and wealth of a nation. Those living in the lower social classes have a lower life expectancy than those in higher social classes (Book 3, Page 216). There are many tools and precautions that may be used to bridge the gap. Occupations within the social classes tend to be more manual and risk-based occupations such as mining or engineering. In recent times, Acts of Law have been passed by Governments to protect employees, and as such limit the risk involved in the work practices. By reducing the risk, the Government can enable the employees to work in a safe environment thus providing a longer and healthier work and social life.
Communicable diseases are infectious and parasitic diseases that can be spread by air, food, and water or by insects. Diseases such as Tuberculosis (Tb), malaria, diarrhoeal diseases and AIDs. The current crisis concerning communicable diseases has a massive impact on a countries economy, health and life expectancy of its population. This can be clearly seen when comparing the differences between developed countries and developing countries.
In the developing world, communicable disease accounts for half of the top twelve causes of death, yet in the developed world they are all but eradicated. Almost 26% of the top twelve causes of deaths (Book 3, Page 37, Table 3.1) in the developing world are as a result of communicable disease, in comparison with only almost 4% in the developed world. Communicable disease in the developed world is not as important than in the developing world, as other degenerative diseases such as heart disease and cancer are of a greater threat. In the developed world, past strategies such as the mosquito eradication programme in the 1950’s and 60’s by the world health organisation, helped remove malaria as a risk to Europe, and North America. Enforcing strategies has enabled the control and containment of such diseases, whilst other diseases remain their main priority and focus (Book 3, Page 45). Communicable disease in the developing world plays a major part in the development, growth, prosperity and health of the nations.
The most common methods used to indicate the health of a nation is by measuring Infant Mortality Rates (IMR) and Life expectancy. High IMR is partly due to communicable diseases and is also closely linked to high adult mortality rates. In South Africa the IMR is 8 times greater compared to the UK and the life expectancy of a male in South Africa is 13 years less than in the UK (Book 3, Page 22, Table 2.2). The impact of these diseases can also result in reoccurring illness both in children and adults. Morbidity in young adults in the developing countries, as a result of communicable diseases such as malaria, result in a greater number of days lost at work, in comparison with developed countries. It has been established that the poorer the country, the higher the number of work days lost, and, when work days are lost, so there is a loss of earnings and subsequently leads to a lower quality of life and poorer health (Book 3, Page 41). This in turn leads to economic damage for the country. It is of major importance to prevent and control these diseases not only to save lives and improve health but also to help further socio-economic development and to alleviate poverty in the developing countries. The eradication of these diseases is also a concern for the developed countries. Re-emergence of diseases such as Tb and the current mass population movement leaves a risk of a global epidemic that prompted the WHO to describe TB as a global emergency’ (Book 1, Page 80).
In the fight to control communicable diseases it is important to recognise that there are many factors that contribute to the spread of disease and that these factors are complex and often perpetuate each other. A multi-disciplinary approach needs to be taken.
In the case of Tb, vaccinations and drug therapy was used to aid in the decline of this disease. A drug therapy strategy set up by WHO for the purpose of addressing the Tb epidemic is the Directly-Observed Treatment Short-course (DOTS) programme. This involves patients being monitored while taking their drug therapy. Health workers keep a record, which is then sent to a national register. The WHO claim that this programme can cure up to 95% of TB patients (Book1, Page 82). Despite the excellent result these methods have some limitations. The supervision of patients can be difficult especially in developing countries. Some patients do not have transport to get to the clinics and may also need to choose a days work over going for treatment (VC 1265). Another limitation is that not all countries adopt this drug therapy treatment. The vaccination also has limitations in that it is only effective in children.
Medical intervention is not the only successful method, which can address the spread of infectious disease. The spread of communicable diseases has been impacted by densely populated cities, poverty conditions such as contaminated water and poor sanitation. These factors along with education and good housing need to be addressed. Other factors that need to be addressed regarding health are education, sanitation, good water supplies and adequate housing. Thomas McKeowns’ research showed that Tb deaths were on the decline before vaccines and drugs were used. He argued that higher living standards and better nutrition were responsible for the decline (Reader, Page 219).
In the late 1970’s the WHO commissioned a programme of Comprehensive Primary Health Care. This strategy was much more encompassing and involved co-ordinating efforts across a number of activities. Educating people regarding the prevention of ill-health, and what to do when you do become ill; Ensure the quality of food is substantial for a healthy nutritional diet; Clean water supply and basic sanitation; Child health care programme including family planning; immunisation against the major infectious diseases; prevention and control of locally endemic diseases and appropriate treatment of common diseases and injuries; and provision of essential drugs (Book 3, Page 58). The limitations of this were that is was too broad ranging and ambitious. The approach needed to be more disciplined in its objectives.
Alternatively, a Targeted Approach would be able to set realistic and attainable goals for a single disease. By targeting one disease and assessing the feasibility and cost of controlling them, resources are efficiently employed and deployed. Indeed, a collective effort by international agencies saw the production of grouping vaccine-preventable diseases, meaning that more than one communicable disease could be treated at the same time. This strategy led to the formation of Global Alliance for Vaccines and Immunisations in 1999. The aim of the organisation is to increase worldwide-access to vaccines, and invest more in research to new vaccines to combat and prevent communicable diseases such as malaria, tuberculosis and AIDS (Book 3, Page 59). The limitations of this strategy are that not births in developing countries are recorded.
One obvious factor when looking at these differences is that the countries that have the most deaths are also the countries that have the least amount of money for health care. The World Bank tabled a concept of essential national package of health services. This concept was based on “the measured burden of diseases and the cost-effectiveness of interventions available to deal with them”. The package of health services would cost $12 per person, which some developing countries would not be able to afford (Book 3, Page 59). For example the cost of treating a Tb patient amounts to $11 yet health care cost in Bangladesh is only $3.50 per person (Book 1, Page 82).
Another strategy is to address the underlying cause of communicable disease, which is believed to be poverty. Poverty provides the right environmental conditions for contaminated water supplies and insufficient sanitation leading to ill health; inappropriate food supplies leading to hunger; and inadequate health care. The developed world effectively built’ its way out of these poor conditions via the industrialisation process, and it is suggested that the developing world can combat communicable diseases by addressing poverty in a similar way. But there are many disagreements regarding this, as there is no documented proof of when the diseases subsided, and indeed, what are the long-term effects of global industrialisation therefore questioning this strategy (Book 3, Page 60).
More work is required in the measurement communicable diseases, especially in the developing world, and the onus is on the developed world to find additional vaccines by investing in further research. The developed world cannot be complacent in its attitude towards communicable diseases. As more and more people are able and free to roam from country to country, so it becomes harder to ensure that adequate strategies can be enforced and that the appropriate vaccines have been administered. Therefore, there still has to be concerted efforts from the developed and the developing world that a multi-disciplinary strategy can be adopted and enforced, and only by such mechanisms can the long-term goal of eradicating communicable diseases be achieved.
Szreter,S (1998) The importance of social intervention in Britain’s mortality decline c. 1850-1914: a re-interpretation of the role of public health.’ in Davey, B, Gray, A and Seale, C (eds) Health and Disease: A Reader, Open University Press, Buckingham.
U205 Health and Disease Book 3 (2001) World Health and Disease, Gray,A, Open University Press, Buckingham.
U205 Health and Disease Book 1 (2001) Medical Knowledge: Doubt and Certainty, Seale, C. Pattison, S. and Davey, B. (eds), Open University Press, Buckingham.
VC 1265, Video 1, South Africa: Health at the crossroads’ Open University.