Contemporary threats to health Session aims • To develop your understanding of how health threats can be conceptualised • To analyse how changing patterns of health relate to key societal events • To identify the main public health issues within contemporary society Conceptualising and determining threats to health • Defining what we may see as a threat to health will be intrinsically linked to how we define health. • If we define the influences on our health as biological in nature, leading to ill-health and malfunctioning of the healthy physiological state of the body, threats will be conceived as factors influencing our biological states. • If we subscribe to the social model of health and acknowledge the importance of socio-economic factors in determining well-being and disease then we will view threats more broadly and shaped by the social world in which we live Causal pathways • Examining the causal pathways for health and illness can aid our understanding of the diversity of threats to health. • Bhopal (2008) provides a useful model for analysing the complexity of causal pathways called a web of causation which visualises the interconnectedness of factors that influences health and illness. • Bhopal’s (2008) diagram represents a complex group of health determinants such as the environment, behaviour and the workplace. It also shows the interrelatedness of these factors in terms of how they contribute to the occurrence and spread of disease. Contemporary discourse • The dominant contemporary discourse for health is one of threats and disease. • Gidden's (2009) argues that the societal focus upon health risks leaves both governments and individuals debating the outcomes of such risks because there are no definitive answers. • Generating positive health is often a less important priority than preventing and reducing mortality and morbidity. • Most ‘health’ targets which underpin practice are framed around reducing illness. • There are some examples of targets that consider the wider determinants of health e.g. the Millennium Development Goals Magnitude and severity • Other factors that can influence what issues are seen as threats to health are the number of people affected and the seriousness of the threat. • Large and visible dangers tend to receive more attention and are therefore more likely to be categorised as threats to health. • Pandemics can be classified as stronger threats because of their scope being across continents and the world. • Notions of mortality (death), morbidity (burden of diseases), impact on quality of life and chronic and acute disease can also be brought to bear on how threats are conceptualised • However, some issues that are perceived by society as stigmatised or shameful can go under-reported, under-investigated and unrecognised, for example disability. Media construction and moral panics • The way that health issues are reported within the mass media influences understandings of the nature of these threats. • Media generated scares often emphasise both physical and emotional threats that are posed by everyday occurrences such as sunbathing, using a mobile phone and vaccinations like Measles, Mumps and Rubella (the combination of three vaccines into a single injection known as MMR) despite the lack of science behind many of the claims that are made (Wainwright, 2009). • The media plays a role in the social amplification of risk, where risks categorised as minor by scientific experts actually elicit strong public concerns and even reactions, resulting in large scale impacts. • Health scares reported in the media arguably give rise to a heightened sense of public panic, creating more physical and mental vulnerability (Buckingham, 2009). • People often have higher levels of fear than are necessary (Buckingham 2009). Changing threats across the 20th and 21st Century • The types of diseases that affect populations change as countries develop, so risks shift from infectious diseases such as cholera in poorer countries to non-communicable and lifestyle associated health problems such as cancers and heart disease in richer countries. • Wainwright (2009) labels this as an ‘epidemiological transition’ • The WHO (2009) labels this as a ‘risk transition’ caused by improvements in medical care, the ageing of the population and successful public health interventions such as vaccinations and sanitation. • The impact of risks to health varies at different levels of socio-economic development. Contemporary threats to health: Climate Change (Summerhayes 2010) Main impact of climate change Some effects on health • Extreme weather events Increasing burden from malnutrition, diarrhoeal, cardio-respiratory, and infectious diseases •Changes in levels of water •Changes in food production •Damaged eco-systems Increased morbidity and mortality from heat waves, floods, and droughts Changed distribution of some disease vectors e.g. mosquitoes transmitting malaria Risks from populations on the move resulting in homelessness and overcrowded conditions Substantial burden on health services Contemporary threats to health: Degraded environments • Our health is linked to the environment and the destruction of the natural environment is therefore a threat to our health. • In destroying our environment, we threaten our basic needs such as food, shelter and clean air and water (Stone 2009). • Degraded environments are associated with health problems, and high levels of mortality. • WHO evidence suggests that each year 800,000 people die from causes related to air pollution, 3.5 million from malnutrition and 1.8 million from lack of clean water (WHO, 2005b; 2008). • All of these physical health problems certainly may impact upon mental health too. Contemporary threats to health: population growth Problems caused by population growth Benefits of population growth Population growth is generally argued to be problematic for health because of increased demands for scarce resources including food, shelter, fuel, water and all types of service provision (for example education and health care). Having a healthy population of working age can serve to enhance economic development which in turn promotes better health (Bloom and Canning, 2001). These factors will not only impact on physical health but will also threaten social and mental health as a consequence of overcrowded living conditions. Contemporary threats to health: Ageing population • The WHO (2007a) predicts that the world's elderly population (by which they mean people aged 60 years and over) will reach 2 billion by 2050. • Ageing populations can result in – changing patterns of illness and disease with increased conditions associated with fragility, chronic diseases and disorders such as dementia – An increase in poverty and therefore associated ill health for older age groups in society • Preparing health providers and societies to meet the needs of elderly people is essential Contemporary threats to health: safety, security and fear Issue Potential effects Conflict and War Deaths and injuries on the battlefield Displacement of populations Breakdown of health and social services Heightened risk of disease transmission Psychosocial impact of living with conflict Domestic Violence Physical injuries and death Living in pain Depression and post-traumatic stress Poor esteem Death and injury Crime Terrorism Emotional impact long term stress Direct death and injury Rape as an instrument of war Direct effect of psychological impact of trauma and fear Contemporary threats to health: poverty • Poverty and inequality limit the achievement of full health. • As a result of poverty individuals experience under-nutrition, unsafe sex and poor sanitation (WHO 2009) therefore increasing their health risks significantly. • Material deprivation plays a huge role in the causation of disease Contemporary threats to health: inequality • Gender health inequalities, e.g. risk behaviours such as drinking alcohol are more prevalent among men • Social Class inequalities, e.g. people in high social classes having better health compared to lower social classes • Geographical inequalities, e.g. Health is generally poorer in the North of England compared to the South of England • Ethnic inequalities, e.g. suicide rates in young Asian women are more than double those for young white women in the UK • Age inequalities, e.g. many risk factors for poor health, such as obesity, hypertension, disability and poverty increase with age (Raleigh and Polato 2004) Contemporary threats to health: mental health • Mental health issues are often neglected in a world that tends to prioritise physical health. • Achieving good mental health is fundamentally important in daily functioning, quality of life and integral to the health of individuals and communities (Brundtland, 2001) • The WHO (2001) suggests that approximately 450 million people worldwide are suffering from some form of mental disorder. • One in four people will be mentally ill at some point in their life, representing 13% of the global burden or morbidity (WHO, 2001). • A major issue for mental health sufferers is the serious stigma and discrimination associated with poor psychological and psychiatric status. Indeed, stigma is a major barrier to both mental health treatment and recovery (Pinto-Foltz & Logsdon 2009). Contemporary threats to health: infectious diseases • There are many infectious diseases that threaten the health of humans such as rotavirus, Ebola, HIV and the more recently discovered SARs and H5N1, bird flu (Kaufmann 2009). • These epidemics are transnational and hard to control, so instil fear in many people. • Experience varies according to where you live about four million people die annually from respiratory infections, mostly in lower income countries. Contemporary threats to health: reemergence of infectious diseases • On some occasions, a number of infectious diseases have been declared to be ‘defeated’ and eradicated and then later reappear to once again pose a threat to the health of humans. • Tuberculosis is one such example within contemporary society (Kaufmann, 2009). • This is partly because of TB’s close relationship with those infected with the HIV virus, so people often develop TB as a result of their weakened immune systems • The situation has been made worse by the bacterium that causes TB becoming increasingly resistant to drugs and treatment. • The principle reasons for the re-emergence of the disease are overcrowded housing, increasing homelessness, rising immigration rates, poor urban living conditions and rising levels of HIV infection (Kaufmann 2009). Contemporary threats to health: lifestyle diseases • The types of food we choose to consume, levels of inactivity, our sexual behaviour, attitudes to alcohol and recreational drug use as well as attitudes to risk are all having a huge impact on our health. • The prevalence of obesity in England is the highest in the European Union. So in 2005, 24.3% of UK females were obese and 22.1% of men were. • Changing life-styles are affecting health. • The idea of life-style choices as a threat to our health has been associated with victim blaming. Summary • Identifying substantive health threats is constructed by definitions of health, considerations of determinants of health, magnitude and seriousness and media and moral panics about health threats. • Epidemiological transition has changed global patterns from infectious diseases at the start of the 20th Century to chronic diseases in the 21st Century and this pattern is predicted to continue. • Health threats in the 21st century will require global action around the major determinants of health such as poverty, inequity, climate change and population growth.