AQA AS Geography
Health Issues
David Redfern and Professor Hazel Barrett
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Health Issues
This is the content guidance for the Human Option, Health Issues. It summarises the essential
information of the module and indicates (in italics) the material that has to be covered and
learnt. You will also find a number of short-answer questions which are linked to the content
guidance.
Global patterns
Health, morbidity and mortality.
Be sure of the meaning of each of these terms, and the general factors that affect them. The
global patterns of each of mortality and some aspects of morbidity, eg influenza, should be
studied
Health in world affairs.
Be aware of the general importance of health in global, national and local areas
The study of one infectious disease
(e.g. malaria, HIV/Aids) its global distribution and its impact on health, economic development
and lifestyle.
Two examples are given in the specification, but you could choose to study another, such as
cholera. Whichever disease you choose, make sure it is infectious, and has a global
distribution [areas where it tends to occur, and not occur]. There is also the requirement to
study the impact on each of the health of the population, the level of economic development of
the area where it is prevalent, and the lifestyle of the people. It is also a good idea to examine
ways in which the disease can be managed and/or prevented.
The study of one ‘disease of affluence’
(e.g. coronary disease, cancer) its global distribution and its impact on health, economic
development and lifestyle.
Two examples are given in the specification, but you could choose to study a variation of one,
eg lung cancer only. Whichever disease you choose, make sure it is infectious, and has a global
distribution [areas where it tends to occur, and not occur]. There is also the requirement to
study the impact on each of the health of the population, the level of economic development of
the area where it is prevalent, and the lifestyle of the people. It is also a good idea to examine
ways in which the disease can be managed and/or prevented.
Food and health
Malnutrition, periodic famine, obesity.
Be sure of the meaning of each of these terms, and the general factors that cause them. A case
study of the causes, effects and possible solutions of famine of should be studied
Contrasting health care approaches in countries at different stages of development.
It is important that at least two national health care systems are examined – their main
characteristics, with named examples of where they operate. The two countries must have
contrasting levels of economic development – choose at least one from the developed world,
and at least one from the developing world.
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Health matters in a globalising world economy
Transnational corporations and pharmaceutical research, production and distribution; tobacco
transnationals.
The general principles of the ways in which TNCs operate should be fully understood, which
should then be related to these two types of TNCs. Consider both beneficial and adverse
aspects of their operations.
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.
Variations in health within the UK are regularly featured on tv and other media outlets. On
each occasion, some attempt to explain is often made – monitor these reports and collect the
information. The essential aspect here is that variations are described, both between and
within regions, with some attempt to explain in terms of socio-economic factors, behaviours or
environment. This area of research is still developing, and hence any reasonable view or
opinion will be accepted
Health care systems
Age, gender, wealth and their influence on access to facilities for exercise, health care, and
good nutrition.
This can be best examined by means of a research investigation, which may include fieldwork,
within a small scale area (for example a electoral ward). Using data from the census you can
compare the demographic and social make-up of a population with the health related facilities
available. Be sure to evaluate any work you do – is the level of health related activity
appropriate or not?
A local case study on the implications of the above for the provision of health care systems.
This can extend the above investigation into the provision of health care systems in a local
area. It would be advisable to look at a slightly larger area, such as a Primary Care Trust
[PCT] as most facilities such as A&E, maternity and mental health are organised at this scale.
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Questions
Here are a number of short answer questions which can help in making sure that you have
understood the subject content of this option.
1. Define the term “infant mortality rate”
2. Explain what the term “morbidity” means
3. Describe the global distribution of one illness (eg influenza) you have studied
4. Describe the global distribution of one infectious disease (eg AIDS) you have studied
5. Outline the effects that an infectious disease can have on a population
6. Give three ways in which an infectious disease can be prevented or managed
7. Identify two diseases of affluence
8. For one disease of affluence, state the main causes
9. Give three costs of this disease to a nation as a whole
10. Identify three prevention strategies for this disease
11. Distinguish between malnutrition and under-nourishment
12. Give two physical causes of famine
13. Give two human causes of famine
14. Outline the effects of famine on the people affected
15. Give two ways in which famine can be prevented over a longer term
16. Define the term “obesity”
17. Give two health consequences for an individual from being obese
18. Suggest three ways in which obesity can be reduced at a national level
19. Summarise the main features of a National Health Service such as that in the UK or Canada
20. How is the health service of China or Cuba different to that of the UK/Canada?
21. Define the term “transnational corporation (TNC)”
22. Name two large TNCs in the pharmaceutical industry, and two large TNCs in the tobacco
industry
23. What is meant by the term “generic product” in connection with the pharmaceutical
industry?
24. Outline two ways in which tobacco TNCs are impacting on the lives of people in the
developing world
25. Define the term “life expectancy”
26. Give three variations in morbidity within the UK
27. Suggest three reasons why morbidity varies within the UK
28. Define the term “Primary Care Trust”
29. Briefly describe the provision of health care in your own local area
30. Identify two charitable organisations that play an important role in health care provision
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Health Issues
Hrs
Objectives
Key questions
Activities
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Global patterns of
health, mortality and
morbidity: health in
world affairs
What sorts of issues are important at present and
why? (HIV epidemic/ effects of climate change on
health, improving healthcare, poverty and health)
What are the meanings of the terms mortality,
infant mortality, birth and death rates, morbidity,
attack rate and case mortality rate?
What are the general regional patterns of health as
measured by terms above?
What are some of the main reasons for differences
at a global scale?
Intro to Health- World affairs- WHO website home and
BBC news has recent world health news. Could report
back on issues of interest
Comparison of life expectancy and medical care from
Schools Atlases for general trends and intro
In depth investigation using WHO website- interactive
mapping of health indicators and diseases
Written paragraph to describe patterns
Can you explain patterns by comparing mortality levels
with things like education/ health care provision?
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Study of one infectious
disease: (malaria/ HIV
aids)
Global distribution
Impact on health,
economic development
and lifestyle
What are infectious diseases?
Case study area e.g Uganda
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Map globally using WHO global health atlas.
Note concentrations.

What is malaria/HIV and how is it
transmitted? (comparison of incidence with
incidence of poverty)

Symptoms?

Impact on economy and lifestyle in Uganda
(malaria)

(can link in to health provision)
What causes the disease and what are the
symptoms?
What is its global distribution and frequency and
why?
What impacts does it have on economy, people and
lifestyle?
Resources
Homework/
Assessment
How is it being managed?
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Study of one disease of
affluence: (coronary/
cancer)
Global distribution
Impact on health,
economic development
and lifestyle
What is a disease of affluence and is this a
misleading term?
What causes the disease and what are the
symptoms?
What is its global distribution and frequency and
why?
What impacts does it have on economy, people and
lifestyle?
How is it being managed?
Case study area e.g UK
(heart disease UK’s biggest killer)
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Food and health:
Malnutrition
Periodic famine
Obesity
Contrasting healthcare
approaches in countries
at different stages of
development
Health matters in a
globalising world
economy:
TNCs
Pharmaceutical
research, production
and distribution.
Tobacco transnationals
Regional variations in
health and morbidity in
the UK
What is malnutrition?
What is famine?
What causes famine and where does it occur?
What solutions are there to famine?
What is obesity?
What causes obesity and where does it occur?
What solutions are there to obesity?
How do countries at varying stages of development
approach healthcare?
What is a TNC and how do modern pharmaceutical
companies operate (R&D)?
Study of one eg of each type of health care system:
emergent (India), Pluralistic (USA), Insurance/ social
security (France/Spain/ Japan), National Health Service
(UK) and Socialised (Cuba).
e.g Glaxo-Smith Klein?
How does production and distribution of
pharmaceuticals work?
What influence do tobacco transnationals have on
health and employment?
What differences in health exist at a national scale?
What differences exist at a regional scale?
Are there any significant variations between rural
and urban areas?
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Factors affecting
regional variations in
health and morbidity:
What factors affect regional variations in health?
(age structure, income, occupation type, education,
environment and pollution)
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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.
In your local area how do age, gender and wealth
affect access to exercise facilities, health care and
good nutrition?
How does this compare with another area?
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Famine case study- could look at Ethiopia and
Zimbabwe
Obesity study- e.g USA and Middle East
What is the health care provision in our local area?
What is the NHS and how is it run?
What other providers are used in our area? (e.g
Bupa)
How does age, gender, wealth etc influence
people’s requirements for healthcare?
Local area
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Global patterns
Maternal mortality
The latest estimate is that 536,000 women died in 2005 as a result of complications of
pregnancy and childbirth, and that 400 mothers died for every 100,000 live births (the
maternal mortality ratio). The maternal mortality ratio was 9 in developed countries, 450 in
developing countries and 900 in sub-Saharan Africa. This means that 99% of the women who
died in pregnancy and childbirth were from the developing countries. Slightly more than half
of these deaths occurred in sub-Saharan Africa and about a third in southern Asia; together
these two regions accounted for over 85% of maternal deaths worldwide.
Morbidity: Breast cancer
At present, breast cancer, along with cervical, colorectal and oral cancers, is the only type for
which early screening has been shown to reduce mortality from the disease. There is
sufficient evidence to show that mammography screening among women aged 50-69 years
could reduce mortality from breast cancer by 15 to 25%. The risk of dying from breast cancer
is estimated at about 33 per thousand among women in high-income countries compared with
25 per thousand in middle-income countries and less than 15 per thousand in low-income
countries. The higher rates in wealthier countries reflect increasing longevity, higher
exposure to breast cancer risks such as being overweight, hormone replacement therapy and
lower protective factors such as breastfeeding and contraception. Among women in their late
30s in high income countries about 10% of all deaths are due to breast cancer, rising to 14%
in women in their 50s.
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AIDS
The majority of people living with HIV in low and middle income countries are not aware of
their HIV infection. Increased provision of treatment and care services will help motivate
people to be tested. This, in turn, requires increased availability of voluntary counselling and
testing (VCT) services. VCT stands at the heart of prevention and treatment.
Behavioural counselling and provision of condoms, clean needles and syringes must be made
available to people. After testing positive, people living with HIV can be offered care,
treatment and support services, including ARV if necessary. Counselling and other services
aimed at prevention of secondary transmission, as well as the provision of ARV to prevent
mother-to-child transmission, are an essential component of follow-up services for
individuals who test positive. Effective prevention programming and treatment, care and
support services therefore go hand-in-hand.
The impact of AIDS is devastating to the economies of low and middle income countries
with high HIV prevalence. These countries, already suffering from heavy debt burdens, low
productivity and weak infrastructures are being further impoverished by the scourge of AIDS.
There is strong evidence that investment in HIV-related treatment and care can reduce
hospitalisations and other direct and indirect costs of HIV/AIDS. Brazil has completed a
number of economic analyses demonstrating significant cost-savings and expenditures
avoided since the introduction of universal coverage of HIV-related treatments, including
ARV, in 1997. Other countries that are beginning to scale up HIV treatment are also
documenting savings due to avoidance of hospitalisations and lower incidence of
opportunistic infections. In addition to prolonging the lives of countless teachers, health
workers, farmers, students and other precious human capital, it makes sense for countries to
invest in health care in general, and HIV treatment specifically, because access to care and
treatment is a human right.
Comprehensive care for people living with HIV/AIDS includes, but is not limited to, the
following:
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Available, accessible, voluntary counselling and testing services
Antiretroviral therapy (ARV)
Prevention and treatment of tuberculosis and other opportunistic infections
Prevention and treatment of sexually transmitted infections
Palliative care to reduce the suffering of infected people
Prevention of further HIV transmission, through existing technologies (e.g. male and
female condoms, antiretrovirals for the prevention of mother-to-child transmission,
clean needles and syringes) and investment in future technologies (e.g. vaccines and
microbicides) as well as behaviour change
Family planning
Good nutrition
Reduction of the stigma associated with HIV/AIDS
Different approaches are being used to help fund access to care and treatment in low and
middle income countries. These include universal, free-of-charge, access to treatment
programmes through the public sector (the approach used by Brazil and a number of other
Latin American countries), direct government subsidies to patients (the approach used by
Chile, Cote d’Ivoire, Gabon, Mali, Romania, Senegal and Trinidad and Tobago), and out-ofpocket purchasing by patients after large-volume purchases at reduced prices by governments
(the approach being used by Uganda). It is clear, however, that the vast majority of people
living with HIV and in need of treatment will not be able to afford to cover the costs of their
care. Countries that have maximised treatment access have done so through universal access.
In the Brazilian model, for example, HIV treatment is free. HIV care will need to be provided
at a price that is proportionate to local purchasing power – and for many people, in many
communities, in many countries, that means HIV care and treatment must be free.
Treatment brings many wider benefits and its effects on national development are also
substantial. What makes AIDS uniquely destructive is that it targets adults in the prime of
their lives as workers, parents and caregivers. Treating HIV, therefore, saves children from
ophanhood, keeps households and businesses intact, maintains social cohesion, enhances the
return on social investments in sectors such as education and rural development, boosts
economic growth, enhances national security and helps prevent the exacerbation of poverty
which a mature epidemic is hypothesized to cause. Prevention can help stave off such threats
in the future, but people, societies, economies and nations are at risk today – and the risk
stems primarily from the likely impact of millions of premature deaths within the next decade
among those already infected. Moreover, those countries with the highest rates of infection
are at disproportionately greater risk, which makes treatment there all the more important.
For much of the world’s population living with HIV, the need for food remains an
overwhelming priority. People living with HIV and AIDS need substantial nutritional inputs
(up to 50% more protein) to fortify their compromised immune systems. Those suffering
from hunger, famine and/or nutritional deficits are more likely to fall ill with opportunistic
infections and are less likely to be able to recover from them. Malnutrition is also one of the
major clinical manifestations of HIV disease. Where drought conditions exist, access to clean
water is reduced, further increasing the risk of infection for adults, children and infants,
particularly those on formula feeding. Clean water supplies and adequate food must be part of
an overall HIV treatment, care and support package.
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Extracts from a Report for The University of Nottingham School of Nursing, May 2003
Introduction. This report describes my experiences whilst on a five-week placement in the
Southern Province of Zambia as part of my nursing degree … The focus of my placement
was to see the work of SAPEP – an HIV/AIDS project
SAPEP is a non-governmental organisation which works in two rural districts in Zambia’s
Southern Province, surrounding the towns of Monze and Mazabuka. The project used to be
funded by the government Family Health Trust. The project was under-funded … and has
been funded by PEPAIDS, a British-based charity, since December 2002. SAPEP employs
two District Co-ordinators, one in Monze and one in Mazabuka. Their districts are divided
into 20 Zones, each with a part-time Zone Co-ordinator (ZC).
Anti-AIDS Clubs. Anti-AIDS Clubs had been running in Zambia since 1991. However, they
were suffering from a funding and management crisis in 2002, so SAPEP took over the
support of the Clubs in Southern Province. The ZCs train individuals within their zones to run
Anti-AIDS clubs, which operate in local communities. The Club Leaders organise and lead
activities, including running sports leagues, and competitions, and doing drama/role-plays
about situations that may leave people vulnerable to HIV/AIDS transmission. Sport has
proved to be a very effective way of reaching the youth and giving health education, because
it attracts a large audience. The ZCs also liaise with local health clinics, hospitals and
schools. ‘Youth Friendly Corners’ are run in rural health clinics, where young people can go
for advice and discuss sex and HIV, which are usually taboo subjects in Zambian society.
There is a huge stigma surrounding HIV/AIDS in Zambia. Issues around sex are not
discussed. Heterosexual intercourse is responsible for the vast majority of HIV infections in
Zambia. Zambian women have an extremely low status in society. Women have no power
within relationships to refuse sex, insist on condom use or demand that their partners be
faithful. This is one of the most crucial reasons for the spread of AIDS in Zambia, and in
Africa as a whole.
Some practices and beliefs have a direct effect on the transmission of HIV. For instance, it is
believed that men can cure sexually transmitted diseases by having sex with a virgin, and
family and tribal elders are also expected to initiate young girls into womanhood, through
sexual intercourse.
Poverty plays a major role in HIV transmission. For many people each day is, literally, a
struggle for survival. Many women and young girls are forced into prostitution, which
obviously contributes to the spread of HIV. I visited three different areas in Monze with
home-based care services. The majority of the patients we visited had AIDS … they were
dying without any food or pain relief. For many people, AIDS meant their family had no
source of income as the sole earner was sick. There were countless orphans who had lost both
parents to AIDS. One woman I met had seven grandchildren to look after, her own children
having died from AIDS.
In my opinion, SAPEP’s work is proving effective. Statistics of sexually-transmitted
infections at health clinics in the areas where SAPEP operates show that they have been
reduced. SAPEP is effective because it delivers health education through local people with
whom the target population can identify. Health promotion activities and information are
appropriate to the community’s needs.
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An infectious disease: Malaria
Key facts
 Malaria is both preventable and curable.
 A child dies of malaria every 30 seconds.
 More than one million people die of malaria every year, mostly infants, young
children and pregnant women and most of them in Africa.
Infection and transmission
Malaria is a disease which can be transmitted to people of all ages. It is caused by parasites of
the species Plasmodium that are spread from person to person through the bites of infected
mosquitoes. The common first symptoms – fever, headache, chills, and vomiting – appear 10
to 15 days after a person is infected. If not treated promptly with effective medicines, malaria
can cause severe illness that is often fatal.
Malaria transmission differs in intensity and regularity depending on local factors such as
rainfall patterns, proximity of mosquito breeding sites and mosquito species. Some regions
have a fairly constant number of cases throughout the year – these are malaria endemic –
whereas in other areas there are “malaria” seasons, usually coinciding with the rainy season.
Large and devastating epidemics can occur in areas where people have had little contact with
the malaria parasite, and therefore have little or no immunity. These epidemics can be
triggered by weather conditions and further aggravated by complex emergencies or natural
disasters.
Global and regional risk
Approximately 40% of the world’s population, mostly those living in the world’s poorest
countries, are at risk of malaria. Every year, more than 500 million people become severely
ill with malaria. Most cases and deaths are in sub-Saharan Africa. However, Asia, Latin
America, the Middle East and parts of Europe are also affected. Travellers from malaria-free
regions going to areas where there is malaria transmission are highly vulnerable – they have
little or no immunity and are often exposed to delayed or wrong malaria diagnosis when
returning to their home country.
Treatment
Early diagnosis and prompt treatment are the basic elements of malaria control. Early and
effective treatment of malaria disease will shorten its duration and prevent the development
of complications and the great majority of deaths from malaria. Access to disease
management should be seen not only as a component of malaria control but a fundamental
right of all populations at risk. Malaria control must be an essential part of health care
development. In contemporary control, treatment is provided to cure patients rather than to
reduce parasite reservoirs. Antimalarial treatment policies will vary between countries
depending on the epidemiology of the disease, transmission, patterns of drug resistance and
political and economic contexts.
Drug resistance
The rapid spread of antimalarial drug resistance over the past few decades has required more
intensive monitoring of drug resistance to ensure proper management of clinical cases and
early detection of changing patterns of resistance so that national malaria treatment policies
can be revised where necessary. Recent efforts to scale-up malaria control in endemic
countries throughout the world including increased support for commodities and health
systems, as well as the proposed price subsidy on artemisinin-based combination therapies
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(ACTs) is resulting in greater access to and a vastly increased use of antimalarial medicines,
in particular ACTs. This is leading to a much higher degree of drug pressure on the parasite
which will almost certainly increase the likelihood of selecting for resistant parasite
genotypes. There are currently no effective alternatives to artemisinins for the treatment of
Plasmodium falciparum malaria either on the market or towards the end of the development
pipeline. The parasite's resistance to medicines continues to undermine malaria control
efforts. WHO has therefore called for continuous monitoring of the efficacy of recently
implemented ACTs, and countries are being assisted in strengthening their drug resistance
surveillance systems.
Prevention: vector control and intermittent preventive therapy in pregnant women
The main objective of malaria vector control is to significantly reduce both the number and
rate of parasite infection and clinical malaria by controlling the malaria-bearing mosquito and
thereby reducing and/or interrupting transmission. There are two main operational
interventions for malaria vector control currently available: Indoor Residual Spraying of
long-acting insecticide (IRS) and Long-Lasting Insecticidal Nets (LLINs) or Insecticide
Treated Nets (ITNs). These core interventions can be locally complemented by other methods
(e.g. larval control or environmental management) in the context of Integrated Vector
Management (IVM). Effective and sustained implementation of malaria vector control
interventions (IRS or LLINs) requires clear political commitment and engagement from
national authorities as well as long-term support from funding partners.
Pregnant women are at high risk of malaria. Non-immune pregnant women risk both acute
and severe clinical disease, resulting in up to 60% foetal loss and over 10% maternal deaths,
including 50% mortality for severe disease. Semi-immune pregnant women with malaria
infection risk severe anaemia and impaired foetal growth, even if they show no signs of acute
clinical disease. An estimated 10 000 of these women and 200 000 of their infants die
annually as a result of malaria infection during pregnancy. HIV-infected pregnant women are
at increased risk. WHO recommends that all endemic countries provide a package of
interventions for prevention and management of malaria in pregnancy, consisting of (1)
diagnosis and treatment for all episodes of clinical disease and anaemia and (2) insecticidetreated nets for night-time prevention of mosquito bites and infection. In highly endemic P.
falciparum malaria areas, this should be complemented by (3) intermittent preventive
treatment with sulfadoxine–pyrimethamine (IPT/SP) to clear the placenta periodically of
parasites.
Insecticide resistance
In spite of increased national and international efforts to scale up cost-effective malaria
vector control interventions and maximize the protection of populations at risk, significant
challenges continue to threaten these objectives and the sustainability of achievements.
Challenges include increasing resistance of vector mosquitoes to insecticides, the behaviour
and ecology of local malaria vectors – which often change as a result of vector control
interventions -- and the diminishing number of available insecticides that can be used against
malaria vectors.
There are currently no alternatives to DDT and pyrethroids and the development of new
insecticides will be an expensive long-term endeavour. Therefore, immediate sound vector
resistance management practices are required to assure the continued utility of the currently
available insecticides. Recent evidence from Africa indicates that pyrethroid and DDT
resistance is more widespread than anticipated. It is believed that the same level of resistance
will have a more detrimental impact on the efficacy of IRS than on that of LLINs, but
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evidence for this is very limited. Networks for vector resistance monitoring still need greater
strengthening in order to make resistance detection a routine operational feature of national
programmes, particularly in countries in Africa and the Eastern Mediterranean region.
Regional level databases feeding into a global database accessible by governments, scientists
and policy-makers would greatly assist in the rational use and deployment of vector control
interventions.
Socioeconomic impact
Malaria causes an average loss of 1.3% annual economic growth in countries with intense
transmission. When compounded over the years, this loss has lead to substantial differences
in GDP between countries with and without malaria. Malaria traps families and communities
in a downward spiral of poverty, disproportionately affecting marginalized populations and
poor people who cannot afford treatment or who have limited access to health care. Malaria’s
direct costs include a combination of personal and public expenditures on both prevention
and treatment of disease. In some countries with a very heavy malaria burden, the disease
may account for as much as 40% of public health expenditure, 30-50% of inpatient
admissions and up to 60% of outpatient visits. Malaria has lifelong effects through increased
poverty, impaired learning and decreases attendance in schools and the workplace.
ITNs = Insecticide treated nets
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A disease of affluence: Diabetes
Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin,
or alternatively, when the body cannot effectively use the insulin it produces. Insulin is a
hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common
effect of uncontrolled diabetes and over time leads to serious damage to many of the body's
systems, especially the nerves and blood vessels.

Type 1 diabetes (previously known as insulin-dependent or childhood-onset) is
characterized by a lack of insulin production. Without daily administration of
insulin, Type 1 diabetes is rapidly fatal.
 Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia),
constant hunger, weight loss, vision changes and fatigue. These symptoms
may occur suddenly.
 Type 2 diabetes (formerly called non-insulin-dependent or adult-onset) results from
the body’s ineffective use of insulin. Type 2 diabetes comprises 90% of people with
diabetes around the world, and is largely the result of excess body weight and
physical inactivity.
 Symptoms may be similar to those of Type 1 diabetes, but are often less
marked. As a result, the disease may be diagnosed several years after onset,
once complications have already arisen.
 Until recently, this type of diabetes was seen only in adults but it is now also
occurring in obese children.
 Gestational diabetes is hyperglycaemia which is first recognized during pregnancy.
 Symptoms of gestational diabetes are similar to Type 2 diabetes. Gestational
diabetes is most often diagnosed through prenatal screening, rather than
reported symptoms.
DIABETES FACTS
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The World Health Organization (WHO) estimates that more than 180 million people
worldwide have diabetes. This number is likely to more than double by 2030.
In 2005, an estimated 1.1 million people died from diabetes.1
Almost 80% of diabetes deaths occur in low and middle-income countries.
Almost half of diabetes deaths occur in people under the age of 70 years; 55% of
diabetes deaths are in women.
WHO projects that diabetes deaths will increase by more than 50% in the next 10
years without urgent action. Most notably, diabetes deaths are projected to increase
by over 80% in upper-middle income countries between 2006 and 2015.
WHAT ARE COMMON CONSEQUENCES OF DIABETES?
Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.
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Diabetic retinopathy is an important cause of blindness, and occurs as a result of
long-term accumulated damage to the small blood vessels in the retina. After 15
years of diabetes, approximately 2% of people become blind, and about 10%
develop severe visual impairment.
 Diabetic neuropathy is damage to the nerves as a result of diabetes, and affects up to
50% of people with diabetes. Although many different problems can occur as a
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result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or
weakness in the feet and hands.
Combined with reduced blood flow, neuropathy in the feet increases the chance of
foot ulcers and eventual limb amputation.
Diabetes is among the leading causes of kidney failure. 10-20% of people with
diabetes die of kidney failure.
Diabetes increases the risk of heart disease and stroke. 50% of people with diabetes
die of cardiovascular disease (primarily heart disease and stroke).
The overall risk of dying among people with diabetes is at least double the risk of
their peers without diabetes.
WHAT IS THE ECONOMIC BURDEN OF DIABETES?
Diabetes and its complications impose significant economic consequences on individuals,
families, health systems and countries. WHO estimates that over the next 10 years (20062015), China will lose $ 558 billion in foregone national income due to heart disease, stroke
and diabetes alone.
HOW CAN THE BURDEN OF DIABETES BE REDUCED?
Without urgent action, diabetes-related deaths will increase by more than 50% in the next 10
years. To help prevent type 2 diabetes and its complications, people should:
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Achieve and maintain healthy body weight.
Be physically active - at least 30 minutes of regular, moderate-intensity activity on
most days. More activity is required for weight control.
Early diagnosis can be accomplished through relatively inexpensive blood testing. Treatment
of diabetes involves lowering blood glucose and the levels of other known risk factors that
damage to blood vessels. Tobacco cessation is also important to avoid complications.
Interventions that are both cost saving and feasible in developing countries include:
 Moderate blood glucose control. People with type 1 diabetes require insulin; people
with type 2 diabetes can be treated with oral medication, but may also require
insulin;
 Blood pressure control;
 Foot care.
Other cost saving interventions include:
 Screening for retinopathy (which causes blindness);
 Blood lipid control (to regulate cholesterol levels);
 Screening for early signs of diabetes-related kidney disease.
These measures should be supported by a healthy diet, regular physical activity, maintaining
a normal body weight and avoiding tobacco use.
WHO ACTIVITIES TO PREVENT AND CONTROL DIABETES
WHO aims to stimulate and support the adoption of effective measures for the surveillance,
prevention and control of diabetes and its complications, particularly in low and middleincome countries. To this end, WHO:


Provides scientific guidelines for diabetes prevention;
Develops norms and standards for diabetes care;
18

Builds awareness on the global epidemic of diabetes; including partnership with the
International Diabetes Federation in the celebration of World Diabetes Day (14
November);
 Conducts surveillance of diabetes and its risk factors.
The WHO Global Strategy on Diet, Physical Activity and Health complements WHO's
diabetes work by focusing on population-wide approaches to promote healthy diet and
regular physical activity, thereby reducing the growing global problem of overweight and
obesity.
1
This would underestimate the true burden from diabetes. Although people may live for years
with diabetes, their underlying cause of death is usually recorded as heart disease or kidney
failure. An alternative estimate, taking into account deaths in which diabetes was a
contributory condition, suggests that approximately 2.9 million deaths per year are
attributable to diabetes.
19
Tackling the Weight of the Nation
(Lecture by Dr Susan Jebb)
Synopsis: As obesity soars, the pressure to take effective action is increasing. Who should
take responsibility – government, the food industry, or the individual?
Overall Message: Obesity is a BIG topic!
 Obesity has trebled among adults in the last 20 years and increased by 50% in
children in the last 10 years
 Obesity = BMI > 30 Overweight = BMI 25 – 30
Why should we be worried?
 Risk of premature mortality, but morbidity is a greater issue (associated with heart
disease/various forms of cancer/infertility/joint pain).
 Obesity affects every organ in the body
 The strongest relationship is with Type 2 Diabetes – about 90% of cases can be
attributed to weight.
 The cost to the NHS is considerable – treating obesity related illness is likely to reach
14% of overall costs by 2050.
 The overall economic cost is also considerable through time off work/sick
pay/incapacity benefits.
One big problem is prejudice – some health care centres may even deny overweight people
treatment. Currently, there are many diabetes clinics in the UK, but only 11 for obesity. Yet
studies over a 15 year period in Sweden show that operations for obesity (bariatric surgery)
reduce diabetes by 75% and increase life expectancy by 4 years on average. Even relatively
small weight loss of around 4kg, can reduce the risk of diabetes by 50%. Diabetes is the
leading cause of renal failure and blindness. In addition, 75% of diabetics will go on to suffer
from coronary heart disease.
Secret of successful dieting is to maintain it - it doesn’t really matter WHICH diet – though
Rosemary Conley’s combined diet and exercise regimes seem to work best! The trouble is
that we are endowed with an ancient physiology moulded by famine and we are ill equipped
to deal with our modern food environment – especially when we do so little (even doors open
automatically!). Sadly, however, although it ought to be as simple as ‘eat less, do more’, not
everyone seems able to have this degree of self discipline.
The Answer?
We need to intervene at all levels of society. We need the Government, schools, the food
industry (smaller portions, responsible marketing), town planners, health professionals etc to
work together. For example, strategies to restrict the advertising of junk food, along with
intervention in school meals. 70% of food is purchased in supermarkets – the Government
could regulate this given the right political climate. ‘Social marketing’ has to play a large part
here – mobilising people to recognise obesity as a health issue, engendering the will to
change as with the ban on smoking in public places, which would have been unthinkable just
5 years ago.
20
Pharmaceutical TNCs
Response from the Head of Education, Association of the British Pharmaceutical Industry
(ABPI)
I am now in a position to say that there are clear inaccuracies in the text which, presumably,
reflects the author's opinions and could mislead students and their teachers. Our concerns
cover the following sections in Chapter 8 of the AQA AS Geography textbook: Branded
pharmaceuticals, Essential drugs, Drug development, Marketing and distribution.
There are a number of separate and overlapping issues with the text on pages 298 and 299 of
the Health Issues chapter. Some of the statements are factually incorrect, many others are
misleading. The overall tone is negative towards the pharmaceutical industry and makes no
mention of the multiple benefits that multinational companies bring to the many societies in
which they invest and have a presence in – through employment, tax, balance of trade,
investment in technology and in many other ways.
With regard to medicines, the author does not make it clear why some branded medicines are
so expensive, and makes no mention of ongoing research to develop new medicines for
diseases that are common in developing countries, nor of the many initiatives that aim to
provide medicines at low cost to those that need them most. Although research and
development is mentioned, the reader is not made aware of the
fact that development of new, innovative medicines is highly regulated to ensure that
marketed medicines are effective and are as safe as possible; hence the testing of a new
medicine takes around 12 years and costs over £500 million. Testing therefore takes up a
substantial part of the patent life of the new medicine; research into new medicines is funded
from the profit that is made once the medicine is marketed.
Research is being carried out by pharmaceutical companies into a number of diseases that
affect people in developing countries, including the WHO’s priority infectious diseases;
malaria, TB and HIV/AIDS. However the development of any new medicine is a long,
complex, and risky process and, as stated above, it takes many years for a new medicine to
emerge. Once the patent has expired generic forms of the medicine can be sold. We do not
believe that there is evidence that branded drugs are always more expensive than the generic
medicine; indeed, there are many examples of branded medicines being donated or sold at
cost price in the developing world.
A number of large scale initiatives have been set up with pharmaceutical industry partners to
improve access to the branded medicines. For example, the Accelerating Access Initiative,
involving UNAIDS, the World Health Organization (WHO), UNICEF, the UN population
fund, the World Bank and seven research based pharmaceutical companies. Participants are
working together to broaden access to medicines for HIV/AIDS-related illnesses. The
initiative has led to more than 427,000 patients being treated through this initiative in the
first 5 years. www.ifpma.org/health/hiv/health_aai_hiv.aspx).
Other joint initiatives, such as the public private partnership, Medicines for Malaria venture
bring together pharmaceutical companies and other organisations carrying out research into
new forms of treatment with charities and other funders. The aim of this venture is to bring to
market several new medicines to treat malaria at a price tailored to low-income target
populations. (www.mmv.org)
21
Education programmes are also supported. Evidence shows that education, with
accompanying financial support, leads to a sustainable reduction in instances of diseases
such as malaria, HIV/AIDS and diarrhoea-related diseases.
The paragraph on essential drugs is confused and misleading. The list provides a
recommendation from the WHO on medicines that are deemed essential, and should
therefore be available through national health systems. Many developing countries use it as a
model, as they don't have the resource to develop their own national drugs policies and lists.
They are neither popular nor unpopular, and don't have any relevance to presence of
pharmaceutical companies. The reason they are not used by many developed countries is that
generally their healthcare systems are more robust, availability of medicines is better, and
they have incorporated the WHO list into their own, national drugs policies. The WHO
Essential drugs list uses generic names for all the recommended drugs and, as far as I can
tell, the vast majority, if not all, are available in generic form.
I have not been able to verify the accuracy of the claim that, in the USA, the federal
government is prevented from encouraging the use of generic drugs following legal action
from the Pharmaceutical Manufacturers Association; however all evidence I have found
suggests the statement is false. Data from IMS Health shows that 67% of medicines
prescribed in the US are generic, the US body that approves medicines for sale, the FDA, has
launched an initiative to help streamline the generic medicines approval process, and
Richard I Smith, the Senior Vice-President of the Pharmaceutical Research Manufacturers
Association (PhRMA) – which I assume is the organisation referred to in the textbook –
praised the success of the Medicare Part D programme, in which two thirds of all medicines
prescribed are generics, when he spoke to the US House of Representatives Committee on
Oversight and Government reform on July 24 2008. I do wonder, however, why the US is
used as an example in a text book aimed at UK students. I suggest it would be much more
appropriate to cite the situation in the UK, where doctors are encouraged to prescribe by
generic name. In 2007 82.6% of prescriptions were written in this way, and 64.1% of
prescriptions were dispensed by community pharmacists using generic medicines.
Promotion of prescription medicines in the UK is regulated by the Prescription Medicines
Code of Practice Authority (PMCPA), the Code has been in existence for 50 years and is
regularly updated. The examples of promotional items given in the paragraph are all allowed
within the Code of Practice. However breaches of the Code are taken seriously to avoid
inappropriate inducements being made to doctors, and others, to influence their prescribing.
The statement regarding medicines treating symptoms rather than the root cause of the
problem is incorrect. There are many examples of medicines, including all vaccines, which
are aimed at preventing disease or in curing patients who have a disease. Iron folate does not
only treat anaemia, it also prevents neural tube defects and spina bifida in unborn babies.
Use of supplements does not stop people in the developed or developing world eating a
healthy diet, but they do help prevent illness in those who are unable to obtain sufficient
vitamins and minerals from their food.
22
Tobacco usage.
Tobacco kills a third to a half of all those who use it. On average, every user of tobacco loses
15 years of life. Total tobacco-attributable deaths from heart disease, cerebrovascular disease
(stroke), chronic obstructive pulmonary disease and other diseases are projected to rise from
5.4 million in 2004 to 8.3 million in 2030, almost 10% of all deaths worldwide. More than
80% of these deaths will occur in developing countries.
Tobacco use is highly prevalent in many countries. According to estimates for 2005, 22% of
adults worldwide currently smoke tobacco. Some 36% of men smoke compared to 8% of
women. Over a third of adult men and women in eastern and central Europe currently smoke
tobacco. Adult smoking prevalence is also high in south-east Asia and northern and western
parts of Europe. However, nearly two thirds of the world’s smokers live in just 10 countries:
Bangladesh, Brazil, China, Germany, India, Indonesia, Japan, the Russian Federation, Turkey
and the United States, which collectively comprise about 58% of the global population.
23
Fieldwork ideas and skills activities in the Health context
1. Investigating quality of life
Quality of life means different things to different people. Often the term has a medical
meaning, but in its broadest sense it includes issues such as levels of crime, amount of open
space, cleanliness of streets, facilities for young children and many more.
Possible investigation titles could include:

What is it about Area A which makes life good for its inhabitants?

What indicators can be used to suggest that quality of life in Area X is better than that
in Area Y?

A study of perception of quality of life by gender/age/socio-economic background.

A study of the reliability of census data as a means of evaluating quality of life in
Ward Z.
One technique could be to undertake a local environmental quality survey. The first step is to
decide on the scale of location studied. You may also want to compare two or more areas.
Possibly the best size of area is to use the SOAs (Super Output Areas) of the census, but be
sure that the areas chosen will bring out what you want them to – check out a literature based
or web-based survey first perhaps?
There is a wide range of environmental quality surveys that could be undertaken, based on:






Air quality and pollution
Bi-polar environmental quality surveys (see example)
Route pavement quality
Measurement of anti-social behaviour (eg. questionnaires on general nuisance factors
such as young children on the streets at night, joy-riding, drug concerns, vandalism,
off street motorcycling)
Evidence of fear of crime
Litter surveys
Questionnaires can be a useful source of data for quality of life investigation, allowing the
analysis of people’s perceptions of quality of life. The following advice may be useful:

Think about the style and sequence of questions. Closed questions can be analysed
using statistical methods; open questions may give more insight into people’s feelings

Think about sampling techniques (random, systematic and stratified). Which is easiest
to use, yet at the same time yielding the fairest and least biased set of results?

Think of how the questionnaire is to be delivered. Surveys carried out on the street
may be appropriate in some situations, but often a better return rate can be achieved
from ‘drop and collect’ methods.
24
An example of an environmental quality survey: a bi-polar exercise
+3 to -3 indicates ‘very good’ to ‘very poor’
Criterion
Housing:
(a) Quality of external upkeep (walls,
doors, paintwork, guttering,
windows
(b) Variety and attractiveness of
house designs
Gardens:
(a) Proportion and variety of green
space – grassed areas, bushes,
trees, pots/tubs
(b) Quality of upkeep, including
gates, fences and paths
Streets:
(a) Pavement quality – width,
surface, excrement, obstacles,
litter, street furniture
(b) Road quality – congestion, noise,
safety, parking
(c) Landscaping – trees, gardens,
grass strips
Amenities:
(a) Proximity and quality of
community services – local shops,
play areas, church
(b) Accessibility to public transport
and parking
Perceptions:
(a) How safe is the area at night?
(b) How low is the level of
burglary/theft?
(c) How good are levels of
employment in the area?
How would you feel about living in this
area?
+3
Fine
+2
+1
0
-1
OK
Not
sure
Doubtful
-2
-3
Notes
No
way
25
2. Age, gender, wealth and their influence on access to facilities for exercise.
The management of a David Lloyd Tennis and Leisure Club commissioned a survey into the
views of the membership on possible future developments of the club. The club has about
4000 members. Approximately 25% of these returned questionnaires.
The questions asked:
(a) What development would you most like to see in the future?
Extra car parking: 54%
Squash courts : 23%
Improved access: 8%
Improvements to changing facilities: 5%
Other: 10%
(b) If new squash courts were built would you be likely to use them?
No: 25%
Probably not: 35%
Yes, definitely: 16%
Yes, possibly: 14%
Yes, probably, occasionally: 10%
(c) If new squash courts are not built would this affect your decision to renew
membership?
No effect: 86%
Yes, probably won’t renew: 8%
Yes, possibly won’t renew: 6%
(d) If more car parking space is not provided would this affect your decision to renew
membership?
No effect: 65%
Yes, probably won’t renew: 14%
Yes, possibly won’t renew: 21%
(e) How do you come to the club?
Always by car: 53%
Usually by car: 23%
Never by car: 18%
Always on foot/cycle: 8%
Sometimes on foot/cycle: 22%
Always on public transport: 6%
Sometimes on public transport: 14%
(f) Do you regularly use the car park at the club at these times, and if so, have you
experienced problems with car parking?
26
Times
Regularly use car park (%)
0600 - 1000
1000 - 1400
1400 - 1800
1800 - 2200
8
25
40
30
% yes to experiencing
problems
0
9
80
50
An A Level student who lives in the area is a member of the club. She was asked to complete
the management questionnaire and this then suggested a further investigation that she could
undertake. She carried out her own survey of the people living in the area. She gave out
questionnaires to 50 people on the estate, chosen by a stratified sampling technique and had
43 questionnaires returned. The questions were:
(a) How long have you lived here?
Over 15 years: 8
11-15 years: 5
6-10 years: 10
1-5 years: 15
Less than 1 year: 5
(b) Are you a member of the club?
Yes: 11
No: 32
(c) Does the club cause you any problems? If so, what?
Yes: 20
No: 21
Left blank: 2
Noise in the evenings: 3
Parking in the area: 20
Spoils the views: 3
(NB some people mentioned more than one problem)
(d) On a scale of 1 to 7 (where 1 = strongly in favour and 7 = strongly against) how
would you rank the following proposals for development of the Tennis and Leisure
Club?
Question
Use the outdoor tennis courts to extend the car park
Use other land on the site to expand the car park
Buy additional adjacent land to expand the car park
Use other land on the site to build squash courts
Buy additional adjacent land to build squash courts
Buy land nearby for new squash courts and a car park
1 2
15 20
0 2
5 4
0 0
0 0
1 0
3
5
0
3
0
0
3
4 5
0 0
10 3
4 12
3 1
4 8
18 2
6
1
13
10
12
11
12
7
2
15
5
27
20
7
27
Resident population: age and health (from the 2001 census)
Age
Under 16
16 - 19
20 - 29
30 - 59
60 - 74
75 and over
Ward population (%)
19
7
12
42
12
8
Town population (%)
19
6
17
38
13
7
Health
Good
Fairly good
Not good
70
21
8
65
23
12
28
Health Profiles
http://www.apho.org.uk
“Health data are essential for monitoring the health of the population and for evaluating the
effects of health interventions. Yet the information collected nationally is often poor and there
is no regular mechanism by which a PCT or LA can gather reliable information on its own
population.” Wanless (2004).
Background
In England there were at least 24 different sets of health indicators and databases but no
consistent countrywide health profiles. The government white paper “Choosing Health:
Making Healthy Choices Easier” stated: “Public Health Observatories will produce reports
designed for local communities at local authority level which will support Directors of Public
Health in promoting health in their area.”
Health Profiles
The Association of Public Health Observatories was commissioned by the Department of
Health in 2005 to produce Health Profiles. The first batch of profiles was produced in 2006,
with updated and improved Health Profiles 2007 being released in June 2007.
The aims of the profiles are:
 To provide a consistent, concise, comparable and balanced overview of the
population’s health that informs local needs assessment, policy, planning,
performance management, surveillance and practice.
 To be a distillate of the absolutely key, most useful (currently available) indicators
(with a reference to new data/indicators and unavailable data/indicators).
 To be primarily of use to joint efforts between local government and the health
service to improve health and reduce health inequalities, but ultimately to empower
the wider community
 To describe the health of the local population and enable comparison local, regionally
and nationally as well as over time. It is hoped that they will be used for action
planning by local strategic partnerships.
Development of Health Profiles 2008
Health Profiles 2008 are a further development from the 2007 profiles. The most significant
development for 2008 is the release of the Health Profiles Interactive website, which enables
users to easily create their own comparisons of different indicators and areas, and to create
charts and access data for download. Further additions include new indicator data on child
health showing local rates of obesity, physical activity, smoking in pregnancy and
breastfeeding. Regional profiles were also created for the first time in 2008 to provide a
ranked comparison of local authorities and counties within each region.
29
Assessment exercises.
(a) Describe the changes in the number of global reported cases of polio between 1974
and 2000.
4 marks
Mark scheme.
One mark for each appropriate statement to a maximum of 4 marks.
Commentary
When answering questions that ask you to describe changes in data, first of all look for
overall patterns of change, and then look for trends, peaks or troughs within the overall
pattern of change. On no account should you describe minor changes – simple ups and
downs, and certainly not put the data into words. Examiners call this low level descriptive
material “data waffle”.
Credit any of the following points for 1 mark to a maximum of 4 marks:
 Overall there has been a fall in the number of polio cases (this could gain two marks if
the fall is quantified)
 There have been reversals in this trend, in the early 1980s (a significant peak) and late
1980s; a fluctuating decade
 Case numbers have been constant over the last 10 years – it would appear a difficult
disease to eradicate totally
(b) For one named area that you have studied where periodic famine has taken place:
(i) Describe the causes of famine in that area
5 marks
Mark scheme.
Level 1 – simple statements of causes, generalised in nature and not specific to the area
named by the student.
1-3 marks
Level 2 – more detailed and/or sophisticated statements of causes. Specific reasons that
apply to the area named access this level.
4-5 marks
30
Commentary
For this question and the next there is an overall “stem” which applies to both sections. This
requires you to name an area you have studied and then to refer to this area in terms of causes
of, and then actions to prevent, famine. In order to access the higher level your answer must
refer to the named area given in detail. Generalised factors that may have caused famine,
such as drought and population increase, that could apply to any area in the world suffering
famine keep the answer within Level 1. Note also that the mark scheme refers to
sophisticated statements – this is when you give a cause that goes beyond a simple statement
and demonstrates greater depth of understanding. An example of this is that famine is often
caused by economic factors – the price of food spirals out of control and the economic
control mechanisms are too weak to react and have a significant calming effect.
(ii) Outline the actions taken to prevent famine arising there again.
6 marks
Mark scheme.
Level 1 – simple statements of actions, generalised in nature and not specific to the area
named by the student.
1-4 marks
Level 2 – more detailed and/or sophisticated statements of actions. Specific reasons that
apply to the area named access this level.
5-6 marks
Commentary
The same commentary as above can be given here. Your answer should refer to specific
actions that have taken place in your named area to access Level 2. Note also that the
question asks for “actions” – plural. It is always better to have a range of options that you can
write about – this is another route to higher marks. This can be exemplified in this context by
the fact that actions after a famine can be short term and long term. Clearly, in response to the
question, the more longer term actions that have been introduced the more likely they are to
have the effect of preventing famine occurring in the area again.
(c) Discuss the impact of one infectious disease on the health, economic development
and lifestyle of the area(s) where it occurs.
15 marks
Mark scheme.
Level 1 – simple statements of impact, with no depth or detail. Statements are generalised
and not related to a named/located area.
1-6 marks
Level 2 – detailed statements of impact, which are likely to have some imbalance. References
to detailed impacts in areas studied access this level.
7-12 marks
Level 3 – a wide ranging account of impacts, which examines at least two of health,
economic development and lifestyle in detail, and in relation to the area(s) affected. The
answer is balanced and sophisticated.
13-15 marks
31
Commentary
There are a variety of infectious diseases that could have been studied, from sexual
transmitted diseases such as AIDS, to insect vector diseases such as malaria, to water borne
diseases such as cholera. Each of these will have an impact that affects the overall health,
economic development and lifestyle of the area affected, but to varying degrees. Hence,
although three separate forms of impact are given in the question, examiners recognise not
every disease has the same impact on every area. Indeed the nature of the area affected will
influence the overall impact. You will note that this is reflected in the mark scheme where
only two impacts are required to be discussed in detail to access the highest level. As
elsewhere in the assessment of the specification, the key to accessing Level 2 is to provide
specific detail of impact in a named area, and the more this is done, both in terms of depth
and level of sophistication, the more marks will be awarded.
Exemplar responses.
(b) i.
One area that suffers from famine on a regular basis is Ethiopia, especially that area in the
east near Somalia. The causes are several. A lack of rainfall, drought, causes soil and
groundwater sources of water to decline. The soil moisture will not allow plants such as grass
and agricultural crops to grow causing serious problems for the subsistence farmers in that
area. People begin to migrate out of the area in search of better grassland for their animals.
This causes a population increase putting further pressure on the receiving area. This in turn
causes the price of foodstuffs and animals to go up. Panic sets in and inflationary price rises
lead to shortages of basic foodstuffs in the markets. The causes are often natural initially, but
made worse by humans activity.
(b) ii.
The actions needed to prevent famine arising there again take two different forms. Firstly,
there needs to be short term relief aid. This takes the form of distributing food. Famine relief
is usually carried out by non-governmental aid organisations (NGOs, e.g. Oxfam, Red Cross
and Save the Children). Care has to be taken over this type of aid as it has to be appropriate to
the area, people need to know how to cook the food and have the ability to do so. However,
some people say it could result in overdependence by the receiving area and might damage
the agricultural economy in that area.
This needs to be followed up by a longer term response which involves helping people
develop a more productive system of farming, to prevent another famine. This could include
an increased use of fertilisers, high-yielding varieties of seeds, irrigation systems and better
transport systems to markets. People such as Bob Geldof also believe that Ethiopia should
have its debts cancelled so it can invest in its own development better.
(c)
Malaria is a type of infectious disease spread by a parasite which lives in the anopheles
mosquito (female). Symptoms include fever, sweating, anaemia and ultimately death. It is
common in the tropical areas as the mosquito needs temperatures of 16 to 32C to survive and
breed. One female mosquito can produce 1000 offspring. 10,000 children die from malaria
every day, this year 2 million people will die and in parts of Africa half the children there will
die as an impact of this disease. It is a problem for the community as they will lose skilled
workers and for the country as they will lose a young workforce.
It also creates a heavy financial burden on the economy of many less developed countries.
Direct costs include medical costs, measures such as mosquito bed nets, loss of earnings and
32
on a national scale, public health spending on health care. Indirect costs include lost
productivity for employers, lack of continuity in education for children, reduced investment
in an area as, for example, investment in tourist facilities is reduced, and there is more
emphasis on the growth of subsistence crops at the expense of cash crops due to the impact of
the disease on labour supply at harvest time.
The costs of responding to malaria can be great. In 1960 the World Health Organisation
(WHO) created DDT, a cheap insecticide that could be sprayed on walls and would still kill a
mosquito a year later. At first this was very successful and as it was cheap was used
worldwide. WHO said that by 1990 the world would be rid of malaria. They were wrong.
Soon the mosquitoes adapted and now DDT didn’t work anymore. They made newer
insecticides to stay one step ahead of the mosquito but each one was more expensive and so
LEDCs could not afford them. Americans could still afford it so in Florida they have
helicopters which spray insecticides over housed areas. Also they have mosquito traps – one
caught 365000 mosquitoes in one night – which is very successful.
Finally, a new mosquito killer has been discovered in China. It comes from a natural plant
and it has taken 10 years to research to find out how it worked. Because it is their last hope, it
is still being developed as they don’t want the mosquito to outsmart them again. At the
moment if you go to an LEDC where malaria is around you have to take tablets every day for
long period of time before you go. The negative of this is possible side effects including
mental health problems such as schizophrenia.
Malaria was completely got rid of in North America, Europe and Russia and greatly reduced
in Sri Lanka, India and South America. However, with the impacts of global warming,
mosquitoes and malaria may return to these countries.
Other possible questions:
1. Use the maps in the materials earlier to ask questions on distributions and patterns eg
breast cancer screening.
2. Describe and suggest reasons for regional variations in health and morbidity in the
UK.
15
3. Discuss the impact of obesity on both people’s health and health care approaches.
15
4. Outline and comment on the role of TNCs on world health affairs.
8
5. With reference to a local case study, assess the relative importance of factors such as
age, gender, and wealth on access to facilities for exercise, health care and nutrition.
15
33
Additional AQA question.
Study the figure below which gives healthcare comparisons between the UK, USA and Cuba.
(a) Describe the differences between expenditure on health care and health care schemes
in the USA and Cuba. Suggest reasons for some of the differences in health care
outcomes shown.
6
(b) In some countries infectious diseases cause the deaths of many children under 5 years
old. In other countries very few children die from infectious diseases. Explain these
differences.
5
(c) Name a major transnational corporation involved in pharmaceutical research,
production or supply. Outline its role in a range of countries at different stages of
development.
4
(d) With reference to a local case study, evaluate how well the authorities provide a
health care service that is accessible to all groups, whatever their age, sex, occupation
or place of residence.
15
34