Disease Dilemmas Flashcards
Health
The combination of physical, mental/emotional, and social well-being
Epidemiology
Branch of medical science concerned with the incidence, distribution, and control of diseases that affect large numbers of people.
infectious disease
A disease that is caused by a pathogen and that can be spread from one individual to another.
non-infectious disease
a disease that cannot spread from one person to another
contaga disease not capable of being spread from one person to another
ious
Able to be passed easily from one person to another directly
non-contagious disease
not readily transmitted from one host to another
communicable disease
A disease that can be spread from one person or species to another, directly or indirectly
Types of NCDs
Cardiovascular
Cancer
Chronic respiratory
Diabetes
endemic disease
Present at a continuous level throughout a population/geographic area
epidemic
A widespread outbreak of an infectious disease.
Pandemic
Disease that occurs over a wide geographic area and affects a very high proportion of the population.
zoonotic disease
a disease communicable from animals to humans under natural conditions; also know as zoonosis
mortality
death
Morbidity
Refers to ill health in an individual and the levels of ill health in a population or group.
Vector
A third party organism that carries and transmits a communicable disease
Pathogen
An organism that causes disease
prevalence of disease
total number of existing cases with respect to the entire population
incidence of disease
the number of new cases of a disease in a given area or population during a given period of time
incidence rate
number of people contracting a disease during a time period, per head of those at risk
example of endemic disease
common cold, affects virtually everyone
example of epidemic
Ebola, killed 11,000 from 14-16
Pandemic example
Covid-19
4 Hagerstrand Models of Diffusion
Expansion
Relocation
Contagious
Hierarchical
Expansion Diffusion
One place of origin, spreads but stays in the origin. For example, TB in East Asia, where 22 countries have had 80% of cases.
relocation diffusion
Moves from one place to another. Cholera spread Nepal to Haiti, Covid-19 spread from China to Europe most significantly at first.
Contagious Diffusion
Spreads by direct contact. Influence strongest at origin, lessens as you go away. Ebola example.
Hierarchical Diffusion
Spreads through a group or class, around a city. Channelled through road, rail or air. For example, H1N1 in LA first spread around city .
Neighbourhood effect
Probability of contact between a carrier and non carrier is determined by the number of people in a 5x5km square. More people = higher probability.
4 stages of diffusion
Primary step sees the first rise in diffusion rate.
Expansion step sees acceleration in diffusion rate, which starts to level out in Condensation step, until it is level in Saturation Step.
Physical barriers to diffusion list
Neighbourhood effect
Island or land borders
Transport links are poor
Physical geographic barriers (terrain, climate, rivers, water, distance)
Trade
Quarantine
Communication
Socioeconomic barriers to diffusion
Poverty/wealth
Class separation
Treatments
Migration
Social boundaries (personal space)
How does climate change impact disease (general)?
Sea level rise pollutes water sources and increases incidence of water borne diseases, devastating poor low lying areas.
Mass migration could move diseases around, due to climate crisis.
Tropical countries could see devastating epidemics.
Food crisis could cause starvation, malnutrition and dehydration.
$100bn a year of aid would be needed, possibly diverted from healthcare.
83% rise in food prices could cause malnutrition.
Temperature rise leads to rise in Lymes Disease, kidney stones, allergies.
More pollen = more hayfever and sneezing.
Ecoli increases by 8%.
West Nile Virus: epidemology, symptoms, history, prevention, link to climate change
Leading cause of mosquito borne disease in US. No vaccines. 1 in 5 get symptoms, 1 in 150 serious. 1 in 1500 die. Recovery can take weeks or months, or be permanent.
Symptoms are:
- encaphilitis
- meningitis
- fever, headache, neck stiffness, stupour, disorientation, coma, tremours, convulsions, muscle weakness, vision loss, numbness and paralysis.
History: first identified Uganda 1937, first US case in 1999 in NYC, now widespread globally. 286 US deaths in 2012. Birds spread virus to other mosquitos.
Prevention: pesticides and land use changes to deny stagnant water pools.
Climate change: allows spread of mosquitos further north, into densely populated temperate regions. Could be as far north as British Columbia by 2080. Climate change reduces effectiveness of prevention. Vector mosquito now found in Southern England, no UK cases yet - they live in the increasingly warm salt marshes of the Thames estuary.
How can extreme weather affect disease?
Heat and droughts can fuel forest fires that drive disease-spreading wildlife closer to humans.
Droughts and floods affect crop yield, which causes malnutrition, and increases vulnerability of other disease.
Flooding provides breeding ground for vector insects, and can cause water contamination, leading to water borne diseases.
How did climate change impact ebola?
Dry seasons followed by heavy rain produce an abundance of fruit, leading to increased fruit bat exposure to humans, providing more close contact.
Pressure on resources will force more people into alternative food sources, including bats. 50% of historical ebola outbreaks have been linked with bushmeat handling.
How has climate change impacted malaria?
Longer transmission season due to longer warm and wet periods.
Larger range due to increased temperatures.
Plasmodium reproduces faster in warmer temperatures.
Mosquitos take blood meals more often.
High rainfall increases reproduction rates.
Least likely transmission type to be affected by climate change and why?
Direct transmission - spends little to no time outside the body, so unaffected by environmental factors.
Impact of climate change on vector borne diseases?
Temperature changes allows wider vector range. Survival rates are also affected. It impacts the susceptibility of vectors to pathogens. Changes in feeding rate and host contact.
More precipitation = easier reproduction due to more stagnant water. Alternatively, snow etc can destroy breeding grounds. Low precip can turn previously fresh water into stagnant water. Increased humidity improves vector survival.
Changes in sea level alter estuary flows and change existing salt marshes.
Impact of climate change on water borne diseases?
Flooding can cause contamination of potable water with pathogens.
Air temperatures can impact reproduction of pathogens in water.
Changes in the food web due to climate change can influence reproduction and survival of certain water borne diseases (for example, cholera depends on zooplankton, which sees population booms in warm water)
Relative effect of climate change on disease
Very unlikely an isolated effect - other factors will all play a part, or enable the impacts of climate change.
Very likely dependant on the extent to which humans can cope with the counter trends of other disease modifying influence.
Zoonotic diseases facts
Kill 2.2m per year
Compose 60% of human diseases
75% of emerging infectious diseases
27% of livestock show signs of current or past infection with a bacterial food-borne disease
75% of rural poor depend on livestock - and they spend lots of time in close contact
Livestock production is rapidly increasing in response to population growth, income growth, urbanisation and changing diets
Factors causing rise in zoonotic diseases?
Increased livestock production
Eating infected bushmeat
Contamination of global food supply (75% of EU chickens have campylobacter)
Violence and conflict - in Sierra Leone, Lassa Fever killed 80% infected in the civil war
Rabies: transmission, symptoms, epidemiology, prevention
Transmitted through bites and scratches, 99% of the time from dogs.
Weeks long incubation, then pain, fever and agitation, then encephalitis, aggression and anger, then death - almost 100% of cases lead to death.
Occurs in 150+ countries, 10s of 1000s of deaths per year (mostly Asia and Africa).
Immediate washing of rabies site, post-exposure prophylaxis injection (costs $40-50, which is too much for some), vaccine exists and 100% effective, not yet widely available globally but available for western travellers, education on how to avoid it.
Cholera key facts
Water borne disease
People unknowingly drink, cook with and wash in cholera infected water frequently, in areas with poor sanitation
Fecal-oral transmission route
Causes diarrhoea and vomiting, and dehydration
Boiling the water, or chlorinating, kills it
Can kill a child in 4 hours
Haiti earthquake facts
Magnitude 7 earthquake, epicentre 10 miles from Port Au Prince
Buildings collapsed etc
5 aftershocks
250,000+ killed, making it the deadliest modern natural disaster
Hospitals destroyed and overrun
How did cholera arrive in Haiti and spread?
Nepalese aid workers brought it to the island for the first time in 200 years
Extremely poor sanitation spread it around urban areas - exacerbated by the earthquake destroying infrastructure
Education on the disease was very poor
Only 69% of population have access to a safe water source, and 17% adequate sanitation
26 days of rain in the first month of cholera hugely aided the spread
Mass movement of people after the earthquake allowed the disease to easily spread around the small and densely populated country - 83% of them didn’t have access to waste disposal
No immunity at all, due to lack of exposure
Issues with combating cholera in Haiti
Large scale - millions affected, in a short space of time
NGOs and UN had to support WHO and government
Required infrastructure changes - wells being dug, bottled water distribution
Haiti cholera numbers
658k 2010-13, 8,100 deaths
Haiti: government short term targets
Oral rehydration therapy
To reach 1 Heath Agent for every 500-1000 people, by training more
Educate people on how to avoid infection
Test water sources, remove contaminated ones
Coordinate NGOs and other organisations
Establish “community health clubs”
Vaccinate the at-risk population
Haiti: government long term targets for 2022
85% of the population to have access to potable water
Repair existing water infrastructure, especially in urban areas
90% coverage of waste removal
80% healthcare access
Strengthen epidemiological surveillance to better detect cases of disease
Response of NGOs in Haiti
Oxfam responded quickly, helped repair water sources and divulge clean water
Oxfam allocated $500k a month for water distribution by truck - but people didn’t trust this and continued to drink contaminated water
Targeted vaccination campaigns, aiming to reach 750k by the end of 2017
Disease of affluence
Diseases and other health conditions caused by an increasing wealth in a society. Generally include NCDs such as CVD, certain types of cancer, ageing diseases etc.
Disease of poverty
Diseases that result from impoverishment. Typically CDs, such as TB, cholera, malaria etc.
Why should we care about diseases of poverty?
Current and future trading partners - economic state (influenced by disease) affects us directly
We depend on disease-hit countries for food imports
Moral and ethical obligation to promote global equality
Travelling becomes easier and safer
Globalisation and migration move the diseases around
Tuberculosis epidemology
More than 10% of hospital admissions globally
10m cases in 2018, 1.5m deaths - making it the deadliest communicable disease
Multi-drug resistant TB is on the rise, with 440k cases in 2008, and increased travel could spread it more
Abdel Omran’s Epidemiologic Transition (ET): 5 steps
Directly linked to Demographic Transition Model - describes relationships between disease and development
Era of pestilence and famine - malnutrition common, infectious disease prevalent, pandemics and famines common, Life Expectancy at 35, <10% of deaths due to CVD, >50% infant mortality rate. Medieval Britain.
Era of receding pandemics - technology becomes more advanced, some forms of public health and sanitation concepts, population grows due to death rate falling, live expectancy rises to 50, CDs still prevalent but NCDs becoming more prevalent. Modern LIDCs.
Era of degenerative and man made disease - higher fat and calorie intake, air pollution due to industrialisation, life expectancy rises to 60, medicine improves so CDs are less of an issue, but NCDs rise due to lifestyle changes. 30-65% of deaths now from CVD. Modern EDCs such as Brazil or China.
Era of delayed degenerative diseases - Life expectancy rises to 80, as CDs cause few deaths, NCDs (especially cancer and CVD) cause most deaths, but over long periods pf time due to medicine, and CVD death rate drops to 40-50%, National Health Services massively improve public health. Modern ACs.
Era of health regression - lower herd immunity due to MDR CDs evolving (such as SARS), medicine becomes less effective, emerging diseases (Covid-19). No countries yet, but ACs are moving towards it.
Preston Curve
an empirical cross-sectional relationship between life expectancy and real per capita income. Steep at first, before levelling out.
How poverty can cause certain types of disease:
Less access to clean water -> water borne d’s
Insecure land tenure -> malnutrition
No money for healthcare -> death
Poor or expensive transport -> no access to care
Poor sanitation -> wastes left
Inadequate housing -> lack of protection from elements and disease vectors
Lack of immunisation -> more infant deaths
Low employment -> more work in sex industry -> STIs
Stress of daily life -> mental health issues
Child workers -> lack of health and safety
Why do LIDCs have higher prevalence of communicable diseases?
Stigma and discrimination around diseases of poverty - people have fear of disease and don’t understand how it works, which can have individual socioeconomic consequences. Furthermore, marginalised groups are often deprived of medicine etc.
Lack of money - lost labour time to disease reduces income (spiral of decline), often treatment costs are diverted to pay for education etc.
Housing conditions - tend to be more cramped (easier spread), slums have poor sanitation and clean water.
Hunger, starvation and famine - leads to malnutrition, which can weaken the immune system.
Economic burden - areas of high transmission of certain diseases (i.e. malaria in Africa) divert significant health expenditure away from development investment, compounding the problem.
Weak health systems - weaker in poorer countries.
Lack of economic incentive - perceived “lack of market” has reduced incentive to develop technology against diseases of poverty.
Infrastructure - lack of sanitation or clean water, poor drainage or flood defences provides breeding grounds for mosquitoes.
Politics - diseases of poverty affect those with little political voice.
Location - most LIDCs are in tropical regions where most communicable diseases spread
Why do ACs have higher rates of NCDs?
Less exercise - car ownership, service industry work often involves sitting at a desk for 8 hours.
High fat and sugar diet - meat becomes common to eat, cheapest food is processed and unhealthy.
Increased leisure time - people spend this relaxing, binge-watch culture supports extended time not moving, internet permits for social connections without having to move.
Higher usage of tobacco and alcohol - tobacco use accounts for 6m deaths a year, and alcohol is an expensive luxury made more affordable by increasing incomes.
Longer life spans - older people are much more likely to be affected by DOAs.
Variance in socio-economic status - lower income individuals in ACs are often forced into unhealthy lifestyles due to income effect, and their environment.
Lack of political will to change - globalisation normalises behaviour and activity that are harmful, and few people are willing to change.
Increased exposure - people are less exposed to CDs at a young age, via immunisation, which makes them more vulnerable to chronic autoimmune and respiratory diseases.
Incidence and patterns of Malaria in Ethiopia
Endemic in 75% of country - all but the Central Highlands (up to 2200m)
70k deaths per year
Transmission highest after June-Nov rainy season
Malaria: transmission, symptoms, global impact
Mosquitos (only Anopheles) spread the Falciparum plasmodium (others also, but this is 90% responsible) through bites. They pick it up from an infected person, and spread it to uninfected people.
Causes weakness, fever, aches and eventually death in some - these are all caused by bursting blood cells.
3.3bn at risk globally, 214m cases caused 440k deaths in 2015.
Physical and environmental factors affecting malaria
Can’t tolerate <20C - ideal range is 20-40, 27C is optimum.
Mosquito lifespan restricts plasmodium to 15-20 days of transmission period.
Mosquitos more likely to survive in warmer climates, so malaria more common.
They lay eggs in stagnant and warm water, at an air humidity of 60-80%.
90 countries hit optimal conditions, but global warming will expand this.
How human activity affects malaria
Humans eradicated malaria in much of the world, including Southeastern England.
Population movement allows the spread of the parasite.
Urban slums create stagnant pools of water for breeding - good urban planning required to avoid this.
Human proximity allows expansion of mosquito population.
Humans tend to live in low-lying areas with lots of surface areas - the same place as mosquitos.
Hydroelectric dams creates huge areas of stagnant water
Socioeconomic impacts of malaria (global)
290m cases in 2017, 500k deaths, 90% in Africa.
Most deaths in young children under the age of 5.
Causes 10-14 days off work - significant income losses, affects whole family and community.
Treatment can be a months wages per episode - many families try ineffective alternative methods.
Costs Africa $2bn a year.
Diagnosis costs $10.
Short term impacts of malaria in Ethiopia
Can reduce schooling by 3-7 months on average.
Productivity loss is 18 days on average.
Causes 10% of hospital cases - impacts other health spending.
70k deaths per year.
Short term food security is impacted as high season for malaria coincides with harvest season.
Long term impacts of malaria in Ethiopia
Cycle of decline from school and work losses.
Economic losses as a result.
Increased cost of hydroelectric power as dams create breeding grounds, so prevention methods are required.
Food insecurity creates more health issues, stretching health spending more.
Families have to pay off loans for medical aid.
Top Down Strategy
Governments with help from external agencies undertake expensive projects to deal with disease. Usually requires World Bank funding.
Direct prevention strategy (malaria)
Eradication of the mosquito
Indirect prevention strategy (malaria)
Focus on prevention and early diagnosis
Strategies in malaria prevention in Ethiopia - destroying mosquitos
Destroying mosquito populations is the main method:
- getting rid of stagnant water (not always practical)
- putting a layer of oil over the water which stops larvae from emerging (but can cause ecosystem damage)
- introducing Gambusia fish to eat the larvae (could cause further ecosystem damage)
- chemical pesticides (DDT) which is sprayed in houses and other mosquito hotspots (causes significant environmental damage, affects whole food chain)
- GM to disrupt reproduction, by either preventing birth of females or totally sterilising females (10 years until possible)
Strategies in malaria prevention in Ethiopia - other
Mosquito repelling:
- chemicals put in paint on house
- mosquito repellent on skin (expensive)
- mosquito nets (caused a 70% drop in cases in last decade in some regions)
- burning fragrant incense
- long clothes preventing exposed skin
Treatment:
- quinine the main traditional medicine
- Artemisinin - most important modern drug, based on Chinese traditional medicine - up to 95% effective (however, parasite develops rapid resistance)
President’s Malaria Initiative
$48m per year since 2005 from US to Ethiopia and aims to halve malaria mortality rates.
Future challenges of malaria in Ethiopia
Climate change is expanding elevation range of mosquitos - has risen 100m since 1981.
What is air pollution?
Chemicals or particulates in the atmosphere causing negative health effects.
Main contributors are human activity and volcanic emissions.
Fossil fuel usage emits carbon dioxide and nitrogen dioxide, which cause respiratory problems.
Smog is caused by sulphurous and petrochemical particulates.
Lead particulates from certain types of emissions cause cancer, reproductive problems and birth defects.
Air pollution in China
Beijing is 1200% above WHO health limit for air pollution.
Of the 5.5m annual deaths from AP, 1.6m are in China.
1000 cars added to Beijing’s roads daily, with regulation lax.
“Blue sky days” - days with no smog - are often fabricated by local authorities.
Many athletes opted out of 2008 Beijing Olympics due to pollution worries.
Coal power is the main source of power in China, and the government continue to prioritise economic growth over dealing with pollution.
Xingtai is 5200% above WHO air pollution limit.
Impact of air pollution on cancer in China
Microparticles are responsible for 8% of lung cancer cases in the UK.
22% of global cancer cases are in China, and 27% of cancer deaths - 2.8m deaths per year, and 4.3m new cases.
700k lung cancer cases, causing 600k deaths - only 1/3rd from tobacco usage.
Smog levels in cities are 7x the WHO max exposure levels for cancer risk.
90% of Chinese cities fail to meet air pollution standards.
People unable to speak up about the issue due to censorship, and democratic solving of issue is impossible.
Average 18 year old from Beijing spends 40% of the rest of their life in ill health.
National solutions to air pollution in China
In 2014 18,000 factories were shut in Hebei.
Social media networks have been allowed to discuss the issue and how to solve it.
Xi Jinping has emphasised importance of nuclear power in the future.
From 08-24 factors are required to reduce emissions by 30%.
$17bn spent on moving factories away from urban areas, adding new subway lines to reduce car/bus usage and improving home designs.
Schools can be closed or force children to stay inside if air pollution is particularly bad (above a certain Air Quality Index threshold).
Suggestions to fix large water sprinklers on buildings to disperse heavy gases.
Giant vacuum cleaners have been suggested.
Listeria: facts, how it spreads, symptoms
2017 South Africa factory outbreak killed 180.
Spreads through infected processed meat.
Bacterial infection.
Can also spread in unpasteurised meat or dairy.
Causes high temperature, vomiting and diarrhea.
Most infected are symptomless.
Affects young and elderly most.
Listeria facts
Spreads through infected meat
Causes high temperature, vomiting and diarrhoea
Can also spread in unpasteurised milk
measles facts
Some measles-free countries have lost their status due to declining numbers in MMR vaccinations
5000 deaths per year in DRC - only 60% vaccinated
Disease of affluence
An NCD brought on by increased societal wealth, and result from lifestyle and genetic factors.
Factors causing DoAs
Cars, trains etc becoming more affordable and common, as well as changes in working patterns (people working at a desk as opposed to in the fields or in factories), have meant that strenuous activity is less frequent.
Easier access to unhealthy fatty or sugary food, which is often cheaper than healthy alternatives.
Increased leisure time means that people can engage in unhealthy activities, with prolonged periods of inactivity common.
Greater use of alcohol, tobacco and drugs
Reduction in diseases of poverty means an automatic increase in DoAs as a percentage of deaths.
How can medical advances make people more susceptible to DoAs?
Antibiotic resistance increases with time and scale of use.
Increased life expectancy means increased chances of age-related diseases.
Exposure to pathogens in infancy is lower.
Social factors affecting DoAs
Stress due to high workload leads to dementia and strokes.
Low priced and easy to buy fast food.
False correlation between weight and health.
Anorexia due to societal pressures.
Smoking/drinking culture.
Influence of social media on mental health.
Obesity in UK and world statistics
Costs the NHS £15bn a year.
Could be as high as £100bn by 2050.
By 2050 the majority of adults could be overweight in the UK.
There are now more obese than malnourished people.
Causes of rising obesity globally
TNCs and global culture pushes energy dense, cheap food (SL to CSMP).
Urbanisation causes more people to live in cities with low pay, only able to afford unhealthy food.
Rise of use of cars and public transport.
Influences of advertising.
Eating out is more common due to higher levels of disposable income.
Jobs are less physically demanding.
Stages of nutrition transition
1 - low calorie, limited income, local food mostly consumed, physical work common, little meat or dairy, undernourishment common.
2 - higher calorie intake, urban living, higher income, more meat and fat, eating out more common, snacking common
3 - move towards healthier food as incomes rise to the point where they are affordable.
Social and economic impact of obesity
Obesity causes other health issues - kidney/heart malfunction, blindness, gangrene, T2 diabetes.
Obese people more likely to take sick days.
The more common it becomes, the more socially acceptable it becomes.
Causes of obesity in the UK
Poverty has a positive correlation with obesity levels - it’s more expensive to have a healthy diet in the UK.
Healthy food has a shorter shelf life, and requires more effort than a weekly shop.
Television advertising of unhealthy food is often targeted at children.
Decline in number of children walking to school.
Sports are played less by children.
Future problems with obesity/CVD
Second biggest cause of cancer behind smoking, likely to overtake it in the future.
Each generation continues to become more overweight.
Rising cost to national healthcare.
May cause up to 35k extra deaths per year in the UK.
Strategies (direct) to combat obesity/CVD
Change 4 Life encourages children to live a healthy lifestyle.
WHO finance solutions globally.
Public Health England wants a cut in calorie consumption of 20% by 2024.
Sugar tax introduced on 9 food or drink groups.
Strategies (indirect) to combat obesity/CVD
Recommendations for 400 calorie breakfasts, 600 calorie lunches and dinners.
Fast food options are encouraging healthy options.
WHO Aims
Reduce air pollution
Promote healthy diets
Monitor child development
Recommend vaccines
Monitor food and water hygiene
Ensure contraception
Road safety
Make travel safe
Plan for elderly
Protect from second hand smoke
Malaria safety
Recruitment of health workers
Hospital safety
Mother care
HIV testing
Aid and disaster relief
Protect from medical costs
Universal access to medicine
WHO use of technology
Prioritising use of new super antibiotics to deal with MRSA and drug-resistant Ecoli and Salmonella.
Role of WHO - predicting diseases
Zika virus a recent example
Emerged in Uganda in 1947, causes birth abnormalities such as small heads.
WHO had vaccine programme already in place and operating prior to outbreak in 2016, with clinical and non clinical trials.
The virus could potentially spread globally, and the WHO continue to fund vaccine development to deal with it.
WHO data gathering
1/3rd of 150 members give data on cause of death.
21 sustainable development goals for health, with data the main method of measuring success.
However, 2/3rd of members don’t give cause of death data which makes mitigation difficult.
Data is collected by household surveys, routine reporting by health services, civil registration and disease surveillance systems.
WHO research - Dengue Fever
Mosquito born viral infection, deadliest tropical disease, 100-400m cases per year.
Mortality rates <1% with proper access to medical care.
WHO-led research using GIS data in Fortaleza to map outbreaks and isolate the major mosquito hotspots, allowing specific control of city blocks.
Allows prevention by cleaning water storage, covering water stores and sometimes insecticide.
WHO support programmes - HIV/AIDS
Drug resistant HIV/AIDS due to uptake in antiretroviral therapy, price has increased by 200% since 2010.
2015 - WHO recommend the therapy for all HIV patients.
WHO provide a roadmap for Kenya and other African nations for long term prevention - distributing contraception to mitigate.
WHO fund programmes to educate the most at risk (sex workers and LGBT people).
Pushing voluntary male circumcision to reduce chance of infection by 60%, 20k have already done it.
WHO work with other agencies and governments
Work to promote universal healthcare - since 2012, WHO have worked in China and now 172m previously uninsured are insured.
Helped create Peoples Insurance in Mexico, giving universal coverage.
WHO led programmes in Rwanda has halved child mortality and increased life expectancy by 10 years since 1994.
Effect of physical barriers on disease mitigation: relief
Stops spread through vectors due to climatic changes with elevation, or through rain shadow effects.
Restricts movement of people, prevents transfer of CDs.
Makes it difficult to access communities to respond to outbreaks or give medical aid - either means slow access roads or expensive aerial transport.
In the past, it made communication very difficult.
Effect of physical barriers on disease mitigation: natural hazards
They can restrict movement of people by damaging infrastructure or making people poorer.
Extreme weather can wipe out vectors - for example, rabid stray dogs in earthquakes.
Can mobilise quicker response from NGOs, as high risk regions likely have the response protocols in place, allowing response to events other than natural disasters.
Earthquakes, tsunamis and hurricanes can contaminate water supply, leading to water borne diseases, especially when people use open water sources in coastal areas.
Hospitals being destroyed.
Homes being destroyed often forges large scale movement of refugees.
Injuries from NDs can lead to worse disease i.e. infections.
Infrastructure damage makes moving equipment harder.
Danger such as aftershocks to response teams.
Effect of physical barriers on disease mitigation: excess water (ELSS SL)
Water can be used to clean or sanitise areas.
Can reduce impact of fires or volcanic eruptions.
Ships can help move medical supplies.
Ease of quarantine imposing.
Stagnant water can lead to water borne diseases, or act as a mosquito breeding ground.
Water supplies can become contaminated.
Flooding can make emergency relief experts extremely difficult.
Flooding can damage buildings and lead to mass movement of refugees.
Effect of physical barriers on disease mitigation: remote communities
Restrict population movement.
Lack of contact reduces incidence of disease, however can lead to lack of immunity which can spell disaster upon first contact.
Natural quarantine of diseases such as Ebola in the DRC rainforest.
Can delay the arrival of medical supplies.
Lack of natural resistance to disease.
Less developed, lack of healthcare and vaccinations.
Agrarian places can be more vulnerable to zoonotic diseases.
HIV/AIDS - key stats
Spreads though bodily fluid transmission, but not saliva or urine.
35m+ deaths since start of pandemic.
25% of 15-50 year olds in Botswana have it.
1.1m in USA.
HIV/AIDS - organisations involved in mitigation
UN MDG 6a was to reverse the spread of disease by 2015 - achieved
6b to achieve universal AIDS healthcare by
2010, not achieved.
WHO and UNICEF fund government strategies.
HIV/AIDS - prevention strategies
Reduce high risk behaviour through education on spread.
Encouraged use of physical (not chemical) contraception.
Don’t needle share.
Promotes equality for groups at risk - gay men, sex workers, migrant workers/refugees and drug users.
Better data gathering by governments to help each country target those most at risk.
Campaigns to remove social stigma - big success.
HIV/AIDS - diagnosis strategies
Screening for antibodies the main method used in ACs - reduces risk of HIV developing into AIDS.
Education pushes people into getting tested.
These tests are expensive, so many lower income countries can’t afford it.
HIV/AIDS treatment
8m globally use these drugs, 6m in developing countries through a global fund. Still too expensive for many in the poorest
Salicin: use, plant, location, soil type, climate
Pain relief, gout and osteoarthritis
Bark of white willow
River banks, floodplains and wetlands in temperate zones - mostly Europe and West/Central Asia
Light sands to heavy clays, pH 5.5-8
6-18C, with seasonal changes, 500-800mm precipitation
Caffeine: use, plant, location, soil type, climate
CNS, heart and muscle stimulant, used for migraines, epidurals and anaesthesia
Tea, coffee and cocoa plants
Tropical and subtropical climates
Well drained and organic soil, pH 4-6.5
20-27C, 1000-2000mm rainfall
Quinine: use, plant, location, soil type, climate
Kills malarial parasites in red blood cells
Dried bark of cinchonas evergreen tree
Tropical Andean forests of West S America, in cool and humid mountain regions, 1200-3000m
Well drained fertile soil with organic matter, pH 5.5-6.5
Averaging >20C, humid, 2000+mm rainfall, no frost
Colchicine: use, plant, location, soil type, climate
Cancer and gout treatment
Autumn crocus
Mediterranean climate, in woodland and meadows, sea level to Alpine tundra in Med basin
Deep and well-drained soils, pH 6.5
10-27C, 350-700mm precipitation, rainy winter and dry summer
Nicotine: use, plant, location, soil type, climate
Treats wounds and Alzheimers
Tobacco plant
Tropical and subtropical Americas
Light to medium textured soil with good drainage, pH 5.8
20-30C, 600-800mm rainfall, frost free
Medicinal plants: key facts
25% of all prescription drugs are found only in plants.
Usually found by chance, or though cultural tradition.
1200 plant species used to treat malaria globally.
Traditional Chinese Medicine is mostly ineffective, but there are some working plants.
For the 400m with Type 2 Diabetes, metformin (plant based) is usual prescription.
Opium poppy: location, climate, soil, cultivation, drug extracted
Native to Med Basin, but now widespread across Central Asia (narrow belt stretching 4,500 miles from Turkey to Burma) and also present in the Americas
Warm, dry climates, 30-38C and sunny weather, only 150-300mm precipitation needed.
Sandy loam soil.
Mainly grown in Central Asia belt, mostly Afghanistan
Contains opiates (morphine, thebaine, codeine, papaverine, noscapine and oripavine)
Milky fluid seeping from cuts in the poppy seeds is scraped off and air dried, producing opium resin.
Opium: history, politics, economy
Major good of the Silk Road.
Early 1800s, UK smuggled Indian opium into China and got a significant percentage of the population addicted, leading to Opium Wars.
Chinese migration brought the drug to the US.
Legal cultivation allowed under UN, subject to strict supervision - currently only occurs legally in India, Turkey and Australia.
Generates $60m annually for Turkish economy, $100m for Australia.
Grown illegally in Burma, Afghanistan and Colombia, 90% in Afghanistan.
Opium: use in medicine
1803 - morphine extracted from opium resin, used widely for severe pain relief in mid-1800s, still widely used today as the most effective painkiller.
Codeine - most commonly consumed opiate, 250 tonnes produced per year. Moderate pain relief, only available by prescription after previous issues with addiction.
Opium: heroin issue
Heroin most powerful psychoactive drug, but also causes most drug related deaths.
Has been illegal since 20s.
Major trafficking routes from Central Asia to Europe and North America.
Illicit cultivation is directly linked to rural poverty, so poverty reduction is a necessary way to combat heroin production.
Opium: sustainable use/conservation
Legalisation for medical use in EU and Canada has been gaining traction since 2007 - global shortage of painkillers.
Poppy field destruction to stop illegal production - has led to death, destruction and political turbulence in Afghanistan.
Education: prevention campaigns focusing on youth, or those with special needs and concerns, to decrease demand for heroin.
Media campaigns: have rarely dealt with heroin issue due to poor targeting, generally refer to all dangers of heroin use including needle sharing.
Treatment: counselling, guidance, motivation, medical treatment, rehabilitation and social integration.
Successes of the Red Cross in Haiti
4.4m benefited from hygiene promotion activities (door to door education).
Supported more than 50 medical facilities, including $5.5m towards a large hospital.
Funding construction of the first wastewater treatment plant.
130k provided with a form of temporary home.
Cash grants given to people for business investment, giving them a career path.
$66m emergency relief stopped spread of cholera by providing basic sanitation.
$24m spent on cholera education, vaccination and other prevention.
$47m on water and sanitation.
Rebuilt key infrastructure allowing easier movement of volunteers.
Trained first responders in the event of another earthquake.
Failures of the Red Cross in Haiti
Dubious data
Housing projects planned but never built.
Most investment went to bureaucracy instead of infrastructure.
Hiring of Haitians only as lower level staff, not in management roles.
Only 6 permanent new houses actually constructed - 130k promised.
Residents taught how to use soap and clean water without access to either.
Senior management took $140k salaries.
Some funds ended up going to the US government.
100k+ still live in refugee camps with dire conditions, poor hygiene and easy spread of cholera.
8k+ still died from cholera.
GSK overview
World’s sixth largest pharmaceutical, headquartered in Brentford.
Employs 100k people in 115 countries.
3 businesses - vaccines, pharmaceutical and consumer healthcare.
Leading in HIV and respiratory illnesses.
Largest vaccine company prior to Covid - 2m doses per day.
Largest consumer healthcare company.
40% of children have received a GSK vaccine.
Developed the first ever Malaria vaccine, Mosquirix - not-for-profit
GSK scientific breakthroughs
80% of research spending focuses on new medicine in HIV, oncology and immune-inflammation.
£2.6bn invested into new pharmaceutical medicines.
90% of GSK vaccines are being developed with other firms, governments, universities and NGOs.
First malaria vaccine.
£40m investment in genomic research in 2017.
GSK patents
40 vaccines developed for 22 diseases, with 14 more in development.
In LIDCs, all existing and future GSK medicines aren’t patented, allowing for free generic manufacture (60% of Africa included).
In EDCs, GSK files for patents but allows licenses with generic producers for a small royalty fee.
In ACs, they seek full patents.
GSK drug manufacturing
27k people in manufacture and supply, in 36 countries, producing 4bn packs of medicine, 900m vaccine doses and 18bn consumer healthcare products annually.
Carbon neutral supply chain by 2050.
Specialist chemistry unit researching new ways to synthesise existing medicines in more eco-friendly ways.
AI development to accelerate development process - from $1.5bn and 5-6 years down to lower costs and 1 year.
How can GSK aid development in LIDCs?
OpenLab in Africa - £25m investment - increase scientific knowledge and development in regions that need it most.
Aims to create a pharma industry in these regions.
20% of profits are reinvested into infrastructure development in SS Africa for access to their low-cost healthcare.
Will improve public and general health, increase life expectancy, and quality of life for 1bn people.
GSK: challenges, conflicts of interest and potential healthcare gap
They need to optimise drug delivery to LIDCs.
Corruption in LIDCs could potentially neutralise healthcare investment.
1bn people in Africa - one company can’t help them all.
Third party companies don’t conform to code of conduct - environmentally or ethically questionable.
Difficult to operate in war torn regions which leads to uneven development and healthcare gap.
Guinea Worm description
A parasitic worm that is transmitted when people drink stagnant water infected with water fleas that carry guinea worm larvae.
Affects mostly rural, deprived and isolated communities with open surface water sources.
Painful blister forms a year after infection on the lower leg/foot, patients soothe by putting foot in burning water, worm goes through body to blister and releases larvae into the water, which are ingested by water fleas.
Takes 10-14 months for emergence, making source tracing extremely difficult.
Rarely fatal, but can cause weeks of non-function.
Guinea worm epidemiology
3.5m annual cases in 80s in 17 African and 3 non African countries.
Fewer than 10k in 2007.
22 in 2015, rose to 30 in 2017, in 20 villages in Chad and Ethiopia.
Guinea Worm in Ghana epidemiology
179k cases in 1989.
Last case in May 2010.
Guinea Worm free certification in Jan 2015 by the WHO - zero indigenous cases for more than 3 consecutive years.
Final cases were mostly in the rural and poverty stricken North.
Why were grassroots strategies important in Ghana?
No cure for Guinea Worm, so could only be mitigated by changing behaviour.
Ghana Guinea Worm mitigation: education
Previously, migrant farmers didn’t filter their water (cost issues, forgetting to, or religious beliefs) and waded through ponds with open sores.
Heath education - radio messages, use of picture books and public awareness campaign to fight stigma - Ghana Worm Eradication Program
Training of villagers to use household water filters, to treat stagnant water with larvicide, and building of safer wells.
Ghana Guinea Worm eradication: women
2001, Carter Centre engaged 6,200 women of the Ghana Red Cross Society to work with volunteers in the most affected districts.
Reported cases, ensured proper use of filters, and prevented worm contamination.
Women are the ones who deal with water, so this helped to target the issue specifically.
2001, massive increases in case numbers due to rise in reporting.
Religious leaders (often oppressive) were glad to aid these women, as they were very effective.
Smallpox overview
Variola virus spread by person to person contact and saliva droplets.
High fever and fatigue, then pustules form all over the body, which form a crust and fall off.
7-17 day incubation period, most infectious period, but the person is infectious until the last scabs fall off.
30% of affected died.
Spreading mostly limited to households.
Last natural case in 1977, declared eradicated in 1980 - only human disease so far.
Why did smallpox become a global issue?
Originally spread from it’s centre in Ancient Egypt throughout the Old World due to trade and expansion of empires.
Portuguese colonisation introduced it to West Africa in 15th century.
European colonisation of the Americas and the African Slave Trade imported it to the Caribbean and South America.
17th century it was introduced to, and devastated, North America
18th century, British introduced it into Australia
Smallpox early control efforts
Variolation - giving smallpox pus to the unaffected to build immunity. People developed symptoms but rarely died.
Vaccination - 1796 Jenner invented the first ever vaccine, using cowpox to inoculate.
British government started to introduce national vaccination campaigns in the early 1800s, the first instance of this in history.
Smallpox: eradication program
1959 - WHO initiate plan to eradicate smallpox, but it suffered from lack of funds, personnel and commitment, and a shortage of vaccine donations.
Smallpox outbreaks were still common in the 60s in the developing world.
Intensified Education Program began in 1967 - countries able to produce higher quality freeze dried vaccines.
Development of bifurcated needle, a global surveillance system to monitor cases, and mass vaccination campaigns, facilitated greater success.
Eradicated in 50s in Europe and North America, 1971 in South America, 1975 in Asia and 1977 in Africa.
1980 declared eradicated.
Factors contributing to smallpox eradication other than role of WHO
Has visible symptoms that appear quickly after exposure, making it easy for cases to be identified and outbreaks to be identified.
Incubation period is short so spread can be traced.
Has no other host, so no animal reservoir made it much easier to eradicate. Most other major diseases are zoonotic, making eradication difficult or impossible. Once the human population was vaccinated, the virus had no other hosts.
Covid-19: background info and key facts
Early cases of Covid were attributed to the Huanan Seafood Wholesale Market in Wuhan, China - it is thought that the disease is zoonotic in origin and spread to humans from live animals there, most likely bats.
First person with symptoms fell ill on December 1st 2019.
Became an international crisis in January, spreading to other East Asian countries.
Public Health Emergency declared by WHO on 30 Jan.
Declared a pandemic on 11 March.
Spread to Europe via Italy, and to North America via NYC.
New strains developed - most notably South Africa, England and Brazil. Kent variant much more infectious.
First vaccine was Pfizer in November 2020, followed by multiple more.
As of 18/3/21 - 121m cases and 2.7m deaths.
Covid-19: what is it
Highly contagious communicable disease caused by SARS-CoV-2 virus, which is spread through human to human contact and saliva droplets in the air, or on contaminated surfaces.
Symptoms include cough, fever, fatigue, breathing difficulties, and loss of smell and taste.
Long Covid can cause effects for months after.
1/3rd don’t develop symptoms.
Of those who do, 80% are mild, 15% are severe and 5% are critical.
Older people and those with underlying illnesses are more likely to have bad symptoms.
Covid-19: rate of spread
R number measures average number infected by an infectious person. Went up to 2.5 in some instances, currently below 1 in UK.
Massively varies by country, but ACs tend to be hit the hardest. This may be due to poorer immunity to related diseases, or increased levels of human contact.
Pandemic rapidly developed - daily cases first exceeded 100k in May. New virus, so 0 immunity.
Peak of pandemic was 8 Jan 2021 - 845k cases in one day.
Many countries are seeing second and third waves, with far higher death tolls and case numbers.
Numbers aren’t reliable - mass testing only available from May-June onwards, and many countries manipulate numbers for political reasons.
Reinfection is possible, but very rare.
14 countries and territories have reported no confirmed cases.
Covid-19: pattern and distribution
The virus has caused “waves” of infections, which have been brought about by tightening and loosening of lockdown restrictions. In ACs, where government intervention is highest but cases are also highest, many countries are on their third wave now.
The 2.7m deaths in the space of 12 months has made it the deadliest year due to a pandemic since 2004, the height of the AIDS pandemic.
This is a minimum estimate.
WHO leaders have suggested that up to 10% of the human population has had Covid (780m people).
Older people are far more at risk of death as they have weaker immune responses.
The highest death rates are in developing countries, however this is more likely due to restricted testing.
The highest deaths per capita are in developed countries - it is unknown why these countries have been hit hardest.
Chances of death by age group:
- 5-17 year olds are the base rate
- 50-64 year olds 400x more likely to die
- 65-74 1100x more likely
- 75-84 2800x
- 85+ 7900x
China smoking and lung cancer facts
22% of cancer cases, 27% of deaths
7500 lung cancer deaths per day
1/3rd of young Chinese men die due to smoking
However, many cases are caused by air pollution and not smoking
Therefore smoking culture has effect on incidence of NCDs - cancer a main NCDs
Car culture and TSC facts
Time space compression has caused a shift to tertiary, and a sedentary lifestyle - office based jobs
Increased access to tech, people go outside less
Globalisation increased access to fast foods
Leads to CVD, obesity and diabetes
58% of diabetes cases are due to high BMI (overweight)
Japan mental health facts
Culture is that suicide has never been a sin - kamikaze and samurai honour
Only considered a problem due to mental health recently
1 in 4 have considered it
60 suicides per day
Depression is widespread, undiagnosed and untreated due to cultural sigma of talking
Work culture - work until you drop
Maintain a façade - always look happy
25% of suicides are financially motivated
