Disease Dilemmas Flashcards

Question

What is the global pattern of Cardiovascular Disease?

Answer 1

Includes a range of disorders of the heart and blood vessels including coronary heart disease, stroke, hypertension and angina. These are non-communicable diseases and so cannot be passed from person to person. Globally CVDs account for 17.9 million deaths per year, and more die from CVDs worldwode than from any other cause, of which 80% of CVDs are heart attacks and strokes. Incidence rises steeply with age, CVD is a major cause of mortality and morbidity in ageing populations in high income countries, but there are many premature deaths below 70. Low and middle income countries are disproportionately affected, having 80% of all CVD deaths, mortality rates are particularly high in parts of the Middle East, Eastern Europe, South Asia and Africa when standardised by age. Premature deaths from CVD is linked to lifestyle factors, such as smoking, harmful use of alcohol, unhealthy diet and physical inactivity. Underlying causes include population ageing, poverty and hereditay factors. Low income countries and groups have less capacity to control and prevent CVDs, and in low resource settings, healthcare costs for NCDs drain houshold resources and force millions into poverty, limiting development. Rapid, unplanned urbanisation can have negative socio-economic effects, exposing children to crowded living, air and water pollution, inadequate sanitation and tobacco, alcohol and fast food, there is higher incidence where there is poor access to medical care. Poverty is closely linked with CVD, vulnerable and socially disadvantaged people get sicker and die sooner than those of higher social positions because they are at a greater risk of being exposed to unhealthy dietary practices and limited health services. Governments are encouraged to participate in the WHO's and US CDC's Global Heart Initiative, launched in 2016 to reduce death rates through education. As GDP per capita increases, age standardised deaths from CVDs decrease, because ACs have more capactiy to diagnose, treat and prevent CVDs.

Answer 2

Diffusion is the movement of particles or molecules from an area of high concentration to an area of lower concentration. The concept of diffusion applies to science, innovations, migration and settlement, as well as the spread of disease, which is the process by which a disease spreads outwards from its geographical source.

Answer 3

Affected by distance so that places closer to the source of a disease are most likely to see higher incidence.

Answer 4

Occurs when a disease spreads from its source outwards into new areas of prevelance, whilst carriers in the source area remain infected possible intensifying in the original area. Has one main node and spreads out from there but can be spread by contagious or non-contagious means. (TB)

Answer 5

Occurs when a disease leaves its source and moves into a new area. Several nodes are formes and can be spread by contagious and non-contagious means. (cholera in Haiti 2010)

Answer 6

Involes the spread of disease though an ordered sequence of classes or places, for example from large cities to remote villages. Dictates that bigger/more important places with highest conectivity are likely to be affected first. It is a form of relocation diffusion but based of a hierarchy of places. (2009 H1N1 flu virus)

Answer 7

Describes the spread of disease through direct or indirect contact with a carrier, it is strongly influenced by distance, so individuals in nearby regions have a much higher probability of contact than those in remote regions. In theory, it could take the form of expansion, relocation or hierarchical diffusion. (Ebola in West Africa 2014)

Answer 8

A model based on the spread of agriculture innovation in central Sweden, can be applied to spatial patterns of disease diffusion. It is probablistic rather than deterministic and as a result it produces slightly different outcomes each time it is run. There are 4 stages to the diffusion process: 1. The primary stage: strong contrast in disease incidence between the area of outbreak and more remote areas. 2. Diffusion stage: diffusion is centrifugal - new centres of disease outbreak occur at distance from the source and this reduces the spatial contrasts of the primary stage. 3. Condensing stage: the number of new cases is more equal in all locations, irrespective of distance from the source. 4. Saturation stage: diffusion decelerates as the incidence of the disease reaches its peak.

Answer 9

1. A neighbour effect - probability of contact between a disease carrier and a non-carrier is determined by ther number of people living in each 5x5km grid square and their distance apart. Thus, people living in proximity to carriers have a greater probability of contracting a disease than those further away, this distance-decay function is assumed to be geometric in character. 2. The number of people infected - by an epidemic approximated an 'S-shaped' or 'logistic' curve over time. After a slow start, the number of infected people accelerates rapidly until eventually levelling out - as most of the susceptible population have been infected. 3. Barriers to disease - progression and diffusion of a disease may be interrupted by physical barriers.

Answer 10

1. The most important is often distance 2. High mountain ranges 3. Large maritime areas 4. Extensive areas of aridity 2,3 and 4 keep people contained, restricting movement, with relatively small amounts of in and out migration, spread of disease in and out of these regions is less likely 5. Climate - tropical conditions?

Answer 11

National government and international organisation strategies to tack communicable diseases such as: Medical health checks at international borders and airports Quarantine Mass vaccination programmes Cancelling public events Curfews Wearing face masks in public places School and workplace closures International travel controls - closing borders which can have great economic impacts that this is an extreme method Health education programmes Public health messages Provision of automatic soap dispensers, toilet flushes and taps in public places

Answer 12

Increases diffusion due to more connected places although it allows for the sharing of research/education/treatment

Answer 13

Unprotected, stagnant water can often be a breeding ground for vectors of disease pathogens, and many people in LIDCs rely on surface water or water from wells for cleaning and drinking

Answer 14

Inherently linked to climate, because as altitude changes so does climate; temperature and rainfall regimes affecct vectoor habitatis, on average temperatures decrease by 0.65C per 100m and relief rainfall can be triggered in upland areas, water is also more likely to collect and stagnate in valleys or lowlands. In Ethiopia, malaria is concentrated in the humid lowlands but absent in cooler highlands: over 2000m it is too cold for P. falciparum to develop in a mosquito vector.

Answer 15

Temperature, rainfall and humidity influence habitats of disease vectors. Temperature often influences the rate of vector development and temperature often determines rate of bacterial or viral replication. Precipitation creates aquatic habitats which allow both disease and pathogens to flourish and complete their lifecycles, monsoon season is particularly dangerous in LIDCs however too much rainfall can wash away immature vectors

Answer 16

They are living organisms that can transmit infectious diseases between humans or from animals to humans, many of these vectors are bloodsucking insects and most transmit pathogens via their blood meals, these are often endemic in th etropic and sub-tropics due to idea physical conditions

Answer 17

Precipitation - anapholes mosquitoes lay their eggs in water which hatch into larvae. The abundance of aquatic habitats, ideally unpolluted fresh wates, depends on the collection of water that is not flowing, such as puddles towards the end of, or just after, the rainy season, this allows them to complete their life cycles. There are around 400 types of Anapholes mosquito (30 carry malaria) and each have their own preferred aquatic habitats. Relative humidity - where average monthly humidity is over 60%, often increased by vegetation growth, the mosquito has a better chance of survival and becomes more active. Temperature - where average temperatures are between 18C and 40C, the mosquito takes more blood meals and increases the number of eggs laid, increasing the number of vectors. The larvae develop faster at higher temperatures, so the parasite has more time to compete its life cycles inside the mosquito.

Answer 18

Seasonality of temperature and rainfall regimes influences the prevalence of vector borne infectious diseases. These factors affect the time avaliable for vectors and parasites to complete their life cycles and the avaliability of suitable aquatic habitats. Malaria outbreaks are closely linked to seasonal changes in rainfall, relatively sudden transmission of P. falciparum occurs where seasonality is most marked, such as in tropical areas that are further from the equator in Africa or following monsoonal rainfall in Asia. Influenza in temperate latitudes of Europe and North America, epidemics tend to peak in the winter. Transmission is more efficient at lower temperatures and when relative humidity is low, and this occurs most in winter but because the north and south hemispheres have different winters, there are two peaks of flu season each year. Sleeping sickness in the woodland savanna of west and central Africa, outbreaks occur in the wet season when the tsetse fly vector can live longer, there is a significant regression of both vector and parasite in the dry season.

Answer 19

Emerging infectious diseases (EIDs) are new diseases that have emerged in the last 20 years. Either they have ot occurred in human populations before of they have occurred previously but affected only small numbers in isolated places. Outbreaks and diffusion of these diseases can result from changes in climatic conditions in which vectors survive and develop. Global warming has had the effect of extending the geographical area in which these vector borne diseases are developing. WNV and Lyme disease are expected to spread northwards within the USA and into Canada within the 21st century. Lyme is spreading because ticks thrive in warmer conditions. High temperatures favour the transmission of WNV, now considered a global disease. Shorter term climate changes include the impact of El Nino Southern Oscillation on rainfall and temperatures in south America especially. Effects such as higher temperatures, heavier rainfall and greater frequency of tropical cyclones and flooding have been persistent enough in some regions to create conditions from the transmission of malaria, cholera or dengue fever. Droughts can lead to a scarcity of clean drinking water or water for sanitation, leading to diahorreal disease. Some EIDs have re-emerged in areas where conditions have been made favourable to their transmission

Answer 20

Zoonotic disease are caused by bacteria, viruse, parasites and fungi. Zoonotic diseases are transmitted to humans from disease reservoirs of non-human speciers through: direct contact with animals, dog or bat bites insect vector bites, such as mosquitoes contaminated food or water

Answer 21

Rabies is an infectious viral disease causing about 60, 000 deaths annually worldwide. 95% of these occur in Africa and Asia, children being the frequent victims (50% of cases). India accounts for 60% of rabies deaths in Asia and 35% of deaths globally. Conditions: Lack of access to immunisation after a bite; incidence is highest in remote and rural communities where vaccines are not readily available or affordable. However 29 million people worldwide recieve a post bite vaccination, preventing deaths (100% mortality rate is disease develops) Lack of prevention measures, mainly lack of control of stray dogs, insufficient government legislation on dog licensing/behaviour/dog immunisation; many dogs are community property. Lack of funding for vaccinating dogs against it (most cost effective strategy) Lack of community education on dog behaviour, bite prevention and immediate care after a bite.

Answer 22

A natural hazard is when a natural process puts human lives, infastructure or economic interests at risk.

Answer 23

It is important to recognise that many 'natural' hazards have both natural and artificial components because hazards are threats of harm mainly to human systems, human activities play a large role in how severe a hazard is. The more severe the geophysical event, the more vulnerable the population, the greater the hazard. For example, when large numbers of people crowd into floodplains and low-lying areas, they are putting themselves in harm's way, increasing the severity of potential floods.

Answer 24

Complex - we often witness major natural hazards leading to the spread of infections. However, major health epidemics are rare in the aftermath of natural hazards alone, main problems arise if: Large numbers of the population are displaced, gathering in confined spaces There is poor sanitation and water contamination, wells being contaminated by sewage There is disruption to infastructure, roads for aid and immediate healthcare provision There may be interruption of public health programmes, vaccines leading to loger term problems. Infectious disease transmission or outbreaks may be seen days, weeks or even months after the onset of the disaster, short and long term effects

Answer 25

Advanced countries usually have non-communicable disease prevalence vs developing countries having infectious or communicable disease prevalence

Answer 26

As life expectanvy increases, the major causes of death and disability in general shift from communicable, maternal and perinatal causes to chronic, non-communicable ones

Answer 27

The main causes of death in the 19th century were infectious diseases, vaccination became more effective with public health policies, clean water and improved nutrition, sanitation and housing have led to significant decline in deaths from these diseases, these now cause a very low percentage of all deaths in the 21st century. The main causes of death in the UK today are non-communicable diseases, for men the main cause is coronary heart disease, and for women between 35-49 it is breast cancer, above 80 it is dementia.

Answer 28

A characteristic shift in the disease pattern of a population as mortality falls during the demographic transition: acute, infectious diseases are reduced, while choronic, degenerative diseases increase in prominence, causing a gradual shift in the age paterrn or mortality from younger to older ages

Answer 29

Abdel Omran, it illustrates the relationship between development and changing patterns of population age distribution, mortality, fertility, life expectancy, causes of death. Changes are driven by improvements in health care, standards of living and the quality of the environment. According to Omran, societies underfo change in three epidemological phases

Answer 30

A change in the population dynamics of a county as it moves from high fertility and mortality rates to low fertility and mortality rates. This is linked to the epidemiological transition model.

Answer 31

The age of pestilence and famine - lease developed countries (Sub-Saharan Africa) Pre-industrial societies Mortality is high and fluctuates from year to year life expectancy is low and variable, averaging around 30 years Poor sanitation, comtaminated drinking water and low standards of living make people more vulnerable to infectious diseases which dominate mortality Population growth is slow and intermittent Today, most countries have passed though this phase

Answer 32

The age of receding pandemics - developing countries (India) In industrial societies (LIDCs and EDCs today) Advances in medical technology, diet, hygiene, and living standards mean epidemics causing large-scale mortality to become rarer Life expectancy rises above 50 years, death rates start to fall Population growth is sustained There is a shift in the main cause of death from infectious diseases to chronic degenerative diseases

Answer 33

The age of chronic diseases - developed countries (USA, UK, Japan) Many emerging economies (EDCs) such as Mexico, Brazil and China are now entering this phase Further improvements in medical technology, hygiene and living standards mean that mortality related to infectious diseases is rare Life expectancy rises further to above 70 years Reduced fertility rates mean population growth starts to slow Degenerative diseases become the main cause of mortality, man-made diseases associated with environmental change (cancer) become more common

Answer 34

Some observers suggest a fourth stage - the onset of delayed degenerative diseases Medical advances delay the onset of degenrative diseases The so-called cardivascualr revolution of the past 40 years has raised average life expectancy in ACs from the early seventies to the mid eighties However, a lack of physical activity and unhealth eating have resulted in the rise of obesity and diabetes as increasingly problematic health factors

Answer 35

The model is a generalisation Countries will not all follow the same pattern at the same time Some countreis are passing through the model at an accelerated rate

Answer 36

``` Communicable diseases (diseases of poverty) cause a higher proportion of death and morbidity than non-communiable diseases. These diseases are classified into 3 groups; animal borne, water borne and food borne. Water borne diseases are now mostly eliminated in ACs but remain endemic in many LIDCs. Their prevalence is due to a number of factors, although most are related in some way to poverty ```

Answer 37

Poverty and disease are tied closely together, with each factor aiding the other Many diseases that primarily affect the poor serve to also deepen poverty and worsen conditions Poverty also significantly reduces people's capabilities making it more difficult to avoid poverty related diseases Poor hygiene, ignorance in health-related education, non-avaliability of safe drinking water, inadequte nutrition and indoor pollution are faactors exacerbated by poverty

Answer 38

The type and structure of governments and their policies affects the health of the impoverished more than other population groups Every component of government - from finance, education, housing, employment, transportation and health polity - affects population health and health equity Impoverished people depend on healthcare and other social services to be provided in the social safety net, therefore avaliability greatly determines health outcomes

Answer 39

Impoverished people's health outcomes are especially determined by whether they live in a metropolitan area or rural area, according to the WHO An estimated 30% of the world population lacks regular accuess to existing drugs, rising to over 50% in the poorest parts of Africa and Asia The implications are profound, over 10 million children die unecessarily each year, almost all in low-income or poor areas of middle income countries

Answer 40

In theory, cities should be better placed than rural districts to cope with infectious disease. However, all too often low-inome countries are poorly resourced and have weak health systems The threat of infctious disease is increased in LIDCs by the appalling conditions in which millions of people live. Slum housing and overcrowding are closely linked to TB and respiratory illness Rapid urbanisation reduces the number vaccinated as it is hard to keep track; the risk of urban epidemics rises

Answer 41

Inadequate food intake gives rise to undernutrition and malnutrition Undernutrition results from too little food and malnutrition is the result of an unbalanced diet, in particular shortages of protein and essential vitamins Depletion of macronutrients and micronutriens promotes viral replication - this contributes to greater risk of diseases spreading, and can even aid HIV transmission from mother-to-child Further, anaemia, a decrease in the number of red blood cells due to lack of iron in the diet, increases viral shedding in the birth canal, which also increases risk of mother-to-child transmission

Answer 42

Contaminated water and inadequate sanitation are related to diseases of poverty such as cholera, parasitic disease and schistosomiasis Standpipes and sanitation are provided in many developing areas, but death rates are not significantly reduced. To effectively decrease the morbidity and mortality, populations require access to water from home instead from outside. Therefore, in addition to the installation of standpipes, water supplies and sanitation should be provided within houses

Answer 43

High temeperatures and abundant rainfall create the conditions for a wide range of infectious diseases - malaria, dengue fever, sleeping sickness, filariasis, yellow fever, ebola Polluted water from wells and surface streams provides a disease resovoir for cholera, typhoid and bilharzia Meanwhile, poo drainage provides breeding sites for disease vectors such as mosquitoes and water snails that transmit diseases like malaria and bilharzia

Answer 44

Climate change - increases inteperature, rainfall and humidity - has stimulated transmission of vector-borne diseases and extended their geographic range Warmer and wetter conditions have favoured the growth and spread of mosquitoes carryign tropical and sub-tropical diseases, such as WNV, malaria, and dengue fever

Answer 45

The riddle of health and economic development - it can spiral in two directions Upwards - as economic development supports better healthcare, this in turn leads to higher productivity and further economic growth Downwards - as poor health slows economic development, either there is less money from healthcare or money is diverted that should be spent on sustaining economic development

Answer 46

Successful reduction or elimination of communicable diseases: this is partly the result of government wealth and affluence of households, enabbling investments in medical advances High standards of living including proper sanitation, clean water supplies and good nutrition Education and awareness of potential medical conditions The result is that health populations have longer life expectancies, but prolonged life expectancy inevitably increases the proportion of deaths and illnesses connected to degenerative diseases and old age.

Answer 47

Behavioural risk factors such as tobacco use, physical inactivity, harmful use of alcohol and unhealth diet In addition, air pollution and overnutrition contribute to these conditions Heightened risks are increasingly apparent in younger age groups

Answer 48

Gloablly there is a growing proportion of non-communicable diseases in low and middle income countries, where mortality from NCDs occurs increasingly at younger ages. Overnutrition, once confined to the developed world is becoming a significant health problem in the developing world

Answer 49

``` When a person has a BMI of over 30, it can lead to a range of further diseases/complications, including heart disease, type 2 diabetes, stroke and cancer (overweight is a BMI greater than 25). Sedentary lifestyle (TV, video games), sedentary jobs (service sector, sitting in offices, using computors), increasing car usage, diets containing large amounts of sugar and calories (processed, fast food), food marketing (deals on unhealthy food products), lack of government inclination to tackle food industry giants, poor euducation about diet and consequences of obesity, rural-urban migration (change in lifestyle, higher likelihood of working in offices rather than primary sector), environment has an important influence on decisions people make about their lifestyle - 'obesogenic environments' places, especially uraban areas that encourage unhealthy eating or inactivity. Worldwide obesity has tripled since 1975, 30 years ago 15% of the world's population was overweight now 39% are overweight and 13% obese, over 2 billion adults in the world are overweight, over 378 children and adolescents aged up to 19 are overweight or obese, average calorie intake was 1996 per person 30 years ago now it isi 2234. ```

Answer 50

A chronic condition where blood sugar levels become too high because the hormone insulin isn't being produced in large enough quantities to breakdown glucose ingested, diabetes is a major cause of blindness, kidney failure, heart attacks, stroke, limb amputation. Type 2 diabetes is linked with lifestyle, particularly weight and is more common in older age groups, it is a disease of affluent countries. Raised blood-sugar levels so diet is also a large factor. Food marketing, diets containing large amounts of sugar and calories, processed and fast foods are especially bad. Poor education about diet and lack of understanding about the disease, lack of exercise and tabacco use can also be linked to onset. Lack of diagnosis and treatment, the consequences of diabetes can be avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications. 3.9 million people in the UK have diabetes. 90% of these have type 2. Diabetes is the fourth biggest cause of NCD deaths globally (1.6 million deaths per year) and the seventh leading cause overall. 422 million people worldwide (8.5% of global population) have diabetes, the majority living in low and middle-income countries, where prevalence has increased faster than in ACs. The number of people with diabetes rose from 108 millio in 1980 to 422 million in 2014.

Answer 51

Conditions involving narrowed or blocked blood vessels, which can lead to chest pain, heart attack or stroke. Build up of fatty material in arteries, diet and lack of exercise therefore a cause of CVD. High cholesterol clogs up arteries, high levels of cholesterol in the blood are caused by poor diet (lots of saturated fats), harmful amounts of alcohol, smoking and lack of exercise. High blood pressure (hypertension) damages artery walls making it easier for fatty material to buildup, high blood pressure is caused by ageing, smoking, harmfu amounts of alcohol, poor diet, lack of exercise and a lack of sleep. Smoking is harmful to the arteries because of the chemicals in nicotine. CVD can lead to heart attacks if an artery which supplies bood to the heart is blocked, CVD can lead to a stroke if an artery which supplies blood to the brain is blocked. Lack of early diagnosis and treatment (lifestyle interventions and drug treatment). CVDs are the number 1 cause of death globally. CVDs account for the largest number of global NCD deaths per year, in 2016 17.9 million followed by cancer (9.6 million) and respiratory diseases (4.2 million). At least 3/4 of the world's deaths from CVDs occur in EDCs and LIDCs. CVD accounts for approx 26% of the UKs deaths every year.

Answer 52

Cancer is a condition where cells in a specific part of the bbody grow and reproduce uncontrollably, the cancerous cells can invade and destroy surrounding healthy tissue including organs. Causes vary according to the type of cancer, but around 1/3 of deaths from cancer are due to the leading 5 behavioural and dietary risks, high body mass index, low fruit and veg intake, lack of physical activity, tobacco use and alcohol use. Tobacco use is the most important risk factor and is responsible for 22% of deaths. Cancer causing infections, such as hepatitis and human papilloma virus (HPV) are responsible for up to 25% of cancer casus in low and middle income countries. Late stage presentation and inaccessible diagnosis and treatment are common. In 2017, only 26% of low-income countries reported having pathology services generally avaliable in the public sector. More than 90% of high-income countries reported treatment services are avaliable compared to less than 30% of low-income countries. Cancers are the second biggest NCD cause of death globally (9.6 million deaths per year). 1 in 6 deaths from cancer. 70% of deaths in LIDCs and EDCs. Over 350, 000 people were diagnosed with cancer in the UK in 2017. 50% of all cancer cases in the UK each year are diagnosed in people aged 70 and over. 4 in 10 cancer ases in the UK each year are linked to lifestyle factors. Smoking the largest single preventable cuase of cancer each year in the UK.

Answer 53

Any infectious disease which spreads from host to host

Answer 54

The effort to reduce loss of life and property by lessening the potential impact of disasters, taking action now - before the next disaster - to reduce human and financial consequences later

Answer 55

A reaction to something after it has happened

Answer 56

A life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. In 2015, 91 countreis and areas had ongoing malaria transmission. Malaria is preventable and curable, and its subject to mitigation and response efforts that are dramatically reducing the malaria burden in some places. Between 2010 and 2015, malaria incidence (the rate of new cases) among populations at risk fell globally by 21%. In that same period, malaria mortality rates among populations at risk fell by 29% globally among all age groups, and by 35% among children under 5. Sub-Saharan Africa carries a disproportionately high share of the global malaria burden, in 2015, the region was home to 90% of malaria cases and 92% of malaria deaths. Whilst malaria deaths are on the decline globally, Africa still takes the burden of the disease

Answer 57

Plasmodium parasites in the hosts of Anopheles mosquitoes and humans. The mosquitoes act as vectors and transmit the disease to humans by biting. Tropical and sub-tropical climate allows mosquitoes to develop, whilst precipitation leads to stagnant water which allows the mosquitoes to flourish. Mountain ranges - main barrier - (relief associated with drop in temps), deserts (too dry) and areas where the heat is too intense and actually inhibits mosquito breeding (climate change) are the barriers to diffusion of malaria>

Answer 58

Anapholes mosquitoes lay their eggs in water, these hatch into larvae which then emerge as adult mosquitoes, the female mosquitoes seek a blood meal to nurture their eggs. Each species of mosquito have their own preferred aquatic habitat. Transmission is more intense in places where the mosquito lifespan is longer (parasite can complete development within mosquito) and where it prefers to bite humans rather than other animals. The long lifespan and strong human-biting habit of the African vector species is the main reason why nearly 90% of the world's malaria cases are in Africa. Transmission also depends on climatic conditions that may affect the number and survival of mosquitoes, such as rainfall patters, temperature and humidity. In many places, tranmission is seasonal, whith the peak during and just after the rainy season. Malaria epidemics can occur when climate and other conditions suddenly favour transmission in areas where people have little to no immunity, or migration of low immunity people to high transmission areas. Partial immunity is developed over years of exposure, and while it never provides complete protection, it reduces risk that the infection will cause severe disease, for this reason most malaria deaths in Africa occur in young children, whereas in area with less transmission and low immunity, everyone is at risk.

Answer 59

Vector control - insecticide-treated mosquito nets, indoor residual spraying, antimalarial drugs to prevent infection Early diagnosis and treatment after infection (usually through artemisinin-based combination therapy) Surveillance Problems: resistance to insecticides resistance to anti-malarial drugs

Answer 60

Increased global mobility diminishes the importance of: physical barriers 'friction of distance' of disease expansion diffustion (instead relocation and hierarchal diffusion predominate) Increased global mobility will lead to: increased rate of disease spread more extensive spatial patterns of disease spread Globalisation: increased travel and trade at a global scale, this leads to a growth of global networks and flows based around: increased size and number of airports and aircraft to handle increased intensity of global air travel increased car ownership - impacts more on local and regional scales increased number of railways development of high-speed trains and cross-border railways greater shipping intensity due to continerisation and increased scale of international scale -these make disease diffusion more likely

Answer 61

Easier to access/record health data from remote areas which can help to target interventions in areas at greatest risk or deliver mitigation strategies in a more effective manner. Easier to raise awareness. Easier to transport medical supplies/equiptment/staff and clean water around the world (even to remote areas). Refridgerated containers and aircraft storage means medicines/vaccines can travel further than ever before. Global collarboration helps us to work together to contain and repond more effectively. Need to implement politically 'difficult' reponses (travel restrictions, quarentines). Disease is less contained and faster spreading than ever, therefore it is becoming more difficult to contain within more localised boundaries. Response has to keep up with faster rate and greater spatial extent of disease diffusion.

Answer 62

Rate of spread: influenza spreads easily through coughing and sneezing and is highly infectious Method of spreading: diffused through relocation and hierarchal from country to country, but on a local scale expansion and contagious diffusion Patterns of outbreak distribution: The outbreak started in Veracurz, Mexico, the virus was similar to the Spanish flu pandemic in 1918, it quickly spread to other parts of Mexico and North America. Most of Africa and parts of Asia had no cases confirming hierarchal diffusion. The disease followed hierarchal diffusion because North America, Australia and the UK had a high incidence of cases - they are developed, globalised countries with more transport links allowing for relocation diffusion, on a smaller scale contagious and expansion diffusion will have occurred.

Answer 63

An agency with funding that comes from multiple governments or an institution representing a group of countries

Answer 64

Governemental agencies in a single country which provides aid to developing countries (USAID)

Answer 65

A non-profit organisation that operates independently of any government, typically one whose purpose is to address a social or political issue

Answer 66

World Health Organisation (WHO) - the directing and coordinating authority on international health within the UN system World Bank United Nations Children's Fund (UNISEF) United Nations Development Programme (UNDP)

Answer 67

United States Agency for International Development (USAID) United States Public Health Service (USPHS) Centre for Disease Control and Prevention (CDC)

Answer 68

Red Crescent Movement International Red Cross Medecins Sans Frontieres

Answer 69

Gathers health data - from 194 member states and publishes them annually in the World Health Statistics, which is avaliable to each country to provide an insight to health risks, mortality from communicable diseases and non-communicable diseases, government spending on healthcare. Provides leadership and identifies priority areas in matters critical to health - takes a leading role for epidemics and outbreaks of new diseases and develops gobla strategies to combat diseases such as malaria, HIV and tuberculosis. Researches health problems - research groups dedicated to influenza, tropical diseases, mental health and vaccines, these are often in partnership with other international agencies. Monitors the international health situation Supports UN member states to devise health strategies - an important part such as during the 2015 Nepal earthquake, delivered mobile medical units as emergency health services. Provides technical support during health crises Sets targets - to improve prevention, diagnosis, treatment and care, promoting research into new drugs and insecticides is also as important as predicting the spread of disease.

Answer 70

Increased distance means disease is less likely to spread via contagious or expansion diffusion, if a place is remote and therefore not well connected, it is less likely to be infected by relocation or hierarchal diffusion therefore mitigation strategies may be less necessary in the first place. Equally, if the origin of the disease is in a remote region, it is less likely to spread outwards and can usually be contained more easily. However, there will be delayed arrival of medical assistance and emergency aid. Isolation can lead to a lack of immunity, meaning that when a disease does reach a remote region the effects can be more severe. Health data from remote areas is less well recorded and harder to access, this means that targeting interventions in areas at greatest risk or deliver mitigation strategies in effective manners are not tailored exactly to a region. Awareness is likely to be reduced due to the diminished effect of global connections. Education initiatives are less likely to reach remote communities.

Answer 71

Can isolate communities and restrict population movements, meaning diseases are less likely to spread to areas with extreme relief, therefore mitigation strategies may not be necessary. Some diseases are not a risk at high altitudes. However, there will be delayed arrival of medical assistance and emergency aid. Isolation can lead to a lack of immunity, meaning that when a disease does reach a remote region the effects can be more severe. Health data from remote areas is less well recorded and harder to access, this means that targeting interventions in areas at greatest risk or deliver mitigation strategies in effective manners are not tailored exactly to a region. Awareness is likely to be reduced due to the diminished effect of global connections. Education initiatives are less likely to reach remote communities.

Answer 72

Can isolate communities and restrict population movements, meaning diseases are less likely to spread to areas with extreme relief, therefore mitigation strategies may not be necessary. Some diseases are not a risk at high altitudes. However, there will be delayed arrival of medical assistance and emergency aid. Isolation can lead to a lack of immunity, meaning that when a disease does reach a remote region the effects can be more severe. Health data from remote areas is less well recorded and harder to access, this means that targeting interventions in areas at greatest risk or deliver mitigation strategies in effective manners are not tailored exactly to a region. Awareness is likely to be reduced due to the diminished effect of global connections. Education initiatives are less likely to reach remote communities.

Answer 73

Aid workers may already be in the area to deal with the aftermath of a natural hazard (Haiti, earthquake and cholera outbreak). Hazard response teams can lead to improved disease awareness for the future and also can lead to infastructure improvements which may help to combat diseases in the first place. However, natural hazards can have isolating effects on communities (cutting off road access, damaging power lines - communication, gas pipes, sewage and water pipes), as well as hampering relief efforts, all of these things can lead to heightened risk of diseases (particularly water-borne diseases) spreading in the aftermath of a hazard event. Also, financial resources aimed at dealing with hazards can mean resources are diverted away from disease mitigation.

Answer 74

Until the mid-twentieth century the vast rainforest of the Amazon Basin isolated hundreds of indigenous Indian tribes from the outside world, for many this isolation was a disater. With little or no immunity to common 'western' diseases (influenza, measles, chickenpox) early contact with cattle ranchers, oil explorers and loggers often proved fatal. In Peru, half of the Nahua tribe, contacted for the first time in teh early 1980s, was wiped out by disease following an exploration on their land. A similar tragedy happed to the neighbouring Murunahua traibe, contacted for the first time in the mid 1990s by illegal mahogany loggers

Answer 75

Outbreaks of water-borne diseases resulting from poor hygiene and contamination of water supplies, often accompanies natural disaters such as floods and earthquakes. In remote and isolated regions that are particularly difficult to acces, disease can quickly get out of hand and assume epidemic proportions. After the 2005 Pakistan earthquake and 2015 Nepal earthquake, medical teams and emergency aid struggled to reach the remote regions. In Nepal, many isolated villages were cut off by landslides, meaning epidemics took hold before medical help could arriver.

Answer 76

Remoteness can protect the wider population from disease risks. The Ebola virus first appeared in equatorial Africa in the 1970s, the communities affected were so isolated in the Congo rainforest that the disease was contained. In 1996, hunters in a remote part of Gabon fell ill with Ebola after they ate a dead chimpanzee infected with the virus. Of the 31 cases, 23 people died from the disease, including some of the hunters' family members. Ebola did not spread beyond the tribe itself. In 2014, Ebola struck a less remote region of Africa and the number of infectioins and deaths were considerably higher. In 2018, there was another Ebola outbreaks, this time in DRC, this spread rapidly killing well over 500 people.

Answer 77

Many modern medicines originate from natural compounds found in wild plants. Long ago, the Greek physician, Hippocrates, recorded more than 300 medicinal plants and herbs, which were classified accoring to physiological action. Before the advent of scientific medicine, the healing qualities of many plants were so well known that their common name reflected this (woundwort, bladderwort, lungwort and liverwort). Now, scientists have been able to identify the active constituents in tehse plants and sythesise tham in the lab. The first naturally derived medicine isolated from a plant was morphine. They are used as analgesics to reduce pain. Other alkaloids (quinine) were extracted from wild plants, and towards the end to the century, glycosides were discovered.

Answer 78

Bark of white willow and other willow species. Widespread on riverbanks, floodplains and wetland throughout the temperate zone. Thrives on a range of soils, from light sands to heavy clay with a soil pH from 5.5 to 8.0. Acts like aspirin, used for pain relief, gout, osteoarthritis.

Answer 79

Tea, coffee, coca and other plants. Trpoical and sub-tropical conditions with temperatures averaging 20-27C with abundant rainfall (1000-2000mm/yr). Soils which are well drained, with good orgainic content and nitrogen. Stimulant for central nervous system, heart, muscles, migraine, epidural, anaesthesia.

Answer 80

Dried bark of cinchonas evergreen tree. Average temperatures above 20C, humid conditions with annual rainfall in excess of 2000mm over at least 8 months. No frost, well drained, fertile soils with abundant organic matter and good moistrue holding capacity. Malaria, kills the parasites in red blood cells.

Answer 81

Autumn crocus. Moist, temperate climate conditions. Deep, well drained soils with slightly acidic pH (c6.5) and good mositure retention. Cancer and gout.

Answer 82

Tobacco plant. Optimal mean daily temperatures 20-30C. Rainfall 600-800mm, with 20-30mm every two weeks in the growing season and frost free conditions, Light to medicu textured soils with good drainage. The main active ingredient in new drugs to treat wounds, Alzheimer's, depression.

Answer 83

Dried latex from seed pods of several species of opium poppy. Warm, humid conditions. Clear sunny days with temperatures 30-38C. Susceptible to frost and wet weather. Deep, clay loam, well drained soils rich in humus. Soil pH 6-7.5. Pain reliever.

Answer 84

Artemesia annua plant leaves. Temperate climape, optimal temperatures 13-29C, frost tolerant. At least 600-650mm rainfall. Soils light to medium textured, well drained and fertile with a soil pH between 6-8. Anti-malaria agent.

Answer 85

Temperate climatic conditions, tolerates high rainfall, cool summers and acidic soils. Dropsy, heart failure.

Answer 86

The rosy periwinkle is a small evergreen shrub which is native to Madagascar, although it is now common in many tropican and sub-tropical regions. The plant requires a warm tropical climate without frost and where soils are well drained but mositure retaining and slightly acidic. The rosy periwinkle's use in traditional medicines is long established, from the treatment of wasp stings in India, to diabetes in China and the Philipines, it is also a popular ornamental garden plant. However, the plant came to the attention of scientists in the late 1960's when analysis revealed it contained 70 alkaloids, several of which have significant medicinal value. Vincristine is successfully used in chemotherapy in childhood leukaemia and has helped increase survival rates from 10% in 1970 to 90% in 2012. Vinblastine has also proved highly effective in treating Hodgekin's lymphoma. Currently scientists have been unable to synthesise these alkaloids and production of the drugs relies on commercial cultivation of the rosy periwinkle, mainly in India, central Asia and Madagascar. Global sales of vincristine and vinblastine are worth hundreds of millions of dollars annually to Eli Lilly, the US pharmaceutical giant that developed them. However, few of the profits are channelled back to Madagascar and its indigenous rainforest people, this is an exploitation of biological resources. It deprives LIDCs like Madagascar of valuable international trade, potential exports and value added. Biopiracy inders economic growth and progress in tackling poverty and inequality.

Answer 87

The exploitation of biological resources, this is unsustainable because it deprives LIDCs of valuable international trade and potential exports. It hinders economic growth and progress in tackling poverty.

Answer 88

Medicinal plants are mainly sourced from wild populations; only a small number of medicincal species, like the rosy periwinkle are cultivated. Medicinal plants supply the raw material for pharmaceutical medicines, though the majority of drugs are made from synthesised products. In contrast, most products used in traditional medicine are harvested from wild plants - 80% of the developing world (5billion) rely on traditional medicines so demand is high. As a consequence, the most sought after species collected and delivered to market are under enormous pressure. Market demand has led to an increased pressure on the natural resources that lend to the production of some of these plants. The most serious proximate threats when extracting medicinal plants generally are habitat loss, habitat degradation, and over harvesting. Additional reasons for decline of wild medicinal plants are the preference of Traditional Chinese Medicine for wild plants rather than cultivates, and the preference for roots rather than leaves, flowers and seeds, this is less sustainable.

Answer 89

Increasingly, the sourcing of wild medicinal plants for traditional Chinese medicine is unsustainable, it reduced plant populations and their genetic diversity, endangering their survival. Slow growing plants, and those occupying highly specialised niches - associated with climate, relief or soil properties, are particularly vulnerable. At least 4000 species are threatened and 14 acutely endangered.

Answer 90

Yew tree - cancer drug paclitaxel is derived from the bark, but it takes six trees to create a single does so growers are struggling to keep up. Hoodia - plant has sparked interest for its ability to suppress appetite, but vast quantities have alreagu been 'ripped from the wild' as the search for the miracle weight drug continues. Magnolia - has been used in traditional Chinese medicine for 5, 000 years as it is believed to help fight cancer, dementia and heart disease. Half the world's species threatened, mostly due to deforestation. Autumn crocus - Romans and Greeks used it as poison, but now one of the most effective treatments for gout.

Answer 91

Its not just collecting that threates medicinal plants, habitat destruction, in particular deforestation in the tropics, is of even greater concern. Tropical rainforests are extraordinarily biodiverse, containing 70% of terrestrial plant species, and yet no more than 1% have been screened for potential medical use. Thus, on medical grounds alone, there are powerful reasons to conserve the rainforest and protect its genetic diverstiy. Deforestation rates averaging 325km/day, may species have become extinct before scientists have a chance to investigate or even discover them. In the past, pharmaceutical companies exploited rainforest ecosystems, targeting medicinal plants for cultivation and synthesising chemical compounds, however, benefints for the local people have been negligible. To many, this is seen as a type of theft also known as biopiracy.

Answer 92

One response is to use the medicinal plants as a means of conserving not only habitats, but entire ecosystems. In the 1980's scientists identifies and extracted prostialin, a powerful new drug for treating HIV, found in the bark of the Samoan mamala tree in teh Samoan rainforest. Parts of the revenues from sales of the drug are returned to Samoa as compensation for protecting the rainforest and to assist economic development in forest communities. The National Cancer Institute in the USA and the Swedish International Development Authority also provides funds for economic development and forest protection in Samoa. Thus, the local people benefit directly from forest conservation, a sustainable supply of valuable medicinal plants is assured, and ecosystems flourish an dprovid a range of free ecological services at both local and global scales. As a result, Samoa's national park was established to encourage local healers to use medicinal plants in a sustainable way, in order to pass their knowledge on to the next generation.

Answer 93

Global campaigns to eradicate major human diseases have had limited success. A notable exception was the worldwide eradication of Smallpox in 1979. Currently WHO and other agencies are working to eradicate Poliomyelitis (polio), Malaria and Dracunculiasis (guinea worm)

Answer 94

A highly infectious viral disease, which mainly affects young children, the virus is transmitted person-to-person and is spread mainly through the faecal-oral route or, less frequently, by a common vehicle (contaiminated water/food) and multiplies in the intestine, from where it can invade the nervous system and can cause paralysis. Initial symptoms include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. 1 in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5-10% die when their breathing muscles become immobilised, while there is no cure for polio it can be prevented by vaccination. Prior to the development of a vaccine in 1952, polio killed or paralysed 600, 000 people a year.

Answer 95

The successful eradication of smallpox in 1980 spurred the creation of the Global Polio Eadication Initiative in 1988 supported by national governments, WHO, Rotary International, the US Centres for Disease Control and Prevention, UNICEF, and later joined by key partners including the Bill and Melina Gates Foundation and Gavi, the Vaccine Alliance. Overall, since GPEI was launched, the number of cases has falled by over 99%, from an estimated 350, 000 cases then, to 33 reported cases in 2018. Of the three strains of wild poliovirus, wild poliovirus type 2 was eradicated in 1999 and no case of wild poliovirus type 3 has been found since the last reported case in Nigeria in November 2012. In 1994, the Americas were certified polio free, followed by the Western Pacific Region in 2000 and the European Region in June 2002. On March 2014, the South-East Asia Region was certified polio fee, meaning that transmission of wild poliovirus has been interrupted in this bloc of 11 countries stretching from Indonesia to Inda. This achievement marks a significant leap forward in global eradication, with 80% of the world's population now living in certified polio free regions. However, as long as a single child remains infected, children all over the world are at risk of contracting polio. Failure to eradicate polio from these last remaining strongholds could resuly in as many as 300, 000 new cases every year, withing 10 years, all over the world.

Answer 96

War, poverty, religious beliefs, remoteness/isolation, insurgencies, environmental conditions, sanitation/living conditions. Rainy season helps the spread which hinders eradication.

Answer 97

Within Afghanistan, Pakistan and Nigeria, uptake of the vaccination to provide immunity for children remains uneven. Political instability and more than 80 murders of health workers in Pakistan and Nigeria in recent years by military extremists has interrupted vaccination programmes, this is a major setback for the GPEI. In addition, since 2013, new outbreaks of polio have re-emerged in war torn Iraq and Syria, where vaccinations and basic hygiene has broken down. In the past, resistance to vaccination programmes, related to political and cultural factors as well as ignorance, provided unexpected challenges, especially in Pakistan and Nigeria.

Answer 98

Poverty/lack of basic health infastructure - which limits vaccine distribution and delivery (especially when multiple doses are needed) - funding management and community perceptions of vaccine safety, insecurity of human resources, mutations of virus. War - civil ear and internal strife creates a disruption to delivery of vaccine and to sanitation - political pressures and corruption. Cultural barriers - the sometimes oppositional stance that marginalised communities take against what is percieved as a potentially hostile intervention by outsiders - USA sterilistation of Muslim populations using intentionally contaminated vaccines after Afghanistan invasion and Iraq, suspicion of modern biomedicine, colonialism and the projection of the power of western nations, refusing vaccines as resistance to western expansionism, suspicions that vaccine contained contraceptives, exacerbated by the CIA's fake hepatits B immunisation to collect blood samples from Osama bin Laden's Abbottabad compound in order to confirm the genetic identity of the children and his own presence leading to his killing. Climate - maintaining the potency of live vaccines in extremely hot or rmote areas - the oral poliovaccine must be kept at 2-8C for vaccination to be successful.

Answer 99

Caseload: Polio cases have decreased by over 99% since 1988, 350, 000 cases in more than 125 endemic countires to 74 reported cases in 2015. Of the three strains, type 2 was eradicated in 1999, type 3 cases are down to the lowest levels ever, no reported cases since Nigeria in November 2012. Innovation and research: The Polio Research Committee reviews polio eradication research, identifies knowledge gaps, determines research priorities and funding levels; the overall strategy. The PRC is comprised of global experts from a variety of disciplines, including virology, epidemiology, sociology and public health. The Polio Pipeline annual publication provides ongoing research by the GPEI. Developing affordable inactivated polio vaccine and preparing for stopping routine use of OPV by developing affordable options for IVP use. Global Polio Eradication Initiative: Renewed international determination to finish polio eradication - WHO adoption of resolution 59.1, outlined procedures for reporting and addressing polio cases, inclusion of polio in the Internation Health Regulations; requirements issue by the kingdom of Saudi Arabia for pilgrims attending Haj to be vaccinated against polio with OPV. Assists countries in carrying out surveillance for polio and large scale vaccination rounds. Refined laboratory procedures allowed the confirmation of poliovirus 50% faster than before. New tools such as monovalent vaccines (mOPV) were developed which significantly reduced transmission of type 1. In 2009 the Global Polio Eradication Initiative now has an amoury of five different vaccines to stop polio transmission. World Polio Day was established by UNICEF partner Rotary International. Polio Eradication and Endgame Startegic Plan 2013-2018: is the first plan to eradicate all the types of polio disease simultaneously. Launch improved immunisation campaigns. Oral polio vaccines (OPV) will be phased out an inactivated polio vaccines (IVP) will be gradually introduced. Polio-free countries must adress gaps in surveillance to detect suspected polio cases. Accessing the most marginalised and hard-to-reach communities, sharing heath expertise.

Answer 100

Projects that are planned and controlled by local communities, perhaps with the help of NGOs to help their local area, they are smaller scale and not as expensive.

Answer 101

Usually large scale and very expensive involving governments and/or large external organisations, llocal people who will be affected by the scheme have little say in the process and have little influence in the project.

Answer 102

In Ghana in West Africa, the Guinea Worm eradication strategy has partnered with the Ghana Red Cross Women's CLubs to reduce transmission. This innovative programme involve teaching women volunteers how the Guinea Worm is transmitted and how transmission can be prevented. The volunteers then visit local villages and educate local communities.

Answer 103

Entering the body - a person drinks water containing tiny eater fleas that are infected with guinea larvae. Multiplying - the fleas are digested, releasing the larvae into abdominal tissues, where they mate. Growing - female wormd, growing up to 1m long, move through the body mostly to lower limbs. Leaving the body - about a year later, the worm emerges from the blister it creates, the victim in pain rushes to cool the limb in water. Infesting the water - on contact with water, the worm releases clouds of larvae. Infecting the water fleas - water flease consume the worm larvae, whcih resist digestion.

Answer 104

Monitoring, identifying and reporting all new cases of Guinea worm. Ensuing that those infected did not contaminate water sources. Distributing, checking and replacing water filters that remove water fleas (the vectors) from drinking water. Identifying water sources used by the community and requiring treatment with larvicides

Answer 105

This was because men frequently work outside villages and it is mainly women who are responsible for sourcing water and its use for household consumption. Women were able to appreciate the value of filtering drinking water and avoiding contamination of water sourced by people already infected by the parasite.

Answer 106

Highly successful, and the Guinea worm has been eradicated from Ghana. WHO reported that in 1989 there were more than 179, 000 cases, but by 2010 the country reported its last indigenous case of the disease.

Answer 107

In the 1980s, the parasitic infection was widespread in 20 countries, 16 of which were in Africa, with more than 3.5 million people infected. The annual incidence globally has decreased from 892, 640 in 1989 to 542 cases in 2012. Since 1995, WHO has certified 12 countries in the African risk belt as countries free of Guinea worm transmission. Guinea worm remains endemic in 4 countries; Chad, Ethiopia, Mali and South Sudan. Ethiopia has reported 3 cases and South Sudan 5 although Mali has reported zero human cases since the beginning of 2016. Therefore, it is not likely that Ghana will remain free as long as there are other countries in the area with some cases still which may transfer over borders this is as a result of poor water infastructure and high population movement across the region.

Answer 108

Diagnosis is easy and unambiguous, relying on visual recognistion of the emerging worm. The intermediate host is not airborne but restricted to stagnant water bodies. Control interventions are simple and cost effective. The disease has limited geographical distribution and transmission is seasonal. There is no known animal reservoir.

Answer 109

Detecting all cases within 24 hours of worms emergence. Providing new safe drinking water sources. Converting unsafe sources into safe water sources. Constructing copings/installing boreholes with handpumps to reduce water contact. Ensuring regular and systematic filtering of drinking-water collected from shallow unprotected wells. Treating unsafe water sources with temephos to kill the Cyclops. Advocating healthy drinking-eater behaviours in communities through health education.

Answer 110

Reporting on a regular basis, evein if there are zero cases. Managing the certification process for global eradication country by country. Consolidating advocacy for eradication of the disease. Maintaining global and national Dracunculiasis databases to monitor the epidemiological situation.

Answer 111

Wound is cleaned and bandaged regularly until the worm has been completely expelled. A volunteer from among the communitiy trained in basic dracunculiasis surveillance and management. Community members are educated regarding prevention and containment, they are encouraged to filter drinking water regularly.