Disease Dilemmas Case Studies Flashcards
Bangladesh- flooding
0.36 doctors per 1000 people
13.1% has no access to clean water
Low lying country, affected by sea level rise (Large Delta).
2007- Heavy monsoon rainfall caused 60% of the country to become inundated, due to the convergence of the Ganges, Brahmaputra and Meghna. Waterborne diseases account for a quarter of all deaths in Bangladesh.
The 2007 flood triggered severe epidemics of diarrhoea and other water-borne diseases such as cholera and typhoid as 1 in 8 wells became contaminated by bacteria in flood water. The stagnant water and warm temperatures also led to the spread of malaria.
100,000 hospital admissions, Bangladesh government and NGO’s provided emergency relief, like food aid and water purification tablets. UNICEF provided drugs and saline solution. 68,862 affected by diarrhoea.
India - Air pollution
99% of India’s 1.2 billion people breathe in polluted air. Pollution is from NO2 and SO2 particles from a developing nation, from cars, coal burning and factories.
Particulate matter smaller than 2.5 micrometres cause serious respiratory problems, and lung cancer. WHO’s safe guidelines for PM 2.5 are levels at 10micrograms/m3. However in the height of winter in Delhi levels can reach 600. Recent years increase in lung and bladder cancer, 20% increase past 10 years.
In Bihar state, the chimney’s of brick- kilns have been retro-fitted to reduce smoke emissions. 14 Indian cities are currently building rapid transit metro systems. Subsidies for petrol and diesel have been scrapped. Restrictions will be placed on the burning of stubble in fields.
World Cancer Day, 37 countries and EU states agreed to cut emissions by 18% by 2020. The EU has the world largest carbon cap and trade system, and each state has renewable energy targets.
Ethiopia- Malaria
Malaria is endemic to 75% of Ethiopia land area. Kills around 70,000 a year. Malaria present in lowlands, no malaria in highlands, as no mosquitos, the bugs thrive on warm, humid climates. Population movement, urbanisation, irrigation schemes and misuse of malarial drugs has led to the spread of the disease. 5 million episodes of malaria a year. Lost production is estimated to be $12 billion a year. Malaria absorbs 40% of national health expenditure and has an effect on food security.
President’s Malaria Initiative and Global Health Initiative. Ethiopia receives grants of $20-43 million a year. 2011 there was a 5-year plan for malaria prevention and control. Involving direct action, like the spraying of dwellings and destroying breeding sites. Mass publicity campaigns and providing early diagnosis. Death rates from malaria halved 2000-2010. Amhara rates fell from 4.6% to 0.8%.
UK - Cardiovascular disease
Having an unhealthy diet and little exercise can increase chances of CVD. Premature death rate from CVD is 127 per 100,000 in Glasgow whereas in Hart, Hampshire 36 per 100,000. Kills 1 in 4 people, 7 million suffer from CVD in the UK. Deprivation links to CVD. Health expenditure in the UK was 5.92 billion in 2013/14.
Government strategies direct- medicines, operations, heart transplants. Indirect - Smoking bans in 2007 in public spaces, NHS ‘5 a day’ campaign, traffic light food labelling system. International Organisations carry out research on CVD and the World Heart Federation are responsible for promoting education and awareness campaigns. ‘World Heart Day’.
2012 CVD went from being the main cause of death to the second cause of death. Rates of smoking have decreased from 29% (2005) to 21% (2011).
CVD still a massive burden on the health system, 62.9% of UK adults are overweight or obese (2015). 300 million prescriptions for CVD in 2013.
H1N1 pandemic
The disease started in Mexico, similar to the Spanish flu, H1N1 quickly spread into other parts of Mexico and North America. The disease spread to 74 other countries. Highly infectious spread through coughing and sneezing. Average number of deaths was approximately 284,500.
The disease spread rapidly due to aeroplanes and the rapid movement of people.
British Red Cross in Haiti -2010
Haiti was hit by a magnitude 7 earthquake killing 220,000 people and made 1.3 million homeless. 60% survive on less than $2.5/ day. Given the unsanitary conditions, drinking water contaminated, cholera easily spread 720,000 case and 8,700 deaths. British Red Cross was responsible for delivering clean drinking water to 300,000 people in Port Au Prince. Massive hygiene programme, 1300 latrines serving 250,000 people. Treating 18,700 cases of cholera. Raising awareness and education of Haitians. 2011 35,000 new cases a month. 2014 2,200 cases a month.
HIV - Botswana
Over 350,000 living with HIV, 22% of adults suffer from HIV. 3,200 AID’s related deaths in 2015.
Mitigation strategies- increase in sufferers taking antiretroviral drugs and continue to live a healthy and active life. The drugs are not cheap but Botswana has a strong economy. Public education programmes. Condom distribution and education. Improving blood safety.
Example of an international agency AVERT.
Challenges which stand in the way of successful mitigation of HIV/AIDS: Level of development, availability of funding, influence and ability of government, reliance on aid, cultural barriers, poor education, access to prevention and treatment.
Medicinal Drug- Rosy Periwinkle
Native to Madagascar, used for treatment of wasp stings in India, to diabetes in China and the Phillipines. However the plant contains two alkaloids, which can be used in the treatment of cancer. Vincristine is successfully used in chemotherapy in leukaemia and has increased survival rates from 10% to 90%. Viblastine has been effective in treating Hodgkin’s Lymphoba. Global sales of those drugs are worth hundreds of millions, however few of these profits are channelled back to Madagascar. This is called biopiracy, this hinders economic growth.
GlaxoSmithKline
Major Pharmaceutical company in the UK, 2013 turnover of £23 billion. Operations are global, 84 manufacturing sites in 36 different countries. In 2014 it distributed 800 million doses of vaccines. GSK has large research and development into new drugs, spending £3 billion a year, they are currently researching HIV, malaria and TB.
The problem that GSK has is that LIDC’s require the drugs the most but don’t have enough money to buy the drugs. So GSK has had to make drugs cheaper in the developing world but more expensive for the AC’s.
Policies adopted- a commitment to a small return- 5% on each product sold. Providing 3 HIV/ AIDS drugs to LIDC’s at a discount. Granting licences for the manufacture of cheap generic versions of the drugs.
Grass-root strategy - Ghana
In Ghana, West Africa Guinea worm eradication programme has partnered the Ghana Red Cross women’s club, educating the women of Ghana to prevent the transmission of Guinea worm. The responsibilities were to report new cases, ensuring those infected did not contaminate the water sources. Distributing water filters, identifying water sources used by the community. WHO reported that in 1989 there were more than 179,000 cases. By 2010 there was the last reported case.
