Population and the enviroment - Environment, health and well-being

Question 1

What is morbidity

Answer 1

illness or poor health of a population

Question 2

what is mortality

Answer 2

death

Question 3

what are communicable diseases

Answer 3

condition that is passed from person to person

Question 4

what is health

Answer 4

physical mental and social well-being

Question 5

what is disability adjusted life years DALYs

Answer 5

one lost year of ‘hralthy’ life

Question 6

what is a pandemic

Answer 6

rapid spread of an infectious disease in a short period of time causing it to become widespread withing a country, multiple countries, continents

Question 7

what is a non communicable disease

Answer 7

medical condition that is non infectious and non transmissible among people

Question 8

what is an endemic

Answer 8

constant presence of dieases withing a given area

Question 9

what is an epidemic

Answer 9

rapid spread of an infectious disease in a short period of time becoming widespread withing an area or population/country

Question 10

what are deaths cause by in a LIC

Answer 10

8/10 communicable
2/10 non communicable

Question 11

what are deaths caused by in a HIC

Answer 11

2/10 communicable
8/10 non communicable

Question 12

as socities and nations develop what should happen to the social and economic conditions

Answer 12

should improve
improvements in health and healthcare
increases in food productivity and supply and transport infrastructure - population will be fed more reliable + les prone to famine and diseases related to malnutrition
developments in sanitation and public hygiene - reduce chances of water borne infections
advances in medical technology and vaccination programs - reduce risk of infectious diseases

Question 13

what economic developments are linked with improved health

Answer 13

technology to improve food productivity and supply
improved transport infrastructure to distribute food and medical supplies
investment in drainage and sewage systems
trading of resources and manufactured goods in exchange for food and medicine

Question 14

what social developments are linked with improving health

Answer 14

improved sanitation
better education about sanitation and disease transmissions
advances in medical technology - antibiotics, vaccines
better training for doctors, nurses and midwives
aid programs from UN or NGO to improve healthcare and resources

Question 15

what does socio-economic development cause

Answer 15

sudden and stark increase in population growth rates
life expectancy increases
death rates decrease
fertility remains high as big families due to high infant mortality
healthcare development eventually reduce infant mortality rates - have fewer children - decline in fertility rates
improved access to contraception

Question 16

What is the epidemiological transition model

Answer 16

process of socio-economic development accounts for a transition over time
from the most important causes of death going from infectious diseases to chronic and degenerative diseases
transition occurs as country undergoes modernisation
developing nation to developed nation status

Question 17

hat are the four phases of the transition model

Answer 17

age of pestilence and famine
age of receding pandemics
age of degenerative and man made diseases
age of delayed degenerative diseases

Question 18

what is the age of pestilence and famine

Answer 18

mortality is high and fluctuates
prevents sustained population growth
low and variable life expectancy between 20-40 years
wars, famine and epidemic outbreaks interspersed with periods of relative prosperity
poor sanitation and hygiene
unreliable food supply

Question 19

what is the age of receding pandemics

Answer 19

rate of mortality declines
disease epidemics occur less frequently
average life expectancy increases 30-50
population growth is sustained and begins to rise
advances in medicine, development of healthcare
improved sanitation
better diet

Question 20

what is the age of degenerative and man made diseases

Answer 20

mortality continues to decline and becomes stable
infectious disease pandemics are replaced as major causes of deaths by non communicable diseases
life expectancy 50-60
fertility more contributory factor to population growth
reduced risk behaviors in the population
heath promotion and new treatments

Question 21

what is the age of delayed degenerative diseases

Answer 21

declining death rates
life expectancy 70-80
causes of mortality remain the same but are delayed until an older age
new treatments, prevention, health promotion increased occurrence of strokes and heart disease

Question 22

what are the three types of models

Answer 22

classical/western model - slow decline in death rates followed by lower fertility
accelerated model - rapid transitions; falls in mortality take place over shorter periods of time
contemporary/delayed model - recent decreases on mortality not accompanied by a decline in fertility because of infant and maternal mortality remain high

Question 23

what are the three sets of factors that encourage reduced fertility rates

Answer 23

bio-physical factors - reduced infant mortality, expectation of longer life in parents
socio-economic factors - childhood survival, economic perceptions of larger family size
psychological or emotional factors - society changes opinion on family size

Question 24

what evidence is their to support the epidemiological transition model

Answer 24

USA - clear shift in major causes of death between 1990 and 2010 - 1990 - 202.2/1000 deaths infuenza 2010 - 16.2
1990 - heart disease 105.9/1000 deaths 2010 - 192.9/1000 deaths
differences in causes of death by rank between LICs and HICs - LICs - lower respiratory infections 91/10,000 deaths HICs - lower respiratory infections 31/10,000 deaths

Question 25

what are the links between climate and health

Answer 25

Links between natural environment and disease
Drought leads to crop, reduction in food consumption and the potential for famine
Extreme flooding cause by heavy rains or tropical storms can lead to waterborne diseases and respiratory infections
Seasonal affective disorder - type of depression that has a seasonal pattern which episodes tend to occur at the same time each year, usually during winter linking to reduced exposure to sunlight during the shorter days of the year - In NYC 4.3% of population have SAD
Everyday illnesses also linked to natural environment e.g. hay fever, asthma
In uk large scale seasonality of mortality has declined possibly due to increase use of heating
Air quality increased - number of people affected by respiratory problems in cities declined
Small scale aspects of environment have impact on morbidity e.g. relationship between soft water and high levels of heart disease

Question 26

what are the links between topography, drainage and health

Answer 26

LIC’s of asia high density of people occupy flood plains of major rivers (e.g. Ganges)
Attracted by flat land and seasonal flooding - enables growth of rice
Unplanned flooding accounts for 40% of all natural disasters worldwide and causes half of all deaths from natural disasters
Most floods occur in LICs and tropical regions
Flood consequences
impact on health - respiratory infections and typhoid fever occuring after floods, contaminated freshwater supplies increase risk of waterborne diseases, creates breeding grounds for disease carrying insects e.g. mosquitoes
High death toll - drowning
Physical injuries
Damage to homes - large number of people displaced
Disrupt medical and health services
Nepal - mountains and steeps slopes
2015 earthquake caused avalanches on Mount Everest, 19 died and over 120 injured or missing
Langtang valley 329 people killed by landslide of weathered rock and soil
After earthquake hospitals destroyed or badly damaged in four worst affected districts so could not function
Landslides damaged roads and tracks
Medical personnel treated patients on ground and emergency aircraft and aid vehicles were required to transport people to health centres and hospitals further away
Natural hazards have an indirect link to disease
Haitian earthquake, 2010,
before earthquake - lack of public sewage systems, less than half people had access to drinking water, high levels of malnutrition, nearly 200,000 people living with HIV/AIDS and only half the population vaccinated against basic diseases.
after earthquake - in refugee camps, infectious disease spread quickly with UNICEF reporting that from 2010-2014 there had been nearly 700,000 cases and 8,500 deaths of cholera

Question 27

what is the link between air quality and health

Answer 27

Ambient (outdoor) air pollution - major health problem, potential to affect everyone in developed and developing countries
Air pollution is now world’s largest single environmental health risk
Cardiovascular and respiratory health affected by polluted air
linked to 3.7 millions premature deaths worldwide in 2012 - 80% due to heart disease and strokes
People living in low and middle income countries are more affected by air pollution - 88% premature deaths occurring in developing countries,
Sources of outdoor air pollution need to be controlled by authorities and policymakers e.g. cleaner transport, energy efficient housing, power generation which would reduce sources of urban outdoor air pollution.
Rural air pollution in developing areas tackled by reducing emissions from biomass energy systems, agricultural waste incineration, forest fires
Reducing air pollution levels - reduce stroke, heart disease, lung cancer, respiratory diseases
Household air pollution - Use of fuel wood for indoor cooking and heating producing harmful pollutants
Exposure to smoke increase risk of respiratory infections, lung cancer, cardiovascular diseases and cataracts
In 2012 WHO reported that 4.3 million deaths globally were attributable to household air pollution - this is 7.7% of global mortality and almost all is in low and middle income countries with women and children most at risk because they spend more time in fuelwood-burning environments

Question 28

What is the link between water quality and health

Answer 28

Two million deaths annually attributed to unsafe water and poor sanitation and hygiene
Water related diseases and morbidity
Diarrhoeal diseases e.g. cholera - caused by bacteria and chemicals in water that people drink, inadequate drinking water, sanitation and hygiene estimated to cause 842,000 diarrhoeal disease deaths per year, diarrhoea leading cause of malnutrition and second leading cause of death in children under five years, more than 50 countries still report outbreaks of cholera according to the WHO
Schistosomiasis - acute and chronic disease caused by parasitic worms which have part of their life cycle in water, people affected during exposure to infected water, estimated 260 million people suffering
Malaria - water related vectors
Cancer and tooth/skeletal damage - exposure to unsafe levels of naturally occurring arsenic and fluoride
Human sewage is one of the main pollutants of water - will drop into a water source that can then be used for drinking water, washing, watering animals
2015 - 800 million people live without access to safe water, 500,000 children die every year due to diarrhoea caused by unsafe water and poor sanitation
Water related diseases caused by methods of water resource development and management
Manage water supplies through dam construction, irrigation development and flood control lead to health impact of preventable diseases due to water pollution e.g. man-made reservoirs in sub-saharan africa create perfect conditions for malaria spreading mosquitoes to breed
Cases of malaria in high risk areas are associated with people living within the vicinity of a dam
More sustainable strategies e.g. increasing the use of wastewater in agriculture, are also associated with health risks
Diseases and health problems related to water quality are preventable and affordable
WHO claims that 4% of global disease burden could be prevented by improving water supply, sanitation and hygiene
Number of children dying from diarrhoeal diseases fallen steadily since 1990 and 2.3 billion people gained access to improved drinking water
Improve and protect drinking water quality at the community and urban level e.g. water safety plans - better education and awareness to reduce faecal contamination and disinfecting supplies with chlorine
Availability of simple and inexpensive approaches to treat and safely store water at household level e.g. boiling and covered storage
Other contaminants harm human health - oil spills contaminate land and water leading to digestive problems and diarrhoea, in niger delta region oil spills water dumping and gas flaring have damaged soil water and air quality causing hundreds of thousands of people to be affected particularly poorest and those who rely on traditional livelihoods such as finishing and agriculture

Question 29

How has air quality been linked to death

Answer 29

schoolgirl died of asthma attack linked to air pollution
lived 25m from South circular road in Lewisham
died february 2013
3 years of seizures and 27 visits to hospital for asthma attacks
expert linked death to dangerously high pollution from desil traffic that had breached legal limits
association between times she was admitted to hospital and recorded spikes in nitrogen dioxide

Question 30

what are international agencies

Answer 30

an organisation with global mandates, generally funded by contributions from national governments
Top down organisations

Question 31

what is a non-governmental organisation

Answer 31

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

Question 32

what are the positives of international agencies

Answer 32

further reach to help people
government funded - get money easily
money to use technology to do research in science

Question 33

what are the negatives of international agencies

Answer 33

more general - do not meet specific needs
lack of trust from locals (sometimes) - if social practices ignored

Question 34

what are the positives of NGOs

Answer 34

stronger relationship with community if locally run
can understand culture
able to remain independent neutral and impartial - not given money by governments so do not have to priorities certain countries

Question 35

what are the negatives of NGOs

Answer 35

difficult to raise money - 90% of MSFs income comes from individual donations
not as powerful

Question 36

What does the WHO do

Answer 36

provide exchange center for information and research
sponsor measures for the control of epidemic and endemic diseases by promoting mass campaigns e.g. vaccination programs
advising on the prevention of treatment of infectious and noncommunicable diseases
working with other UN agnecies - UNICEF - and NGOs on international health issues and crises
700 employees

Question 37

What do NGOs do

Answer 37

monitor epidemics on the ground and able to mount rapid emergency responses
alerting and responding to diseases epidemics
MSF - work with over 60 countries
- work alongside people
- 3 million donors

Question 38

How did WHO deal with smallpox

Answer 38

Over 2 million people dying yearly around 1900
1950 advances in vaccination production techniques - heat-stable, freeze-dried smallpox vaccines stored without refrigeration
Smallpox eliminated in North America - 1952, Europe - 1953
Global smallpox eradication program
1959 World Health Organisation plan to rid world of smallpox
Permanent reduction to zero cases without risk of reintroduction
Lack of funds, personnel, commitment from countries, shortage of vaccine donations
Smallpox still widespread in 1966 - regular outbreaks across South America, Africa, Asia
Intensified Eradication Program began 1967
Renewed efforts to eradicate smallpox
Laboratories in many countries where smallpox occurred regularly
Soviet Union able to produce more, higher quality freeze dried vaccine - elimination of smallpox in eastern europe, china, india
Success dues to the development of bifurcated needle, establishment of a case surveillance system, mass vaccination campaigns
Cases still occurring in South America, Asia, Africa
1970 - outbreak in south-west India, over 1300 cases and 123 deaths.
Response - all available national and international health personnel were dispatched on a week-long house-by-house search of the area, vaccinating everyone identified as a contact of a recent case.
1971 smallpox eradicated from South America
1975 smallpox eradicated from Asia
1977 smallpox eradicated from Africa
Cost of $300 million - ⅔ came from endemic countries for their own eradication efforts
British, Canadian, Cuban, French, Soviet, and US vaccines given freely to WHO and distributed onwards
Strategic financial support of sweden
May 8th 1980 world declared free of smallpox disease
Two locations store and handle virus under WHO supervision
Universal childhood immunisation programs, mass vaccination, targeted surveillance - containment strategies

Question 39

How did the WHO deal with ebola

Answer 39

Vaccines to protect against some types of ebola have been used to control the spread of ebola outbreaks
Vaccines in development
Early care with rehydration and treatment of symptoms improves survival
WHO made strong recommendations for the use of two monoclonal antibody treatments
Average fatality rate 50%, varied from 25-90% in past outbreaks - depends of circumstances and response
Good outbreak control - care of patients, infection prevention and control, disease surveillance and contact tracing, good laboratory services, safe and dignified burials, social mobilisation
Community engagement key to successfully controlling outbreaks
WHO prevents Ebola outbreaks - maintaining surveillance, supporting at risk countries to develop preparedness plans
WHO responds to an outbreak detected by supporting community engagement, disease detection, contact tracing, vaccination, case management, laboratory services, infection control, logistics, training and assistance with safe and dignified burial practices
More than 11,000 people died in the ebola pandemic
WHO criticised for not declaring the epidemic an international emergency sooner - cost of delay was enormous
WHO failed to recognise the risks of the disease in Guinea, Liberia, Sierra Leone
Volunteer doctors started to treat the cases as soon as the outbreak was officially diagnosed which was three months after the first case
A failure of WHO experts in the field to send reports to WHO headquarters in Geneva
WHO head of its Guinea office refused to help get visas for an expert Ebola team
$500,000 in aid was blocked by administrative hurdles
Unethical - burial practices e.g. cleaning the body, was ignored causing local communities and authorities to go against the WHO as they did not trust the WHO
People hiding family who were ill as they didn’t want them to be taken away when they were ill or died as they could not bury them according to their culture

Question 40

How did MSF deal with ebola

Answer 40

Went into Guinea before outbreak had been declared - March 18 2014
Next 2 weeks joined by over 60 more staff
Over 1,000 workers during first year
Opened 19 ebola treatment units in 6 countries - capacity of over 700 beds over 8,000 patients been admitted - 5,100 with confirmed ebola, 2,400 survived disease
Distributed 70,000 protection kits, 65,00 antimalarial treatments in Monrovia, Liberia
Try to contain virus - carry out health promotion campaigns within community to change community infection behaviours and interrupt disease transmissions, reinforce infection control in health care facilities to try prevent transmissions
When cases identified they decontaminate households and the immediate environment
Assist with safe burials
Find ebola cases by going to known contacts of a known case and explaining to them that it is good for them to be visited everyday so that when they fall ill they can be brought to care to protect their family and receive the best care
Some communities enforce own quarantine on people who were visited by contact tracers
enlist community support - film activity within ebola treatment units - take films out into the communities and show them what is actually going on so they can see that health care is in fact being delivered, because the rumours - accused of coming there to spread the disease, not to stop it, of drawing blood and sending it off to pharmaceutical companies to enrich Western economies, and of stealing organs and selling them on the black market - makes communities trust MSF
Ebola vaccine
6,000 people receiving vaccine all free of virus 10 days later

Question 41

what is the global prevalence and distribution of CHD

Answer 41

Asia, Russia and India had highest number of DALYs lost a year in 2012 with over 30
areas with 10-19 DALYs lost a year - majority of central Afrcia, several areas of Indonesia
lowest number of DALYs lost a year - Europe, China, Australia, USA
distribution reflects the wealth of the countries - HICs have lowest number of DALYs lost a year because they can afford better healthcare and therefore improve treatments which further increases the number of deaths
LICs much higher amount of DALYs lost per year - have lower income means better healthcare cannot be afforded so therefore number of deaths will rise
1990 - 42 million DALYs globally
2020 - 82 million DALYs globally
number of CHD cases decreasing in developed countries but they are increasing in developing countries which hugely populate the planet

Question 42

What are the causes of CHD that link to the physical environment

Answer 42

Air quality - industrialization increases exposure to airborne pollutants increasing the risk of CHD, suggests rural environments with less air pollution would have decrease risk however no clear evidence
Climate - air quality not necessarily link to CHD mortality rates however temp and sunshine do, average CHD mortality rates were higher in areas of lower average temp and hours of sunshine, may be because cold/damp winters can have negative impact on the cardiorespiratory system increasing risk of a heart attack
Relief and topography - no clear link but it is implied that areas with more challenging relief require more physical effort when walking, can increase exercise - therefore decrease risk of CHD, could also be a threat for those with other risks

Question 43

what causes of CHD link to socio-enconomic environment and impact of life style

Answer 43

lifestyle choices important risk factors - Japanese diet consume a lot of fish which reduces CHD risk but when Japanese migrants move to America they may adapt American lifestyle habits which can affect the CHD rates
social deprivation - positive correlation between deaths from circulatory diseases and deprivation e.g. those living in tower hamlets in London 3x more likely to die of CHD than those living in Kensington
tobacco use - mortality from CHD 60% higher in smokers
alcohol use - WHO estimates 2% CHD in men in due to alcohol consumption
high blood pressure - 22% heart attacks in wester Europe due to hypertension which double risk of heart attacks
high cholesterol - 45% heart attacks in western Europe due to abnormal blood lipids
poor nutrition - WHO states that poor diet of lots of fat, sodium and sugar increases CHD risk
obesity - huge risk factor, associated with high blood pressure and diabetes
diabetes - men with type 2 4x more likely to get CHD, women 3-5x
infrequent exercise - physical activity reduces rick of CHD
family history - first degree relatives of patients with premature heart attacks have doubled the risks of themselves getting CHD

Question 44

What are the impact of CHD on health and well being

Answer 44

man symptoms of CHD - angina (low level but constant chest pain which can spread to other parts of the upper body), heart attacks - permanently damage heart muscles and have potential to be fatal if not addressed immediately can lead to heart failure which can cause fluid to build up in the lungs leading to respiratory problems, those suffered from heart attacks may feel less confidence in taking part in physical exercise and may have to take medication for the rest of their lives

Question 45

what are the impact of CHD on economic well being

Answer 45

cost individual and family lots of money and time
estimated CHD cost UK healthcare system £8.7 billion and the economy £19 billion in 2009
US - accumulative cost of treatment of heart diseases in those over 65 amounted to US$76 million in 2000

Question 46

what are the management and mitigation strategies of CHD for prevention

Answer 46

public needs to be educated on the causes and effects
treatment needs to be made affordable and available and patients should be advised on healthy living practices - some dieticians promote the benefits of eating oil fish, more fruit and veg, less saturated fats in the UK while Japan there have been government health lead education campaigns and an increased treatment of high blood pressure, New Zealand - government introduced recognizable logos for health foods which have resulted in may companies reformulation their products which has therefore led to reduced salt content in processed foods

Question 47

what are the management and mitigation strategies of CHD for health education

Answer 47

schools can provide healthier diets, ban smoking and provide exercise opportunities
WHO coordinated world heart day events since 2000 on 29th sep each year - includes blood pressure testing, engaging the public health in physical activity, scientific conferences and activities to promote a heart-healthy diet and from 2015 over 120 countries take part

Question 48

what are the management and mitigation strategies of CHD for policies and legislations

Answer 48

governments can pass legislations in order to prevent/control CHD - most common being reduction in tobacco smoking which has clear links to reduce heart disease
can advertise bans, create smoke free areas put health warnings on packets and put outright bans in public areas
first smoking ban came in 1970 in singapore
UK, smoking has been banned in virtually all indoor places since July 2007
Uk 2024 - propose a new law called the Tobacco and Vapes Bill - bans selling cigarettes or any other tobacco product to anyone born on or after 1 January 2009
2023 - WHO global tobacco report said around 5.6 billion people - 71% of the world’s population - were covered by at least one smoke-free policy.