Читать книгу Contemporary Health Studies - Louise Warwick-Booth - Страница 69

In general the types of diseases that affect populations change as countries develop, so risks shift from infectious diseases such as cholera in poorer countries to non-communicable and lifestyle-associated health problems, such as cancers and heart disease, in richer countries. Indeed, the risks for non-communicable diseases are also higher for richer individuals living within poorer countries. Therefore, identifying threats ultimately depends upon the context in which the population is based.

Gaye et al. (2019) report upon an ‘epidemiological transition’ in sub-Saharan Africa, with fewer infectious diseases and a move to more non-communicable diseases. The traditional diseases of poverty, such as infectious diseases and malnutrition, are replaced by diseases of affluence, such as cancers and heart disease (Wainwright 2009a). The WHO (2009) labels this as a ‘risk transition’ caused by improvements in medical care, the ageing of the population and successful public-health interventions such as vaccinations and sanitation. Therefore, the impact of risks to health varies at different levels of socio-economic development. So, although new and infectious diseases can occur anywhere in the world, risks do indeed vary according to where people live. Put simply there are ‘hot spots’ that favour the emergence and spread of specific conditions. Evidence for this is given in table 2.1 (see next page), which describes changing patterns of disease, health and illness by comparing the UK and Botswana 1900–2009.

Data in the table utilize childhood mortality rates, which are considered to be one of the most sensitive indicators of the health of a population, as they are intrinsically related to the whole scope of determinants of health. In a comparison between England and Wales and Botswana it is evident that the industrialization and improvements in working and living conditions have impacted on life expectancy and the patterns of ill-health, although life expectancy increased proportionally more in the UK, largely due to the industrial revolution taking place prior to 1900. In Botswana gains in life expectancy were limited, mainly as a result of high childhood mortality and adult deaths related to infectious diseases, particularly HIV and AIDS, malaria and cholera.

Kaufmann (2009) identifies a number of factors that favour epidemics such as poverty, catastrophes and conflicts because people often have to live in unhygienic and crowded conditions in such situations. He argues that it has never been so easy for epidemics to spiral into pandemics because of diseases travelling across the world via the global movement of both people and animals. WHO (2020a) also notes the importance of environmental factors in relation to the development of epidemics, such as water supply, sanitation, climate and food. All of these threats combine differently according to location. Indeed, countries historically show different trends in relation to changing life expectancy because of the inter-relationship of these threats to health and other social determinants. The incorrect use of antibiotics, which leads to the development of resistant microbes, is also an issue (see the case study at the end of this chapter). Learning task 2.4 will help you to explore changing trends in life expectancy.