Читать книгу Contemporary Health Studies - Louise Warwick-Booth - Страница 71

It is not possible to consider all health risks within the scope of this chapter; therefore, in this next section we aim to give a sense of the threats drawing on the conceptual framework outlined earlier, rather than producing a definitive list of the major threats to health. More comprehensive reading about risk factors and diseases can be found in the suggestions for further reading at the end of this chapter. This section is organized into a discussion of key global threats to health starting with a description of broader threats and then moving to a focus upon more direct health issues.

Climate change Climate change is now receiving both media and political attention and is certainly a health threat, based upon the evidence that has been gathered about how potential changes in the climate might impact upon health. Table 2.2 outlines different categories of the different key impacts on health.

Table 2.2 Effects of climate change upon health

Source: adapted from Summerhayes (2010); Donkersley (2019); Haines and Ebi (2019)

Elements of climate change	Impacts of climate change	Effects on health
Extreme weather events	Increased:typhoonscyclonic eventstorrential rainsextended hot dry periods (and associated wild-fires)high windshailstorms.	Increasing burden from malnutrition, diarrhoeal, cardio-respiratory and infectious diseases. Increased morbidity and mortality from heat waves, floods and droughts. Changed distribution of some disease vectors. e.g. mosquitoes transmitting malaria. Risks from populations on the move resulting in homelessness and overcrowded conditions, associated conflicts over land and borders. Substantial burden on health services. Negative impacts upon mental health – exposure to floods and other extreme events can lead to depression and anxiety.
Water	Increased water insecurity and drought in mid and low latitudes.
Food	Food production reduced or entirely lost in some regions. Negative impacts on small holders, subsistence farmers and fishers.
Coasts	Increased damage from floods and storms. Increased costal erosion.
Ecosystems	Increasing species shifts and extinctions may lead to collapse of food chains. Pollution leading to declining insect populations and related decline in pollinators.

Rao (2009) suggests that impacts within the UK may include increased deaths, injuries and disease (because of heat waves; for example, vector-borne diseases), floods and storms, poorer air quality, increased pollens and reduced food safety. Haines and Ebi (2019) highlight several areas of health-related risks, such as direct effects from higher temperatures and indirect effects such as poverty. Extreme weather events are certainly happening more often and when these do occur they result in deaths, disease and injuries because people drown, and sanitation and clean water supplies become a problem. Heavy rains and more flooding may lead to the further spread of diseases carried by rodents. The depletion of the ozone layer is also a related health issue because of increased exposure to ultra-violet radiation (UVR), although this is slowly repairing, following international action (World Meteorological Organization et al., 2018). This is not specifically associated with climate change, rather with air pollution, but too much exposure to UVR can result in many detrimental health effects: sunburn, heatstroke, skin cancers, cataracts and weakened responses to immunizations. The environment is also likely to be affected negatively by climate change and the health impact may again be detrimental.

Our health is linked to the environment, and the destruction of the natural environment is therefore a threat to our health. In destroying our environment, we threaten our basic needs, such as food, shelter, clean air and water (Stone, 2009; Le Roux et al., 2019). Degraded environments are associated with health problems, and high levels of mortality. Hawkes (2019) highlights that air pollution arising from traffic is responsible for four million new cases of childhood asthma worldwide every year. These numbers are likely to increase as current damage to our environment continues. In 2018, WHO held its first ever Global Conference on Air Pollution and Health in Geneva, reflecting increasing concern with this issue. All of these physical health problems certainly may impact upon mental health too, and the effects of climate change upon mental health have not yet been estimated. For example, post-traumatic stress rates are likely to soar after events like flash floods, typhoons and torrential rains.

WHO (2014) estimate that approximately 250,000 deaths annually between 2030 and 2050 will be due to climate change, but Haines and Ebi (2019) suggest that this is a conservative assessment. So, even if we begin to tackle some aspects of climate change, and its effects are stopped or even reversed, the impact upon our health still remains a threat. Hence, climate change remains a risk to health for the immediate, as well as the long-term future.

Population growth An issue intrinsically linked to climate change is the growing population of the world and movements of people from rural to urban areas in search of better and more affluent lives, or to escape war. The Syrian refugee crisis led to the estimated movement (outwards from Syria) of 4.2 million persons in 2010–2015 (UN, 2017). All continents are predicted to increase in population size in the twenty-first century and globally, while the rate of population growth has slowed over the past few decades, the absolute number of people continues to increase. The UN (2019) estimates that the world population is expected to grow to around 8.5 billion in 2030, 9.7 billion in 2050, and 10.9 billion in 2100.

Figure 2.1 illustrates two population pyramids from Zambia in sub-Saharan Africa, indicating the population structure by sex and age categories. The second pyramid is an estimate for 2050, which shows projected increases in total population size, as people live longer.

Figure 2.1 Population pyramids – Zambia

Source: data from US Census Bureau

Population growth is generally argued to be problematic for health because of increased demands for scarce resources including food, shelter, fuel, water and all types of service provision (for example education and health care). These factors will not only impact on physical health but will also threaten social and mental health as a consequence of overcrowded living conditions.

One way to address population growth is to deliver effective family planning services. However, some cultural, moral and religious objections to contraception can pose practical barriers in the development of these services. WHO (2020b) reports that 214 million women of reproductive age in lower-income countries who want to avoid pregnancy are not using a modern contraceptive method. This is for a variety of reasons, such as limited choice, restricted access, fears associated with side-effects, cultural and religious barriers as well as gender-based barriers.

Ageing populations Viewing the population pyramids for Zambia, it is evident that most societies are projected to have higher life expectancy and have larger proportions of the population who live to much older ages. Storey (2018) estimate that in the UK by 2068, there are likely to be an additional 8.6 million people aged 65 years and over. Globally, estimates of the ageing world population are that by 2050, one in six people in the world will be over age 65 (UN 2019). To some degree this should be seen as the success of health improvement programmes and an economically developed world. However, it does require a revision of what may be needed to provide healthy older age. This is influenced by two main factors:

Increasing life expectancy and related ageing of populations poses a significant threat to individual health and health service provision across society.

 The changing patterns of illness and disease to conditions associated with fragility, chronic diseases and disorders such as dementia.

 Universal state pension schemes to keep older people out of extreme poverty may not be able support the increased growth in over-65s.

Preparing health providers and societies to meet the needs of elderly people is essential: training for health professionals on old-age care; preventing and managing age-associated chronic diseases; designing sustainable policies on long-term care; and developing age-friendly services and settings. Work around promoting positive images of older people, social isolation and quality of life may be also be crucial for older populations.

Safety, security and fear A whole range of related issues can be considered under the terms ‘safety and security’. These all impact upon health and are summarized in table 2.3.

The above issues are commonly not perceived as being public-health threats in their own right but are seen superficially in terms of how public health should be providing health-care responses (Geiger, 2001). Crime and terrorism are constructed as media/moral panics that potentially exaggerate the risks and create a culture of fear but in some areas of conflict there is great evidence that fear impacts upon holistic health, while the direct effects also have a large health impact (Bleich, Gelkopf and Soloman, 2003).

Table 2.3 The impact of safety and security upon health

Issue	Potential effects	Reference
Conflict and war	Deaths and injuries on the battlefield Displacement of populations (internally and externally) Breakdown of health and social services Sexual violence Heightened risk of disease transmission Psychosocial impact of living with conflict Reduction on development and maintenance of infrastructure Disruption of subsistence agriculture Increased risk of further violence	Murray et al. (2002) Levy and Sidel (2016)
Domestic violence	Effects upon health fall into four categories: physical impact (injuries and death); sexual and reproductive consequences (unwanted pregnancies, infections); mental health (depression); and behavioural issues such as self-harm and substance misuse	Campbell (2002) WHO (2012)
Crime	Death and injury Emotional impact of long term stress – lower personal well-being and increased anxiety Loss of work earning Property destruction	Dubourg et al. (2005) ONS (2015)
Terrorism Bombing Bioterrorism Kidnapping	Direct death and injury Rape as an instrument of war Direct effect of psychological impact of trauma and fear (long-term physical and mental-health effects) Indirect effect on society living in fear of terrorism even if the actual threat is low Physical and mental health impacts on first responders	Bleich, Gelkopf and Soloman (2003) Alexis-Martin (2018)

War and conflict pose a major threat to health, not only in direct ways as we may expect, but also as economic and social development are impeded. Basic infrastructure such as roads, sanitation and commercial settings can be devastated, affecting the ability for basic human needs (e.g. food and shelter) to be satisfied. Displaced persons who have been fleeing their homes in order to avoid the effects of armed conflict and violations of human rights experience much poorer health as a result of this displacement, which can exist for generations (UN, 2017).

Poverty and inequality There is a large amount of evidence to show that among all threats to health risks, it is poverty and inequality that are much more likely to limit the achievement of full health. Lewer et al. (2019) report that over 900,000 deaths in England have occurred prematurely as a result of social inequalities, and if everyone in England had the same mortality rate as those residing in the richest locations, there would have been 877,000 fewer premature deaths between 2003 and 2018 (see chapters 10 and 12 for more on this).

In recent years, evidence has been used to demonstrate that material deprivation plays a huge role in the causation of disease (see chapter 4 for further discussion of health inequalities). This social determinants of health model shows a strong social gradient for most diseases, with those who are poorer experiencing higher rates of disease than those who are richer (Wainwright, 2009a; CSDH, 2008; Marmot 2019). WHO (2017) data demonstrate this when discussing the global burden of disease statistics, which illustrate large differences in health and disease burden, depending upon level of socio-economic development. Schrecker (2019) points out that there is no talk about inequality as an emergency because its consequences are less visible, with lives ending sooner and more painfully than they should.

Health inequality refers to the differences in health status between people and/or places and manifests in many ways, as box 2.2 demonstrates.