Inequalities in global health

Key knowledge:•Factors contributing to the health status and development outcomes in developing countries including poverty, illiteracy, cultural factors, conflict and lack of access to primary healthcare systems.

•The impact on health and development in developing countries of changes in the consumption of tobacco, alcohol and processed foods as a result of globalisation.

What are the factors contributing to similarities and differences in global health?

•Poverty

•War/conflict

•Cultural factors: status of women, children fulfilling adult roles (work, combat, marriage)

•Exploitation of children

•Safe water and sanitation

•Access to education – literacy

•Access to healthcare and immunisation

Poverty

• Children who are born into poverty have less opportunity to have access to adequate food, shelter, water, sanitation and healthcare.

• Families experiencing poverty are more likely to experience violence and discrimination and poor health. They have few choices and find it difficult to break the cycle

• Governments experiencing poverty are less able to provide resources such as safe water and sanitation, education, social security and healthcare

Poverty

• The world bank identifies poverty as people living on less than $ 1 per day

• 1.4 billion people in developing countries were living in extreme poverty in 2005.

• There is a direct link between poverty and ill health

Programs that have worked to reduce poverty

• For the past two years, Malawi’s voucher programme for fertilizers and seeds has helped double its agricultural productivity, turning the country into a net food exporter after decades of famine as a perennial food importer. Malawi needs 2.2 million tons of maize a year to feed itself. Before the subsidy programme began, the 2005 harvest fell to a low of 1.2 million tons of maize. The implementation of the National Input Subsidy Programme resulted in a dramatic increase to 3.2 million tons of maize in 2007, according to the Ministry of Agriculture. The bumper harvests resulting from the programme are helping poor farmers to earn more income.

War/conflict• Govts. involved in conflict spend a large amount of GDP

on military expenses, leaving little for healthcare and education

• They will also experience loss of lives, injuries and disabilities from conflict and landmines, even after the conflict is over. This will place an increased burden on the healthcare system.

• Loss of infrastructure (such as hospitals and schools) will also reduce availability of services and rebuilding will be another expense for the government

• People may leave rural areas for safety, meaning they may no longer be able to grow crops. This leads to a loss of income for families and may also contribute to food shortages

• Many women may be left as widows and be unable to support their families and many children orphaned, leading to an increase in child exploitation

War and conflict

• Conflict continues to displace people from their homes and drive them into poverty. One indication of the impact of conflict is the number of refugees worldwide, which has increased significantly over the last few years, primarily because of the conflict in Iraq. More than 42 million people are currently displaced by conflict or persecution, both within and outside the borders of their own countries. Of these, 16 million are refugees, including 11.4 million who fall under the responsibility of the United Nations High Commissioner for Refugees (UNHCR) and 4.6 million who are under the aegis of the United Nations Relief and Works Agency for Palestine Refugees in the Near East. In addition, more than 26 million people have been uprooted by violence or persecution but remain within the borders of their own countries.

Cultural factors: status of women, children fulfilling adult roles (work, combat, marriage)

• In many developing countries women are treated very differently from men. They have fewer opportunities and less access to education, income, food and employment. They also have fewer legal rights.

• Women often spend many hours doing very labour intensive work, for little or no pay. They may also spend many hours tending crops, collecting water and preparing food for their family.

• Domestic violence against women in developing countries is common.

Cultural factors, cont.

• Some developing countries also do not value education in the same way developed countries do. As a result of this, added to the poverty experienced in some countries, young children are often forced to start work from a very young age. This robs them not only of an education but also a childhood.

• Young women may be forced into marriage at an early age and have many children.

• http://www.youtube.com/watch?v=3w-fOmovijc&feature=channel

Invisible children

• http://www.youtube.com/watch?v=qds5MQCqWnk

• Child labour

• Children forcibly removed- may be forced into hazardous physical labour, sex trade or combat

• Separated due to natural disasters or conflict

Child marriage • The practice of girls marrying at a young age is most

common in sub-Saharan Africa and South Asia. However, in the Middle East, North Africa and other parts of Asia, marriage at or shortly after puberty is common among some groups. There are also parts of West and East Africa and of South Asia where marriages much earlier than puberty are not unusual.

• In countries like Bangladesh, Central African Republic, Chad, Guinea, Mali, and Niger more than 60 per cent of women entered into marriage or into a union before their eighteenth birthdays. Children married early are at increased risk of abuse, denied education and health problems

Child labour

• An estimated 158 million children aged 5-14 are engaged in child labour - one in six children in the world. Millions of children are engaged in hazardous situations or conditions, such as working in mines, working with chemicals and pesticides in agriculture or working with dangerous machinery. They are everywhere but invisible, toiling as domestic servants in homes, labouring behind the walls of workshops, hidden from view in plantations.

• In Sub-Saharan Africa around one in three children are engaged in child labour, representing 69 million children.

• In South Asia, another 44 million are engaged in child labour.

Safe water and sanitationhttp://www.youtube.com/watch?gl=GB&hl=en-GB&v=8vZQKQDD7fE&feature=related

• In some developing countries people do not have access to sufficient water. As a result they may not be able to grow food and keep animals alive (e.g. goats, cattle)

• In other developing countries , there may be enough water, but it is often not safe to consume. Unsafe water can spread disease.

• Sanitation is also a concern in many developing countries as the environment is unsanitary due to poor access to amenities, overcrowding, inappropriate housing, poor drainage and a lack of knowledge of how to reduce the spread of disease.

Literacy & education• Females in developing countries are less

likely to be educated than males and those in rural areas are less likely to be educated than those in urban areas.

• Poor literacy and a lack of education means many children are sent to work from a young age.

Adult literacy rates

• Adult literacy rates: % of population over 15 years who can read and write. 2000- 2004

Country Male Female % of students reaching grade 5

Afghanistan 43 13 92

Botswana 80 82 96

Ethiopia 41 13 64

Mozambique 47 24 93

Pakistan 63 36 90

Zambia 76 60 88

Total of all developing countries

85 72 91

• Drought, food shortages, armed conflict, poverty, lack of birth registration, child labour, and HIV and AIDS contribute to low school enrolment and high dropout rates for both boys and girls

Education

• Data for 114 refugee camps in 27 countries show that full primary school enrolment has been achieved in only 6 out of 10 camps, and that at least 1 in 5 refugee children is not part of the formal education system. In 1 out of 8 of the camps with inadequate primary school opportunities, less than half of all primary school age children are enrolled. Girls are at particular risk of dropping out before completing their primary education, often because they lack a safe, quality learning environment, or because of poverty and early marriage.

Access to health care and immunisation

• Developing countries have fewer doctors per capita

• Urban areas all over world have higher ratio of doctors than rural

• Exercise 13.2 pg 332-333