GEOG 2400 GEOGRAPHY OF WORLD DEVELOPMENT

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GEOG 2400 - GEOGRAPHY OF WORLD DEVELOPMENT

• Morbidity and Mortality Consequences of Under
  Development

Spring 2002
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Mortality and Morbidity

• Death and disease are not uniformly distributed
  around the globe.
• Life expectancy is still overwhelmingly
  correlated with degree of poverty/wealth.
• The WHO calls poverty the worlds biggest killer.
• While there are diseases of the affluent
  societies (cancer, heart disease), high morbidity
  rates, due in many cases to the inability to
  avoid or overcome disease, are also closely
  allied with poverty, although geography is a
  contributory factor (i.e. tropical illnesses).

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Life expectancy

• As one of the key indicators in the HDI, life
  expectancy shows great global disparities.
• To be born and live in Africa means, on average,
  to live almost 30 years less than if born in a
  high-income, industrialized nation 48.8 v 78.0.
• The low HD nations now have life expectancies
  averaging 52.6 compared to 77.3 in the high HD
  nations and 64.5 in all developing countries as a
  whole.
• While progress has been spectacular the last 50
  years (global average was 67 in 1950, 40 in the
  developing countries), attainments still differ
  widely.
• Sierra Leone has the lowest life expectancy of
  38.3 compared to Japans 80.8 and our 76.8.

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The Way of Death

• Over 60 million people die worldwide each year.
• In 1996, according to the WHO, of the 56 million
  who dies that year, only 1/4 came with reliable
  cause of death information.
• In developing nations, fully 42 of deaths
  appeared to be from communicable diseases,
  whereas in developed nations these account for
  only 6.1.
• The susceptibility to communicable diseases
  differed widely by region and country - Africa
  65, Latin America 31 China 16, India 52,
  etc.
• Big developing nation killers hardly responsible
  for a blip in the death rates of richer nations
  are pneumonia (10), diarrhea (7.5), TB (5) and
  measles (3).

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Environmental Health Threats

• Africa and Asia are the geographic regions with
  the largest risk from health impacts resulting
  from air, water or food contamination (WRI, 1998)
• In the developing nations today, perhaps the
  biggest single influence on mortality and
  morbidity is poor hygiene, sanitation and water
  supply.
• Industrialized nations went through a sanitary
  revolution at the end of the 19th century but
  many developing nations have yet to complete
  theirs..
• As we saw last class, around 7.5 of all deaths
  worldwide are directly due to waterborne or
  water-transmitted disease, diarrhea alone kills
  at least 2.5m children a year.

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In Sickness and in Health

• Contrasting countries based on how sick their
  people are is difficult and complicated.
• Health and development analysts have come up with
  the concept of DALYs - disability-adjusted life
  years - to try and capture the notion
  quantitatively (WRI, 1998).
• DALYs combine premature death (actual death age
  minus expected death age) and loss of healthy
  life from the debilitating effects of illness.
• Thus short-lived acute illnesses and those
  occurring at old age contribute little to the
  DALY metric.
• Over 90 of the global DALYs accrue to the
  developing nations, where only 10 of the health
  care are spent.
• DALYs basically measure if you die young or have
  to live impaired lives e.g. from blindness,
  paraplegia, etc. because of illness.

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Malnutrition

• One of the best ways to ensure a long and
  disease-free life is to have a good diet from
  birth.
• Malnutrition is a persistent problem leading to
  diseases of obesity in the rich nations and
  diseases of under-nourishment in the developing
  nations.
• Poverty, not a lack of global food production, is
  the cause of malnutrition - the unequal
  distribution of calories.
• According to the FAO, some 1/5 of the people in
  the world do not have enough food for a healthy
  living.
• Insufficient calorific intake leads to low
  body-weights, protein deficiency to low energy
  levels, and micronutrient deficiencies to
  avoidable diseases like blindness (vit. A
  deficiency- 300,000 children/yr), brain damage
  (iodine deficiency - 26m/yr), etc.

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HIV and AIDS

• UNDP 1999, focusing on environment and health,
  summarized the world situation AIDS situation.
• AIDS killed 2.5 times more people than malaria.
• More than 33m worldwide were suffering from
  HIV/AIDS this is now 34m (1.1 of 15-49 age
  group) - 15.8 m women, 1.3 m children.
• Over 95 of all those infected are in the
  developing nations.
• 16 countries have 15-49 age group HIV infection
  rates of 10 or greater (1999 data from HDR
  2001), all in Africa.
• These nations can expect life expectancies to
  drop an average 17 years in the coming decades
  according to the UNDP 1999 HDR.
• Botswana has 35.8 of its 15-49s living with
  HIV/AIDS. 

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Prevention, Cures and Poverty

• As we saw during our earlier homework on new
  technologies, curing the diseases that afflict
  poor people in LDCs is not high on the priorities
  of multi-national drug companies.
• A new drug in the US usually costs around 500m
  to get to the human testing stage and thus those
  that make it to market are priced high to make a
  profit.
• Of all global research, only 0.2 of the funding
  goes to medicines aimed at the common diseases,
  like diarrhoeal pathogens, pneumonia and TB, that
  cause close to 20 of all morbidity. 

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Drugs for profit

• High-cost research performed by private
  corporations neglects opportunities to develop
  technology for poor people.
• For instance, in 1998 global spending on health
  research was 70 billion, but just 300 million
  was dedicated to vaccines for HIV/AIDS and about
  100 million to malaria research loads went to
  allergies, cholesterol, etc.
• According to HDR 2001, of 1,223 new drugs
  marketed worldwide between 1975 and 1996, only 13
  were developed to treat tropical diseasesand
  only 4 were the direct result of pharmaceutical
  industry research.
• Previously, much drugs research was carried out
  by government labs and later licensed to
  companies.
• A new hope is the decision by the Bill Melinda
  Gates Foundation to subsidize malaria vaccine and
  other research that would otherwise not get done.

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Prevention Needed, Not Cures

• The best prevention is to educate the poor (esp.
  women) and raise their standards of living,
  especially their diet.
• Removal of environmental hazards through the
  provision of public services, particularly safe
  drinking water and sanitation and solid waste
  collection, provides major improvements.
• Improving fuel efficiency and reducing the use of
  indoor wood-burning stoves can cut respiratory
  diseases drastically.
• Controlling disease vectors - mosquitoes
  (malaria, dengue, etc.), Chagas
  (tripanasomaisis), river snails (bilharzia),
  Cyclops (guinea-worm), etc. - is an effective
  preventive technique.
• Universal inoculation programs for childhood
  diseases cuts infant mortality and later disease
  susceptibility enormously.

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Health Care Statistics

• Table 6 in HDR 2001 has a wealth of data on
  health access, services and resources.
• In many of the lowest HD nations, there may be
  less than 10 physicians per 100,000 people and
  the proportion of births without skilled health
  staff in attendance can be 80-90.
• Measles turns out to be a killer of children with
  more than 50, sometimes 80 not inoculated.
• The WHO have provided data on whether peoples
  have access to the drugs they need for their
  various illnesses and these numbers are usually
  well below 50.
• In the most HD nations, the number of doctors per
  100,000 will be in the 200-500 range, 99-100
  will be able to get the drugs they need, 80-90
  of children will be inoculated and so forth.

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Regional Summaries

• HDR 2000 provides regional summaries of health
  statistics.

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Graphs from UN Population Division HIV/AIDS
wallchart.
http//www.un.org/esa/population/publications/aids
wallchart/MainPage.htm
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