Global Health and Epidemiology

Health in High-Income Nations

Obesity, which is on the rise in high-income nations, has been linked to many diseases, including cardiovascular problems, musculoskeletal problems, diabetes, and respiratory issues. According to the Organization for Economic Cooperation and Development (2011), obesity rates are rising in all countries, with the greatest increases occurring in the highest-income countries. Among OECD countries, which represent the most economically developed nations in the world, as of 2017, half of adults were overweight or obese, as well as nearly one in six children.^[1] The United States has the highest obesity rate. Wallace Huffman and his fellow researchers (2006) contend that several factors are contributing to the rise in obesity in developed countries:

1. Improvements in technology and reduced family size have led to a reduction of work to be done in household production.
2. Unhealthy market goods, including processed foods, sweetened drinks, and sweet and salty snacks are replacing home-produced goods.
3. Leisure activities are growing more sedentary, for example, computer games, web surfing, and television viewing.
4. More workers are shifting from active work (agriculture and manufacturing) to service industries.
5. Increased access to passive transportation has led to more driving and less walking.

Obesity and weight issues have significant societal costs, including lower life expectancies and higher shared healthcare costs. While the United States fares well in terms of health outcomes, it actually has a relatively shorter life expectancy than countries similar in economic development, standards of living, and wealth,^[2] which is partially due to obesity and its consequences.

High-income countries also have higher rates of depression than less affluent nations. A recent study (Bromet et al. 2011) shows that the average lifetime prevalence of major depressive episodes in the ten highest-income countries in the study was 14.6 percent, compared to 11.1 percent in the eight low- and middle-income countries. The researchers speculate that the higher rate of depression may be linked to the greater degree of income inequality that exists in the most affluent nations.

Remember from previous sections, however, how culture can shape medical conditions, the stigma attached to them, and how healthcare deals with specific conditions. It is possible that society has conceptualized conditions such as depression differently across multiple contexts. Think about it: underdeveloped nations are facing deadly and terminal epidemics that are seemingly uncontrollable, with diseases and viruses like Zika, Ebola, and HIV being at the forefront of government policy and healthcare agendas. These societies are not yet concerned with mental illnesses, despite their well-documented effects on individuals.

Health in Low-Income Nations

In peripheral nations with low per capita income, it is not the cost of healthcare that is the most pressing concern. Rather, low-income countries must manage such problems as infectious disease, high infant mortality rates, scarce medical personnel, and inadequate water and sewer systems. Such issues, which high-income countries rarely even think about, are central to the lives of most people in low-income nations. Due to such health concerns, low-income nations have higher rates of infant mortality and lower average life spans.

In addition to these challenges, and largely because of these challenges, underdeveloped regions face epidemics of disease. As was mentioned in the introduction, several countries in Africa have dealt with the spread of Ebola in the last 5 years, and the Democratic Republic of the Congo is currently trying to address an Ebola epidemic. The Ebola  epidemic is not the result of a single factor, but instead is the consequence of a combination of them, ranging from the lack of a cure, to Ebola being highly infectious and difficult to diagnose, to its being coupled with structural contexts of underdeveloped health systems, lack of workers, stigmatizing cultural beliefs, and migratory practices.

The Zika virus, which was first discovered in Uganda over 6 decades ago, has resulted in recent outbreaks in the Pacific Islands and Brazil and in a widespread epidemic in 2015-2016. The virus causes Zika fever, which is a mild illness with symptoms such as a fever and a rash, but as the disease became more common, evidence suggested that the virus was also connected to Guillain–Barré syndrome in adults, as well as birth defects and other neurological problems. The virus can be transmitted from an infected pregnant woman to her fetus, then can cause microcephaly (an abnormally small head) and other severe brain anomalies in the infant. The virus is spread mainly by the Aedes aegypti mosquito, which is commonly found throughout the tropical and subtropical Americas, and in parts of the southern United States. It can also be spread by the Aedes albopictus (“Asian tiger”) mosquito, which is distributed as far north as the Great Lakes region in North America. Men infected with Zika can transmit the virus to their sexual partners.

One of the biggest contributors to medical challenges in low-income countries is the lack of access to clean water and basic sanitation resources. According to a 2014 UNICEF report, almost half of the developing world’s population lacks improved sanitation facilities. The World Health Organization (WHO) tracks health-related data for 194 countries. In their 2018 World Health Statistics report (supplemented by UNICEF 2018 demographic reports)^[3] they document the following statistics:

1. Globally, the rate of mortality for children under age five in 2018 was 41 per 1,000 live births. More than half of under-five deaths occurred in Sub-Saharan Africa.^[4] In low-income countries, however, that rate is almost double at 74 per 1,000 live births. In high-income countries, that rate is significantly lower than seven per 1,000 live births.
2. The most frequent causes of death for children under five were prematurity and respiratory infections, accounting for 18 an 16 percent, respectively. Diarrhea also accounts for 8% of deaths in children under five, and malaria in 5%. Many of these deaths could be easily avoided with cleaner water and more coverage of available medical care.
3. The availability of doctors and nurses in low-income countries is less than one-tenth that of nations with a high income. In 2006, per 1,000 population, African countries had 2.3 health workforce employees, while European countries had 18.9, and countries in the Americas had nearly 25.^[5] Challenges in access to medical education and access to patients exacerbate this issue for would-be medical professionals in low-income countries (World Health Organization 2011).