Global Health and Epidemiology
Learning Outcomes
- Apply theories of social epidemiology to an understanding of global health issues
- Compare and contrast health conditions in high- versus low-income countries
Social epidemiology is the study of the causes and distribution of diseases. Social epidemiology can reveal how social problems are connected to the health of different populations. These epidemiological studies show that the health problems of high-income nations differ greatly from those of low-income nations. Some diseases, like cancer, are universal. But others, like obesity, heart disease, respiratory disease, and diabetes are much more common in high-income countries and are a direct result of a sedentary lifestyle combined with poor diet. High-income nations also have a higher incidence of depression (Bromet et al. 2011). In contrast, low-income nations suffer significantly more from deadly diseases such as malaria and tuberculosis, diseases that are rare in high-income contexts.
How does health differ around the world? Some economic and political theorists, most notably Immanuel Wallerstein, differentiate among three types of countries: core nations, semi-peripheral nations, and peripheral nations. Core nations are those that we think of as highly developed or industrialized, semi-peripheral nations are those that are often called developing or newly industrialized, and peripheral nations are those that are relatively underdeveloped. While the most pervasive issue in the U.S. healthcare system is affordable access to healthcare, other core countries have different issues, and semi-peripheral and peripheral nations are faced with a host of additional concerns. Reviewing the status of global health offers insight into the various ways that politics and wealth shape access to healthcare, and it shows which populations are most affected by health disparities. As we move across international contexts, it is imperative to keep in mind the influence of cultural significance on health, as it is a mechanism that plays a role in the conceptualization of health conditions, the role of healthcare and its providers, and the consequences of illnesses.
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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:
- Improvements in technology and reduced family size have led to a reduction of work to be done in household production.
- Unhealthy market goods, including processed foods, sweetened drinks, and sweet and salty snacks are replacing home-produced goods.
- Leisure activities are growing more sedentary, for example, computer games, web surfing, and television viewing.
- More workers are shifting from active work (agriculture and manufacturing) to service industries.
- 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.
Watch It
This video explains population health and describes some of the key health indicators that measure health for different populations. Consider what factors contribute to health disparities among populations.
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.
WATCH IT
Hear about Ebola’s effects and consequences during the height of the epidemic, as well as the context in which Ebola-infected individuals seek assistance.
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.
WATCH IT
Learn about the spread of the Zika virus—and beware of massive soccer events! The Zika virus is said to have begun its recent spread after visitors flocked to Brazil for the World Cup in 2014. Some athletes even declined to participate in the 2016 Summer Olympics in Rio de Janeiro, citing ongoing concerns about the virus and its impact on fetal development.
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:
- 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.
- 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.
- 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).
Think It Over
- Study these maps on global life expectancies. What trends do you notice?
- If social epidemiologists studied the United States in the colonial period, what differences would they find between now and then?
- What do you think are some of the contributing factors to obesity-related diseases in the United States?
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glossary
[glossary-page]
[glossary-term]social epidemiology:[/glossary-term]
[glossary-definition]the study of the causes and distribution of diseases[/glossary-definition]
[/glossary-page]
<a style="margin-left: 16px;" target="_blank" href="https://docs.google.com/document/d/1vy-T6DtTF-BbMfpVEI7VP_R7w2A4anzYZLXR8Pk4Fu4"
- OECD (n.d.). OECD Obesity Update 2017. Retrieved from http://www.oecd.org/health/obesity-update.htm. ↵
- OECD (2019), Life expectancy at birth (indicator). doi: 10.1787/27e0fc9d-en (Accessed on 02 April 2019) ↵
- World health statistics 2018: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2018. License: CC BY-NC-SA 3.0 IGO. ↵
- Unicef (March 2018). Under-five mortality. Retrieved from https://data.unicef.org/topic/child-survival/under-five-mortality/. ↵
- World Health Organiation (2006). Health Workers: A Global Profile. https://www.who.int/whr/2006/06_chap1_en.pdf ↵