1. Variations in and Measurements of Health
IB Geography II

2. Objectives By the end of these guided notes, students will be able to:
Understand and calculate the different ways of measuring the health of a population.
Evaluate the strengths and limitations of indicators used to measure health.
Describe variations in health as reflected by changes in life expectancy national and global scales since 1950.
Explain patterns and trends in terms of differences in income and lifestyle.

3. What is health?
The World Health Organization defines health as ‘a state of complete physical, mental and social well-being’.

4. Morbidity – The level of sickness, numbers of people who are sick, prevalence of disease.

5. Mortality – The level of deaths, numbers of people dying due to sickness.

6. Variations in Health: Key Indicators
Infant Mortality Rate
Child Mortality Rate
Life Expectancy
Calorie Intake
Access to Safe Water
Access to Health Services
Health-Adjusted Life Expectancy (HALE)

7. Infant Mortality Rate Total # of deaths of children < 1 year old
________________________________ per 1000
Total # of Live Births

8. Infant Mortality Rate
Ranges: 2 per 1,000 in Sweden to 178 per 1,000 in Angola

9. Child Mortality Rate ________________________________ X 1000
Total # of deaths of children and infants < 5 years old
________________________________ X 1000
Total # of Live Births

10. Infant Mortality Rate/Child Mortality Rate
Advantages
IMR/CMR are good measures of human welfare because it reflects household income, nutrition, maternal age and education, housing conditions, and sanitation
Disadvantages
Not all data is collected, some births go undocumented, so deaths would go undocumented as well.
If it is collected by a household survey, national birth and death registration systems may be unreliable, AIDS epidemic, civil war and migration lead to further inaccuracy in Africa

11. Life Expectancy
The average number of years that a person can be expected to live if demographic factors remain unchanged
Ranges from globally
Males < Female
Life expectancy globally has increased since 1950 due to greater food production, more clean water, better living conditions, and better health care.

13. Advantages of using Life Expectancy
Life expectancy can tell you a lot about a population/country including:
Pollution levels, conflict, occupation, shelter, food, medical facilities, income, literacy… ALL IMPACT LIFE EXPECTANCY!!!
You can compare some of these differences within a population: Rich v poor, urban v rural, male v female, ethnic groups, age groups.

14. Limitations to using Life Expectancy
Considers only length of life, not number of years spent living in poor health
YLDs (years lived with a disability)
DALYs (disability adjusted life expectancy): the sum of years of potential life lost due to premature mortality and the years of productive life lost due to disability
It is just an average, there can be regional/urban-rural variations

15. Calorie Intake Afghanistan: 1,500 per day per person
USA: 3,774 per day per person
WHO outlines that the recommended calorie intake is:
Men: 2500 per day
Women: 2000 per day

16. Advantages of Calorie Intake
Can tell you a lot about the food system in a given country, and it can be linked to other health indicators and social indicators like income.

17. Limitations to Calorie Intake
Does not take nutrient consumption into account
Example: eating 1,000 calories worth of apples is very different from eating 1,000 calories worth of chips
It is not linked to calorie requirement
Example: Construction worker who works 12 hours a day in the heat and cold doing manual labor will need more calories than an accountant who sits at his desk for 8 hours a day

18. Chronic v. Acute Food Shortage
Occurring over a long period of time
Acute
Occurring over a short period of time

19. Access to Safe Water
Access to water that is affordable, in sufficient quantity and available without excessive effort and time
Directly related to poverty
Often caused by governments failing in the ability to finance sanitation and water systems
In 2008, 2.6 billion people had no access to a toilet, and 1.1 billion were defecating in the open
Inadequate sewage and water systems spread infections like cholera and viral hepatitis

21. Access to Safe Water Advantages Disadvantages
Directly related to poverty- can tell you a lot about the income of a person, or economic state of the country.
It is also directly related to the ability of governments to finance satisfactory sanitation systems.
It can also be linked to health because poor access to safe water can be linked to the spread of infectious disease like cholera, diarrhea disease, etc.
Disadvantages
Doesn’t account for differences in rural to urban or regional variations.
It’s an average, so people with higher incomes most likely have better access.

22. Access to Health Services
Usually measured in the number of people per doctor, health worker or hospital per every 10,000 in the population
Country
Switzerland
Brazil
Ethiopia
Physicians per 10,000 40 17 .5
Hospital Beds per 10,000 55 24 2
Health Expenditure $ per capita
4,417
674 26

24. Access to Health Services
Advantages
Can show you how much money is being spent per individual by giving data on health beds, medication, physicians per person in the population.
Disadvantages
Doesn’t account for differences in rural to urban or regional variations.
It’s an average, so people with higher incomes most likely have better access.

25. Health Adjusted Life Expectancy (HALE)
Combines measures of both age and sex specific health data and mortality data into a single statistic
HALE indicates the number of expected years of life equivalent to years lived in full health, based on the average experience in a population
Not just quantity of life, but quality of life

27. Calculating HALE
The WHO uses life expectancy + Sullivan’s Method to compute the HALE for countries
Sullivan’s Method: the number of remaining years, at a particular age, which an individual can expect to live in a healthy state
Method includes weight assigned to each type of disability, depending on severity

28. Limitations to HALE
Major challenge due to lack of reliable data on mortality and morbidity, especially from low income countries
There’s also a lack of comparability of self-reported data from health interviews.

29. Comparing Life Expectancy/HALE
Region
Life Expectancy
HALE
Europe 76 70
North America 78 69
Oceania 68
Sub-Saharan Africa 52 41

30. Epidemiology – The study of the factors affecting the health, morbidity and mortality of populations. Closely linked to Geography as the factors will vary spatially and will be place specific.

31. The Epidemiological Transition Model (Health Transition)
As health improves, morbidity and mortality fall thus life expectancy increases.
This is called epidemiological (health) transition (Omran 1971).
This model focuses on both health and morbidity.
Changes will be apparent through modernization.
Changes will appear at different times depending on each country and its developmental processes.

33. Epidemiological Transition Model
LEDC ____________________________________ MEDC
Infectious diseases ____________ Degenerative diseases
Diseases of Poverty ____________ Diseases of Affluence
Cancer, Heart and circulatory disease, Obesity, Type two diabetes, Alzheimer's disease.
Aids, Cholera, Tuberculosis, Diarrhea, Malaria, Typhoid, Yellow fever, measles, Polio, Perinatal deaths (in first week of life).

34. Demographic Transition Model v. Epidemiological Transition Model
Similarities
Both deal with how countries develop over time.
Differences
epidemiological transition model focuses more on the reasons for development through health and not solely on births and deaths.

35. Similarities and Differences
Epidemiological Transition Model (Health model)
Demographic Transition Model

36. Disease Categories Endogenetic (from inside)
Congenital diseases from birth and degenerative diseases resulting from old age.
Exogenetic (from outside)
Environmental conditions, social habits and hazards.

37. Exogenetic Factors LEDCS and MEDCS compared
Nutrition (being underweight)
The environment (unsafe water, sanitation and hygiene)
Poor living standards
Social norms and disease such as HIV/AIDS (unsafe sex).
MEDC
Lifestyle causing high blood pressure (stress)
Physical inactivity (heart disease, diabetes)
Leisure activities (tobacco, alcohol, and drugs)
Nutrition (being overweight, high cholesterol levels, low fruit and vegetable intake).

38. Global Variations in Health and Income 1950

39. Global Variations in Health and Income 1980

40. Global Variations in Health and Income 2009