1. Variations in and Measurements of Health IB Geography II

2. How Ignorant Are you??? The Ignorance Quiz! http://www.cnn.com/2013/12/10/world/gap minder-us-ignorance-survey/http://www.cnn.com/2013/12/10/world/gap minder-us-ignorance-survey/ Let’s take the quiz!

3. The Ignorance Quiz Debrief In groups, discuss the following questions: –What surprised you about the answers to the questions? –For the answers you got incorrect, why do you think you were incorrect? What influenced your thinking on these issues? What leads to our “ignorance” about the world? –Ignorance Video: http://www.gapminder.org/ignorance/ http://www.gapminder.org/ignorance/ –Start at min. 8:30-12 min

4. The Ignorance Quiz Debrief What are the causes of our ignorance, according to the video? To what extent do you agree? Final Question: How can we be less ignorant about our world as we begin our year in IB Geography???

5. Intro to Health Quote Analysis You will read 2 quotes relating to health with your partner. Together, do the following: –Deconstruct/rewrite it in your own words. –Do you agree/disagree with the quote? Why? –Discuss how this connects to “geography” Does where you live change/influence the meaning behind this quote?

6. Intro to Health Quote Analysis #1 We’re all of us ill in one way or another; We call it health when we find no symptom Of illness. Health is a relative term. T.S. Eliot

7. Intro to Health Quote Analysis #2 Poor health is not caused by something you don't have; it's caused by disturbing something that you already have. Healthy is not something that you need to get, it's something you have already if you don't disturb it. - Dean Ornish

8. Variations in Health Intro Activity Watch Hans Rosling’s “200 Countries, 200 Years, 4 Minutes” https://www.youtube.com/watch?v=jbkSRLYS ojohttps://www.youtube.com/watch?v=jbkSRLYS ojo Summarize the main things that you learned from this video with relation to: – the main changes (trends) in regards to health –causes of those changes

9. Looking for Patterns: Gapminder Health/Wealth Graph Analysis We will use the ATLAS Protocol for looking at data in order to better understand the relationship between health and wealth on a global scale and the patterns that exist. –1. Silent Reading time of data (5 min) –2. Elbow partner discussions Observations: What do you see? (3 min) Interpretations/Wonderings: What does the data suggest? What questions does the data bring up? (3 min) Implications: What does this data mean those organizations trying to fix the health disparity that exists in the world? (3 min)

10. PART 1:VARIATIONS IN HEALTH INTRODUCTION

11. 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.

12. Make a Statement Describe the global trend in health (as indicated by life expectancy). [Has it increased or decreased?] What’s the correlation? Describe the global trends income since 1950. Do some regions make bigger gains since 1950 than others? Why do you think this is?

13. Global Variations in Health and Income 1950

14. Global Variations in Health and Income 1980

15. Global Variations in Health and Income 2009

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

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

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

19. PART 2: STUFFED AND STARVED BY RAJ PATEL

20. Opening Sentences Think Pair Share Think: Read the first paragraph of the Introduction. (5 min) – What is your immediate reaction to this statement? –What do you think has led to this imbalance in access to food and health on a global scale? Pair: Share your ideas with your elbow partner (3 min) Share: Whole group share out (3 min)

21. Elbow Partner Discussions Consider this quote by the Indian leader Mahatma Gandhi –“The world has enough for everyone's need but not enough for everyone's greed" In elbow partners, discuss the following (5min): –To what extent do you agree with this statement? –How do you think we can apply it to the Geography of Food and Health? –How does this quote apply to other units we have studied in IB Geography?

22. Why, Why, Why Chain As each quote from the Introduction of Stuffed and Starved appears on each slide, complete a why, why, why chain with your partner. Keep asking “why” for as long as possible.

23. Quote #1 “The closer a Mexican family lives to the US border, the more overweight the family’s children are likely to be.”

24. Quote #2 “In the USA in 2005, 35 million people didn't know where their next meal was coming from.”

25. Quote #3 “In the last decade, India has become home to the world’s largest concentration of diabetics.”

26. PART 3: MEASURING HEALTH

27. Task 1: Note-taking You should be able to define each of the key indicators of health.

28. 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)

29. Infant Mortality Rate Total # of deaths of children < 1 year old ________________________________ per 1000 Total # of Live Births It is generally recognized that the early years are a dangerous time, where access to proper pediatric services may be limited in some regions or countries. These deaths are often easily preventable, if appropriate medical support was available. It is affected by the age of the mother, the nature of the household the child is born into, education and sanitation.

30. Infant Mortality Rate Ranges: 2 per 1,000 in Sweden to 117 in Afghanistan

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

33. Life Expectancy The average number of years that a person can be expected to live if demographic factors remain unchanged Ranges from 49-89 globally (Chad/Monaco) Males < Female Life expectancy globally has increased since 1950 due to greater food production, more clean water, better living conditions, and better health care.

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

36. Chronic v. Acute Food Shortage Chronic Occurring over a long period of time Examples: often a reflection of poverty, a worsening debt crisis, economic effects at the household level of the HIV epidemic, mismanagement of water resources Acute Occurring over a short period of time Examples: Can be a result of a severe drought or a conflict

37. Access to Safe Water Access to water is deemed safe if it is affordable, in sufficient quantity and quality, 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

39. Access to Health Services Usually measured in the number of people per doctor, health worker or hospital per every 10,000 in the population CountrySwitzerlandBrazilEthiopia Physicians per 10,000 4017.5 Hospital Beds per 10,000 55242 Health Expenditure $ per capita 4,41767426

41. 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

43. 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

44. Comparing Life Expectancy/HALE RegionLife ExpectancyHALE Europe7670 North America7869 Oceania7668 Sub-Saharan Africa5241

45. Review of Syllabus Objective Evaluate the strengths and limitations of indicators used to measure health. Possible Exam Question: – Evaluate __________ as an indicator used to measure health. – Possible Indicators: Life expectancy, calorie intake, infant and child mortality, access to health services, access to safe water, HALE

46. Task 2: Evaluation Homework For homework, establish a judgment on one of the six indicators, and an overall judgment on the relative merits of each using a Strengths/Limitations T-chart. Consider the extent to which they do, or don’t provide a suitable indicator. Refer to the following factors: –How accurate is the data that is used, and how is it collected? –What is the data not telling us about the links with health? –Is each indicator actually measuring health or is it a factor that affects health? StrengthsLimitations

47. Task 4: Evaluation Review with Whole Group

48. Infant Mortality Rate/Child Mortality Rate Strengths – IMR/CMR are good measures of human welfare because it reflects household income, nutrition, maternal age and education, housing conditions, and sanitation Limitations –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

49. Strengths 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.

50. 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

51. Strengths 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.

52. 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

53. Access to Safe Water Strengths 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. Limitations –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.

54. Access to Health Services Strengths –Can show you how much money is being spent per individual by giving data on health beds, medication, physicians per person in the population. Limitations –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.

55. Strengths to HALE Can give a better picture of actual health in terms of quality of life of a person, without additional years lived in poor health.

56. 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.

57. PART 4: EPIDEMIOLOGICAL TRANSITION

58. 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.

59. 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. The Epidemiological Transition Model (Health Transition)

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

62. 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.

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

64. 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.

65. Exogenetic Factors LEDCS and MEDCS compared LEDC 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).