Option F: The Geography of Food and Health

Revision Notes for Examination in May 2012

Option Theme F: The Geography of Food and Health

Table of Contents
1. Health
Variations in Health Measuring Health Prevention Relative to Treatment

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2 4 6

2. Food
Global Availability of Food Areas of Food Sufciency and Deciency Production and Markets Addressing Imbalances Sustainable Agriculture

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9 11 19 20 22

3. Disease
Global Patterns of Disease The Spread of Disease Geographic Factors and Impacts

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23 24 26

Option Theme F: The Geography of Food and Health

1. HEALTH
Variations in Health
Describe the variations in health as reected by changes in life expectancy at national, and global scales since 1950: Infant & Child Mortality Rates IMR in Sweden: 2 per 1000. High access to healthcare/sanitation/nutrition. IMR in Angola: 178 per 1000. Low access to healthcare/sanitation/nutrition.

Life Expectancy e average number of years a person can be expected to live if Demographic factors remain unchanged. Life Expectancy in MEDCs (Oz, Canada, Japan): 80 years. L.E in LEDCs (sub-saharan Africa): under 45 years. Male L.E less due to higher incidence of degenerative illness caused by smoking, drinking, high exposure to pollutants. Also, accidental death by violence & road accidents. Lower amongst ethnic groups, blacks in USA live 5 years less. Urban city-dwellers in LEDCs live longer than rural counterparts. Since 1950 large increase in most places due to improvements in healthcare, availability of food/clean water, improved living conditions. Decreased in Sub-Saharan Africa between 1955-2005 due to AIDS epidemic.

Calorie Intake: 1,500 calories per person per day in Afghanistan and Eritrea 3,774 calories per person per day in USA. Rising amounts in developing nations: 2,951 (China), 2,459 (India). Access to Safe Water: Access to water that is aordable, in sucient quantity and available without excessive eort and time. Percentage of world population with access is increasing, from 77% in 1990 to 87% in 2006. A gap persists between urban and rural areas.
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2.6bn people had no access to a hygienic toilet in 2008, meaning 1.1bn people were defecating in the open. is results in the spread of infections such as Cholera. Africas percentage of people with access to a hygienic toilet dismally increased from 30% in 1990 to 34% in 2008. Not meeting MDG. Factors which aecting access to safe water: - Environmental, the natural water supply. - Economic, public/private distribution. - Political, allowing access or not (Palestine and Israel, Cochabamba) - Social, level of income: more or less access depending on income/ neighbourhood. E.g: Catalonia - Has technology but no natural reserves: - Desalinisation uses up other resources.

Access to Health Services: Usually measured in the number of people per doctor, health worker or hospital. Per 10,000 population.

Option Theme F: The Geography of Food and Health

Measuring Health
Evaluate life expectancy, infant and child mortality rates, HALE (Healthadjusted Life Expectancy), calorie intake, access to safe water and health services as indicators of health: Infant (under 5) and Child Mortality Rates: Indicator reects social, economic and environmental conditions in which children live. Good measure of human welfare as it reects: - Household income - Nutrition - Maternal Age - Education - Housing condition - Sanitation Unreliable measure if collected by household survey, national birth and death registration. In LEDCs low access to healthcare means certain births/deaths may not be counted.

Life Expectancy: e average number of years a person can be expected to live if Demographic factors remain unchanged. Measures the average health of a person. Only considers the length of a persons life. Does not include years spent living in ill-health. More precise to look at age-specic life expectancies, explains variations better. Unreliable data is collected due to dierent techniques used when collecting and representing data.

Calorie Intake: Unreliable as an indicator of wellbeing, does not consider nutrient consumption. More accuracy if linked to calorie requirement. Varies greatly Canadian Male Lumberjack needs over 3,500. Female Indian textile worker needs less than 2,500. Data is averaged for a country. Greater intake in large wealthy cities (Shanghai, Hong Kong) much lower intake in rural areas, therefore unreliable.
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Access to Safe Water: Access to water that is aordable, in sucient quantity and available without excessive eort and time. Important as provides a direct route to improved life expectancy. Lack of access directly related to poverty. Lack of access shows govt inability to provide adequate and basic infrastructure. Causes widespread health problems, excessive use of labour (travelling to get water) and limits economic growth.

Access to Health Services: Usually measured in the number of people per doctor, health worker or hospital. Per 10,000 population.

Health-Adjusted Life Expectancy (HALE): e number of years in full health that a newborn can expect to live, based on current rates of ill health and mortality. Combines age and sex-specic measures of mortality in one statistic. Indicates the number of expected years of life equivalent to years lived in full health, based on a populations average experience. Measure of both quantity and quality of life. Broader spectrum of health status than Life Expectancy. Includes a weight assigned to each type of disability, adjusted for the severity of it. is is bad as stigmas surrounding disabilities vary from country to country, as does treatment. Also is subjective. Limits include: -Lack of reliable data about morbidity and mortality from low-income countries to produce statistics. - Lack of comparability of self-reported data from health interviews. As conducted through interviews it is limiting because people may be unaware if they are in full health. Some diseases remain relatively low key but still aect people. Important factors: - Income - Ethnicity - Age - Habitat HALE has too many factors to be as reliable as Life Expectancy as a measure of health (much smaller sample out of total population).

Option Theme F: The Geography of Food and Health

Prevention Relative to Treatment

Discuss the geographic factors that determine the relative emphasis placed by policy-makers, in ONE country or region, on prevention as opposed to treatment of disease: Overview Provision of healthcare varies globally and is a reection of the available funds of a country, and its public spending priorities. 3 key aspects of curative healthcare, access to: - Health professionals - Medication - Other therapies Patient access may depend upon ability to pay and accessibility to these services. In developing countries these limitations tend to exclude the already vulnerable poorer sectors of society, making them even more susceptible to disease. Prevention and the attempt to implement barriers to the spread of disease, is a more eective and less costly way of containing disease. Prevention can include: Improvements to domestic hygiene Improvements to basic sanitation Creating access to a safe water supply e success of preventative depends on the provision of healthcare education, with a focus on childcare, e.g. long-term breastfeeding strengthening immune systems, the promotion of contraceptives in stopping the spread of STDs like HIV. Prevention of degenerative disease can be in the form of better education about the causes of, for example, heart disease. Healthcare programmes need to consider the bigger picture and implement such strategies with other objectives in place, such as better access to food, improving resistance to disease, and access to safe water limiting the transmission of disease.

Option Theme F: The Geography of Food and Health

CASE STUDY: Spanish Public Health Services Prevention through Education Primary school - Nutrition, Hygiene, exercise (PE). Secondary school - STDs, Health and Social Edu, Nutrition Post-secondary - Awareness campaigns, health centres, courses, support programmes, social networking, phones (helplines). Pregnancy courses: Health, nutrition, complications during and after pregnancies. LIMITATION: Courses only start 6 months into gestation, may be to late to inform someone of a danger, risk that has been happening. Courses for the Elderly, held near retirement homes: How to manage a pension, Preparing for old age.

Prevention through Vaccination Start from very early on. Recorded and monitored using a national database.

Other Preventative Checks - Pregnancy screenings - Health checks - Mobile clinics - General hygiene: regular monitoring of availability and quality of public drinking water, regular cleaning of public spaces/services/transport/rubbish collection. - High food safety standards and regulations - Non-smoking laws

Treatment 1st Step: Diagnosis through local GP. 2nd Step: Medical Treatment // Referral to specialist - hospital. 3rd Step: Treatment. In most cases through the public health system, private healthcare optional. If private cant most people will go through public system. Medication on the public service is subsidised by local governments.

Option Theme F: The Geography of Food and Health

Better quality: Well-educated, competitive specialists. Aftercare and follow ups are poor, e.g. Rehab. Physiotherapists in shortage.

Methods of prevention will continue to improve as they are cheap and eective. Treatment will be less prominent. Spain has an ageing demographic, costly burden. Economically dicult to provide public health services. Prevention methods reduce these costs.

Option Theme F: The Geography of Food and Health

2. FOOD
Global Availability of Food Identify (nd an answer from a range of possibilities for the) global patterns of calorie intake as one measure of food availability: Generally the LARGEST (>3500 calories per day) calorie intakes can be seen in MEDCs and more auent nations. Mostly in regions such as Europe, North America, certain parts of North Africa and China. LOWEST level calorie intakes (<2000 calories/day) occur in most LEDCs. Places such as sub-Saharan Africa, Mongolia, Africa and Afghanistan. e inbetween calorie intake (2500-3000 calories/day) are most common in developing/emergent nations found in South America, eastern Europe and South-East Asia. Distinguish (make a clear distinction) between malnutrition, temporary hunger, chronic hunger and famine. Malnutrition: A diet that is lacking (or has too much) in quantity or quality of foods. Temporary Hunger: A short-term decline in the availability of food to a population in an area. Famine: A long term decline in the availability of food in a region. Chronic Hunger: A long-term form of hunger caused by factors such as drought, famine, war, conict or political upheaval.

Option Theme F: The Geography of Food and Health

Discuss (offer a considered and balanced review that includes a range of arguments of) the concept of Food Security: Food Security exists when all people, at all times have access to safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life. is includes: Ready availability of nutritionally adequate and safe foods. Assured ability to acquire acceptable foods in socially acceptable ways. Food Security is aected by physical (Food Availability Decit - FAD) as well as political and economic factors (Food Entitlement Decit - FED).

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Areas of Food Sufciency and Deciency Explain (give a detailed account, including reasons or causes of) how changes in agricultural systems, scientic and technological innovations, the expansion of area under agriculture and the growth of agribusiness have increased the availability of food in some areas, starting with the Green Revolution and continuing since: Green Revolution: Increasing populations led to: Need to improve food production (done by improving cross-breeding). Focus on rice, wheat and corn. Create High Yield Varieties (HYVs), which needed: - More nutrients/fertilisers and water/more pesticides. HYVs were all similar heights allowing more machinery, less labour needed. Faster growth allowed for 3 harvests a year for rice. Green Revolution has been a success in increasing food production. PROBLEMS: More use of pesticides, water and (articial) fertilisers. Has lead to GM foods, labour extensive, capital intensive farming. Rich get richer and the poor get poorer and unemployed.

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CASE STUDY: Indias Green Revolution An attempt to increase food production to support growing population in the Indian subcontinent in 1967-8. Adopted Mexican IR8 HYV rice. Had a short stalk, a larger head and yielded twice as much as traditional varieties. HYVs required too much water and nitrogen. Currently, up to 55% of Indias crops are HYVs. Successes: Well-o farmers who could aord seeds, fertilisers and machinery became richer Increases in yields lead to a fall in price - consumers benet Reduces balance of payments decit in LEDCs Reduce food imports Boost productivity in commercial agriculture Meet demands of growing population Failures: Excess fertilisers caused eutrophication (=creation of water systems with intense algae vegetation due to excessive richness in nutrients, which kills all animal life due to lack of oxygen) Some new crops more susceptible to pests and disease Soil degradation Mechanisation reduced employment, rural-urban migration caused overcrowding, poorer farms couldnt buy new equipment Mismanaged irrigation systems have led to salinisation Impact of necessary articial fertilisers and pesticides leads to groundwater contamination. In Punjab, high incidence of neonatal illness and adult cancer. CASE STUDY - AGRA, Africa A Green Revolution for Africa is an NGO funded by the Gates and Rockefeller Foundations. It aims to help the African continent to feed its growing population by initiating a Green Revolution, similar to that in the Indian Subcontinent. Involves the use of: Water for irrigation Fertilisers Improved storage of crops Improved access to markets by road building programmes Education in crop management, pest control and water management
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CASE STUDY: Genetic Modication of crops All living things contain DNA. Genetic modication involves mixing the DNA of dierent species. Examples: Adding a gene that grows well in arid conditions to a rice plant so it can grow in drier areas Herbicide resistance Pest resistance Advantages: Reduce chemical input Could solve food shortages Disadvantages Crops on organic farms might be contaminated by GM crops, losing organic status. Pollen from GM plants may pollinate nearby plants, spreading the modications in an uncontrolled way Long-term eects unknown

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Examine (consider an argument or concept in such a way that uncovers the assumptions and interrelationships of) the environmental, demographic, political, social and economic factors that have caused areas of food deciency and food insecurity: Economic Factors: Speculative trading in agriculture commodities has grown dramatically, giving way to enormous uctuations in market prices that do not appear to relate to change in supply and demand. Soaring oil prices pushed up the cost of food production by about 70%, as well as transportation and labour costs. Demographic Factors: Increasing global population = increasing global demand for food. Environmental Factors: Increase in natural disasters such as cyclones and droughts limit availability of food. Climate change encourages water shortages and means that areas will become drier. Social Factors: Developing nations become wealthier and demand more meat and diary products meaning that more grain will go to feeding animals = less ecient. Pushed further by dumping of excess crops & crops used for biofuels = less food.

Political Factors: Farming subsidies in the west make farm products more competitive than those produced in developing countries. Crushing livelihoods of small poorer farmers. Price stability serves to squeeze much of the remaining life out of African farmers. Underinvestment in agriculture leads to little scope to improve and innovate. Examine (consider an argument or concept in such a way that uncovers the assumptions and interrelationships of) the variety of causes responsible for a recent famine - Case Study: 2010 Sahel Famine:
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Where: *Apr 3 - Sept 18 2010 Sahel Region - Parts of Mauritania, Mali, Senegal and Guine.

How many: 9 conrmed fatalities. 42 indirect fatalities. 20 unconrmed fatalities. 17,800,000 at immediate risk of starvation. Causes: Drought. Reduced rainfall & river discharges due to global warming. Poverty + population growth = growing food insecurity. Temp increaase of 3.5 degrees, changed rainfall patterns. Over-using natural resources: overgrazing/deforestation = limit to food. Air pollution from Eurasia/N. America. e demise of lake Chad - due to lack of rain water.
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 Global Warming (Increased pollution = drier - irregular rainfall). Global Dimming: More dust particles from the burning of fossil fuels, blocked sunlight leading to less evaporation. Farming mismanagement. (Minimal inuence) Switch to cash crops - sell but dont eat. Less land for food crops. Increasing food prices - less aordable for the locals. Likelihood of another this year. Early warning systems in the Sahel region show that overall cereal production is 25% lower this year than the previous year and food prices are 40% higher than the ve-year average. A recent Save the Children assessment in Niger showed families in the worst-hit areas were already struggling with a third less food, money and fuel than is necessary to survive. CASE STUDY: Famine in the Horn of Africa 2011 Average calorie in-take in region: 2,100 per day.

Causes: Drought and Flooding - only one short rainy season annually. Shortage of land - rapid population growth leads to subdivision and redistribution of land holdings to an inadequate size. Land Degradation - Overpopulation, overgrazing, over-cultivation, soil exposure and wind erosion. Political conict - Somali conict with Eritrea has disrupted infrastructure and access to markets and food. Also reduces agricultural productivity and diverted govt investment away from programmes that provide relief to areas with shortages. Food aid - Largely emergency aid rather than long-term development aid to get out of poverty. Causes a culture of dependency undercutting the markets. Cash aid would allow the locals to buy what they need and allow bottom up development, invigorating the local economy instead of depressing it. Population growth - Malthusian increases, highest fertility rates in the world- 6. Rise in world food prices - price of maize doubled and wheat gone up 40%.
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 Terms of trade - agriculture accounts for 85% of exports and 80% of employment. Coee providing 35% of foreign exchange in Ethiopia. Earnings down 65% from slump in coee prices. IMF and WB liberalisation policies had a catastrophic impact on Ethiopian coee industry. Poverty - Low income and lack of assets, leaves people unable to purchase food.

Responses Improving production through irrigation Promoting soil conservation Diversifying crop production, encouraging specialisation Intensifying cropping and yields through inputs. Improving access to food by increasing farm and o-farm incomes Improving access to micro-credit mechanisms Improving health services Developing safety-net programmes to limit erosion of productive capacity in times of crisis.

Although drought sparked the East Africa crisis, human factors turned it into a disaster. A culture of risk aversion caused a six-month delay in the large-scale aid eort because humanitarian agencies and national governments were too slow to scale up their response to the crisis, and many donors wanted proof of a humanitarian catastrophe before acting to prevent one. Sophisticated early-warning systems rst forecast a likely emergency as early as August 2010, but the full-scale response was not launched until July 2011, when malnutrition rates in parts of the region had gone far beyond the emergency threshold and there was high-prole media coverage. Waiting for a situation to reach crisis point before responding is the wrong way to address chronic vulnerability and recurrent drought in places like the Horn of Africa. e international community must change the way it operates to meet the challenge of recurrent crises Long-term development work is best placed to respond to drought.

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Somalia's remains the most acute food crisis in the world, with hundreds of thousands of people still at risk. According to UN estimates, the rate of malnutrition, measured by the median global acute malnutrition (GAM) standard, increased in southern and central Somalia from 16.4% to 36.4% in 2011. e 15% "critical" threshold was exceeded early in 2011.

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Production and Markets

Examine (consider an argument in a way which uncovers the assumptions and interrelationships of) the impacts at a variety of scales of trade barriers, agricultural subsidies, bilateral and multilateral agreements, and TNCs on the production and availability of food:

Trading Blocs and Subsidies Allows free trade amongst member countries (EU) Common Agricultural Policy (CAP) subsidy to guarantee prices for unlimited production. Allowing farmers to maximise production for guaranteed market: - Imports are subjected to duties/levies to increase competitiveness for EU goods - Export subsidies given to EU farmers to ensure competitiveness in global markets. - Overproduction large problem: Surplus dumped on world markets causing depressed crop prices for those outside trading blocs. Cost poor in LEDCs $100bn per year in 1990s. Free Trade Trading competitively - no restrictions - Working to reduce protectionism policies such as CAP.

Multilateral Arrangements A number of countries agree to import goods from a number of other countries: - EU from ACP (Africa.Caribbean.Pacic Nations). Grants ACP access to EU markets. Denies others. Unfair disadvantage Caribbean still only accounts for 7-9% of bananas sold in EU.

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Addressing Imbalances
Evaluate (make an appraisal by weighing up the strengths and limitations of) the relative importance of food aid, free trade and fair trade in alleviating food shortages: Global trade and investment policies have driven instability in global food markets, hindering the ability of poor nations to grow their own food. Technological Solutions GM Crops - Improve yields - Research has been devoted to developing crops for rich countries in the northern hemisphere. Not always suitable Expanding Irrigation - Perennial Irrigation Systems: Water supplied all year as crops need it Appropriate Technology - Small scale self help schemes Diguette construction (stone lines placed along hillsides to stop run-o) Seeds and Fertilisers - Rural poor need help to plant next years harvest, as were forced to eat all seeds. - Fertilisers needed, yet price driven up sixfold due to high oil prices Sustainable Practices - Local knowledge, Appropriate Technology and avoid Pollution Conserves resources (soil and biodiversity) for future generations

Socio-cultural Solutions Agricultural Investment - Yields increase with right help Irrigation Appropriate Fertilisers Infrastructure (farms to market access)

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 Food Aid - Reaches most desperate after natural disasters/famine. - Not a long term solution Depresses local economies Land Reform - Successful in Kenya. Slow to occur Improved infrastructure - Roads, Railways, Electricity and water to improve agribusiness. Trade Reform Fair Trade - Attempts to be socially, economically and environmentally responsible. - Aimed at sustainable development for excluded and disadvantage producers Helps farmers obtain a fair price for products. - Attempt to address fallings of the global trading system.

CASE STUDY: Fair Trade Pineapples in Ghana Fair Trade Buying directly from producers Increased price paid by consumers to give a fairer price to the producer Encourages decent working conditions Much of this prot may be used to nance development projects Valued at $2.3 billion worldwide Ghana Prudent Exports - Better working conditions, wages and longer contracts for farmers - Buys pineapples from smallholders and exports direct to EU supermarkets - Cut backs on pesticides and chemical fertilisers by request of consumers Blue Skies Organic Collective Association - 80 pineapple farmers from village level collectives - Supplying organic pineapples to Blue Skies products - Blue Skies help BSOC achieve Fair Trade status and built collection points to ensure pineapples could get to processing plants to be sent to EU. - Blue Skies built boreholes with raised funds from sales to bring much needed water supplies to local communities
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Sustainable Agriculture Examine (consider an argument in a way that uncovers the assumptions and interrelationships of) the concept of sustainable agriculture in terms of energy efciency ratios and sustainable yields: Energy eciency ratios measure the input of energy into the farming system compared with the outputs of energy in food produced. Process such as shifting cultivation have a ratio of 1:20 and is sustainable due to the continuous movement from one plot of land to another. Such movement allows pieces of land to have fallow years enabling soil to replenish nutrients. CAFO food production has a ratio of 10:1 making it highly inecient as many more inputs are put in and few come out. is also makes it unsustainable because crops will be needed to raise cows instead of humans meaning that there will be greater stress put on growing crops and this will remove much needed nutrients from the soil. Examine (consider an argument in a way that uncovers the assumptions and interrelationships of) the concept of food miles as an indicator of environmental impact: Food miles refers to the distance food travels from where it is produced to where it is consumed. Food distribution now accounts for between a third and 40% of all UK road freight. e food almost completely dependent on crude oil, thus food supplies are vulnerable, inecient and unsustainable.

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3. DISEASE
Global Patterns of Disease Explain (give a detailed account including reasons or causes for) the global distribution of diseases of: Auence: Diseases of auence are a consequence of increasing wealth in a country. Mostly caused as a result of increased longevity, improved environmental quality and the combined impact of over-consumption and lifestyle. Largely degenerative diseases such as: Cancer. Heart disease. Strokes. Poverty: Commonly found in LEDCs. 5 distinctive causes of poor health in LEDCs: Poor diet. Poor hygiene. Waterborne parasites. Poor public health facilities. Lack of info/education. Diseases of poverty are mostly contagious. Some examples are: Malaria. River blindness. Cholera. Leprosy.

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The Spread of Disease Explain (give a detailed account including reasons or causes of) how the geographic concepts of diffusion by relocation and by expansion apply to the spread of disease: Relocation diusion: Involves the movement of individual people who carry the disease into new locations. e disease generally evacuates the source area along with the carrier. Expansion diusion: Disease develops in a source area and spreads out from there, while still remaining strong (if not intensifying) in the source. is happens in 2 ways: Contagious Diusion: Spreads out in several directions aecting most people who come into contact with the infected person. Hierarchical Diusion: Spreads amongst certain groups/individuals who are susceptible to the disease. Diusion is a process which only applies directly-transmitted diseases. Such as those common to diseases of poverty. It is simply one person passing an infection on to someone else, who in turn passes it on to others and so on.

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Examine (consider an argument in a way that uncovers the assumptions and interrelationships of) the application of the concept of barriers in attempts to limit the spread of disease: Barriers to Diusion: Draining swamps (malaria). Using pesticides. Medications. Educating the local community. Vaccinations. Immunisations. Time-Distance Decay: the further a disease moves from its source the less likely it is to remain viable. Time reduces eectiveness. Describe (give a detailed account of) the factors that have enabled reduction in incidence of disease: Vaccinations. Immunisations. Climate. Time-Distance Decay. Educating the local population in ways they can minimise the risks of catching diseases.

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Geographic Factors and Impacts Examine (consider an argument in a way that uncovers the assumptions and interrelationships of) geographic factors responsible for the incidence and spread of TWO diseases: Malaria: Causes fever, sweating, anaemia & spleen enlargement. It can be fatal. Facts: Kills up to 3 million people annually (mostly in sub-Saharan Africa). Widespread in tropical countries. Costs $1.1bn annually. ENDEMIC (localised/restricted to a certain area). Incidence: Stagnant water for mosquitoes to lay their eggs. Temperatures >16 degrees for parasites to develop. Temperature >32 degrees kills parasites. Spread: Many not immune. Parasite becoming more drug-resistant. Mosquitoes spreading to new areas. Agricultural schemes expanding. Increase in irrigation schemes. Increase in International travel and trade. No accepted vaccine available.

Acquired Immune Deciency (AIDS): = STD. Caused by Human Immunodeciency Virus (HIV). Facts: 33.2 Millions infected by HIV. 90% of AIDS cases are in LEDCs. In MEDCs, is becoming more signicant cause of death than cancer. PANDEMIC: Large-scale global health problem in a short time. Incidence: Killing and Eating Chimpanzees.
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Spread: Sexual Activity. Intravenous Drug Use. Using infected needles. Getting a poorly screened blood transfusion. From an infected mother to her unborn baby. (LEDCs) Lack of healthcare and education. Evaluate (make an appraisal by weighing up the strengths and limitations of) the geographic impact of TWO diseases at local, national and international scales: MALARIA: Direct Costs: Cost of Prevention. Cost of Treatment. Indirect Costs: Tanzania: 80% of children infected. Tanzania: 4% of children die with Malaria by age of 5. Halving the infected cases would cost $600 million. DDT chemicals = acutely toxic. Deaths mean fewer working force people. Especially children.

AIDS: Direct Costs: Cost of Diagnosis. Cost of Treatments. Indirect Costs: Loss of earnings due to premature death. Patients draw upon health services for many years. Mainly aects young adults, which aects productivity of the working sector.

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Local

National

International

Loss of earnings

Reduces quality & efciency in education systems. Ongoing problem for national development Lack of education = high illiteracy = less scope to develop Prejudice

Pandemic

Loss of primary income Reduced supply of teachers Prejudice

Steep drops in life expectancy Rising child mortality rates (Bahamas) Prospect of widespread food shortages and hunger if agriculture is not sustained.

Children forced to leave school to earn income

Funding treatment reduce levels of funding in other areas

Evaluate (make an appraisal by weighing up the strengths and limitations of) the management strategies that have been applied in any one country or region for one of these diseases: CASE STUDY: AIDS in Senegal Government departments took the problem seriously. 1970s brothels began to be regulated. Condom use was rmly encouraged. e nations blood supplies were screened for the disease early and eectively. Vigorous education resulted in 95% of adults knowing how to avoid the virus.

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