week 4 lec/chp notes
DepartmentInternational Development Studies
ProfessorAnne- Emanuelle Birn
Oct, 5 (week 4, lecture 4) chp 5
-health related info and knowing how to obtain it is essential to taking action to improve health.
-plays a vital role in helping to identify needs and shape solutions.
-not all deaths recorded; most of 50 million deaths each year lack medical certification
-social, political and economic factors for illness and death are insufficiently captured by routine health
-many factors that influence health do not qualify as health statistics (rain, pollution, transport, etc.)
-one of first priorities is to secure reliable health statistics collection. But data costs money. Where
disease occurrence is highest, the numbers are the least trustworthy.
-two assumptions: disease and death are medicalized processes that are certified by trained medical
practitioners and publicly recorded. There is an agreed upon disease classification process universally
applied by doctors through common diagnostic procedures.
-International classification of diseases (ICD): cultural and economic factors limit adoption
*****Table 5-1 Uses for statistical health data (11 uses listed)
-detailed census date gives a voice to the voiceless.
-health data used in public sphere for info regarding political system, education campaign.
-Vital for determining whether goals and priorities are being met.
-mortality and morbidity data can help provide causal explanations
-have to make correlations between behaviours and health outcomes. Example: smoking causes
-use of data in terms of deciding what variables are important.
-primary reason for collection of health data is to track trends in population health status at the level of
coutnreis, regions and subpopulations.
-health data employed to measure success or limitations of medical or health promotion intervention, or
social and economic policies.
-health data used to compare populations with and between countries to evaluate effects of programs
and policies, in order to use successful experiences in the future.
-Health impact Assessment (HIA): considered health impact of both public and private sector policies in
diverse arenas including zoning, transport, labour, energy, education. Calls for action and accountability
on part of decision makers for promotion of health and reduction of health disparities.
Monitoring and compliance under the 2007 international health regulations (196-8)
-smallpox: eradicated but re-emerged as bioterrorist threat
-under surveillance: malaria, polio
-annual report on actions taken and progress achieved in improving health of people.
-International Health Regulations (IHR): national governments notify WHO of cases or outbreaks of
certain diseases, and of measures taken to prevent their spread
-public EMG international concern if:
1- constitutes a public health risk to other states through international spread of disease
2- potentially requires a coordinated international response.
-notification within 24 hours of first official case
-International Sanitary Regulation (ISR): adopted by WHO in 1951 as legal instrument to protect against
international spread of diseases.
-following SARS in 2003, WHO held a series of meetings to update international health regulations.
-Update included mandatory reporting of public emergencies.
-prior to that the only mandatory reporting was for the four diseases listed above. Reason for
update had to do with Chiv[o}Á}]vPP]vP}µlP]vPZ^Z^}µl]v
-Cases reported a week after the President of the USA went on his planned visit to Mexico.
Reporting is very calculated by governments
-early detection can lead to knowledge of their cause, and important steps can be taken to minimize
hazards. New conditions can be discovered before larger population groups are exposed.
Limitations to health data:
-highly sensitive and laden with political overtones.
-may be pressure for governing bodies to distort figures
-concern with international trade or tourism may prompt cases of cholera to be reported as
-data may be interpreted to support a particular position (ex. Pro or against smoking, guns, etc.)
-biased or selective info to get money or public attention
Types of Health Data (199)
-Population data: number of people in population and their attributes (sex, age, ethnicity, religion,
-vital statistics: births, deaths, marriages, by sex, age and cause
-health statistics: morbidity by type, severity, and outcome( monitor levels of health and disease, rather
than death. Difficult to obtain, extremely costly, need trained healthcare workers, etc.)
-health services statistics: number and types of facilities and services available; distribution,
qualifications, and functions of personnel; hospital and health care center operations (the health care
systems capacity; doctors, nurses, hospitals, clinics, etc.)
-data on social inequalities in health: social factors that lead to inequalities in health ( look at each of the
other four categories in terms of their breakdown on social class, sex/gender, racial/ethnic origins,
-need to look beyond disease manifestation and think through economic consequences.
-ex. Disabled person have stigma associated with them, so less likely to have job
-societal variable- measure of social welfare and security, distribution of power and resources- vital to
health related decision making.
Census Taking (204)
Preconditions for conducting a census
-sponsorship: legal basis
-universality: everybody taken into account. Problematic because homeless people, babies, illegal
immigrants, refugees, illiterate people, those living in very remote areas are all missed.
-simultaneity and specified time: what a sense of a snapshot in time because you want accurate data
before demographics change drastically.
-periodicity: census taken in regular intervals. Only few countries invest in census more often than every
ten years (costly to collect census data).
-compilation and publication
Census Challenges (205-209)
-Cost and Scope
-India: 2 million enumerators trained, 150 million households, 25 days
- Nigeria: 300 ethnic groups, 1 million workers, 7days GPS and 6 years of planning
-errors and underestimates
-Varied application of categories (even age)
-racialized and racist typologies
-U.S race-based classification (legacy of slavery)
-historically this was used for purposes of discrimination. The population of African
American decent was not fully counted for voting.
-Complex, because people may be of multiple racial background.
-important categories in large part in countries that have experienced racism, to see
improvements or deterioration of certain ethnic populations.
-south African apartheid (Coloured, black, Asian, white)
-used for allowances of school attendance, residences, employment.
-should these categories remain or are they a legacy of racism? The government
decided for the purposes of census and data collection, they were important to note
changes in different ethnic groups
-Fact fudging: providing inaccurate information. Example: saying that urban neighbourhoods are getting
more financial support than they really are, so that more money would go to the suburbs.
-India has a classic pyramid form: larger younger population group and smaller older population group.
-China had a pyramid shape, until 35 years ago. This is due to the one child policy. The younger
population is less than the older population
-S.A: Demographers estimated that without AIDS deaths, the population of south Africa would be much
-Why are population pyramids lopsided? More men or more women?
-sex selective abortions
-Paradox: women have higher illness rates, but they are also more likely to go to the doctor and
-demographers think of marriage as protective for men, but dangerous for women.
-stable households gave men more secure access to food, fewer sexual partners.
-women had added responsibilities and stress.
Vital Statistics (Table 5-5)
-birth certificate necessary for identity to enter school or government services, and obtain other
-keep estimates of population size.
-used to prevent child labour and trafficking, child soldiers