International Development Studies
Course Code
Guerra Salazar, Rene

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Chapter 6: Epidemiologic Profiles of Global Health and Disease
Public Health Epidemiologic Terms
oAnalytic study, census, communicable disease, death rates, birth rates, ,
exposure, fertility rate, incidence, Infant Mortality Rate (IMR), life expectancy,
maternal death, MSM (men who have sex with men), notifiable disease,
population pyramid, standardization, stratification, trend
oAdjustment – a summarizing procedure for a statistical measure in which the effects of
compositional differences are adjusted
oCase fatality – (# of deaths from a disease/ # of diagnosed cases of that disease) x 100
oDisability-adjusted life year (DALY) – a measure of burden of disease on a population
and effectiveness of interventions
Leading causes of morbidity and mortality
oCoronary heart disease (CHD), cancer and stroke are the leading causes of death –
CHD is found in both high and low-income countries
oDenmark (high-income/highly redistributive) has a high life expectancy (78yrs), low
child and IMR (5deaths/1000births), but high mortality rate from cancer and leading causes of
death (l.o.c.d) due to heart disease, stroke, pulmonary disease and cancer
oEgypt (middle-income/partially redistributive) has lower life expectancy (68yrs), higher
child IMR (25 to 35deaths/1,000) than Denmark and l.o.c.d from heart disease, stroke, and
oNigeria (low-income/marginally redistributive) has life expectancy (46yrs) IMR =
100deaths/1000births (1/5 children die before 5yrs), l.o.c.d HIV/AIDS, malaria, measles and TB
– 50% of deaths due to communicable disease
oIn 1990, communicable disease caused 59% of death and disability among the world
poorest 20%...[among the rich] non-communicable diseases caused 85% of death and disability”
The Coming Plagues: Non-communicable Disease
oCommunicable diseases causes high DALY rates in low-income countries but non-
communicable diseases are expected to exceed communicable disease in all income
groups by 2015
oThough changing risk factors can reduce the death by non-communicable diseases, large-
scale intervention can be taken (e.g. reducing salt in processed food, taxing tobacco products, and
increasing disease screening and disease-control measures)
§Primary prevention – prevention of exposure or infection and promotion of
good health (e.g. immunizations, pap smears, condom use, diet and exercise)
§Secondary prevention – early detection (e.g. screening, checking bp, blood tests, x-rays,
physical exams, etc)
§Tertiary prevention – disease management
Health in infants and children
oWith improved sanitation, maternal and infant nutrition, vaccination and primary
health care interventions globally IMR has decreased but IMR is still a concern as is
seen with child deaths (b4 5yrs) in poorest populations 2 to 3 times more likely than
in more affluent nations.
oMalnutrition increases susceptibility to disease and chronic undernutrition has adverse
health effects as well lowering workplace productivity.
oProvision of skilled attendant at delivery, immunization, antibiotic treatment for pregnant
women and newborns, hygienic practices during delivery, and breast feeding (etc) can prevent
75% of neonatal and 60% of child deaths
oInterventions for improving child survival include improving sanitation and cooking
facilities, provision of potable water, and oral rehydration therapy for diarrhea.
oEducation and employment is a concern for the world youth in extreme poverty,
particularly women, as can be seen in decline in female attendance post primary school and
higher unemployment among young women due to gender discrimination
§Lack of sexual health education programs affects the incidence of
Health of adults
oThough adults have greater immunity than children they have higher rates of non-
communicable diseases and adult heath plicy are not emphasized. Adult health illness
createsocial and financial burdens on health services and caregivers (255)
oDisability Difference between disability and impairment – disability: results from
medical, physical and environmental factors determined from social discrimination and stigma;
impairment: problems in body function or structure (255)
§Poverty is a cause and consequence of disability and in low-income
countries ppl with disabilities dont have access to rehab programs and therapy
oAging populations are a result of factors such as improvements in health and its
determinants through the life course, and decreased fertility rates (256)
oInjecting drug use (IDU) – Harm reduction strategies are practiced in some countries
and local municipalities offering safe injection locations, clean needles and disposable facilities,
etc for injecting drug users – this has helped to reduce the spread of disease via sharing needles
oDental health – dental health is a concern among the poor, in developing countries there
is insufficient number of dentists and globally dentists are financially inaccessible to low-income
families. Commercial foods, insufficient exposure to fluorides, and costs of tooth brushes are
also dental health issues.
Womens health
oGender-specific health problems can result from the limits on economic and social
power, lower levels of education and lack legal autonomy that women face –e.g. they
experience “occupational diseases and death due to gendered work patterns and
unequal power in the workplace” (259)
oWomen tend to have more morbidity and physical disabilities than men
oMaternal mortality is higher in developing countries because of lack of sufficient
infrastructure for prenatal care, resource allocation, etc. Other concerns they may live far from
health services, have insufficient funds to pay costs an dlack decision-makign power in their
§3 main types of essential care for pregnant women
Antenatal care: (while pregnant) most pregnant women dont see
care during pregnancies in Africa, Asia, Caribbean and Latin America
Perinatal care: (during childbirth) skilled birth attendants are not always present during
births in developing countries
Postpartum care: (post delivery) care is need after delivery to prevent infections and
provide support – rare in developing countries
oWomen in developing countries also suffer from unsafe abortions causing 50% of
maternal deaths – poor hygiene during delivery is also a cause of maternal deaths
oThe hindering of women from attaining higher levels of education is not only at her
disadvantage but her family
§Universal education and social security measures have helped (Micro
credit loans have also been initiated to help women support their families)
Mens healthbesides sex specific health concerns, some mens health issues are related
to gender roles (e.g. dangerous/stressful work conditions, habits like smoking and drinking,
armed conflict
LGBT health issueshomophobia and heterosexism endanger LGBT health through
housing and employment discrimination, lack of social security benefits, harassment, stress,
isolation and abuse (leading to mental illness or depression)
Health of indigenous people
oIndigenous populations have higher mortality rates and worse health than non-
indigenous populations – e.g. in the US they have higher mortality rates from TB and
diabetes, and there is generally life expectancy gaps between the two populations
oResearch is being on the contribution of “poor living conditions, substandard schools,
chronic unemployment and persistent discrimination” (265)
Disease typologiesglobal disease patterns according to macro-structural causes
oDiseases of marginalization and deprivation – “disease that result from poverty,
substandard living conditions, geographic isolation, and political oppression” (266) –
result from exposure to contaminated water, air food and physical environments
§Diarrhea – leading cause of children deaths, “the main determinants… are
structural factors such as water quality and level of sanitation as well as overall
health-promoting and immune-boosting determinant (268).
Can be addressed biologically (immunizations), changing behaviors
(education and training), on a community level, or environmental level
(water supply)
Oral rehydration therapy (ORT) involves replacement of fluids, is cheap and easily
administered but requires clean water
§Neglected Tropical Disease (NTDs)diseases that are not required to be
reported because they affect a small population (hence neglected – though
this could refer to how the affected populations tend to be the socially and
politically marginalized) e.g. Chagas disease, dengue fever, trypanosomiasis,
leprosy, etc
There are drugs that can treat and prevent NTDs but are often not
distributed because pharmaceutical companies dont see profit since
users dont have money to buy them
NTDs cant be controlled at an individual level since they are influenced by environment
and affect whole communitiesrequiring improvements in water, housing, sanitation, the