Chapter 2&3

Life Expectancy

• There have been wide variations in life expectancy over time.
• The average life expectancy in pre-industrial Europe and Canada was less than 40 years.
• Today, females and males in Canada can expect to live for about 84.7 and 80.9 years, respectively, among the highest rates in the world.
• Changes in life expectancy over the past 150 years in the developed world can be explained by a host of factors.

Epidemiological Transition

• As the economy transitions from low to high per-capita income, a corresponding transition occurs from high mortality and high fertility to low mortality and low fertility.
• Changes in disease patterns occur in three stages: Age of Pestilence and Famine, Age of Receding Pandemics, Age of Degenerative and Man-Made Diseases.
• Age of Pestilence and Famine is characterized by a high mortality rate largely attributable to famine and infectious diseases.
• Age of Receding Pandemics involves a decrease in epidemics and famine, leading to a decline in the mortality rate while fertility remains high, causing a population explosion.
• Age of Degenerative and Man-Made Diseases is when the fertility rate declines as people live longer and succumb to industrial and degenerative diseases like cancer, stroke, and heart disease.

McKeown (1976)

• The decline in mortality rates in many European countries over the last few hundred years was mainly due to a decline in infectious diseases.
• Improvements in nutrition, hygiene, disease-causing microorganism control, and birth control have led to a decline in infectious diseases and have affected life expectancy.

Global Inequalities

• Inequalities continue due to workers' conditions in the global economy, which impact equality, living conditions, and health.
• Dependency theory/World systems theory suggests multinational expansion by powerful nations maintains underdevelopment in the rest of the world.
• Core countries exploit periphery countries by extracting raw materials, employing inexpensive labour, and using poorer countries as consumers.
• Health outcomes depend on location in the world economy.

Death, Disease, and Disability in Global Context

• Death and disease vary globally, influenced by socio-economic, political, and cultural factors.
• In 2012, about 6.6 million children under five years of age died.
• Greater inequality results in a larger population living in poverty.
• Major causes of death today are preventable through minor and inexpensive interventions.

United Nations Millennium Declaration

• The declaration was signed in 2000 to promote equal development internationally.
• The goals comprised the eradication of poverty, hunger, violence, and war, improved access to essentials, universal primary education, gender equality, child and maternal health, disease reduction, environmental sustainability, and global partnerships.
• Most major causes of death worldwide are preventable through interventions like poverty eradication, violence prevention, and improved access to food, water, birth control, healthcare, and immunization.

Poverty and Inequality

• Health costs of economic recession mostly affect those who are least well-off.
• Public policies regarding income security are linked to infant mortality rates.
• The more equal democratic socialist countries, such as Sweden, Norway, and Finland have relatively low rates of Infant mortality.
• Less equitable countries such as Turkey, Mexico, and the United States have higher infant mortality rates.

Food Security

• Food refers to a situation where safe, nutritious, and culturally acceptable food is inaccessible.
• Improvements in nutrition have a larger impact on morbidity and normality.
• More than half of deaths in the developing world each year are linked to malnutrition.
• Food insecurity results from war, poverty, natural disasters, epidemics, and political and economic crises.

Food and Women

• Nutrient deficiencies in women, especially pregnant and breastfeeding women, have a greater need for calories which is pivotal for their offspring.
• Underweight babies are more likely to suffer from diseases and die as infants.
• Women's education was associated with almost 43% of the reduction in child malnutrition in developing countries (Smith and Haddad).

Physical and Social Environment

• Over 1 billion people lack access to safe drinking water.
• Shortages of clean water are due to political and economic decisions, not necessarily a lack of water available.
• Fatal and debilitating chronic illnesses are unsanitary water (e.g., cholera and dysentery).
• Diarrheal disease remains a leading cause of childhood death.
• Diarrheal prevention includes changes in water supply, hygiene, and sanitation.
• Devastating effects of unclean water can cause dramatic effects in death rates among babies.
• Infant formula was associated in the minds of Third World peoples with the successful middle and upper classes in the Western world.

Safety, Security, and Safety

• Personal safety is of great concern and civil war, international warfare, and violence in communities, workplaces, etc, are all threats.
• Violence and war grow as a result of social and international inequities.
• The consequences of violence have expanded dramatically globally along with population growth.
• About 1.5 million people lose their lives due to violence every year around the world.
• Approximately 80% of homicides are of men, but women are at greater risk of violence from their domestic partners.
• In 2017, 87,000 women were killed by their intimate partners.
• Other population with a high risk for violence include children, adolescents, old people, the homeless, the unemployed, migrants, refugees, members of visible ethnic minorities, the chronically ill, the mentally disabled, and victims of war.
• The lifetime consequences of abuse justify the need for prevention measures.

Health and Women's Place in Society

• Women's health is generally poorer than men's.
• Women continue to have less occupational opportunities along with earning less, so they are less likely to have economic and political power.
• Educated women are more informed about nutritional needs for their children.
• Countries with the largest gaps in educational and income status between men and women have the highest rates of, and fastest growth in HIV infections.
• Women's health outcomes are closely linked to those of children.
• Improving water, sanitation, and the decrease in indoor pollution would significantly help in child mortality around the world.

Birth Control, Pregnancy, and Childbirth

• Effective birth control is a good way of decreasing morality rates around the globe.
• Too many pregnancies, or very closely spaced pregnancies, are a threat to the health of the mother and the child.
• Women seek illegal abortions which are extremely dangerous during unwanted pregnancies.
• Because of malnutrition, women's bodies may be undernourished and small, so they experience difficult labor.
• During pregnancy large increases in calories, vitamins, and minerals are required, including more iron, vitamin B12, and folic acid for the baby and the mother.
• Energy is used up during pregnancy, so rest, mainly in the last trimester, is important.
• Childbirth itself, because of the lack of sanitation, prenatal care, or emergency medical services, is responsible for a higher rate of maternal mortality.
• Levels of maternal mortality remain high, with about half a million women dying annually in childbirth.
• Abortion for gender selection has shifted the male-to-female proportions of the population in certain countries in different ways.

Violence Against Women

• Genital mutilation/circumcision is considered by some as a means of violence against women to control their subordinate status, their reproduction and even for beautification.
• In some places, almost 100 per cent of women undergo infibulation between ages 4-10.
• Male circumcision was long supported in Canada, although rates have been decreasing and currently about 32% of male infants are circumcised.
• Approximately one in five women globally will be a victim or attempted victim of rape, according to the UN.
• Rape and domestic violence are leading causes of disability and death, especially among women in their reproductive years.
• The health consequences of and the fear of continuous rape and sexual assault include:
  • Psychological distress
  • Socio- cultural impacts
  • Somatic consequences

Comprehensive Medical Care

• Health care can be divided into three types: Primary, Secondary, and Tertiary
• Primary health care emphasizes equally distributed prevention through community development and education.
• Secondary health care is directed towards disease treatment in hospital and community via medical practitioners.
• Tertiary care occurs in a teaching hospital attached to a university and has a side emphasis on health promotion.

Mckinlay and Mckinlay (1977)

• Stated that most of the decline in mortality from the infectious diseases in 1900 was the result of health measures.
• Data for tuberculosis, typhoid, measles, scarlet fever, polio, influenza, and pneumonia demonstrate significant declines in mortality even before treatment.
• Serious infectious and bacterial diseases barely exist with the exception of HIV/AIDS in the developed world.
• In Canada, many children are not receiving adequate immunization.

The Impact of Specific Issues on Global Health

• Threats to global health over the next 10 years will consist of mental illness, fiscal crises in key economies, high underemployment and unemployment.
• Clean water availability and accessibility, income disparity, climate change, extreme weather events, global governance, food crises and political instability.
• The WHO estimates that 300 million people suffer from depression, 60 million from bipolar disease, 23 million from schizophrenia and other psychoses, and 50 million from Alzheimer's and other forms of dementia

Refugee Health

• Many people around the world do not have a permanent home or even a country in which to establish a home.
• Most refuges are hosted in poorer countries and many do not have some of the basics needed to live.
• Things like reliable shelter, food water, recreation, health care, legitimate identity, etc.
• Refugees are in a continuous battle with both the environmental and social challenges which have a huge affect, and can even lead to death.

Death, Disease, in Canadian Society

• The chief causes of death in Canada have changed over the last century.
• Today, cancer, heart disease, and stroke are the leading causes of death.
• The causes of disease in developed countries are environmental and lifestyle.
• In developing nations, the diseases are often connected to food security, lack of clean water, birth control.

Precursors the Major Causes in Canada.

• Explaining the causes of disease from a purely biological framework is called the biomedical model.
• Explaining the causes of disease from a biological, lifestyle framework is called the social determinants model.
• Causes of disease in developed countries like Canada can be influenced by a range of factors. Things like biology, lifestyle, the environment, etc.
• Leading causes of death in Canada include cancer, heart disease, accidents, and cerebrovascular diseases.

Alcohol and Street Drugs

• Excess consumption of alcohol is associated with mortality.
• Alcohol can lead to cirrhosis, malnutrition, accidents, suicide, homicide and other violent behavior.
• Street drugs can cause a multitude of health effects stemming from immediate death as a result of an overdose, to diseases, and disabilities.
• Drug use in Canada is always changing.
• Cannabis is no longer an illegal drug and people can now eat it and smoke it. Opioid use is increasing and is now seen as a crisis.
• Cigarette smoking is a leading cause of preventable death in Canada. Second-hand smoke can also lead to significant health problems.
• Cigarette smoke poses a significant problems, so those that are exposed are at risk.
• It is shown that poor people often smoke more, as a form of therapy to deal with certain stress.
• Another reason is those that are lower on the status have less networks with friends and neighbors to lean on for support.
• As the rates of cigarette smoking are declining in Canada and throughout the developed world, the rates are soaring in the developing world.

Obesity

• The incidence of overweight and obesity is growing in spite of the products and services to help lose weight.
• Obesity is a big risk factor for a variety of diseases including cardiovascular disease, cancer, and many others.
• Those that profit from this epidemic are the ones pushing it, it serves their interest.
• As of 2014, approximately 635,000 Canadian women have reported sexual assault cases.
• It is claimed that no one is ever accurately reprimanded for these violent actions.
• As of 2011, 71,300 Canadians were living with HIV, an increase of 11 per cent since 2008.

Major Environmental issues

• Hazards in the air, water, land, have increased tremendously over the last century.
• They have all been infiltrated with various types of toxic chemicals.
• Like other health threats, these hazards are unequally distributed.
• The poor and people are more likely to be affected by environmental hazards, plus poorer, less-developed countries are subject to the destructive effects of environmental degradation.
• Climate change is currently the most critical environmental issues.
• Climate change results in part from the burning of fossil fuels.
• Canada failed to meet its Kyoto commitments to reduce emissions to 6% below the levels of 1990 by 2008-12.
• The likelihood of Canada meeting any reductions is negligible, especially since the hugely polluting tar sands projects in Alberta are supported by governments at all levels.
• Global warming and temperatures can have an effect to human health, through direct and indirect ways.

Chemicals and Health

• Chemicals pose many threats to our health, in fact the World Health Organization found it to be some of the major threats in everyday life.
• Lead, methylmercury, dioxins, dibenzofurans, polychlorinated biphenyls (PCBs), nitrates, nitrites, and benzene-these substances are especially problematic for children, infants, and fetuses.
• Radon, asbestos (that irritates the lungs) and second-hand smoke are among the most harmful air pollutants.
• Source of air pollutants is industrial manufacturing, plus greenhouse gasses (methane)

Water Safety

• Over 1,000 chemical, metal pollutants have been observed coming into the lakes.
• The lakes are the main source of drinking water in Canada.
• Much of what what waste comes from contains harmful materials such as lead, arsenic and other materials.
• Food safety has become very important in the last few decades.
• Yearly, 1 in 8 canadians are affected by some sort of food-related illness.
• In 2008 in Canada, at least 57 people became sick and 22 died as a result of listeriosis.
• About 82% of Canadians purchase organic foods often.

Occupational Health and Safety

• In 2009, there were almost 200,000 claims allowed in Ontario alone.
• Almost 1000 workplace deaths were reported in Canada.
• The largest industrial sectors for workplace accidents are generally: service industry, manufacturing, and chemical processing.
• More then half of all accidents happen in the service and manufacturig industry

Hazards Associated with Workplaces.

• Both physcial and chemical hazards (noise and solvents)
• Many believe that almost 10% of Cancers are related to working enviroments.
• One-thrid of employed Canadians often work long shifts, causing health risks and many health problems.
• Almost always this leaves families suffering too, with mental health decline as well.
• Some jobs that require lots of physical and hard work require it to be done by migrants, many suffer at high accident rates.
• The effects effects of pesticides include nausea, headaches, and etc.
• Automobile accidents is also a cause (speeding)
• In 2015 it was recorded 152,504 falls that required hospitalization.
• Women have a higher rate of violence and 15 to 25% Canadian women have experienced some sort of violence in their time.

Explore the variations in life expectancy over time, from pre-industrial Europe to modern Canada. Discover how the epidemiological transition, driven by economic development, shifts disease patterns through stages like pestilence, receding pandemics, and man-made diseases, impacting mortality and fertility rates.