Sustainable Development Goals and the World Health Organization PDF

Sustainable Development Goals and the World 11 Health Organization LEARNING SEQUENCE 11.1 Overview 581 11.2 Objectives and rationale for the Sustainable Development Goals and key features...

Sustainable Development Goals and the World 11 Health Organization LEARNING SEQUENCE 11.1 Overview 581 11.2 Objectives and rationale for the Sustainable Development Goals and key features of SDG 3 582 11.3 Key features of Sustainable Development Goal 3: Good health and wellbeing 586 11.4 SDG 3 Key feature of maternal and child health and wellbeing 590 11.5 SDG 3 Key feature of communicable diseases 596 11.6 SDG 3 Key feature of non-communicable diseases 610 11.7 The relationships between SDG 3 and SDG 1 621 11.8 The relationships between SDG 3 and SDG 2 627 11.9 The relationships between SDG 3 and SDG 4 633 11.10 The relationships between SDG 3 and SDG 5 638 11.11 The relationships between SDG 3 and SDG 6 643 11.12 The relationships between SDG 3 and SDG 13 648 11.13 The UN’s Sustainable Development Goals and the World Health Organization 654 11.14 KEY SKILLS 667 11.15 Review 672 11.1 Overview Key knowledge Key skills Rationale and objectives of the United Nations (UN’s) Describe the objectives of the UN’s SDGs and justify Sustainable Development Goals (SDGs) their importance Key features of SDG 3: ‘Ensure healthy lives and promote Describe key features of SDG 3 and analyse its wellbeing for all at all ages’ relationships with other SDGs in collaborative approaches to improving health and wellbeing, and Relationships between SDG 3 and SDGs 1, 2, 4, 5, 6 and human development globally 13 that illustrate collaboration between the health sector and other sectors in working towards health-related goals Priorities and work of the World Health Organization Explain the priorities and the work of the WHO and (WHO) discuss how the WHO priorities are reflected in different scenarios Source: VCE Health and Human Development Study Design © VCAA; reproduced by permission. Key terms Antenatal care Maternal mortality Ecosystem Microfinance Extreme poverty Poverty Food security Stakeholders Interdependent Sustainable development Exam terminology Describe Provide a general description Justify Give reasons and/or evidence to support a point of view Analyse Examine the components of; Look for links, patterns, relationships and anomalies Explain Make plain, make clear (may require reasons) Discuss Give an overall account of Resources Digital document Key terms glossary (doc-36133) Exam question booklet Topic 11 Exam question booklet (eqb-0065) TOPIC 11 Sustainable Development Goals and the World Health Organization 581 11.2 Objectives and rationale for the Sustainable Development Goals and key features of SDG 3 KEY CONCEPT Understanding the SDGs, including their rationale and objectives 11.2.1 What are the Sustainable Development Goals (SDGs)? The 17 Sustainable Development Goals (SDGs), also referred to as the global goals, include 169 targets to be achieved by 2030. The goals were developed through a collaborative process by all United Nations member states, non-government organisations, and people around the world with an interest in making the world a better place. The goals include ambitious targets and plans about how each of them can be achieved. They tackle global challenges and aim to meet the needs of all people in all countries. They direct action in five areas of importance, which are shown in FIGURE 11.1 and are explained below. FIGURE 11.1 The SDGs direct action in five areas of importance for humanity and the planet. People “We are determined to end poverty and hunger, in all their forms and dimensions, and to ensure that all human beings can fulfil their potential in dignity and equality and in a healthy environment.” Planet Prosperity “We are determined to protect “We are determined to ensure that the planet from degradation, including all human beings can enjoy through sustainable consumption and prosperous and fulfilling lives production, sustainably managing its and that economic, social and natural resources and taking urgent action technological progress occurs on climate change, so that it can support in harmony with nature.” the needs of the present and future generations.” Partnership Peace “We are determined to mobilize the means required to implement this “We are determined to foster peaceful, Agenda through a revitalized Global just and inclusive societies Partnership for Sustainable Development, which are free from fear and violence. based on a spirit of strengthened There can be no sustainable global solidarity, focused in particular on development without peace and no the needs of the poorest and most peace without sustainable vulnerable and with the participation development.” of all countries, all stakeholders and all people.” 582 Jacaranda Key Concepts in VCE Health and Human Development Units 3 & 4 Seventh Edition  People — End poverty and hunger, in all their forms and dimensions, and ensure that all human beings can fulfil their potential with dignity and equality and in a healthy environment. Planet — Protect the planet from degradation through sustainable consumption and production, management of natural resources and acting on climate change to support the needs of present and future generations. Prosperity — Ensure all people can enjoy successful and fulfilling lives and that economic, social and technological progress occurs in harmony with nature. Peace — Foster peaceful, just and inclusive societies that are free from fear and violence. There can be no sustainable development without peace and no peace without sustainable development. Partnership — Implement the SDGs with a global partnership for sustainable development, focused on the needs of the poorest and most vulnerable, with the participation of all countries, stakeholders and people. 11.2.2 Rationale for the SDGs There were three main reasons, or rationale, for the introduction of the Sustainable Development Goals: 1. A new set of goals and targets were needed when the Millennium Poverty    not having the resources Development Goals (MDGs) finished in 2015. The MDGs provided a global to meet basic needs such as food, clothing and shelter framework of action to address poverty and make global progress on education, Degradation    the deterioration health and wellbeing, hunger and the environment. They resulted in significant of the environment through the improvements in global health and wellbeing and human development. More depletion of resources, such than 1 billion people were lifted out of extreme poverty, progress had been as clean air, water and soil, the destruction of ecosystems, and made against hunger, more girls were attending school and some action had the extinction of wildlife been taken to protect the planet. Sustainable development    2. Progress in all areas was uneven across regions and countries, leaving millions development that meets the of people behind, especially the poorest and those disadvantaged due to sex, needs of the present without compromising the ability of future age, disability, ethnicity or geographical location. This showed there was still a generations to meet their own lot of work to be done. needs 3. New global challenges had emerged that needed to be considered. These Stakeholders    people, groups included the impact of increasing conflict and extremism, widespread and organisations who are involved in or affected by a course migration, economic and financial instability and large-scale environmental of action changes. These challenges had the capacity to undermine many of the Millennium Development achievements that had been made through the MDGs. Goals    a set of goals that were introduced in 2000 to guide global 11.2.3 Objectives of the SDGs action until 2015 Hunger    the continuing lack of The 17 global goals work together to achieve three major objectives: food needed for an active and healthy life end extreme poverty Extreme poverty    living on less fight inequality and injustice than US$1.90 per day address climate change. Extremism    belief in and support for ideas that are very far from To achieve these objectives, the SDGs aim to end poverty and hunger; promote health what most people consider and wellbeing; address inequalities within and among countries; build peaceful, just correct or reasonable and inclusive societies; protect human rights; and promote gender equity and the empowerment of women and girls, all underpinned by the promotion of a sustainable world. A sustainable world means people can escape poverty and enjoy decent work FIGURE 11.2 The UN’s 17 Sustainable Development Goals Source: United Nations, 2015. TOPIC 11 Sustainable Development Goals and the World Health Organization 583 without harming the Earth’s essential ecosystems and resources; where people can stay Ecosystem    a community of healthy and get the food and water they need; where everyone has access to clean energy living things and the non-living that doesn’t contribute to climate change; and where women and girls are afforded equal components of the environment rights and equal opportunities. The three dimensions of sustainability underpinning the in which they live. An ecosystem can include plants, animals, goals are social, economic and environmental. micro-organisms, water, air, soil and rocks. Interdependent    mutually reliant 11.2.4 The Sustainable Development Goals are on each other interconnected Indivisible    unable to be divided or separated One goal is no more important than any other — they complement and interconnect with each other. They are designed as a set of goals and targets that are integrated, interdependent and indivisible. Their achievement requires collaboration across all sectors and at international, national, regional and local levels. 11.2.5 SDG 3: Good FIGURE 11.3 This topic explores the interrelationships between health and wellbeing SDG 3 and other health-related SDGs. Good health and wellbeing contributes to the achievement of many of the SDGs. In turn, the achievement of other SDGs helps achieve good health and wellbeing. It is for this reason that SDG 3: Good health and wellbeing is the focus of this topic, along with its relationship with other selected SDGs, which are: SDG 1: No poverty SDG 2: Zero hunger SDG 4: Quality education SDG 5: Gender equality SDG 6: Clean water and sanitation SDG 13: Climate action. This topic will investigate each of the key features of SDG 3 and then explore the relationship between SDG 3 and the other selected SDGs as represented in FIGURE 11.3. Resources Teacher-led video Features of each SDG (tlvd-0256) 11.2 Activity Access the SDG weblink and worksheet in the Resources tab and then complete the worksheet. 584 Jacaranda Key Concepts in VCE Health and Human Development Units 3 & 4 Seventh Edition  Resources Digital document SDG worksheet (doc-32226) Weblink SDG 11.2 Exercises To answer questions online and to receive immediate feedback and sample responses for every question, go to your learnON title at www.jacplus.com.au. A downloadable solutions file is also available in the resources tab. 11.2 Quick quiz 11.2 Exercise 11.2 Exam questions Select your pathway LEVEL 1 LEVEL 2 LEVEL 3 1, 2, 3, 4 5, 7 6, 8 Test your knowledge 1. When were the Sustainable Development Goals (SDGs) introduced and by whom? 2. What was the rationale (the reasons) for the introduction of the SDGs? 3. What are the objectives of the SDGs? 4. What are the five areas of importance? 5. What are the dimensions of sustainability that underpin the SDGs? 6. Why are the goals described as being interconnected? Apply your knowledge 7. Why is collaboration needed across all sectors to achieve the goals and targets? 8. ‘There can be no sustainable development without peace and no peace without sustainable development.’ Explain this statement. 11.2 Quick quiz 11.2 Exercise 11.2 Exam questions Question 1 (2 marks) Why are the Sustainable Development Goals (SDGs) considered ambitious?  Question 2 (3 marks) Identify the three main objectives that all countries are working towards through the achievement of the Sustainable Development Goals (SDGs). Question 3 (1 mark) Which organisation was responsible for the development of the Sustainable Development Goals (SDGs)? Question 4 (1 mark) Identify by when the Sustainable Development Goals aim to be achieved. More exam questions are available in your learnON title. TOPIC 11 Sustainable Development Goals and the World Health Organization 585 11.3 Key features of Sustainable Development Goal 3: Good health and wellbeing KEY CONCEPT Understanding the key features of SDG 3: Good health and wellbeing GOOD HEALTH AND WELLBEING: ENSURE HEALTHY LIVES AND PROMOTE WELLBEING FOR ALL AT ALL AGES Goal 3 aims to promote physical and mental health and wellbeing, and extend life expectancy by addressing the major causes of morbidity and mortality in high, middle- and low-income countries. The goal includes a number of features each with individual targets. These are: reduce maternal mortality to fewer than 70 per 100 000 live births end preventable deaths of newborns and children under five, reducing neonatal mortality to 12 per 1000 live births and under-5 mortality to 25 per 1000 live births end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases (NTD), and combat hepatitis, water-borne diseases and other communicable diseases reduce by one-third premature mortality from non-communicable diseases through prevention and treatment, and promote mental health and wellbeing strengthen the prevention and treatment of substance abuse, including drugs and alcohol halve global deaths and injuries from road traffic accidents ensure universal access to sexual and reproductive healthcare services achieve universal health coverage, including access to affordable essential medicines and vaccines reduce deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination strengthen the implementation of the WHO Framework Convention on Tobacco Control in all countries, as appropriate support the research and development of vaccines and medicines for communicable and non-communicable diseases and provide access to affordable essential medicines and vaccines increase investment in healthcare services and qualified healthcare staff, especially in low-income countries and small island developing states strengthen the capacity of all countries for early warning, risk reduction and management of health and wellbeing risks. SDG 3 aims to achieve good health and wellbeing for everyone, at every stage of life. Its key features include targets for improvements or outcomes for a range of global health and wellbeing issues as well as actions or means of implementation targets that must be met if Goal 3 is to be achieved. The features of Goal 3 that represent outcomes for health and wellbeing are to: Maternal mortality    death of reduce maternal mortality a mother during pregnancy, childbirth or within six weeks of end preventable deaths of newborns and children under five delivery end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases Tropical diseases    a group (NTD), and combat hepatitis, water-borne diseases and other communicable of diseases that mainly occur diseases in tropical and subtropical environments and are most reduce non-communicable diseases common in countries where promote mental health and wellbeing people lack access to safe water reduce substance abuse, including drugs and alcohol and sanitation reduce road traffic accidents Essential medicines    a range of medicines that meet the reduce deaths and illnesses from hazardous chemicals and air, water and soil priority healthcare needs of the pollution and contamination. population 586 Jacaranda Key Concepts in VCE Health and Human Development Units 3 & 4 Seventh Edition The features of SDG 3 that represent the ‘means of implementation’ or actions are: achieving universal health coverage. This is a prerequisite for achieving SDG 3 and includes expanding health and wellbeing services so all people have access to the health and wellbeing services they need at a cost that does not cause them to suffer financial hardship ensuring an adequate and well-trained health workforce is in place in every country having access to essential medicines and vaccines having access to sexual and reproductive healthcare services strengthening the implementation of the WHO Framework Convention on Tobacco Control in all countries supporting the research and development of vaccines and medicines for communicable and non-communicable diseases increase investment in healthcare services and qualified healthcare staff, especially in low-income countries and small island developing states strengthen the capacity of all countries for early warning, risk reduction and management of health and wellbeing risks. The key features of SDG 3 are represented in FIGURE 11.4, which shows how the actions or implementation targets will contribute to improved health and wellbeing outcome targets. FIGURE 11.4 The key features of SDG 3 Actions Outcomes (Implementation targets) (Health and wellbeing targets) Achieve universal health coverage, including Reduce maternal mortality affordable access to quality and healthcare services and essential medicines and vaccines Access to sexual and reproductive healthcare services End preventable deaths of newborns and children under five Strengthen prevention and treatment of substance abuse End the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases (NTD), and combat hepatitis, water-borne diseases and other communicable diseases Strengthen the implementation of the WHO Framework Convention on Tobacco Reduce non-communicable diseases and Control promote mental health and wellbeing Support the research and development of vaccines and medicines for communicable Reduce road traffic accidents and non-communicable diseases Increase investment in healthcare services and a well-trained workforce Reduce deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination Strengthen capacity for early warning, risk reduction and management of health and Reduce substance abuse, including drugs wellbeing risks and alcohol TOPIC 11 Sustainable Development Goals and the World Health Organization 587 11.3 Exercises To answer questions online and to receive immediate feedback and sample responses for every question, go to your learnON title at www.jacplus.com.au. A downloadable solutions file is also available in the resources tab. 11.3 Quick quiz 11.3 Exercise 11.3 Exam questions Select your pathway LEVEL 1 LEVEL 2 LEVEL 3 1, 3 2, 4 5, 6 Test your knowledge 1. State the name of SDG 3 and its aim. 2. What is the difference between the features of SDG 3 that represent health and wellbeing outcomes and the features that represent ‘means of implementation’ or action features? 3. Describe universal health coverage. Apply your knowledge 4. Why is universal health coverage considered to be a prerequisite for achieving Goal 3? 5. Why is it important to strengthen the capacity of all countries for early warning, risk reduction and management of health and wellbeing risks? 6. The features of SDG 3 can be grouped under a range of categories. Refer to FIGURE 11.4 and complete the following table that represents one way the features can be grouped. Health and wellbeing outcomes Population 1. Reduce maternal mortality groups 2. ______________________________________________________ Disease 1. End the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases (NTD), groupings and combat hepatitis, water-borne diseases and other communicable diseases 2. ______________________________________________________ 3. Reduce non-communicable diseases and promote mental health and wellbeing Causes of 1. ______________________________________________________ burdens of 2. Reduce road traffic accidents disease Actions or ‘means of implementation’ Universal 1. Achieve universal health coverage, including affordable access to quality healthcare health services and essential medicines and vaccines coverage 2. ______________________________________________________ 3. Increase investment in healthcare services and a well-trained workforce Substance 1. ______________________________________________________ control 2. Strengthen the implementation of the WHO Framework Convention on Tobacco Control Medicines and 1. ______________________________________________________ research Early warning 1. ______________________________________________________ and protection 588 Jacaranda Key Concepts in VCE Health and Human Development Units 3 & 4 Seventh Edition  11.3 Quick quiz 11.3 Exercise 11.3 Exam questions Question 1 (1 mark) Source: VCE 2017, Health and Human Development Exam, Q.10.a.i (adapted); © VCAA Name the feature of the SDG represented in the information above. Question 2 (2 marks) Using an example, explain why SDG 3 — Ensure healthy lives and promote wellbeing for all ages is important in promoting health and wellbeing globally.  Question 3 (3 marks) Outline three action areas of SDG 3 — Good health and wellbeing.  Question 4 (2 marks) Explain the difference between the actions and the outcomes of SDG 3.  Question 5 (4 marks) Identify two health and wellbeing features of SDG 3 that are more likely to be an issue in low-income countries than middle- or high-income countries and explain why. More exam questions are available in your learnON title. TOPIC 11 Sustainable Development Goals and the World Health Organization 589 11.4 SDG 3 Key feature of maternal and child health and wellbeing KEY CONCEPT Understanding the key features of SDG 3: maternal and child health and wellbeing 11.4.1 Reduce maternal mortality Maternal mortality ratio    the number of mothers who die as a Maternal mortality refers to the number of mothers who die due to complications result of pregnancy, childbirth or associated treatment per 100 000 related to pregnancy and childbirth. Most maternal deaths occur in low- and middle- women who give birth income countries as a result of five main causes (see FIGURE 11.5). FIGURE 11.5 Causes of maternal mortality Haemorrhage (excessive bleeding) Sepsis (an infection that affects the whole body) Obstructed labour (i.e. when the baby cannot pass Causes of maternal through the birth canal, due to either the mortality mother’s small pelvis or the position of the baby in the uterus) Unsafe abortion Hypertensive disease (heart conditions caused by high blood pressure) Malnutrition can also increase the risk of maternal mortality, FIGURE 11.6 Global maternal particularly in low-and middle-income countries. Iron-deficiency mortality ratio (deaths per 100 000 live births) anaemia contributes to 20 per cent of all maternal deaths. 342 Improvements in maternal mortality 216 211 The number of mothers who survive childbirth has improved significantly since 2000. The maternal mortality ratio was reduced by 38 per cent worldwide between 2000 and 2017, or from 342 maternal deaths per 100 000 live births to 211 per 100 000 (see FIGURE 11.6). 2000 2015 2017 Source: Adapted from data from Report of the Secretary-General, ‘Progress towards the Sustainable Development Goals’, United Nations, 2020. 590 Jacaranda Key Concepts in VCE Health and Human Development Units 3 & 4 Seventh Edition Reasons for improvements in maternal mortality rates There are several reasons for the improvement in maternal mortality rates, including: more women having access to sexual and reproductive health and wellbeing services, including antenatal care. Antenatal care ensures qualified health workers can monitor the mother’s and baby’s health and wellbeing and reduce the risk of complications. more births being assisted by skilled health personnel. During childbirth, skilled birth attendants can assist with obstructed labour and provide medical assistance if a caesarean section is required or if haemorrhaging occurs. Antenatal care    healthcare provided to women during Giving birth in a medical clinic greatly reduces the risk of infection during pregnancy and just after birth childbirth. Caesarean   section a surgical fewer adolescent girls are now having children. In 2020, the adolescent birth procedure in which a baby is rate was 41 births per 1000 women aged 15–19. Pregnancy during adolescence born through a cut made in the mother’s abdominal wall and increases the risk of maternal mortality, as girls are often still developing and the wall of the uterus rather their bodies are less able to cope with pregnancy and childbirth. Stillbirths than through the normal birthing and newborn deaths are 50 per cent higher among infants born to adolescent process mothers compared to infants born to mothers aged 20–29. Adolescent/ce    a stage of the lifespan that commences at greater access to family planning services. In 2020, 76.8 per cent of women puberty and ends when a person aged 15–49 had access to modern contraceptive methods or family planning turns 20 years of age. It is a services. This enables families to plan the number of children they have and biological marker that signals the transition to adulthood and is the spacing of births. By allowing two years between births, mothers and included as part of youth. infants are more likely to survive pregnancy and childbirth and remain healthy. Stillbirth    the birth of an infant that has died in the womb SDG 3 aims to reduce maternal mortality rates from 211 per 100 000 to fewer Modern contraceptive methods    than 70 per 100 000 live births by 2030. However, every day hundreds of women technological advances designed are still dying during pregnancy or from childbirth-related complications. Most to overcome biology and of these deaths occur in low-income countries, particularly in sub-Saharan Africa enable couples to have sexual intercourse at any mutually- and southern Asia where approximately 800 women die each day and the maternal desired time mortality ratio is approximately 14 times higher than in higher-income countries. FIGURE 11.7 A Society for Family Health (SFH) family planning volunteer prepares to speak to women in Kano, Nigeria, about child spacing. TOPIC 11 Sustainable Development Goals and the World Health Organization 591 Reducing maternal mortality rates Most maternal deaths can be prevented by providing access FIGURE 11.8 Maternal mortality rates to sexual and reproductive healthcare services, in particular can be reduced with all women having antenatal care during pregnancy, skilled birth attendants during access to quality antenatal care. It childbirth, as well as care and support for mothers in the weeks is recommended that women have after childbirth (see FIGURE 11.9). Globally, 81 per cent of births four antenatal care visits during their were attended by skilled birth attendants between 2014 and 2019, pregnancy. which was up from 64 per cent in 2000–2005. However, only 60 per cent of all births were assisted by skilled health professionals in sub-Saharan Africa and 77 per cent in southern Asia. Women living in rural areas are also much less likely to have access to these services compared to those living in urban areas. Only half of all pregnant women globally can access the recommended four antenatal care visits. Preventing unintended pregnancy through universal access to family planning is critical to further improve the health and wellbeing of women and reduce maternal mortality. While access to modern methods of contraception for women aged 15 to 49 increased to 76.8 per cent in 2020, there are still many women who do not have the means to control the number of children they have and the timing and spacing of births. This figure is much higher in countries such as those in sub-Saharan Africa where only 55.5 per cent all women can access modern methods of contraception. Adolescent pregnancy has also declined steadily in almost all regions but remains high in sub-Saharan Africa. In 2020, the adolescent birth rate in sub-Saharan Africa was 101 per 100 000 women aged 15–19 years. FIGURE 11.9 Improvements in maternal mortality can be achieved by increasing women’s access to sexual and reproductive healthcare services. 4 antenatal care visits Greater access to Skilled birth attendants sexual and reproductive healthcare services Care and support post birth Improving maternal mortality Access to modern contraceptive methods Achieving universal healthcare 11.4.2 End preventable deaths of newborns and children under five Many infant deaths occur in the neonatal period — the first 28 days of life. Up to half of all these deaths occur within the first 24 hours of birth, and 75 per cent occur in the first week. In 2018, 2.5 million newborns died, with most of these deaths occurring in the first week of Neonatal period    the first 28 days after birth life. The 48 hours immediately following birth is the most crucial period for newborn Birth asphyxia    a condition in survival. Three quarters of neonatal deaths are due to premature birth, birth asphyxia which a baby’s brain and other (lack of breathing at birth), birth trauma and infections. Children who reach their fifth organs do not get enough oxygen birthday have a much greater chance of surviving into adulthood. However, every day before, during or immediately after birth. It can cause temporary or in 2019, 14 000 children died before reaching their fifth birthday, with acute respiratory permanent damage. infections, diarrhoea and malaria being the leading causes of death (see FIGURE 11.10). 592 Jacaranda Key Concepts in VCE Health and Human Development Units 3 & 4 Seventh Edition  FIGURE 11.10 Prematurity, acute respiratory infections, birth asphyxia and birth trauma are responsible for three- quarters of all deaths under five. Prematurity Neonatal (0–27 days) Postneonatal (1–59 months) Acute respiratory infections Under-fives Birth asphyxia and birth trauma Other communicable, perinatal and nutritional conditions Congenital anomalies Diarrhoea Neonatal sepsis Injuries Malaria Other non-communicable diseases Meningitis/encephalitis Measles HIV/AIDS Tetanus 0 5 10 15 Percentage of total under-five deaths Source: World Health Organization, World Health Statistics: 2018, https://www.who.int/gho/publications/world_health_ statistics/2018/EN_WHS2018_Part2.pdf?ua=1, p. 5 Improvements in newborn and child health and wellbeing The global under-five mortality rate was reduced by more than half, from 76 to 39 deaths per 1000 live births, between 2000 and 2018. This represented a reduction from 9.9 million to 5.3 million deaths. Neonatal mortality rates also declined from 31 deaths per 1000 live births in 2000 to 18 deaths per 1000 live births in 2018, representing a reduction from 4 million neonatal deaths in 2000 to 2.5 million in 2018. Sub-Saharan Africa continues to have the highest neonatal mortality rate at 28 deaths per 1000 live births. Improved access to antenatal care, more births being assisted by skilled health personnel, fewer adolescent girls falling pregnant and greater access to family planning services have all contributed. Since 2000, higher rates of childhood vaccination have saved almost 15.6 million lives and reduced the number of reported cases of measles by 67 per cent. Approximately 86 per cent of children worldwide received the required three doses of the Diphtheria-Pertussis-Tetanus vaccine in 2018 compared to 72 per cent in 2000. SDG 3 aims to end preventable deaths of newborns and children under five and reduce neonatal mortality from 19.2 per 1000 live births in 2015 to 12 per 1000 live births in 2030. It also aims to reduce under-five mortality rates from 43 deaths per 1000 live births to 25 per 1000 live births. However, one million newborns continue to die in their first week of life, and 2.5 million die during their first 28 days of life. Four out of every five deaths of children under five occurs in sub-Saharan Africa and southern Asia. Children born into poverty are almost twice as likely to die before the age of five as those from wealthier families. Children of educated mothers — even mothers with only primary schooling — are more likely to survive than children of mothers with no education. TOPIC 11 Sustainable Development Goals and the World Health Organization 593 End preventable deaths of newborns and children under five Preventable deaths of newborns and those under five can be reduced by ensuring that mothers have access to sexual and reproductive health services, especially safe childbirth practices and neonatal care. Many deaths of children under five are due to preventable causes such as malnutrition, malaria, diarrhoea, measles and pneumonia. Breastfeeding, access to nutritious food, access to safe water, health and wellbeing services including vaccinations, and antibiotics are important for reducing the under-five mortality rate (U5MR). To achieve this, there needs to be increased investment in healthcare services. There are many children globally who are not vaccinated or do not receive the full vaccination schedule due to lack of access to healthcare. Investment by the global community is also needed for research and development of new vaccines to prevent diseases such as malaria, HIV and many tropical diseases, which are responsible for the deaths of many children under five (see FIGURE 11.11). According to the United Nations, the impact of COVID-19 in 2020 is expected to have a significant impact on achievements in maternal mortality rates, and newborn and under-five mortality rates. Hundreds of thousands of additional under-five deaths are expected, along with tens of thousands of additional maternal deaths in 2020. FIGURE 11.11 There are many factors that can contribute to ending preventable deaths of newborns and children under-five particularly in low- and middle-income countries. Provide access to sexual and reproductive healthcare services Fund research and development into new vaccines Breastfeeding to prevent disease Preventing deaths of newborns and children under five Increase investment in healthcare services Provide access to and provide universal nutritious food health coverage Provide access to Provision of safe immunisation water 594 Jacaranda Key Concepts in VCE Health and Human Development Units 3 & 4 Seventh Edition 11.4 Exercises To answer questions online and to receive immediate feedback and sample responses for every question, go to your learnON title at www.jacplus.com.au. A downloadable solutions file is also available in the resources tab. 11.4 Quick quiz 11.4 Exercise 11.4 Exam questions Select your pathway LEVEL 1 LEVEL 2 LEVEL 3 1, 3, 4 2, 5, 6 7, 8, 9, 10 Test your knowledge 1. What are the five main causes of maternal mortality? 2. Outline three ways that maternal mortality rates can be reduced. 3. When do most infant deaths occur? 4. What factors have contributed to reductions in under-five mortality rates? 5. How is COVID-19 expected to impact on the achievement of the targets for maternal mortality and preventable deaths of newborns and children under five? Provide two reasons that might explain this. Apply your knowledge 6. Describe how access to sexual and reproductive health and wellbeing services can help reduce maternal and child mortality. 7. Why would children born into poverty be almost twice as likely to die before the age of five as those from wealthier families? 8. Discuss why universal health coverage could help reduce under-five mortality. 9. Refer to FIGURE 11.10. Compare the main causes of death for newborns to those that cause the death of children under five. 10. Create a table or mind map summarising the key points for SDG 3 — maternal and child health and wellbeing. 11.4 Quick quiz 11.4 Exercise 11.4 Exam questions Question 1 (2 marks) Using an example, explain why SDG 3 — Ensure healthy lives and promote wellbeing for all ages is important in promoting health and wellbeing globally. Question 2 (1 mark) Most infant deaths occur in the neonatal period. What is the meaning of neonatal?  Question 3 (2 marks) Describe one way to reduce maternal mortality.  Question 4 (4 marks) Explain the impact of COVID-19 on the progress that has been made in relation to reducing under five mortality rates. More exam questions are available in your learnON title. TOPIC 11 Sustainable Development Goals and the World Health Organization 595 11.5 SDG 3 Key feature of communicable diseases KEY CONCEPT Understanding the key features of SDG 3: Good health and wellbeing: key feature — communicable diseases A feature of Goal 3 is to end epidemics of communicable diseases, in particular AIDS, tuberculosis, malaria and neglected tropical diseases. It also aims to reduce hepatitis, water-borne diseases and other communicable diseases. 11.5.1 AIDS AIDS (Acquired Immunodeficiency Syndrome) is caused by FIGURE 11.12 AIDS is caused by the the Human Immunodeficiency Virus (HIV), which damages HIV virus, which is transmitted via and weakens the body’s immune system. The body loses the exchange of fluids such as blood. It ability to fight infections, and the infected person eventually destroys the immune system and the develops AIDS. Those with AIDS are at high risk of developing body loses its ability to fight infections. infections, cancers and other diseases such as tuberculosis, which eventually leads to death. The HIV virus is transmitted via the exchange of infected bodily fluids such as blood, semen, vaginal secretions and breast milk. It is usually spread by sexual intercourse without a condom and by the sharing of needles and syringes. It is estimated that 75–85 per cent of adults who are HIV positive contracted the infection through unprotected sexual intercourse. HIV can also be passed from an infected mother to a child during pregnancy or birth, or through breastfeeding. There is currently no cure for HIV and no vaccine to prevent the disease. However, antiretroviral drugs (ART) help delay and, in some cases, prevent the progression of HIV to AIDS. ART involves a combination of three or more drugs that stop the virus from reproducing so people with HIV can enjoy healthy lives and reduce the risk of transmitting the virus to others. However, ART does not eliminate the virus from the body and the drugs need to be taken continuously. Improvements in HIV/AIDS-related deaths and illness An estimated 32.7 million people have died FIGURE 11.13 Close to 10 per cent of Swaziland’s total from AIDS-related illnesses since the start of the population are orphans due to HIV/AIDS. epidemic. However, progress has been made in reducing mortality from AIDS-related illnesses and the rate of new infections (see FIGURES 11.14 and 11.15). Progress has also been made in preventing mother-to-child transmission of HIV and reducing deaths of mothers who are infected with HIV. This progress has been due to substantial investment in health services, enabling more people to access ART treatment, ongoing research and development for better ways to diagnose the disease and cheaper medicines. Between 2013 and 2019 the percentage of people living with HIV and receiving ART increased from 596 Jacaranda Key Concepts in VCE Health and Human Development Units 3 & 4 Seventh Edition 39 per cent to 67 per cent. Twenty-six million people were accessing ART as of the end of June 2020. In 2019, approximately 85 per cent of pregnant women living with HIV had access to ART to prevent transmission of HIV to their babies. FIGURE 11.14 The change in HIV infections between 2000 and 2019 5M All ages estimate 4M 3M Number 2M Change in new HIV infections since 2019 1M –23% 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 Source: http://aidsinfo.unaids.org/ SDG 3 aims to end the epidemic of AIDS by 2030. Despite the achievements since 2005, this remains a significant challenge for the global community. AIDS is still a major cause of morbidity and mortality, particularly in low- and middle-income countries. While mortality rates have fallen since 2004, approximately 690 000 people died from HIV-related causes in 2019 compared to 1.7 million in 2004. Sub-Saharan Africa is the most affected region, with 61 per cent of all new HIV infections occurring in this region in 2018. AIDS continues to be the leading cause of death among those aged 10 to 19 years in Africa, the second most common cause of death among youth globally and the leading cause of death for women of reproductive age worldwide. FIGURE 11.15 The change in AIDS-related deaths between 2000 and 2019 3M 2.5M All ages estimate 2M Number 1.5M 1M 0.5M 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 Source: http://aidsinfo.unaids.org/ TOPIC 11 Sustainable Development Goals and the World Health Organization 597  In 2019 there were around 1.7 million new HIV infections, with approximately 38 million people living with HIV. Of these, 1.8 million were children younger than 15. Most of these children live in sub-Saharan Africa and were infected by their HIV-positive mothers during pregnancy, childbirth or breastfeeding. Of the 38 million people living with HIV, approximately 19 per cent (approximately 7.1 million people) do not know their HIV status. In 2019, global ART coverage of adults and children was approximately 67 per cent, however only 53 per cent of children aged 0–14 living with HIV were receiving ART. Approximately 15 per cent of pregnant women living with HIV do not have access to ART. Ending the AIDS epidemic FIGURE 11.16 Ending the AIDS epidemic requires a range of Ending the AIDS epidemic requires actions to be taken at a global level. all population groups to have access to prevention, diagnosis and ART. This requires continued investment in healthcare Increased services and ART, and cost-effective testing access to prevention and ongoing research and development services into a vaccine. Measures are also needed to remove discrimination and stigma, which is a key barrier to accessing HIV services (see Removing Increased barriers to access to FIGURE 11.16). discrimination diagnosis The spread of HIV can be prevented by implementing a combination of actions including using condoms; voluntary male Ending the AIDS circumcision; pre-exposure medication epidemic that works to keep the HIV virus from taking hold in the body; promoting gender equality; and providing access to Research and Investment in development healthcare secondary education. There is still a lack of into a vaccine services knowledge about HIV, its causes and how it can be prevented, particularly among youth. In sub-Saharan Africa, less than 40 per Investment cent of youth aged 15 to 24 have correct in ART treatment knowledge about HIV. 11.5.2 Malaria Malaria is a life-threatening disease caused by parasites that FIGURE 11.17 Malaria is a life-threatening are transmitted to people when bitten by infected female disease caused by a bite from a female mosquitoes. Young children and pregnant women are at mosquito infected with malaria parasites. greater risk of contracting the disease. Malaria destroys the body’s red blood cells and causes fever, headache, diarrhoea and vomiting. If left untreated, malaria can disrupt the blood supply to internal organs, causing death. Actions to control and eradicate mosquitoes is the most effective way of preventing malaria. This is known as vector control and includes the use of insecticide-treated mosquito nets, which protect a person while they are sleeping; the spraying of the inside walls of homes with insecticide to kill and repel mosquitoes; and the use of antimalarial medicines. Vector control    actions taken to Once infected, malaria can be cured with quick diagnosis and control and eradicate the carriers treatment with ACT (Artemisinin Combination Therapy). of disease and infection 598 Jacaranda Key Concepts in VCE Health and Human Development Units 3 & 4 Seventh Edition Improvements in malaria Between 2000 and 2019, the number of deaths globally from malaria declined by 7.6 million. However, improvements in mortality rates have slowed. In 2019, malaria was responsible for the deaths of 409 000 people compared to 445 000 in 2016. Reductions in mortality rates have been significant in the African region, falling from 48.9 per 100 000 in 2015 to 40.3 per 100 000 in 2019. However, Africa accounts for 94 per cent of malaria cases and deaths worldwide (see FIGURE 11.18). FIGURE 11.18 Globally, deaths from malaria have reduced over time. However, the African region continues to contribute to a high proportion of these deaths. 80 for 100 000 population at risk AFR Number of malaria deaths World 60 40.3 40 20 10.1 0 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Source: World Health Organization, World Malaria Report 2020 In terms of incidence, the rates of malaria have increased since 2013. An estimated 229 million cases of malaria occurred in 2019 compared to 210 million cases in 2013 and 237 million cases in 2010 (see FIGURE 11.19). The incidence rate of malaria has increased since 2013, yet remains lower than in 2010, decreasing by 18 per cent globally, or from 76 to 56 cases per 1000 population at risk, between 2010 and 2020. Malaria incidence in the African region reduced from 256 to 225 cases per 1000 population at risk from 2010 to 2019. Globally, more countries are moving towards the elimination of malaria. In 2019, 46 countries reported fewer than 10 000 malaria cases, up from 37 countries in 2010. The World Health Organization estimates 6.8 million malaria FIGURE 11.19 The incidence of deaths since 2001 have been prevented through the introduction malaria has increased since 2013 and of antimalarial strategies. The use of insecticide-treated bed nets raises questions about whether the and internal spraying of homes with insecticide are considered global goal of ending malaria by 2030 to have made major contributions to the reduction in morbidity is possible. and mortality rates. The use of insecticide-treated bed nets was The world is not on track to estimated to account for 50 per cent of the decline among children end malaria by 2030 aged 2–10 years in sub-Saharan Africa. Between 2004 and 2019, 1.9 billion insecticide-treated mosquito nets were provided to people living in malaria-prone countries in Africa, which meant 229 million cases of 52 per cent of the at-risk population slept under a treated net. malaria in 2019 However, the percentage of people protected by insecticide-treated bed nets has been decreasing. In 2019, there were 8 per cent fewer people sleeping under insecticide-treated bed nets than in 2010. 210 million cases of malaria in 2013 The proportion of the population at risk being protected by the internal spraying of homes has also declined from 5.8 per cent in 2010 (180 million people) to 2.0 per cent in 2019 (97 Source: World Health Organization, World Malaria Report 2020 million people). TOPIC 11 Sustainable Development Goals and the World Health Organization 599 More effective diagnosis has made it easier FIGURE 11.20 Baby sleeping under a mosquito net in Togo, and quicker for people suffering from fever West Africa caused by malaria to receive treatment, which has also helped reduce mortality rates. The world’s first malaria vaccine is in the process of being piloted. Preventative treatment given to pregnant women after the first trimester can prevent maternal death, anaemia and low birth weight, a major cause of infant mortality. Between 2010 and 2019, access to preventative malaria treatment for pregnant women increased from 6 per cent to 34 per cent. Malaria can also be reduced by removing or spraying stagnant water, which is a breeding ground for mosquitoes. Ending the malaria epidemic While progress has been made to end the epidemic of malaria by 2030, greater efforts are needed if the target for SDG 3 is to be achieved. Malaria continues to have a devastating impact on people’s health and wellbeing. In 2019: malaria was still endemic in 87 countries more than 100 million people were still not protected by insecticide-treated bed nets there were 229 million new cases of malaria, which was an increase from 2015 when there were 218 million and an estimated 409 000 malaria deaths worldwide, most of which were children under five. Ending the epidemic of malaria FIGURE 11.21 Access to necessary healthcare and medicines is requires significant financial needed to prevent, diagnose and treat malaria. investment in healthcare and the health workforce to ensure universal access to diagnose, treat and prevent malaria. Mass-distribution of insecticide-treated bed nets is needed, along with more people being protected by the indoor spraying of their homes. Health systems in low- income countries are often under- resourced and not accessible to those most at risk of malaria. Investment in the research and development of new vector control strategies, improved ways to diagnose the disease and more effective medicines are needed. Access to clean water and sanitation is also important to ensure that breeding grounds for mosquitoes are controlled. Other challenges affecting the ability of countries to control and eliminate malaria include the risks posed by conflict in malaria-endemic zones, changing climate patterns First trimester    the first three and mosquito resistance to insecticides, particularly those used for indoor residual months of pregnancy spraying (see FIGURE 11.22). 600 Jacaranda Key Concepts in VCE Health and Human Development Units 3 & 4 Seventh Edition  FIGURE 11.22 Ending the malaria epidemic requires action in a range of areas. Investment in healthcare and the health workforce Increased Reduce risks access to caused by diagnosis, conflict treatment and prevention Mass Access to clean Ending the distribution of water and malaria insecticide- sanitation epidemic treated bed nets Investment in research and More effective development medicines of new vector control strategies Increased access to indoor residual spraying 11.5.3 Tuberculosis Tuberculosis (TB) is a disease that affects the lungs. It is highly contagious and is caused by bacteria that can spread from person to person via the air through coughing and sneezing. Ninety per cent of TB sufferers are adults. Its symptoms include night sweats, persistent cough, tiredness, weight loss and coughing up blood. If left untreated, TB destroys lung tissue and results in death. It mostly affects adults, although all age groups are at risk. The chances of developing TB are much higher among people infected with HIV. TB is curable and preventable. It can be prevented with vaccinations and, if diagnosed early, can be treated and cured with appropriate drugs. Approximately 85 per cent of people who develop TB can be successfully treated with a 6-month drug treatment program. Improvements in tuberculosis In 2019, 10 million people developed TB and the disease was responsible for 1.4 million deaths. This represented a decline in mortality from those suffering from TB from 23 per cent in 2000 to 14 per cent in 2019, which is a reduction from 28 per 100 000 to 16 per 100 000. Worldwide, the incidence of TB is declining by approximately 2 per cent each year, falling from 172 per 100 000 population in 2000 to 130 per 100 000 in 2019 (see FIGURE 11.23). TOPIC 11 Sustainable Development Goals and the World Health Organization 601  FIGURE 11.23 Global trends in estimated TB incidence and mortality rates, 2000–17 int-8505 Rate per 100 000 population per year 200 All TB cases 3 150 Total Millions per year 2020 milestone 2 100 HIV-negative 2020 milestone (total) Notifications of new and relapse cases 1 50 HIV-positive 2030 target 2030 target (total) 0 0 2000 2005 2010 2015 2020 2000 2005 2010 2015 2020 Note: Shaded areas represent uncertainty intervals. Source: World Health Organization, Global Tuberculosis Report 2020 Major advances in the prevention, diagnosis and treatment of TB have contributed to these reductions. The BCG vaccine, which was developed almost 100 years ago has been shown to prevent TB in children. In 2019, 153 countries reported BCG vaccination coverage, with 87 of these countries reporting coverage of at least 90 per cent. Ending the tuberculosis epidemic While the disease burden caused by TB is falling in all regions, it is not fast enough to meet the targets set. Nearly all cases of TB can be cured yet the disease is still one of the top ten causes of death worldwide, and caused more deaths than HIV in 2019. Over 95 per cent of TB deaths occur in low- and middle-income countries and the disease is among the top five causes of death for women aged 14–44. In 2019, there were an estimated 10 million people worldwide who contracted TB, of which 56 per cent were among men, 32 per cent were women and 12 per cent were children. Of the 10 million new cases of TB that occurred in 2019, only 7.1 million were officially notified to national authorities and to the WHO. This means many people are not receiving adequate diagnosis and treatment for the disease. However, this represents an increase from 7 million in 2018 and 6.4 million in 2017. Regular BCG vaccinations are still not reaching all children, putting many of them at risk. Drug-resistant TB continues to be a public health threat. Globally, in 2019 almost 500 000 developed drug-resistant TB. Ending the TB epidemic depends on the provision of universal health coverage so all people have access to vaccination, early detection and effective treatment, especially the poor. Increased funding is needed for health and wellbeing services for the prevention, diagnosis and treatment of the disease. Increased funding for health and wellbeing services and trained health workers would also ensure that all cases of TB are reported and accurate data can inform health decisions. Greater investment in research and development is needed for new and better ways to diagnose the disease, and for the development of resistant drugs and vaccines. There is currently no vaccine that is effective in preventing TB in adults, either before or after exposure to TB infection. New TB drugs have begun to emerge, particularly those better able to treat drug-resistant TB, and there are 14 vaccines in various stages of trialing. Funding is needed to enable further development and implementation of these. Access to clean water and sanitation is also important to prevent the spread of TB (see FIGURE 11.24). At the end of 2019 the world was not on track to meet the targets set. 602 Jacaranda Key Concepts in VCE Health and Human Development Units 3 & 4 Seventh Edition  FIGURE 11.24 Ending the epidemic of TB requires the global community to work together to address a range of factors. Provide universal health coverage Increased Access to clean funding for water and health and sanitation wellbeing services Ending the TB Research and epidemic development for more More trained effective drugs health workers and vaccines Research and development to Improved improve reporting diagnosis 11.5.4 Neglected tropical diseases Neglected tropical diseases (NTDs) are a diverse group of 18 diseases that mainly occur in tropical and subtropical environments. Their diversity includes the different ways in which they are transmitted as well as their different biological make-up. They all have a significant impact on health and wellbeing. They are referred to as neglected because they have received very little funding from governments and other organisations for research, prevention and control. Neglected tropical diseases thrive in the poorest, most marginalised communities, where people lack access to clean water and sanitation, have limited access to health and wellbeing services and who live in close contact with domestic animals and livestock. People are also at risk when they are in contact with infectious vectors such as mosquitoes, ticks, fleas and other carriers that transmit viruses or parasites. These diseases can cause severe pain and permanent disability and, together, contribute around 150 000 deaths each year and globally account for 27 million disability-adjusted life years (DALY) (see FIGURE 11.25). TOPIC 11 Sustainable Development Goals and the World Health Organization 603  FIGURE 11.25 Global burden on NTDs (ranking based on the DALY in 2013, the latest data available.) int-8506 5000 1990 2005 4500 2013 Disability-adjusted life years (thousands) 4000 3500 3000 2500 2000 1500 1000 500 0 Visceral leishmaniasis Food-borne trematodiases Schistosomiasis Hookworm disease Lymphatic filariasis Ascariasis Rabies Onchocerciasis Dengue Trichuriasis African trypanosomiasis Cysticercosis Chagas disease Cystic echinococcosis Trachoma Cutaneous leishmaniasis Yellow fever Source: Qian M-B, Zhou X-N 2019, ‘Global burden on neglected tropical diseases’, Lancet Infectious Diseases, 16, pp. 1113–1114. In 2019, 1.76 billion people required mass or individual FIGURE 11.26 A doctor checks for the eye treatment and care for NTDs, down from 1.8 billion in disease trachoma, which can lead to blindness 2015, and 2.19 billion in 2010. Two parasitic conditions as a result of the after-effects of conjunctivitis that are responsible for considerable morbidity and caused by chlamydia infections carried by flies. disability are schistosomiasis, which affects over 220 million people, and trachoma, which affects 137 million people and is responsible for an estimated 1.9 million people being visually impaired. Preventing neglected tropical diseases Strategies that are effective in reducing morbidity and mortality from neglected tropical diseases include: safe and effective drugs that can prevent and treat infection vector control to remove carriers of these diseases such as mosquitoes, ticks, flies, fleas, bugs and worms Schistosomiasis    a worm veterinary public health measures for diseases and infections that are transmitted infection that occurs when people between animals and humans swim, bathe or have contact with fresh water contaminated with improved water and sanitation. human excreta Trachoma    a bacterial infection of the eye that can cause complications including blindness 604 Jacaranda Key Concepts in VCE Health and Human Development Units 3 & 4 Seventh Edition Improvements in neglected tropical diseases FIGURE 11.27 Spraying insecticide is an Vector control and medicines have been successful in reducing effective method of vector control by killing several neglected tropical diseases. Several of these diseases the mosquitoes that cause dengue fever. are close to being eliminated and are no longer a public health problem. All countries have eliminated leprosy as a public health problem since 2010 and guinea-worm disease is also close to being eradicated. Improvements have also been made in addressing schistosomiasis, with more treatments being provided each year. Ending the epidemic of neglected tropical diseases The SDG target is to reduce the number of people needing treatment for these diseases by 90 per cent by 2030. To achieve this, research and development for new and effective drugs and cost-effective diagnostic tests is needed. Additional funding to provide universal health coverage is necessary to ensure all those at risk have access to diagnosis, treatment and medication. Funding is required for the development of new forms of insecticides as increasing levels of resistance to the current insecticides being used is threatening the progress that has been made in controlling some of these diseases. Ongoing commitment and funding for vector control and veterinary public health measures is necessary and has already been shown to be effective. Accurate mapping of disease distribution is also important. Actions outside the health sector are needed, such as access to clean water and sanitation, especially in remote areas where these diseases are more prevalent (see FIGURE 11.28) FIGURE 11.28 Ending the epidemic of neglected tropical diseases requires action in a range of areas and ongoing funding and commitment from the global community. Universal health coverage for diagnosis, treatment and medication Research and Access to clean development for water and new safe and sanitation effective drugs Ending the Accurate mapping epidemic Cost-effective of diseases diagnostic tests of NTDs New forms of Veterinary public non-resistant health measures insecticides Vector control TOPIC 11 Sustainable Development Goals and the World Health Organization 605 Other barriers to addressing neglected tropical diseases include global warming, climate change, ongoing urbanisation, and the global travel of people and goods — all of which have the potential to increase the spread of these diseases. 11.5.5 Hepatitis Hepatitis is inflammation of the liver caused by a viral infection. Globally, 325 million people live with a hepatitis infection. There are five types of hepatitis that contribute to the global burden of disease, and have the greatest potential for outbreaks. These are referred to as types A, B, C, D and E. The five hepatitis viruses are very different — they differ in the way they are transmitted, how they affect population groups and their impact on health and wellbeing (see FIGURE 11.29). FIGURE 11.29 Types of hepatitis: causes, symptoms and transmission. Hepatitis Hepatitis A and E Hepatitis B and C Hepatitis D (food- and water-borne (blood-borne infections) (blood borne) infection) Transmitted through unsafe Transmitted through contact More likely to occur in communities injections and medical with infected blood and only occurs with contaminated water and poor procedures and, less commonly, in people who are already infected sanitation. through sexual contact with the hepatitis B virus. Symptoms include: Hepatitis B can be extreme fatigue, nausea, transferred from vomiting and abdominal mothers to babies at pain. birth. Can be prevented through Hepatitis B and C are the most improved sanitation, hygiene and common cause of liver cancer and food supply. There is also a vaccine cirrhosis for hepatitis A and E Hepatitis A and E are food- and water-borne infections. Outbreaks of these types of hepatitis are more likely to occur in communities with contaminated water and poor sanitation. Hepatitis A and E can cause extreme fatigue, nausea, vomiting and abdominal pain. They can be prevented through improved sanitation, hygiene and food supply. There is also a vaccine for hepatitis A and E. Treatment includes bed rest and providing fluids to prevent dehydration. Hepatitis B and C are blood-borne infections, and are transmitted through unsafe injections and medical procedures and, less commonly, through sexual contact. Hepatitis B can be transferred from mothers to babies at birth. Hepatitis B and C are the most common cause of liver cancer and cirrhosis. In 2020 there were approximately 250 million people living with chronic hepatitis B and 71 million with chronic hepatitis C. Hepatitis C is found worldwide, but the most affected regions are central and east Asia and north and west Africa. Most infections in these regions are caused by unsafe medical injections and other medical procedures. Hepatitis C epidemics related to injecting drug use occur in all regions, with an estimated 67 per cent of people who inject drugs infected with the hepatitis C virus. Hepatitis D is transmitted through contact with infected 606 Jacaranda Key Concepts in VCE Health and Human Development Units 3 & 4 Seventh Edition blood and only occurs in people who are already FIGURE 11.30 Percentage of deaths attributed to infected with the hepatitis B virus. hepatitis viral infections, 2015 All forms of hepatitis are responsible for an Hepatitis B estimated 1.4 million deaths per year, which Hepatitis C is similar to the death rates from HIV and Hepatitis E tuberculosis. Hepatitis B accounts for 66 per cent of Hepatitis A deaths, hepatitis C 30 per cent and hepatitis 66% A and E are responsible for the remainder (see FIGURE 11.30). Hepatitis is also a growing cause of mortality among people living with HIV. 30% Hepatitis B is the form of hepatitis that contributes to the highest number o