HIV/AIDS affects rural areas• 69% of the population of the most

affected countries lives in rural areas

• AIDS affects economic sectors with mobile/ migratory workers (agriculture, mining)

• AIDS-related traditional practices are more prevalent in rural areas

• AIDS-affected urban dwellers often return to rural areas

Disease of AffluenceCoronary Heart Disease

also known as

Ischaemic Heart Disease

CHD – Your heart

CHD – What is it?

CHD begins when cholesterol, fatty material, and calcium build up in the arteries. When this occurs in the arteries that supply the heart, this buildup, or plaque, causes the arteries to narrow, so that oxygen delivery to the heart is reduced. The reduction in oxygen delivery to the heart can create chest pain, also called angina.

The link between heart disease and heart attackWhen plaque builds up to the point that it ruptures, it causes a blood clot to form in the coronary artery. The blood clot blocks blood from flowing to the heart muscle, leading to a heart attack. In a worst-case scenario, sudden cardiac arrest or fatal rhythm disturbance can occur.

CHD – What is it?

CHD the effects - Heart disease begins when cholesterol, fatty material, and

calcium build up in the arteries, a process known as atherosclerosis

CHD – Risk Factors

•smoking,•high blood pressure (hypertension),•high cholesterol,•diabetes,•family history of CHD,•peripheral artery disease•Obesity•lack of exercise,•high-fat diet.

CHD - Symptoms

For others, cardiac arrest can be the first symptom they

experience, and is deadly unless treated immediately

Some people experience shortness of breath or chest pain and make it to the hospital in time to be treated. Besides chest pain (angina) and shortness of breath, other occasional symptoms include jaw pain, sweating, and nausea.

CHD - Diagnosis

Doctors use a variety of tests to detect heart disease.

One common test is the electrocardiogram (ECG)

Symptoms of CHD tend to show up when the person is exercising

because that's when the heart needs a higher level of oxygen delivery. However, for a person with heart disease, the coronary arteries can't deliver the amount

of oxygenated blood needed because of the coronary artery

blockage. That's why stress tests require the patient to perform a

strenuous activity under a doctor's supervision, such as

walking or running on a treadmill.

CHD diagnosis – Identifying the location of the blocked arteries:

Angiography

CHD Treatment – Angioplasty and stent insertion

(Normally done within 24 hours of positive ECG result under local anaesthetic)

CHD - Treatment

Bypass Graft – if the blockages are too extensive then artificial arteries are ‘created’ that bypass the affected areas. This open heart surgery is done under general anaesthetic.

CHD - TreatmentMedication is always necessary to manage CHD. This

is normally:1.Statins – lowers cholesterol2.ACE inhibitors & beta blockers – Reduce stress on

the heart3.Aspirin – thins the blood.

CHD – Impact upon Individuals

Medical advances have reduced the impact greatly in recent years. The effect of CHD will depend upon whether the person knows they have it, and whether it can be surgically treated.

Before treatment, the symptoms already mentioned can lead to difficulties with exercise even walking short distances.

After treatment the main impact is having to take various medication with possible side effects and for some the psychological effect of having a heart attack or nearly dying.

Disease prevention

You can reduce the risk of developing

CHD by exercising,

eating healthily, and not smoking.

Malnutrition, periodic famine & obesity

Why?

• The Sahel region covers a belt of grasslands south of the Sahara stretching from Senegal to Sudan

• Why do people in this area experience periodic famine?

What impact does famine have?

What impact does obesity have?

Contrasting approaches to healthcare - CUBA: Cigars and Clinics

http://news.bbc.co.uk/player/nol/newsid_5230000/newsid_5237000/5237070.stm?bw=bb&mp=wm&news=1&ms3=6&ms_javascript=true&bbcws=2

So why don’t all countries take the same approach as Cuba?

What do Cuba’s critics say?

The Role of TNCs and AIDS drugs – “Lives before profits”?

L.O.s1.To define the terms: TNC, Generic, “Big Pharma”, ARVs, HAART, Tiered Pricing.2.To describe the structure of a TNC3.To explain the role of TNCs in Health Care.

TNCs

• Definition: A company that operates in at least 2 countries. Usually with its HQ and R&D department in the country of origin and manufacturing plants overseas.

• Examples of Pharamceutical TNCs (sometimes called “Big Pharma”): GlaxoSmithKline and Bayer.

How do TNCs develop new drugs?• It is estimated that new drug costs $500 million to

bring to market.• Most money is spent targeting diseases of

affluence as MEDCs can pay high sums for treatments.

• This figure includes the R&D in labs, clinical trials, marketing (especially to doctors) etc.

• Patents make it illegal to copy the drug and for rival companies to make a generic version for 20years.

Brief History of AIDS drugs in Africa

• In 1996, HAART - an effective combination therapy that delays the onset of AIDS - became available in MEDC’s. Within four years, death rates for people with HIV/AIDS in developed countries had dropped by 84%.

• At a cost of US$10,000-15,000 per person per year, these antiretroviral drugs (ARVs) were far too expensive for the majority of HIV infected people in resource poor countries.

• Five years after HAART therapy was introduced in the West, fewer than 8,000 people in sub-Saharan Africa were receiving the life-saving drugs.

• Big Pharma companies refused to lower prices saying there would be no money for research and development (R&D), no innovation, and thus more and more people would die from AIDS and other deadly diseases.

In 2001 an attempt was made by thirty-nine major pharmaceutical companies to prosecute the South African government for passing a law that allowed easy production and importation of generics.

Brief History of AIDS drugs in Africa

• In the Year 2000 an Indian pharmaceutical company called Cipla started to produce generic antiretrovirals that were exactly the same as brand versions made by large pharmaceutical companies, but significantly cheaper.

• This sparked a price war between branded and generic drug makers, which forced the large pharmaceutical companies to lower the price of their AIDS drugs.

• This competition, coupled with pressure from activists, organizations - such as the Clinton Foundation - and governments of poor countries with severe AIDS epidemics, dramatically reduced the price of ARVs for developing countries.

• By the middle of 2001, triple combination therapy was available from Indian generic manufacturers for as little as $295. By 2007 the most common antiretroviral combination (3TC/d4T/NVP) available for only US$87 per patient per year

Graph showing the Prices for ARV’s 2000/2001 Even now prices

have fallen, ¾s of people infected

with HIV go without treatment

Case Study:

• Plus lots of preciption medicines Including:Anti Malarias,cancer & heart disease drugs

• GSK was 1 of the 39 pharmaceutical companies involved in the South Africa legal case.

• GlaxoSmithKline, has now changed its tactics completely and has granted permission (called a voluntary licence) to major South African generics producer Aspen, to share the rights to their drugs AZT, 3TC and the combination Combivir without charge.

• http://www.gsk.com/infocus/world-aids-day.htm video clip/propaganda?!/good PR

The Tobacco Industry and Health

•To describe the effects on health of smoking cigarettes•To describe the current patterns of cigarette consumption•To explain how and why these patterns are changes•To outline how Tobacco TNC’s are looking to expand markets and profits by targeting LEDC’s.

How many cigarettes are smoked each year?

5.5 trillion

5,500,000,000,000

There are believed to be

1.1 billion smokers in the

world, 800 million of them in developing

countries.

Cigarette smoke contains about 4,000 chemical agents, including over 60 carcinogens including substances, such as carbon monoxide, tar, arsenic, cyanide, benzene, formaldehyde, methanol, acetylene, ammonia, lead.

Effects of smoking on your health• Smoking is a greater cause of death and disability than any

single disease, says the World Health Organisation. • According to their figures, it is responsible for approximately

five million deaths worldwide every year. • Tobacco smoking is a known or probable cause of

approximately 25 diseases, and even the WHO says that its impact on world health is not fully assessed.

• 5X more likely to have a heart attack• Increased risk of stoke• Men are 22X likely to get lung cancer• Smoking also increases the risk of oral, uterine, liver, kidney,

bladder, stomach, and cervical cancers, and leukaemia. • Another health problem associated with tobacco is emphysema,

which, when combined with chronic bronchitis, produces chronic obstructive pulmonary disease.

• Smoking in pregnancy greatly increases the risk of miscarriage, is associated with lower birthweight babies, and inhibited child development.

• Smoking by parents following the birth is linked to sudden infant death syndrome, or cot death, and higher rates of infant respiratory illness, such as bronchitis, colds, and pneumonia.

Healthy Lung vs. Smokers Lung

Bar graph showing annual tobacco consumption in grams

As a result of smoking and advertising bans markets in MEDC’s have declined and tobacco

TNC’s have started to look to LEDC’s and emerging economies (eg. China) to guarantee new smoking addicts and guaranteed profits.

• What do you think of this?• Are tobacco TNC’s: drug dealers/ providing consumer choice/ causing

manslaughter/?• Is it ethical to exploit LEDC’s or is it just the way

business works?

World map showing location and % of males who smoke.

Source: WHO 2008

Tobacco TNC’s

Case Study BAT (British American Tobacco)

• Main brands: Dunhill, Kent, Lucky Strike, Pall Mall, Vogue, Rothmans, Peter Stuyvesant, Benson & Hedges.

• Annual revenue: £33,921 million (2008)

• Cigarette factories in 44 countries

• Regional variations in health and morbidity in the UK

• and

• the factors which affect these

Obvious exam questions???

Describe Explain (PATTERN and TREND)

12.35

What factors might cause some regions to have ‘better’ or ‘worse’ health or morbidity?

– AQA says:• Age structure• Income & occupation type• Education• Environment • Pollution

Beware: depends on what ‘disease’ you are talking about…

Health Profile of England 2007

Section 1 – Regional Comparison

• There is a consistent ‘north/south’ divide, with poorer health in the north of England in comparison to the south in almost all cases.

• Women in the NE and NW live over 2 years less than those in the SE and SW. A similar pattern exists for men: men in the NE and NW live over 2½ years less than those in the SE and SW.

• The proportion of men in the NE who assess their health as ‘not good’ is approaching double that in the SE.

• The rate of admissions to hospital for alcohol specific conditions is almost 2½ times higher in the NW than in the East of England.

• Five year olds in the West Midlands have, on average, one decayed, missing or filled tooth. In the NE and NW the average is two teeth.

Urban / rural differences?? Why?Anomalies?

Not regional, except that…

http://www.london.gov.uk/lhc/docs/publications/healthinlondon/2003/Figure_01.jpg

Now look at the South West England case study on p.199 in your revision guide.

Key Questions1. What is primary healthcare?

2. In your local area how do age, gender and wealth affect access to exercise facilities, health care and good nutrition?

3. Local case study: what are the implications of the above for the provision of health care systems in your area?

Factors affecting access to healthcare

Primary Care Trusts (PCTs)

• Started 1948

• Has been more difficult to manage as time has gone on (costs have risen as people living longer and medical advances increasing)

• Year 2000 – Government produced NHS Plan– Creation of primary care trusts (PCTs)

– This is the care provided by the people you see when you first have a health problem e.g. doctors, pharmacists, dentists, opticians

– NHS Direct

• All of the above are managed by local PCT. Control about 80% of NHS budget

AGE

WEALTH

GENDER

Nutrition Healthcare Exercise Facilities

AGE

WEALTH

GENDER

Nutrition Healthcare Exercise Facilities

Private health care e.g. BUPA

No waiting lists – arguably better

treatment?

Wealthier – can afford gym membership

Wealthier – more mobile to access exercise facilities

Employed full time = easier access

Northcroft (more family orientated), Regency, Canons (Nuffield Health)

LA Fitness

Men have easier access than women - childcare

Less accessible for elderly (less mobile). Facilities cater for those

with cars more and moreLess accessible for under 16’s – cost, local area may have ack of

fields, some gyms have restrictions

West Berkshire = ageing, therefore specific facilities

given priority

Cervical Cancer? Targets particular age groupsTeenage pregnancies

Contraceptive clinicsSexually transmitted diseases, teenage

pregnancies, breast screening services –

aimed at specific gender

Better nutrition the wealthier you are?

What supermarkets do we have?

Different attitudes to nutrition over time?Healthy Schools –

Jamie Oliver?Meals on Wheels

service

Different attitudes to food and diet

Private Healthcare and Charities

‘Nuffield Health Taunton Hospital opened in 1974 as a small private unit for the local community and is established as one of the leading providers of private healthcare in the area.’

‘Our hospital is modern, and all of our patient rooms have private en-suite facilities to ensure your comfort.’

‘St Margaret's Somerset Hospice is your local charity committed to providing specialist palliative care, advice, support and respite to patients and their families living in Somerset and parts of neighbouring counties. Our care is available for those who have a terminal or life-limiting illness, for example cancer, motor neurone disease and chronic lung disease.’

That’s all folks!