Topic: World Health Threats• Aim: How do countries undergo an epidemiologic transition?

• Do Now: Describe what you feel are some of the greatest health threats to the United States and the World today.

Epidemiology:• Branch of medicine concerned with the incidence, distribution, and control of diseases that affect large numbers of people

• Rely heavily on geographic concepts such as scale and connection

• Epidemiologic Transition Model: Focuses on the specific causes of death in each stage of the demographic transition

World Health Map:

• http://www.healthmap.org/en/

Stage 1- ‘pestilence and famine’:

• Infectious & parasitic disease key causes of human death (e.g. - the Black Plague of 1348/1349)

• About 25 million Europeans died, ½ of the continent’s population

• Huge impact on economic, social, and political makeup of nations

Stage 2- Receding Pandemics:

• Pandemic: disease that occurs over a wide geographic area and affects a high proportion of a given population

• HIV/AIDS in Africa (modern day), Cholera in the Nineteenth Century

• Cholera was a recurring scourge for decades. A second cholera outbreak in New York in 1849 killed 5,071 out of a population of 500,000. Then John Snow, a British physician, plotted the locations of cholera cases during an outbreak in England in 1854, showing that it was associated with contaminated water. With the advances in knowledge and sanitation, a third cholera outbreak in New York in 1866 was much less deadly. Only 591 people died, out of a population of 850,000.Photo: New York Historical Society

Cholera in the Nineteenth Century:

•Distribution of cholera victims and water pumps to prove that the cause of the infection was contamination of the pump near the corner of Broad and Lexington streets

The highest rates of HIV infection are in sub-Saharan Africa. India and China have relatively high numbers of HIV-positive adults, but they constitute a lower percentage of the total population.

Stages 3 & 4: Degenerative & Human-Created Diseases:

• Decrease in deaths from infectious disease (Polio, AIDS, Cholera, Yellow Fever, etc), and increase in deaths from chronic disorders, primarily heart diseases and various cancers

• Stage 4 (Olshansky, Ault) is simply delayed degenerative diseases to do medical advances

Stage 5- Reemergence of Stage 1:

• Reemergence of infectious and parasitic diseases. 3 possible factors:

1. Evolution: diseases genetically evolve to be resistant to medicine (i.e.- Malaria)

2. Poverty: Diseases that are expensive to cure affect LCD’s the most (i.e.- Tuberculosis)

3. Improved Travel/Globalization: Increased travel within countries and between them causes increase in spread of infectious disease

Death from tuberculosis is a good indicator of a country's ability to invest in health care, because treating the disease is expensive.

The first cases of avian flu were recorded in Southeast Asia.

Why Do Some Regions Face Health Threats?

• Health Care–Health conditions vary around the world, primarily, because countries possess different resources to care for people who are sick.• Expenditures on Health Care–More than 15 percent of total government expenditures in Europe and North America.–Less than 5 percent in sub-Saharan Africa and South Asia.

Health Care Systems:• Developed Countries –Public service available at little or no cost.–Government pays more than 70 percent of health-care costs in most European countries, and private individuals pay about 30 percent of the expense.

• Developing Countries–Private individuals must pay more than half of the cost of health care.»U.S. is an exception to these generalizations, because private individuals are required to pay about 55 percent of health care costs making it more closely resemble a developing country, in regards to health care.

HEALTH CARE EXPENDITURES The lowest levels of per capita health care expenditure are in sub-Saharan Africa and South Asia.

• This document, written by the Edinburgh Board of Health in Scotland and distributed in New York during the cholera epidemic of 1832, reflects misunderstandings of the disease at the time. "Remedies" like laudanum -- morphine -- were ineffective at best; at worst, they added to the suffering of the victims. Most doctors did not believe that cholera was contagious among people, but rather arose from "miasmas," or noxious vapors of decaying organic matter. Certain activities like drinking of alcohol were believed to make one more susceptible to cholera.

• One-third of the reported cases came from New York's Sixth Ward -- the five-sided blue section on the map -- which encompassed Five Points. In 1832, New York's population of a quarter million people was concentrated below 14th Street; 3,515 died in the cholera epidemic.Photo: New York Historical Society

60 Minutes-Bill & Melina Gates:

• http://www.youtube.com/watch?v=2VdMqmVtnOM