Global health may be considered as the health of populations in a global context. Across the globe many countries experience differing levels of health and an awareness of this allows the international community to reach out to countries experiencing relatively low levels of health. An organisation that monitors global health is the United Nations (UN). The UN considers people as the real wealth of a nation, and that increasing levels of health and human development will expand the choices that people have and allow them to lead lives that they value. The UN considers the environment an important aspect that should allow for people to develop to their full potential.
<INSERT FIGURE 7.1>
<Start caption for 7.1> People are the wealth of a nation.
According to the UN, human development is about:
- creating an environment where people can develop to their full potential;
- creating an environment where people can live productive, creative lives in accord with their interests and needs; and includes:
- expanding people's choices;
- enhancing people's capabilities;
- people having access to knowledge;
- people having access to health and a decent standard of living;
- people participating in the life of the community;
- people participating in decisions that affect their lives.
Developed versus developing countries
The World Health Organisation (WHO) gathers and reports on much data in relation to countries health. There are many characteristics that may be used to distinguish between a developed and developing country. Developing countries generally do not have advanced industry and have low gross domestic product, with people in such countries often experiencing poor levels of health. Developed countries often have advanced industry and have strong trade-based economy with its people generally enjoy a high standard of living.
Characteristics used by the World Health Organization to discriminate between a developing and developed country may include:
- under-five mortality;
- adult mortality;
- child mortality;
- infant mortality;
- income;
- adult literacy;
- life expectancy;
- level of economic development;
- gross domestic product.
Developing countries are more likely to have higher levels of under-five mortality, adult mortality, child mortality and infant mortality than developed countries. On the other hand developing countries are more likely to have lower levels of income, adult literacy, life expectancy, levels of economic development and gross domestic product than developed countries.
<INSERT FIGURE 7.2>
<Start caption for 7.2> World Health Organisation logo.
Sustainability and human development
Sustainability
Sustainability can be thought of as meeting the needs of the present without compromising the ability of future generations to meet their own needs. The United Nations considers there to be three dimensions of sustainability:
1. Economic sustainability. This relates to using resources efficiently so that there is economic growth over time that allows for future generations to earn an income.
2. Social sustainability. This relates to allowing future generations to have access to social resources such as education, political sustainability and human rights.
3. Environmental sustainability. This relates to monitoring and preserving resources so they are available for use by future generations.
These three components have an interrelationship, the better they align the more positive it will be for the wellbeing of those involved.
<INSERT FIGURE 7.3>
<Start caption for 7.3> Interrelationship between the three dimensions of sustainability.
Sustainable programs
When programs are implemented in developing countries there are many factors to consider if the program is going to be sustainable. A sustainable program will meet the needs of the current generation and then continue to meet the needs of future generations once aid funds and project partners are no longer present. The three important elements of sustainable programs are appropriateness, affordability and equity.
Appropriateness
A program that may be successful for a disadvantaged population in Australia cannot simply be rolled out in a developing country with an assumption that it will also be successful there. Different countries and groups have cultures and ways of living that need to be considered when implementing a program. Appropriateness means that a program has taken into consideration the needs of a specific community and it setting about to address those needs.
An appropriate program considers the following:
- Do the people in the community desire the outcomes the project will deliver? If community members are going to continue to implement a program once outside assistance has left, the project must have meaning to them and they must desire the project outcomes.
- Does the project involve local community members? Local people should be involved in the creation, set-up and modification of a project that affects them. Local input means programs will have greater relevance for people in the community and it will build skills and capacity of those involved. Projects are more likely to be continued when locals have ownership over a project.
- Is the project culturally appropriate? For a project to be accepted by a community it must consider the cultural values and practices of that group. If this is done effectively the project is more likely to get ongoing support from the community.
- Is the project educating community members? For a program to have longevity people need to know how to problem solve when issues arise. Education regarding running a project, and educating the community in general, is a key to teaching problem solving skills. Women complete much of the daily work within a community, educating and empowering them can reap real benefits for a community.
Affordability
For a program to be maintained once assistance has be withdrawn a community must be able to afford to carry the program on. Regular government or non-government input may need to be secured for some programs to be sustainable. Most people in developing countries have little dispensable income and therefore for maximum health benefits to come from projects they need to be free or available at very little cost. The infrastructure that is required to set up and maintain a project needs to be affordable and accessible to ensure the project's success.
Education and the flow on effect of work and income, is a key to affordability of programs. As people earn income and a countries GDP increases, so does the availability of money via taxes for things such as infrastructure, business support and health programs.
Equity
If all members of the community can access a program then a larger number of people are likely to be involved, and thus the program has a higher chance of being sustainable.
An equitable program considers the following:
- Are people living in all areas able to access the program? For maximum health and human development outcomes to be achieved those in remote and very remote locations should not have to travel large distances to enjoy the benefits of a program. Programs should not just be based in urban areas, as often those most in need live further afield.
- Are women and girls involved in the program?
Women and girls are often more vulnerable than men and given less access to health and education services in developing countries. Ensuring that programs involve and are accessible to women and girls will improve health outcomes for such groups and build the capacities of individuals and communities.
- Is cost a factor that may prevent participation in the program? Access should not be restricted to those who can pay, but focused on need, ensuring a social hierarchy does impact on health outcomes.
<INSERT PUTTING IT TOGETHER ICON>
Sustainable programs need to be well thought out and not simply forced upon a group with the attitude 'we know best'. For groups and communities who have followed a certain way of life for a long period of time it may take some time for new approaches to be embraced. Working with communities and making programs people centered can assist this process.
Human Development Index
There are many elements that make up Human Development and therefore it is difficult to measure each element and provide a comparison across countries. The United Nations Development Program (UNDP) has developed a measurement system in order to attempt to ascertain the level of human development occurring in a country, this is referred to as the Human Development Index (HDI).The HDI is a composite index measuring average achievement in three basic dimensions of human development-health, education and a living standards. The UNDP identifies these three dimensions and four indicators as making up the HDI.
Table 7.1 Components of the HDI
Human
Development
Index
Dimensions
Indicators
Health
Life expectancy at birth
Education
Mean years of schooling
Expected years of schooling
Living standards
Gross national income per capita
When the HDI is calculated a value between 0 and 1 is generated. This value places a country into one of the following four categories (examples of such countries are provided):
- Very high human development: Australia, Norway and Netherlands.
- High human development: Mexico, Serbia and Libya.
- Medium human development: Thailand, China and Egypt.
- Low human development: Pakistan, Nigeria and Uganda.
The HDI was created to emphasise that people and their capabilities should be the ultimate criteria for assessing the development of a country, not economic growth alone. The HDI can also be used to question national policy choices, asking how two countries with the same level of Gross National Income per capita can end up with such different human development outcomes. For example, the Bahamas and New Zealand have similar levels of income per person, but life expectancy and expected years of schooling differ greatly between the two countries, resulting in New Zealand having a much higher HDI value than the Bahamas. These striking contrasts can stimulate debate about government policy priorities.
<INSERT WEBLINK>http://hdr.undp.org/en/statistics/hdi/
<INSERT HOT TIP ICON>
When school assessed coursework and examination style questions ask about the HIDI they are often testing whether or not students have knowledge of the dimensions and indicators. If you are explaining that a country has very high levels of human development, such as Australia, mention that this can be linked to the high life expectancy and gross national income per capita that its citizens experience.
Australia's health compared to developing countries
As Australians we often take for granted the access to services and good conditions in which we live. As a developed country, the majority of the Australian population experiences good levels of health. When compared to developing countries, on average Australians live longer and experience less illness and disability. When compared to developed countries, developing countries generally have:
- Lower levels of sanitation and less access to clean water.
- Lower levels of average income.
- Less access to health care facilities.
- Higher levels of conflict and political instability.
- Higher levels of gender inequality.
- Lower levels of education.
- Low quality infrastructure such as few sealed roads and poorly maintained public transport.
In the following tables the morbidity, mortality, life expectancy, burden of disease, life expectancy and human development index of Australia and two developing countries, Sudan and Uganda, are provided. As you read the data, consider the common characteristics of developed and developing countries and how they may have had an impact on the statistics of each country.
Morbidity
Morbidity refers to levels of ill health and disability. Incidence rates give an indication of the number of new conditions in a population and therefore the potential impact that may have on the morbidity rates in a particular country.
Table 7.2
Country
Incidence rate of tuberculosis per 100,000 population (2010)
Australia
6.3
Sudan
119
Uganda
209
Source: World Health Statistics 2012.
<Permissions brief 7.7>
Mortality
Mortality relates to death. As death rates increase, especially in younger age groups, the life expectancy of a country is likely to decline. Death rates are one of the most commonly used indicators to determine the health status of a country.
Table 7.3
Country
Adult female per 1,000 people (2009)
Adult male per 1,000 people (2009)
Australia
45
79
Sudan
275
291
Uganda
348
539
Adult mortality: Probability that a 15-year-old person will die before reaching age 60.
Source: Human Development Report 2011.
<Permissions brief 7.8>
Table 7.4
Country
Under five mortality
(per 1,000 live births) 2009
Australia
5
Sudan
108
Uganda
128
Under-five mortality: Probability of dying between birth and exactly age 5.
Source: Human Development Report 2011.
<Permissions brief 7.9>
Life expectancy
Life expectancy relates to how long a person is expected to live, this is based on countries mortality rates. This indicator contributes significantly to calculating a countries human development index.
Table 7.5
Country
Life Expectancy (years)
Australia
81.9
Sudan
61.5
Uganda
54.1
Source: Human Development Report 2011.
<Permissions brief 7.10>
Burden of disease
As burden of disease is measured in DLAYs, it considers both mortality and morbidity. Therefore conditions with high prevalence numbers will contribute to the burden of disease in a country.
<Permissions brief 7.11>
Table 7.6
Country
HIV prevalence
Female Youth
(%) 2009
HIV prevalence
Male Youth
(%) 2009
Australia
0.1
0.1
Sudan
1.3
0.5
Uganda
4.8
2.3
HIV prevalence: Percentage of the population ages 15-24 who are infected with HIV.
Source: Human Development Report 2011.
Human Development Index
The Human Development Indices and a corresponding ranking are released annually via the United Nations Human Development Report. The data required to calculate the index is gathered via various national and international bodies, when such data is unavailable estimation techniques may be employed.
Table 7.7
Country
Human Development Index (2011)
Australia
0.929
Sudan
0.408
Uganda
0.446
Source: Human Development Report 2011.
<INSERT FIGURE 7.4>
<Start caption for 7.4> Calculating the Human Development Index.
Influences on health status of developing countries and Australia
Understanding the influence of income, gender equality, peace/political stability, education, access to healthcare, global marketing and physical environments on the health status of developing countries allows us to better come to terms with ways to improve the health of such nations.
Income
Income relates to the amount of money people earn or receive through various sources and have available to them. Generally, the more income a person receives the greater their potential to maintain good health.
Gross domestic product (GDP) refers to the market value, in monetary terms, of all officially recognised final goods and services produced within a country in a given period. GDP per capita (per person in a population) is often considered an indicator of a country's standard of living. GDP per capita is not a measure of personal income, but can influence access to health services and resources such as clean water in a country.
Impacts of income in Australia - a minimum wage and welfare benefits exist that theoretically allow Australians to provide themselves with daily living necessities. Wealth in Australia is generally well distributed with the benefits of the countries rich natural resources shared amongst the population, leading to enhanced opportunities to develop the countries health and human development.
Impacts of income in developing countries - Casual, low paid work and exploitation can be common in developing countries. Often a small number of people have control over the majority of wealth leaving many on or below the poverty line. Poorly distributed wealth can mean that access to healthcare facilities are not widely available and therefore people are often forced to leave health conditions untreated.
Gender equality
Gender equality is where males and females have equal rights, resources, opportunities and protections. Across the world the level of equality between men and women varies greatly. In some sporting arenas men and women receive equal prize money whereas in others the differences can be in the order of hundreds of thousands of dollars. The impact of gender inequality on health can be hard to measure however equality can lead to empowerment and an increase in the ability of people to take control over decisions that affect their lives, this can influence health and human development greatly.
Impacts of gender equality in Australia - Most Australian environments provide equal opportunities for men and women, allowing both sexes the chance to develop to their fullest potential. Discrimination based on sex can have negative mental and social health implications, especially in the workplace, and associated physical health issues can arise. In Australia laws exist to prevent discrimination based on gender.
Impacts of gender equality in developing countries - A lack of gender equality often means that access to education, work and other services is poorer for women and this can lead to poorer health outcomes. Women are often left to cart water, cook meals, care for children and tend to homes. Evidence shows that when women are empowered through work and by contributing to their community, the health outcomes of the community rise. Girls are often less likely than boys to attend school in developing countries, this can have a negative impact on their ability to join the workplace and earn respect in their communities.
<INSERT FIGURE 7.5>
<Start caption for 7.5> Baby carried by a female in a developing country.
Peace/Political stability
Peace and political stability can be thought of as the absence of destabilising conflict or war within a country. On our television screens we are often brought the distressing images of people who are experiencing first-hand the impacts of political instability and conflict. The ability to maintain peace and political stability is vital to ensuring that people and governments are dedicating time and energy into the development of their country and its people.
Impacts of peace/political stability in Australia - Peace in Australia means resources and time can be dedicate to improving the health status of citizens. Peace enables Australians to go about their day to day lives pursuing their interests and needs without the fear of death, destruction or injury. Political stability assists to ensure Australia has a viable economy and that resources are available to spend on health and services. Democracy can assist to limit corruption and avoid large scale conflict within a country. A lack of conflict in Australia means that physical injury and mental scarring, which often results from such instability, is kept to a minimum.
Impacts of peace/political stability in developing countries - The absence of peace can lead to physical injury and death. There is much documentation outlining the trauma associated with living thorough war and the negative impact on the mental health and wellbeing of an individual who endures this. Conflict often leads to destruction of the physical environment of towns and cities, something that can take many years to rebuild once conflict has resolved. Damaged infrastructure within towns and cities can lead to a lack of clean drinking water and difficulty with transporting food goods. When instability arises students can be kept from attending school, often due to fear, and health resources and accessibility can be jeopardised. To fund political campaigns or war related efforts money is often taken from health budgets.
<INSERT HOT TIP ICON>
If a question asks how peace/political stability can impact on health and human development, be sure that your answer refers to peace/political stability. It is easy to fall into the trap of discussing conflict/political instability, however only refer to this if the question asks.
Education
Education may be thought of as the knowledge or skills obtained or developed by a learning process. People have the ability to continuously learn thanks to the amazing capacity of the brain. When provided with education people can live rich and fulfilling lives and contribute much to their community and the human race.
Impacts of education in Australia - Free, widely available primary and secondary education allows Australians the opportunity to take control over the trajectory of their life. Well educated people are more likely to find employment opportunities leading to income, stability and the opportunity to develop to their full potential. Higher levels of education have consistently been linked to greater health outcomes for people.
Impacts of education in developing countries - Education systems are often poorly managed and under resourced in developing counties. An under resourced education system or lack of opportunity to engage in education, limits people's ability to develop and utilise skills. Without school attendance young people in developing countries are more likely to participate in physical labour, and this often takes a toll on an individual's physical health. A lack of education limits earning potential and can therefore lead to a life on the poverty line.
Access to healthcare
Access to healthcare means that those who seek use of health resources are able to engage with them. Quality healthcare services within a country contribute to healthy citizens and productive economies. The opportunity to access and engage with healthcare can be limited by geography, socio-economic status and cultural background. Providing a service that overcomes such barriers can be challenging.
Impacts of access to healthcare in Australia - Adequate access to healthcare, a resource that the majority of Australians enjoy, ensures that people who are unwell can receive timely and appropriate care allowing them to return to their day to day activities as quickly as possible. Preventative health programs are often free of charge or provided at little cost, such as immunisations, which boosts the health status of individuals and groups within Australia.
<INSERT PUTTING IT TOGETHER ICON>
Think back to chapter 6 and Australia's health care system. Access to a well-established health care system contributes to the relatively high levels of health and human development experienced by Australians. Countries that do not have well established health care systems often experience lower levels of health and human development that those that do.
Impacts of access to healthcare in developing countries - People in these countries often need to travel for days to reach major urban centres to access basic medical care and therefore they are at risk of developing complications or even death. Developing countries often do not have national health schemes and therefore medical care and pharmaceuticals can be beyond the financial means of the average person. A lack of education and preventative campaigns can also mean that treatable, easily preventable conditions such as diarrhoea are common and likely to cause death in such countries.
Global marketing
Global marketing is the advertising and selling of goods and services all across the world. Examples of such goods are alcohol, tobacco and fast foods. An increase in regulations regarding sale and advertisement of such products in developed counties have seen companies focus greater resources on generating income from such products in developing countries.
Impacts of global marketing in Australia - Regulations in Australia prevent alcohol and cigarettes from being sold to minors and from fast food being advertised during some children's shows. Such regulations aim to help contain the number of health conditions associated with such products. Laws preventing advertising of cigarettes on billboards and regulating cigarette packaging in Australia aims to limit the ability of global companies from promoting products that have been proven to negatively impact on the health of Australians.
Impacts of global marketing in developing countries -Fast foods, tobacco and alcohol are becoming more readily available to individuals in developing countries and there is a rising level of middle class who have the money to afford such products. Combine this with a commonly unregulated advertising market and the result is an upward trend of non-communicable disease such as cardiovascular disease and cancer which are known to be linked to these products.
<INSERT FIGURE 7.6>
<Start caption for 7.6> Cigarettes are readily available in many developing countries.
Physical environments
The physical environment is external factors that can impact a person. As mentioned in Chapter 1 this may include access to clean drinking water and sanitation, pollution, infrastructure, shelter and the workplace. The ability to regulate and control ones physical environment depends greatly on personal resources and support offered from ones government.
Impacts of the physical environment in Australia - Most houses within Australia have living areas separate from bedrooms, and people are able to access clean washing and drinking water without the need to boil before consumption. Australian roads are mostly sealed and well maintained, sewage is contained and our streets are relatively litter free. This environment reduces citizens exposure to disease and limits their risk of injury and ill health.
Impacts of the physical environment in developing countries - Crowding, excessive noise, increased distance to services and lack of quality of housing can all negatively impact on the health and development of people in developing countries. Communities that lack a clean water supply may see family members travelling significant distances to provide water. Time spent on carting water can take away from employment or education opportunities and this can have a significant impact on the ability for people to reach their full potential and thus achieve optimal levels of human development.
Glossary
Communicable disease
A disease that can be spread from one person or organism to another. Also known as a contagious disease.
Developed country
Refers to a country that has advanced sufficiently in its industry and thus has a strong trade-based economy and its people generally enjoy a high standard of living. Characteristics include high life expectancy and a low under-5 mortality rate as well as adequate demographic indicators.
Developing countries
Refers to a country that has not advanced sufficiently in its industry and generally has a low gross domestic product. Characteristics include a poorer standard of living for its people, lower life expectancy, higher mortality rates and a lack of demographic progress.
Gross Domestic Product (GDP)
The total value of goods produced and services provided in a country, usually during one year.
Globalisation
Transforming the different societies of the world into a global society, where interaction on a global scale can occur.
Human development
Creating an environment in which people can develop to their full potential and lead productive, creative lives in accord with their needs and interests. It is about expanding people's choices and enhancing capabilities (the range of things people can be and do), having access to knowledge, health and a decent standard of living, and participating in the life of their community and decisions affecting their lives.
Human development index
A measurement of human development which combines indicators of life expectancy, educational levels and income. The Human Development Index provides a single statistic which can be used as a reference for both social and economic development.
Non-communicable disease
A non-communicable disease, or NCD, is a disease which is not contagious and cannot be spread from one person to another.
Sanitation
Is the hygienic means of promoting health through prevention of human contact with the hazards of wastes, for example faeces.
Sustainability
Meeting the needs of the present without compromising the ability of future generations to meet their own needs.
Revision check checklist - tick the box once you are confident of your understanding and ability in each key concept.
Knows the characteristics used to differentiate developing and developed countries
Know definitions of sustainability including appropriateness, affordability, equity and human development including the human development index according to the UN
Can outline the similarities and differences in health status and human development between developing countries and Australia in relation to morbidity, mortality, life expectancy, burden of disease and human development index
Understands the influence of income, gender equality, peace/political stability, education, access to healthcare, global marketing and physical environments on the health status of developing countries and Australia
Revision Questions
1. How may global marketing be having an impact on rising levels of tobacco use in developing countries? What are the associated health concerns that are also on the rise?
2. How does the HDI indicator life expectancy relate to human development?
3. List two environmental factors that may contribute to lower levels of health in developing countries?
4. What is the influence of gender equality on the health status of people living in Sudan compared to those living in Australia?
5. Red Cross Australia have supported Cambodian Red Cross HIV programs since 1995, focusing on community education, peer education for those most at-risk, improving access to HIV treatments and reducing stigma and discrimination. How does this program demonstrate the element of sustainable programs, equity?
6. Why would the United Nations want to consider mean years of schooling and expected years of schooling when determining the Human Development Index?
7. Name two elements that may indicate a program has elements of appropriateness.
