Influences on Health Influences on Health StatusStatusHHD Unit 4HHD Unit 4

Influence includeInfluence include

IncomeIncome

Gender equalityGender equality

PeacePeace

EducationEducation

Access to health careAccess to health care

Political stability Political stability

Global marketingGlobal marketing

Physical environmentPhysical environment

GendeGender r EqualitEqualityy

Achieving gender equality includes:

     More and improved jobs for both men and women

     Equal pay for work of equal value

     Providing access for women to promotional opportunities

     Having both men and women equally represented in union groups as both leaders and members

     Removing violence against women in places of employment

     Providing lifelong educational opportunities equally for women and men, including vocational education opportunities

One of the main issues associated with gender equality is the discrepancy that exists in relation to educational opportunities afforded to boys and not girls .

Gender equality means valuing equally the roles of both women and men throughout the world, and removing the prejudice and stereotypes that are so often cast over both sexes. When women and men have equal opportunities, there are chances to display and fulfill their individual potential and to contribute to their country’s social and economic development.

Gender Gender EqualityEqualityWhen women have the same power and control over their lives as men do, their health outcomes improve. Unfortunately, in many cultures and countries, women have less power and less control over resources than men. This in turn typically leads to disadvantage in the economic, political, social, educational and health domains.

There are also differences in gender roles that negatively affect men; such as the higher levels of risk taking, higher rates of smoking and higher levels of violence. On a global scale, however, gender inequalities impact on women’s health more severely than they do on men’s health.

• two-thirds of the 800 million people in the world who lack basic literacy skills are female (AusAID, 2008). This leads to many women working in low paid, often dangerous and laborious jobs which directly put their health at risk. Prostitution is an example of this, raising the levels of HIV/AIDS infections.

• women hold an average three per cent of seats in national parliaments in Pacific island countries, and an average of 19 per cent of seats in East Asia. The lack of input that women have in governments can contribute to women having little say in the issues that affect them, such as male perpetrated violence.

• 500 000 women die each year from complications during pregnancy — 99 per cent of them in developing countries. Women are often neglected with regard to health care and other services and essential supplies. Women may be the last fed and may not receive enough nutrients to adequately nourish them.

• gender norms in many countries make men the sole decision makers. This can affect the role that women play in society and can directly affect their health. For example, one study on a cyclone in Bangladesh noted that many women perished with their children at home as they had to wait for their husbands to return and make an evacuation decision.

• in many countries, women are expected to abide by their father or husband’s decisions. Violence may result if the woman challenges the man’s authority. It may be socially acceptable for men to have more than one sexual partner and he may not use protection with any of them. His wife may be at an increased risk of contracting STIs (including HIV/AIDS) but not be in a position to insist that her husband use a condom.

PeacePeaceA peaceful environment and society are essential for promoting optimal health.

Conflict, on the other hand, significantly affects health. When a country is in conflict their level of human development or HDI is much worse than many other countries.

Infrastructure, agriculture and community resources may be damaged during conflict

Food may be unable to reach certain towns or villagesFood may be unable to reach certain towns or villages

Food may be sent in preference to soldiersFood may be sent in preference to soldiers

The values of the Health as a Bridge for Peace (HBP) policy derive from the United Nations Universal Declaration of Human Rights, based on the notion that it is imperative to adapt peace-building strategies to ensure long-term health gains.

Freedom from disturbance

PeacePeaceBesides the obvious loss of lives that occurs during periods of conflict, the associated effects flow through to all parts of society. Those who are already experiencing poor living conditions are often the most affected. The physical environment can be destroyed which can lead to shortages of food and limited access to services and supplies. As a result, malnutrition is amplified and conditions that may have been able to be treated during peace times are left untreated during times of conflict. Water and sanitation facilities and electricity supplies can also be destroyed and thousands of people are displaced either within their country or as refugees in other countries. Being displaced has a flow-on effect as this new environment may lack food and water, educational opportunities for children and health care.

The effects of conflict also include physical injuries, increased mental distress, worsening of existent malnutrition, higher maternal and infant mortality and increases in communicable disease outbreaks, such as typhoid, dysentry and cholera

During times of conflict the risk of personal injury and the destruction of During times of conflict the risk of personal injury and the destruction of infrastructure can make it difficult to reach those requiring assistance and aid. For infrastructure can make it difficult to reach those requiring assistance and aid. For these reasons, health workers may also find it difficult to carry out their work, these reasons, health workers may also find it difficult to carry out their work, compounding the effects on health. Governments involved in conflict may divert compounding the effects on health. Governments involved in conflict may divert much needed funds towards defence which can leave very little financial support much needed funds towards defence which can leave very little financial support for its citizens.for its citizens.

Women are at higher risk of rape and abuse as conflict grips their country. Lack of Women are at higher risk of rape and abuse as conflict grips their country. Lack of protection from rival forces can impact significantly on the lives of women and protection from rival forces can impact significantly on the lives of women and children.children.

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EducatioEducationnThe impact of having an inadequate education can result in the person’s

inability to become a productive member of society and to earn an income

Education for all (EFA) is an international commitment, launched in 1990, with the aim of bring the benefits of education to every citizen in every society.

Without proper education, individuals are more likely to participate in risk Without proper education, individuals are more likely to participate in risk taking behaviour. For example unsafe sex, smoking and, drinking and taking behaviour. For example unsafe sex, smoking and, drinking and driving. Also they lack education about food choices and lifestyle habits, driving. Also they lack education about food choices and lifestyle habits, and therefore that affects their health negatively.and therefore that affects their health negatively.

While without education as a child, they are more unlikely to gain a substantial income when they are older. Therefore education has a positive benefit in regards to poverty reduction and productive economies.

Adult literacy rates - The higher the level of adult literacy, the greater the Adult literacy rates - The higher the level of adult literacy, the greater the opportunity for people to lead productive and fulfilling lives. Educated opportunity for people to lead productive and fulfilling lives. Educated adults generally have greater choices and have an increased capacity to adults generally have greater choices and have an increased capacity to participate in the life of their community and be involved in decision participate in the life of their community and be involved in decision making processes. making processes.

The process of receiving or giving systematic instruction, esp. at a school or university: "a new

system of public education".

EducatioEducationnEducation promotes literacy, which can lead to higher socioeconomic status (including stable employment and income). This in turn improves access to essentials such as food, shelter and health care. Educated people are more likely to have an understanding of health promotion messages and take notice of them. An example of this is the AIDS epidemic in Africa, where many cases could be prevented through education. Education allows people to communicate effectively, which empowers them. It also enables progress with new discoveries and improved ways to live. It also can break the cycle of poverty and ill health that many individuals, families and societies struggle against.

Women are often those who are most disadvantaged with regard to education. As well as the effects already mentioned, educated women are more likely to have healthier children.They are more likely to adopt health-promoting behaviours such as having their children immunised and implementing methods to reduce the transmission of infectious diseases. Educated women are more likely to have fewer children. This means that the children they do have generally have more opportunities and access to resources such as education, food and health care.

In Australia, education enrolment rates and education standards are high compared to most other countries. In fact, it is compulsory for all Australian children between the ages of 6 and 16 to be enrolled in school. Many of the expenses required to run the education system are met by the government through tax dollars giving people from all socioeconomic status groups the opportunity to enrol their children in school. As a result, the enrolment rates in Australia are very high and this is reflected in adult literacy rates.

In developing countries, many governments do not have the funds available to provide education for their people. This means it is often only the wealthy who can afford to pay for their children to be educated. As a result, the poverty cycle is likely to continue.

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Access to Access to

healthcarhealthcareedeveloping countries- people in poor countries have less access to health care systems. Without access to these service it can reduce their life expectancy’s. When health care is needed but they cannot obtain it, peoples health worsens which leads to lost income and higher health care costs which contributes to more poverty. These people have very little food and safe drinking water, which makes them vulnerable to causing infectious diseases. The lack of transportations also affects their health services due to being isolated and not being able to access health services easily.

developed countries- developed countries have higher access to health care systems and hospitals including private health insurance allowing them to live a healthier and longer life. They have access to fresh food and water, safe homes and transport allowing them to access hospitals. Australians are also very lucky because we all have access to medicare which provides all Australians with affordable, accessible and quality health care.

Being able to access health workers can assist in the prevention of disease (through immunisation and education) and can make available treatments for a range of conditions.

Access to health care during pregnancy and childbirth is critical for the health of mothers and children. There are many complications that can arise during this period and skilled health care workers can significantly decrease the rates of maternal and infant mortality. According to the WHO, more than half a million women die each year from preventable complications during pregnancy or childbirth. In Australia, most women who want a trained person to assist with childbirth can access one.

The prevention, treatment, and management of illness and the

preservation of mental and physical well-being through the services

offered by the medical

Political Stability Political Stability Some of the common effects of political instability include:

• conflict and civil war. The grapple for power often turns violent when the political system breaks down as rival groups fight for power.

• breakdown of law and order. Resources are often directed at fighting off challenges for power leaving the country relatively lawless.

• trade restrictions. The UN or individual countries may place trade restrictions on countries that are being governed illegally, causing economic hardship.

economic turmoil. With disruptions to trade and industry, the economy can be thrown into turmoil meaning that there is less economic benefit for the population.

• unemployment. Rates of unemployment increase as the economy is strained.

• disruption to education. Education systems may also break down as a result of economic and social breakdown.

lack of health care. The health system may have its funds withheld meaning basic levels of health care are not available.

• human rights abuses. Activists for the ruling party may run riot through the streets inflicting violence (including rape) on those opposed to the ruling party.

Political Stability Political Stability In many ways, there is a relationship between peace and political In many ways, there is a relationship between peace and political stability. When the political system is stable, governments and stability. When the political system is stable, governments and individuals can work together to enhance economic development individuals can work together to enhance economic development and living conditions. On the other hand, political instability and living conditions. On the other hand, political instability removes the focus from the people, as rival political groups struggle removes the focus from the people, as rival political groups struggle for power. Political instability is often the result of an individual or for power. Political instability is often the result of an individual or group attempting to gain power through unlawful and often violent group attempting to gain power through unlawful and often violent means. Such contests for power can continue for many years and means. Such contests for power can continue for many years and throw the economic and social environment into turmoil.throw the economic and social environment into turmoil.

When the political structure of a country is under threat, people When the political structure of a country is under threat, people from all walks of life are affected, and those from lower from all walks of life are affected, and those from lower socioeconomic status (SES) groups are often those who are most socioeconomic status (SES) groups are often those who are most affected. They generally lack the resources to survive during affected. They generally lack the resources to survive during difficult times. difficult times. Australia's system of government has been set up to promote Australia's system of government has been set up to promote democracy and reduce the risk of political coups (the democracy and reduce the risk of political coups (the unconstitutional overthrowing of a democratically elected unconstitutional overthrowing of a democratically elected government) and dictatorships (a single, self-appointed ruler). Many government) and dictatorships (a single, self-appointed ruler). Many countries have struggled to maintain stability with regard to their countries have struggled to maintain stability with regard to their government and have endured years of hardship as a result. government and have endured years of hardship as a result.

Global marketingGlobal marketingGlobal marketing means marketing and promoting a product throughout the world. The three specific areas; tobacco, alcohol and processed foods have the biggest impact on the health status of individuals in both developing and developed countries. In Australia as a result, we now have strict controls over tobacco advertising, restrictions on when alcohol products can be advertised and ongoing debate about the amount of advertising of processed foods during children’s television times.

However in developing countries where governments do not have the money or infrastructure to place bans and restrictions on the marking and promotion of alcohol or tobacco products, the rate of the uptake is significantly high. Big multinational companies take advantage of the no restrictions on advertising in developing countries. They strategically promote the three specific areas in a positive way by showing happy families eating McDonalds, beautiful women drinking alcoholic beverages and healthy people smoking cigarettes. The population in developing countries have no knowledge of the consequences of consuming highly processed foods which is why their levels of cardiovascular disease, chronic illnesses and obesity are increasing.

Global marketingGlobal marketingTobacco is being marketed globally by large transnational companies, with developing countries being their main targets for expansion. Tobacco is heavily advertised and marketed to children and adults. As a result, consumption of tobacco has increased enormously with corresponding increases in diseases such as cancer, cardiovascular disease and respiratory diseases.

Global alcohol consumption has increased as a result of global marketing with most of this increase occurring in developing countries. Increased alcohol consumption contributes to increased rates of cancer and injuries.

Food consumption patterns are also changing, particularly in developing countries as large transnational companies market fast foods. This is having an effect more specifically in middle income countries where people are moving to the cities away from their subsistence farming. As a result, they are starting to consume a more energy-dense diet that is high in saturated fat and in refined carbohydrates. This is contributing to higher rates of cardiovascular disease, diabetes mellitus and malignant cancers.

Infant formula is also promoted by large multinational corporations to women in developing countries. This can lead to mothers choosing to bottle feed rather than breast feed their newborn. Where women do not have access to safe water the formula is mixed with contaminated water which contributes to high rates of infectious and parasitic diseases particularly in low and middle income countries.

Physical environmentPhysical environmentHousing: Many people in developing countries live in poor quality housing that is small, cramped, lacking ventilation and does little to protect families from extremes in the weather. Small, cramped living conditions can transmit infectious diseases very quickly so if a child or family member becomes ill, then there is a high likelihood of the disease being transmitted to all family members. Cold and damp conditions create breeding grounds for bacteria and infections. Poor ventilation can mean that dangerous fumes generated from solid fuels such as coal, wood, dung and agricultural waste are being inhaled, leading to respiratory diseases.

Indoor air pollution: Solid fuels such as wood, coal, dung and agricultural waste are used for cooking and heating in almost half of the world. When accompanied by a lack of ventilation, this contributes significantly to the global burden of disease. Children are particularly at risk of respiratory infections such as pneumonia and in adults can lead to chronic respiratory disease and lung cancer.

Natural disasters: Natural disasters can occur in any country at any time and will have a significant effect on health status. However, in many developing countries such as Afghanistan natural disasters occur frequently and the level of poverty and economic growth within the country means the government is not in a position to provide assistance to those affected. Severe drought can lead to a lack of food and high levels of malnutrition. This will bring about high levels of child mortality and contribute to increased poverty, limiting the capacity of families to access adequate health care. Landslides due to flooding can see entire communities being displaced as their homes get engulfed by mud. High levels of infectious diseases and mortality often follows.

Physical environmentPhysical environmentClimate Change: Climate change due the carbon dioxide emissions producing the greenhouse effect is contributing to a rise in global temperature. This rise is affecting traditional food supplies such as fish stocks as a result of changing marine environments. Weather patterns are also predicted to change which will bring about increased drought in some areas and flooding in others. This will contribute to increased rates of diseases such as malaria. Rising sea levels will see millions of people displaced from their homes and live in substandard conditions. These will influence the capacity of families to secure sustainable food supplies and reduce the risk of illness.

Some of the likely effects of climate change include:rainfall patterns. rainfall patterns. These affect the supply of fresh water, increasing the risk of These affect the supply of fresh water, increasing the risk of waterborne diseases.waterborne diseases.rising temperatures. rising temperatures. A rise in temperature can decrease the production of staple A rise in temperature can decrease the production of staple foods in the poorest regions, increasing rates of malnutrition.foods in the poorest regions, increasing rates of malnutrition.rising sea levels. rising sea levels. Changes to sea levels can displace large populations. Some of the Changes to sea levels can displace large populations. Some of the most vulnerable populations live on the coast on small islands and along rivers. most vulnerable populations live on the coast on small islands and along rivers. communicable diseases such as malaria. communicable diseases such as malaria. These can spread to areas that have not These can spread to areas that have not been susceptible in the past. Many of these communities lack the health been susceptible in the past. Many of these communities lack the health infrastructure to deal with this problem.infrastructure to deal with this problem.air pollution. air pollution. Increasing as climates change, air pollution is a problem many cities Increasing as climates change, air pollution is a problem many cities will be unable to deal with.will be unable to deal with.

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Physical EnvironmentPhysical EnvironmentLack of access to clean water and sanitation, as well as problems caused by uncontrolled water courses (see interest box opposite), are responsible for almost 10 per cent of total global DALYs and around six per cent of all global deaths. A vast majority of these occur in developing countries. Many diseases are waterborne and transmit easily from the water source to the individual. Lack of sanitation infects water sources and leads to an increased rate of infectious diseases, such as diarrhoea, cholera and typhoid. Water is also essential for growing crops, maintaining natural environments and generating electricity. Having access to clean water and sanitation is not universal, in fact:Having access to clean water and sanitation is not universal, in fact:

• 1.1 billion people lack access to safe water

• 2.6 billion people lack access to basic sanitation

• when combined, the women in South Africa walk the equivalent of going to the moon and back 16 times a day just to fetch water. This can place a physical strain on the woman as well as leaving less time for work, food preparation or education of children.

• Developing countries are more susceptible to the effects of unsafe water, sanitation and unregulated water courses as they are less likely to have the infrastructure to supply clean drinking water and remove human waste effectively. They often lack strict controls regarding water quality and monitoring. Some of the specific health concerns arising from a lack of clean water, sanitation and/or unregulated water courses are shown in figure 7.36.

IncomIncomee

Income or GNI per capita - The greater the income of individuals and communities, the greater the capacity to create environments in which people can develop to their full potential and enjoy a high level of well being. Higher incomes can increase people’s choices and provide greater access to knowledge, health services and a decent standard of living.

Gross domestic product (GDP) is the market value of all goods and services produced in a country in a given year. It is a reflection of the wealth of a country and affects how much money is available to spend on services and infrastructure. The level of GDP affects access to clean water, sanitation, health services and social security safety nets (such as pensions and disability payments). The GDP of a country does not, however, determine how the wealth is distributed. It is common for a few people to have control of most of the wealth, leaving a majority of the country with living standards well below the wealthy few.

Many developing countries have a small percentage of wealthy people while the rest of the country lives in poverty. This divide in wealth means that these countries experience the health concerns associated with poverty, such as high rates of communicable diseases and higher rates of child and adult mortality, which most developed countries do not experience. They are also likely to experience health concerns associated with wealth which are also common in developed countries, such as obesity, diabetes and cardiovascular disease.

Money received, esp. on a regular basis, for work or through investments

IncomIncomeeThere is a relationship between GDP and poverty, with those countries with low GDP experiencing

higher rates and levels of poverty.

Poverty refers to deprivation. This deprivation often stems from lack of income but presents as a lack of material resources such as food and shelter, and deprivation of intangible resources such as social inclusion, opportunity and decision making. Poverty is generally defined in terms of income and is measured in a number of different ways:

•those living on less than a certain amount per day (often US$1 a day). This is referred to as absolute poverty or extreme poverty.

•those living on less than 50 per cent of their country’s average income. This is referred to as relative poverty.

•those living on less than a poverty line established by their respective government. However it is measured, poverty is associated with:

•higher rates of malnutrition

•higher rates of maternal mortality

•higher U5MR

•greater gender imbalances with regard to access to education, income and living standards

•lower levels of education (if any)

•lower levels of literacy.

Money received, esp. on a regular basis, for work or through investments