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Improving Health

Updated Wednesday, 14th July 2004

Course extract from Preparing For Development - Improving Health

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Clean drinking water - an indication of good health? Copyrighted  image Icon Copyright: BBC

There are two basic divisions in health interventions:

*between prevention of disease before it happens and curing disease once it has occurred;

*between biomedical and public health interventions. The former are associated with medicines and vaccines and can be curative or preventative.

The latter are associated with broader measures, including securing access to clean water and effective sanitation, and health education programmes on a variety of subjects (e.g. on nutrition, hygiene, sexual behaviour, abuse of tobacco, alcohol and other drugs).

Activity twelve

(a) Complete this table concerning commonly known health measures.

Health measure
Prevention or cure?
Biomedical or public health intervention?
Antibiotics for respiratory diseases
CURE
 
Secure and adequate nutrition
 
 
Access to clean water
 
 
Mass immunization against major infectious diseases
 
BIOMEDICAL
Health education
 
 
Safe sanitation
 
 
Oral rehydration therapy (the mixture of sugar and salts given to children)
 
 

Question: Can any of these measures be used in the fight against AIDS at present?

Now, compare your answers with mine, on the next page.

 

Prevention or cure - which is better? Activity Twelve: Suggested Answer

Health measure
Prevention or cure?
Biomedical or public health intervention?
Antibiotics for respiratory diseases
cure
biomedical
Secure and adequate nutrition
prevention
public health
Access to clean water
prevention
public health
Mass immunization against major infectious diseases
prevention
biomedical
Health education
prevention
public health
Safe sanitation
prevention
public health
Oral rehydration therapy (the mixture of sugar and salts given to children)
cure
biomedical (even though it is not medically sophisticated!)

The only item in the above list that is difficult to classify under prevention or cure headings is oral rehydration therapy. It certainly does not prevent diarrhoea, but then neither does it cure it. What it does do is treat the symptoms of dehydration that arise from diarrhoea, and which can be serious for young children, until the diarrhoea goes away of its own accord.

Then, you were asked: Can any of these measures be used in the fight against AIDS at present?

There are no effective drugs or vaccinations for AIDS at present. Nor is the disease a problem of lack of clean water and effective sanitation. In fact, the only measure in the above table that can be used at present is health education on safer sex.

In general, biomedical interventions can be either prevention (immunization) or cure (medicines). Public health measures tend to be exclusively prevention.

However, the line between biomedical and public health is not always clear cut. Note in my table that I include immunization as a biomedical measure and I stand by that. But how do we classify immunization when it is the focus of a 'mass' immunization campaign - such as immunizing every young child in an area against measles? The World Bank clearly thinks that it then becomes a public health measure. For example, Chapter 4 of the 1993 World Bank World Development Report drew together the following prevention measures into a recommended public health package:
* immunization programmes
* nutritional supplements (e.g. vitamin tablets, iron tablets)
* school health programmes to treat worm infections and to promote health education
* general public health education initiatives * specific initiatives to reduce consumption of tobacco, alcohol and other drugs, and to prevent AIDS.

The World Bank then drew another distinction (in Chapter 5 of the same report), this time between the public health package and those services that it described as being undertaken from a clinic (or health centre) - which it called its essential clinical services package. This package includes tuberculosis treatment, 'management of the sick child' (by healthcare providers trained in disease diagnosis and backed up by an adequate supply of drugs), prenatal and delivery care, family planning, and treatment of sexually transmitted diseases. Note that this essential clinical services package is largely curative although some measures, e.g. family planning, are preventative.

The cost of the public health package, the Bank estimated, would be US$4.2 per person for low income countries and the clinical services package rather more at US$7.8 per person. The total of US$12 per person amounts to about 3.5% of Gross National Product for low income countries.

Which is better, prevention or cure? Most people would reply 'prevention' is the ideal but complete prevention is impossible, so cure is important too. Thus, at a world health conference in 1978, a strategy for Third World countries came to the fore that would combine all the items of prevention and cure in Activity Twelve.

This strategy was labelled primary healthcare. By stressing things like nutrition and health education, this also explicitly linked health to poverty.

Delivery was an important part of the primary healthcare strategy too. Local communities would be involved in drawing up and supporting preventative plans and this participation would help ensure greater effectiveness. A network of health centres, to deliver essential services, would be established.

Primary healthcare, as envisaged in 1978, was a bold strategy with the aim of health for all by the year 2000. The main problem of implementation, however, has been cost - the cost of basic medicines and vaccines; the cost of building the health centres; and the cost of providing trained personnel.
Zimbabwe, for example, was a country committed to primary healthcare, building or upgrading hundreds of rural health centres, and providing a comprehensive range of preventative services (which included immunization, nutrition, hygiene and family planning) in the decade following independence in 1981. The Government's Second Five Year Development Plan 1991-95 (Mutizwa-Mangiza and Helmsing, 1991) noted, however:

"...Government is now facing financial constraints such that it may not be able to meet fully its commitment on healthcare provision."

At the time this plan was drawn up, Zimbabwe had recently embarked on a structural adjustment programme of the type advocated by the World Bank and International Monetary Fund which, among other things, required public expenditure cuts.

In truth, the primary healthcare strategy has rarely been fully implemented, even by committed nations. What is often implemented is a wholly biomedical version that is targeted on distributing oral rehydration salts, vaccinating children for diseases where vaccines are available at low cost and curing other diseases where low-cost drugs are available. This targeted version is known as selective primary healthcare.

Thus, the only preventative measure left in your selective primary healthcare list is immunization, and it is easy to see why. Mass immunization programmes are particularly popular among western aid donors who want to show results for their money in a short period of time. In a measles immunization programme, for example, you can measure how many children have been treated within a certain period and measure the change in the incidence of the disease. So evaluation is easy, as there are limited and measurable objectives.

This may satisfy the donors, but whether such campaigns contribute overall to child health is hotly disputed. Unfortunately, behind measles as a killer disease probably lies malnutrition, which generally weakens resistance to disease and the ability of the body to fight it once it does occur. Studies in Africa and Asia consistently show that child deaths tend to occur among malnourished children (World Bank, 1993, p.77) and the argument that malnutrition is an underlying cause of child mortality is now widely accepted. The brutal lesson of a measles immunization programme, therefore, is that it might save a malnourished child from measles, but it won't prevent them catching something else. The World Bank suggests that malnutrition can be at least partially alleviated by providing nutritional supplements in the form of vitamins and other pills along with immunization programmes. Again, these may have some effect in dealing with specific problems (e.g. vitamin A helps combat blindness; iron combats anaemia), but the critics say that they are yet more technical or biomedical fixes which do not address the underlying problems. What really has to be addressed is the question of poverty.

The activity on the next page asks you to enage with this debate.

 

Batticaloa, Sri Lanka Copyrighted  image Icon Copyright: BBC Activity Thirteen

'It is idealistic to believe that poverty can be tackled effectively in the low income countries of the world. The way to improve health is by carefully targeted biomedical interventions.'

Discuss this statement with reference to the low income country of Sri Lanka, drawing on the data in following table and other information presented in this course sample.

You should write about 1000-1500 words on a separate sheet of paper.

First, however, consult the notes below which provide a step-by-step guide to tackling this question. You can find a sample answer plus my comments on the next page, but try not to look at it until you have produced an answer of your own, then compare what you have written with the sample.

  Sri Lanka Average for all low income countries
Headcount index (%) 22 19
Under-5 mortality rate (deaths/1000 births) 19 101
Immunization against measles (%) 79 87
Immunization against diphtheria, polio and tetanus (%) 86 90
Oral rehydration therapy for under-5s (%) 76 38
Life expectancy (males and females in years) 72 62
Female advantage in life expectancy (years) 4.5 2.1
Fertility rate (number of births per woman) 2.4 3.6
Access to safe water (%) 60 67
Access to healthcare (%) 90 96*
Adult illiteracy rate (total %) 12 41
Female adult illiteracy rate (%) 17 53

* The data for the low income countries on access to healthcare are unavailable. This figure relates to the average for the whole of South Asia.
Source: World Bank, 1995b.
Note: The data in this Table is for an earlier year than the data used in other tables in this course sample.

Notes on answering Activity Thirteen

I appear to have given you a daunting task. It is an important question, however, because of the issues it raises: can a broad-based attack on poverty pay off, even in a low-income country, or is this impractical? Can targeted biomedical interventions pay off, or are they a waste of time and money?
These notes are designed to help you do two things:
*produce a good structure for your answer;
*collect some notes on its main content.
Structure is particularly important. It determines what your content will be to a large extent and it sets up your argument.

Step 1: what is the question getting at?

It is important to think about this first, to be clear about what you are being asked to do, and to stop you going off at a tangent.
What is the question about? Identify five key words and phrases from this list:
poverty
idealism
health
the World
targeted biomedical interventions
low income countries
Sri Lanka
These are what are known as the key content words or phrases. They determine the essential subject matter of your answer.
What you have to do to these content words is defined by another set of words - known as process words. In this particular question there is only one process word - you are being asked to discuss the content words.
'Discuss' means that you should give evidence and arguments in favour of the proposition contained in the statement, and evidence and arguments against, and come up with a balanced argument of your own.

Step 2: your basic structure

At the end of Part 2, I advised that key concepts should determine the structure of an answer. The best place to look initially for key organizing concepts is in the subject words/phrases of the title. Of the five content words/phrases that you identified in Step 1, three are more general than the other two. The former can be identified as the key organizing concepts for your answer, whereas the latter, while being no less important, relate to individual countries or groups of countries and form the basis of the more specific, detailed content.
Out of the five content words/phrases, which would you identify as the three key organizing concepts?
Sri Lanka health
poverty low income countries
targeted biomedical interventions

Step 3: make notes under each of the three organizing concepts

Step 2 has provided a basic structure for your answer. We are now in a position to fill in a few details of content. Remember that you are being asked to 'discuss' a proposition. Your notes on content should therefore examine points for and against the proposition in the statement. One way of approaching this is to consider also the implied counter argument (which, in this case, is that tackling poverty is the only way to improve health in the long run).
Your points should be backed up by evidence where possible. The evidence you have is related specifically to Sri Lanka and the low income countries in general, so this is what you will have to work with.

Notes under 'health'
In the table, examine the two basic indicators for health: under-five mortality rate and life expectancy.
Which has the better health record according to these two sets of indicators: Sri Lanka or the low income countries in general?
Would you say that the difference in both cases is important or significant?
(Remember that Sri Lanka is itself a low income country.)
Would you qualify things at all? For example, do you have any reservations about under-5 mortality rate and life expectancy being used as indicators for health?

Notes under 'poverty'
The headcount index has been used as an indicator of poverty in this Part. What does it measure?
Compare the headcount index for Sri Lanka and the low income countries in general. Which has the better record on tackling poverty according to these figures? Bearing in mind what you concluded about the respective health records of Sri Lanka and the low income countries in general, does your comparison support the argument that overcoming poverty is the only way to improve health in a country?

Again, would you qualify matters? Is headcount index an adequate measure of poverty? What dimensions of poverty does headcount index not measure?

Proxies for some of these other dimensions of poverty can be found in access to safe water, access to healthcare and illiteracy rate. How does Sri Lanka compare with the low income countries in general on these indicators? Do these comparisons support the argument that overcoming poverty is the best way to improve health in a country? Are there any inconsistencies between them (i.e. do some comparisons support the argument while others don't) and what importance do you attach to any inconsistencies?

It has been argued in that reducing poverty in women is particularly important in improving health. Examine all the indicators in the table that relate specifically to women. Does the comparison between Sri Lanka and the low income countries in general support this argument?

From the evidence that you have examined, what conclusions can you draw?
Does less poverty mean better health?

Notes under 'targeted biomedical interventions'
The table gives data on the following biomedical interventions: immunization against measles; immunization against diphtheria, polio and tetanus; and oral rehydration therapy.
Compare the data for Sri Lanka and the low income countries in general for these interventions. Do your comparisons support the main proposition that the only practical way forward to improve health in low income countries is for targeted biomedical interventions?

Again, are there any inconsistencies between the comparisons and what importance do you attach to any that you find?

Step 4: putting it together

This is where I am going to have to leave you to your own devices to a large extent, but here are some guidelines.

(i) Write a short introduction stating what the main issues are (using your content words) and explaining how you intend to tackle the question. For example, you might write towards the end of your introduction:
"The essay is based on a comparison between Sri Lanka and the low income countries in general. Firstly, the health records are compared, and then the poverty and biomedical indicators. The discussion centres on whether anti-poverty measures or specific biomedical interventions are responsible for the observed differences in the health records, and on the extent to which a low income country such as Sri Lanka can address poverty."

(ii) Write up the notes you made under Step 3, using the key concepts (Step 2) to organize them. You can use these key concepts as sub-headings if you wish, or use variations of them, e.g. 'health', 'poverty and health', 'targeted biomedical interventions and health'. Many people, however, prefer to write in continuous prose, and so the sub-headings are implied rather than explicitly stated. This is a matter of personal preference (but see below).

(iii) Make one main point per paragraph and back up your points with evidence, especially evidence presented in the table.

(iv) Don't expect the arguments to be clear-cut. They rarely are. For example, you might decide that Sri Lanka is tackling only some of the dimensions of poverty more effectively than the low income countries in general.

(v) Write a conclusion. Conclusions do not introduce fresh evidence but weigh up the balance of the points for and against and make your own argument.
You can come down firmly on one side or the other, but you do not have to.

Postscript: reports and essays

Are you writing a report or an essay? It may seem odd to pose this question, about what is apparently a crucial distinction, in a postscript. The reason is that there is not as much difference between a report and an essay as you might think. In fact, the ground rules for constructing the two forms are the same, and these are the ground rules you followed in steps 1-4 above.
Really, we are only left with differences of emphasis between a report and an essay:

* The object of an essay usually is to analyse a topic. This is captured by the process words typically used when you are asked to write an essay - discuss, compare and contrast, to what extent?, etc.. A report usually has more specific objectives, often being written as an aid to decision-making. Of course, if it is to be of any use as such an aid, it must be based on a clear analysis and argument, backed up by evidence - which is precisely what a good essay does.

* Although your essay will be written for your tutor, it has, at least theoretically, a general value as a contribution towards the analysis of an issue. So you should write it as if for a wider readership. A report is specifically for a person or group of people, to help them make decisions. So it may be tailored to meet their needs quite explicitly.

* Reports are usually structured around headings and subheadings, because readers may only want to look for specific information rather than read from beginning to end. Essays are for reading straight through, and are therefore usually written in more continuous prose. However, a good essay is no less tightly structured, and will often use well-placed signposting words and phrases instead of sub-headings to signal new sections. Also, there is no rule against putting headings in an essay, if you think it makes it easier to read.

My feeling is that your answer could be answered either in essay-style (it asks you to discuss a proposition) or report-style (it is linked to deciding what is the better course of action to take, which requires someone to take decisions).

Now, have a go! When you've completed your essay, come back and compare it with the sample on the next page.

 

Essay writing Activity Thirteen: Sample Essay

 

Many thanks to A. Bhala of the Organization of Rural Associations for Progress Bulawayo, for contributing this sample answer. My comments appear in italics, and on the next page I'll offer my own attempt an answer.

Concepts:
Poverty
Biomedical intervention of health in Sri Lanka
Comparing Sri-lanka health with other Iow income countries
Discussion:
'Tackling poverty is the only way to improve health in the long run.

This is an interesting start, similar to the practice in some academic, journals of listing the 'key words' at the start of an article. It is not, however, normal practice in student essays. A short, prose introduction which sets out the general issues and introduces the concepts in the context of these issues would be more appropriate.

Sri Lanka is a low income country. As a low income country it also is disadvantaged with various resources. Generally poverty occurs in various dimensions which are physical weaknesses due to sickness or disability; physical isolation due to location of areas often of poor soils and environmental resources; social isolation due to lack of basic education and skills and also the issue of powerlessness. To try and redress the situation, capacities need to be developed so that there is both a better supply of food and means of dealing with poverty related issues. this also means that inadequate income and physical resources exposes one to vulnerabilities of poverty. All in all most of these dimensions of poverty apply mostly to women due to lack of endowments and entitlements.

This discussion of poverty highlights its multi-dimensioned nature but needs to be related to the question better. Using concepts like 'poverty' in isolation from the context is like using a tool for the sake of it, without thinking of the job for which it is needed. Here, the discussion of poverty needs to be related to and contrasted with the purely material measure (the headcount index).

With the two sets of health indicators given for Sri Lanka and the low income countries in general, Sri Lanka has a better health situation. While it has only a mere 19 on mortality rate the low income average is 101. Even though the margin for immunization favours the low income, it has a difference of less than 10, that's an indicator of lack of resources and unequal distribution which makes the imbalances. The involvement of women has improved the former indicator on mortality. They are in control of their life situations. the indicator of 72 comparing with 62 on life expectancy also is a sign of better health situation for Sri-lanka.

An interesting gender perspective is being articulated. It needs to be developed more, however, and should be combined with the data on women reviewed later in the essay. It does not seem to fit well in this paragraph as it stands.

The headcount index used in relationship to poverty to me refers to the labour force ratio, which stands at 22 for Sri Lanka and 19 for the low income average. the better ratio implies that few people are dependants of employed people. Spreading resources over few people makes a better livelihood for the area. the better headcounter index also implies that basic needs could easily be met, enabling a wide margin to education and skills training for the people to cope with their livelihood.

This is a wrong definition of the headcount index, which is a material measure of poverty

Going back to the table, most of the indicators are about women: the rate of their illiteracy and fertility rate is an indicator of added advantage and control over what affects them. This has made the Sri Lanka situation to compare favourably over the average of other low income countries.

Health and poverty can not be dealt with separately as separate concepts. Each has a bearing to the other. Evidence in table 3.5 supports the argument tackling poverty is the way to improve health situation in the long run. Sri Lanka's data on its policies sets an example. The targeted biomedical interventions makes the first steps towards a healthy nation; which in turn improves the productivity of the country to fight against the overall concept of poverty.

This point in the first sentence of this paragraph about health and poverty being related is well-made. However, in this conclusion, I would like to see the point made earlier, about addressing poverty among women, taken up again and emphasized, so that there is a consistent argument from beginning to end. The final sentence seems to take the author to a material view of poverty , and introduces an argument that has not previously been covered.

Some general notes:

The basic ideas are present in this answer and, mostly, the data have been analysed correctly, although it is important to avoid attributing wrong definitions to key terms (in this case, headcount index). The argument jumps about too much, however, and does not flow smoothly as a result. It is also made too briefly. For example, in the second paragraph, the better health indicators for Sri Lanka compared with the low income countries as a whole are correctly identified. But the discussion of immunization data, would be better placed as part of a discussion of biomedical interventions, which is generally lacking from this answer. Also, there is no information provided on 'lack of resources and unequal distribution' in Sri Lanka and so it is difficult to justify the comment contained here.

Overall, I think that there are the makings of a good answer, but more attention needs to be given to both structure and content.

On the next page, I provide my attempt to answer the question.

 

Kandy, Sri Lanka Copyrighted  image Icon Copyright: BBC The Author's Answer for Activity Thirteen

 

The health, or lack of it, of millions of people in the world is one of the most pressing issues facing humanity, but there is little consensus on what should be done to improve matters. Some argue that, for relatively quick results, biomedical interventions are needed - immunizations against diseases and drugs to treat them. Others argue that, in the long run, these interventions serve little purpose because they do not attack the root causes of ill-health which are related to poverty. The biomedical interventionists often counter this by saying that alleviating poverty in the world might be a laudable goal but it is totally idealistic, even that it is irresponsible to think that it can be achieved while every day so many are dying of disease.

This essay engages in the debate by comparing a materially poor country (Sri Lanka) with the group of countries to which it belongs in the World Bank economic classification (the low income countries). Firstly the health records are compared, and then the poverty and biomedical indicators. The discussion centres on whether poverty or biomedical interventions are responsible for the differences observed in the health records and on the extent to which a low income country like Sri Lanka can address poverty.

The table reveals that Sri Lanka has far better health indicators than the low income countries in general. The under-five mortality rate is over five times lower and the life expectancy significantly higher. Although these indicators are limited in that they fail to capture the essence of the World Health Organization (WHO) definition of health - a state of complete, physical, mental and social well-being - they are regarded as useful proxy measures for the health of a country. Thus, from this data we can conclude that Sri Lanka is significantly healthier than other low income countries.

Being a low income country does not mean that everyone living in Sri Lanka is materially poor. There are no data in Table 3.5 on wealth distribution, but it would be unsurprising if a wide range did not exist between a few who are rich, those who are comfortably off, and those who are materially poor. The extent of the last group of people is often estimated by the headcount index, which is the percentage of the population who have an annual income less than US$370 per head. Examining the headcount indices in the table suggests that Sri Lanka, with 22% of its population having an annual income less than US$370, has a slightly higher level of material poverty than the low income countries in general.

Thus, on the face of it, Sri Lanka is healthier than the low income countries in general but, if anything, has higher levels of poverty. There are many criticisms, however, of headcount index as a measure of poverty.

The first is that setting the line at an absolute figure in US dollars does not account for differences in purchasing power in different parts of the world. A US dollar will buy far more rice in Sri Lanka than it will in the USA, for example. It also does not account for the fact that many people secure their livelihoods by means that do not involve money. Growing food for oneself is an obvious example.

The headcount index, with its arbitrary line set at US$370, can be pretty meaningless, therefore, but there is a deeper criticism. It only measures material poverty, yet Preparing for Development argues that there are other, inter-related dimensions that are as important as the material ones. These include: • physical weakness arising from poor nutrition, sickness or disability
• physical isolation, such as living in marginal areas of a country
• social isolation, such as lacking basic education and skills
• vulnerability to crisis
• powerlessness.

Some of the other indicators in the table give an idea of these wider dimensions of poverty. Access to safe water and to health care are two proxy indicators of the extent of physical isolation and, in both cases, Sri Lanka performs slightly less well than the low income countries in general and the whole of South Asia respectively. A big difference, however, is in adult illiteracy, with only 12% of adult Sri Lankans being illiterate compared with 41 % for the low income countries in general. This suggests that social isolation is far less in Sri Lanka. So, although, the evidence on the physical and social isolation dimensions of poverty is contradictory, where there is a large difference, it is in Sri Lanka's favour.

The other area where the table suggests large differences between Sri Lanka and the low income countries as a whole is in poverty among women. Sri Lanka has over twice the female advantage in life expectancy, a significantly lower fertility rate and a significantly lower female adult illiteracy rate. This evidence suggests that women in Sri Lanka are less poor compared with their counterparts in the other low income countries and this may be an important factor in explaining the health differences.

If a narrow, material view of poverty is taken, therefore, it seems that there is little apparent connection with health, at least as far as the comparison between Sri Lanka and other low income countries of the world is concerned. A wider view of poverty, however, does suggest a connection, although establishing this does not actually address the biomedical argument. It could be that either tackling poverty or biomedical interventions will improve health; it could also be that both are needed.

Leaving aside the fact that biomedical interventions only attack disease and do not necessarily create a state of complete, physical, mental and social well-being, the biomedical evidence in the table is contradictory. A lower percentage of the population is immunized against measles and against diphtheria, polio and tetanus in Sri Lanka than the low income countries in general, although the difference is not great. The percentage of under-five children in Sri Lanka who undergo oral rehydration therapy, however, is twice that for the low income countries in general (76% compared with 38%), which is a large difference. Oral rehydration therapy deals directly with the lifethreatening symptoms (Le. dehydration) of diarrhoea in children, and diarrhoea is itself a direct consequence of poor nutrition and sanitation. It does appear, from the evidence, that this particular intervention has an impact on health.

In conclusion, it seems that lower poverty levels do equate with better health, as long as a broad view of poverty is taken, and reducing poverty among women seems to be especially important. Only the simplest of biomedical interventions (oral rehydration therapy) seems to have a significant impact and, although poor people won't die of measles if they are immunized against it, the chances are that they will die of something else. As to whether tackling poverty to improve health is idealistic, the example of Sri Lanka shows that inroads can be made, despite the country being materially poor overall. It appears that in this country, the high level of literacy, a comparatively better position for women in society and a targeted, simple and cheap biomedical intervention have contributed to health indicators far better than would be expected.

Notes It was only when I attempted to do Activity Thirteen myself that I realized how difficult a task I had set. Also, like everyone else who has to write essays or reports, time is a constant constraint. I wrote the above while the rest of the Open University system was almost screaming for it, so that 'Preparing for Development' could be finished in time. It is by no means 'perfect', therefore, but you should find the following notes useful:
• The introduction establishes what the debate is about and how I intend to engage with the debate.
• The main discussion moves from a comparison of the health indicators, to the poverty indicators and finally compares the biomedical intervention indicators. In other words, the structure is centred on the key content words of the question. Because I am writing an essay rather than a report, I try to link these themes by signposting sentences, so that the argument flows between them.
• I use many individual signposting words and phrases - 'however', 'thus' and 'therefore' being three obvious examples.
• I try to include and analyse contradictory evidence, rather than ignore it. This, I found, was the hardest bit for me, but one of the most crucial.
• I tie things up in a conclusion, using the actual words in the question to help me structure it. Conclusions should explicitly address the question that has been asked. Although your main discussion should not have wandered off the point of the question, the extra detail and discussion that you need there means that it can fee1lost on occasion. The conclusion brings the main question back into the spotlight.
• Finally, I tried to follow the advice that I gave when I set the question. This is hardly surprising as I wrote the advice! Whenever there is advice with a question, however, it usually gives you important clues as to how you are expected to answer it.

On the next page, to conclude, we'll review what skills you have been exercising, and what you've learned in this sample.

 

A Ugandan hospital - but health is more than absence of sickness Study skills review: teaching yourself

Activity thirteen gives you a chance at sifting through evidence and constructing your own argument in a substantial piece of writing.

Doing the activity should also have taught you much more about the arguments concerning health, poverty and targeted biomedical interventions.

Moreover, you will largely have been teaching yourself.

This is one of the main reasons for asking you to construct your own arguments and communicate them by the written word. You learn far more when you teach - even when you teach yourself.

One final point to emerge from Activity thirteen is that even a materially poor country can make inroads on various dimensions of poverty. Yet education and health do involve resource which has to be raised, by taxation for example.

Allocating resources to these mean that less is available for other development activities, for example grants to promote economic activities. The need to make this kind of decision points to the intensely political nature of health, education and poverty.

Summary of this course sample

1 Health as a state of complete physical, mental and social well-being is a very broad term. Practical action concerning health is usually centred around the more narrowly defined 'absence of disease'.

2 Low income countries generally have a higher prevalence of disease than developed countries. There are, however, wide differences between low income countries that should make us wary of sweeping generalizations.

3 Patterns of disease within countries vary according to such things as level of education, gender and, more generally, poverty.

4 Broad-based approaches for improving health based on primary healthcare combine a variety of preventative measures with basic curative services.

However, in recent years, resource constraints have led to healthcare being narrowed down, mainly to targeted biomedical interventions. These may be effective in preventing specific diseases such as measles, but if susceptibility to disease is based on a poverty-induced condition like malnutrition, the overall effect of targeted interventions is likely to be limited.

5 Even materially poor countries like Sri Lanka can have effective policies in fighting disease.

We hope you've enjoyed this genuine sample of an Open University course. If it's left you keen to try one for real, why not explore the courses on offer? A good starting point would be our Taking It Further page.

About this sample

This course sample is adapted from Preparing For Development, part of the U213: International Development: Challenges for a world in transition and TU871: Development: Context and practice courses.

 

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