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Patterns of disease - looking at the evidence

Updated Wednesday, 14th July 2004

Course extract from Preparing For Development - Patterns of Disease - Looking at the Evidence

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Healthy children: Japan enjoys a low infant mortality rate Copyrighted  image Icon Copyright: BBC

I have called this section 'patterns of disease' rather than 'patterns of health'deliberately, or, rather, I have little choice. 'Complete physical, mental and socialwell-being' is impossible to measure but disease is not.

So, despite the problemsthat we discussed in the last section, we have to use something we can measure ifwe are to get anywhere.

In this section we are going to use measures that are related to the ultimate impactof disease - death. We are going to use measures that tell us how long people canexpect to live and what the rates of child deaths are in different parts of the world,and even within the same parts. Do not be put off by the numbers involved.

Learning to 'read' them comes with practice and you will be surprised by howquickly you can make sense of them and how they can be used to help you findout what is happening and why it is happening.

Don't, therefore, be tempted toskip or gloss over the activities involving numbers, because they are important inbuilding up our understanding. First, however, a few words of caution.

The numbers (or 'data') that we are interested in can be notoriously difficult tocollect and for this reason they may not be reliable, but, even if they are, you haveto be careful when interpreting them. Look back at Figure 3.1.

You probably said,like me, that the baby is unhealthy because it looks malnourished. But when theclinical measure of malnourishment (the actual measure need not concern ushere) was applied to this baby, it was diagnosed as not being officiallymalnourished.

Someone, somewhere, has made an assumption about whatnumber represents the dividing line between being and not being malnourished.In other words, be careful of treating numbers as objective facts as they carrywith them other people's assumptions.

We do not want to give the impression that numbers are no good. We have towork with what we have. But I repeat, be careful with your interpretations as youwork through the activities below.

The main measure we are going to use in this section is the under-five mortality rate (U5MR). This is a measure often used by the United Nations, for example,and it represents the number of children, per 1000 live births, who die before theage of five.

Child mortality is important because it is closely linked to the generalhealth of a country or community. Many health interventions, such asimmunization campaigns, are directed at children.

Abbreviations: Note that I have put the abbreviation for the World Health Organization, WHO, in brackets immediately after it. This is to show that I intend to use the shorter form whenever I refer to the organization later.

You should always write out abbreviations in full the first time you use them, unless they are very common in everyday language (e.g. TV for television).

In other words, you must always assume that an abbreviation that may be common to you may notbe known to your reader. Also, be careful not to have too many abbreviations in your text when you write, as it can become very difficult toread.

Disease variations depending on where youlive

Table: Child mortality rates

Region Country
U5MR (1998)
North or South?
Africa Mozambique
213
South
Sierra Leone
283
 
Malawi
229
 
Uganda
170
 
Ghana
96
 
Egypt
59
 
America Peru
47
 
Brazil
40
 
Jamaica
24
 
Cuba
8*
 
Canada
7
 
Asia Pakistan
120
 
Bangladesh
96
 
India
83
 
Indonesia
52
 
China
36
 
Sri Lanka
18
 
Japan
5
 
Europe Poland
11
 
Greece
8
 
UK
7
 
Sweden
5
North

* UNICEF, 2000
Source: World Bank, 2000

Activity Two
(a) Consider the first table. For each country decide whether you think it belongsto the rich North or to the poorer South. Put your answers in the end column.

(b) Examine the under-five mortality rates (U5MRs) in the first table. In general,which countries have the higher under-five mortality rates - countries in theNorth or the South? Explain briefly whether or not your answer surprisesyou.

(c) Examine those countries that you identified as belonging to the South.What is the highest under-five mortality rate and what is the lowest? Doesthe difference surprise you? Again, briefly explain your answer.

I'll give you my suggested answers on the next page.

 

Warsaw - but is Poland part of the North or South? Copyrighted  image Icon Copyright: BBC My suggestions for approaching an answer Generally speaking, countries with the highest under-five mortality rates are in what is conventionally thought of as the South. Of the nine countries with the lowest under-five mortality rates (less than 25 child deaths per 1000 live births), five are developed countries, and three (Cuba, Jamaica and Sri Lanka) are usually thought of as belonging to the South. But what about the remaining country in this group of nine - Poland? Is this in the South - a developing country, or not? (I leave you to think about that question.)

It seems to me that we can draw two general points from this exercise: *Disease appears to be more prevalent in the South than in developed countries. The under-five mortality rate is generally higher for the developing countries listed.

*There is a large variation between the developing countries listed. This should make us wary of sweeping generalizations, such as 'all of the South is disease-ridden'. The under-five mortality rates for some developing countries in the table (Cuba, Jamaica and Sri Lanka) are not so different from those for developed countries. Why do these countries fare better? We shall return to this question later.

By doing this acitivity we have established a broad pattern in which the South is more disease-prone than developed countries. But several countries don't fit the pattern and when that happens it immediately raises the question: Why don't they fit? What else is happening?

The table tells us nothing about the types of disease in different parts of the world, either. In fact, the tendency is for infectious diseases to predominate in the South and chronic diseases, such as cancers and heart disease, to predominate in the developed countries. Again, however, there are many variations, and certainly cancer and heart disease are problems in many parts of the South.

AIDS is one disease that is recognized as being a global problem. Back in 1993 it was estimated that, by the year 2000, around 1.8 million people would be dying in the world because of AIDS each year. In some communities the disease is already starting to reverse long-term declines in child mortality (World Bank, 1993, p.99). Later you will see that AIDS initiatives form part of the World Bank's public health package. However, although many countries are very open about the AIDS problem, others are quieter.

For a variety of practical, moral and political reasons, a few countries are still reluctant to acknowledge they have an AIDS problem.

On the next page, I'll ask you to consider your home country, and patterns of disease there.

 

Hospital treatment in Uganda Copyrighted  image Icon Copyright: OU image library Activity Three

(a) Reflect on your own knowledge and list the main diseases in the country where you live.

(b) Again using your own knowledge, would you say that AIDS is a problem in the country where you live? What is being done to counteract the threat of AIDS?

I want now to explore whether it is possible to establish other patterns of disease. Are some geographical areas within a country more disease-prone than others? Are some groups of people more disease-prone than others?

Activity Four

Which parts of the country where you live would you expect to be more disease-prone than others? Write down your answer, briefly stating your reasons.

I cannot answer this question as your answer will depend on which country you live in. I would expect, however, the most disease-prone people to live in at least one of the following:
* climatically and geographically unhealthy areas
* poorer areas
* areas with poor access to clean water, sanitation and medical facilities.

Of course, these three types of area might actually be the same places. Thus poor people will tend to live in the unhealthy areas and will tend to have poor access to clean water, sanitation and medical facilities. This suggests that poverty is the basic link with disease, a subject which we will return to later.

We can, once we think about it, establish many patterns of disease, and many have been studied. I intend now to explore three:
* patterns between men and women
* patterns around level of education
* patterns connected to poverty.

We'll start off in Section Three by looking at Disease and Gender.

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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