The Social The Social Patterning of Patterning of

Health and IllnessHealth and Illness

Week 6.Week 6.

OverviewOverview

The social patterning of health and illness. The social patterning of health and illness. Problems with measuring data on health, Problems with measuring data on health,

illness and disease. illness and disease. Researching health and illness Researching health and illness Inequalities in health, Inequalities in health, mental illness. mental illness. Gender, ethnicity, age, social class and Gender, ethnicity, age, social class and

health. health. The ‘racialization’ and ‘feminization’ of The ‘racialization’ and ‘feminization’ of

mental and physiological illness.mental and physiological illness.

Problems in researching Problems in researching Health and IllnessHealth and Illness

relativity of health concepts relativity of health concepts Concepts and understandings vary Concepts and understandings vary

enormously from culture to culture. enormously from culture to culture. Eg. depression recognized in some Eg. depression recognized in some

cultures and not others cultures and not others Dubos and Pines ‘the meaning of Dubos and Pines ‘the meaning of

health also varies widely according to health also varies widely according to all kinds of statuses’. all kinds of statuses’.

'Good health may mean different things to 'Good health may mean different things to an athlete and to a road sweeper, to a tree an athlete and to a road sweeper, to a tree surgeon or an insurance broker, their surgeon or an insurance broker, their lifestyles necessitate very different degrees lifestyles necessitate very different degrees of physical activity, their food requirements of physical activity, their food requirements and environmental stresses vary, they may and environmental stresses vary, they may have very different understandings and have very different understandings and experiences of their own physiology, they experiences of their own physiology, they may have different levels of access to may have different levels of access to information about health and disease’.information about health and disease’.

Problems in researching Problems in researching Health and Illness 2Health and Illness 2

Increased sensitivity to health issues for those who read Increased sensitivity to health issues for those who read about it alot about it alot

Those who do not may over-estimate their own levels of Those who do not may over-estimate their own levels of health health

self assessment questionnaires a poor indicator of actual self assessment questionnaires a poor indicator of actual levels of health due to these wide variations in awareness levels of health due to these wide variations in awareness and understanding. and understanding.

research that uses interview techniques may be research that uses interview techniques may be problematic for the same reasons.problematic for the same reasons.

Problems in finding objective measurements of levels of Problems in finding objective measurements of levels of health and illness. health and illness.

health records compiled by doctors and hospitals??? health records compiled by doctors and hospitals??? Some suggest patient diagnosis is often distorted by all Some suggest patient diagnosis is often distorted by all

kinds of prejudices that the doctor or health care kinds of prejudices that the doctor or health care professional may not even realize he or she has. professional may not even realize he or she has.

Some Problems With Some Problems With Statistics. 1Statistics. 1

Under-reporting and Over-reporting of Under-reporting and Over-reporting of illness.illness.

What constitutes illness varies from What constitutes illness varies from culture to culture.culture to culture.

Depression not recognised in some Depression not recognised in some cultures.cultures.

Some illnesses not deemed serious Some illnesses not deemed serious enough for medical intervention.enough for medical intervention.

Traditional or ‘folk medicine’ or self Traditional or ‘folk medicine’ or self medication often used first.medication often used first.

Certain groups less willing or Certain groups less willing or able to visit the doctor. Why?able to visit the doctor. Why?

Stigmatisation of certain kinds illness.Stigmatisation of certain kinds illness. Cultural Taboos.Cultural Taboos. Some illnesses dealt with in the family.Some illnesses dealt with in the family. Gender issues.Gender issues. Racism and discrimination.Racism and discrimination. Marginal Groups i.e. Gypsies and Marginal Groups i.e. Gypsies and

Travellers Travellers Problems with access to services.Problems with access to services. Language problems.Language problems.

Certain Groups more willing to Certain Groups more willing to visit the doctor.visit the doctor.

Structural factors.Structural factors. Cultural factors.Cultural factors.

Some Problems With Some Problems With Statistics. 2Statistics. 2

Misdiagnosis and misunderstanding. Can be due to a Misdiagnosis and misunderstanding. Can be due to a number of Factors.number of Factors.

Subjectivity and self assessment.Subjectivity and self assessment. Subjectivity and diagnosis.Subjectivity and diagnosis. Subjectivity and comparative understandings.Subjectivity and comparative understandings. Time constraints.Time constraints. Patient reporting Influence of gender, social class and Patient reporting Influence of gender, social class and

ethnicity.ethnicity. Cultural ‘misunderstandings’ and ‘cultural deficit’ models.Cultural ‘misunderstandings’ and ‘cultural deficit’ models. Cultural Stereotyping- particularly with regard to mental Cultural Stereotyping- particularly with regard to mental

illness.illness. Negative stereotyping, cultural misunderstanding and Negative stereotyping, cultural misunderstanding and

Marginal Groups i.e. Gypsies and Travellers.Marginal Groups i.e. Gypsies and Travellers.

Some Problems With Some Problems With Statistics. 3Statistics. 3

Problems with how the statistics are Problems with how the statistics are compiled.compiled.

Sample group.Sample group. Ensuring demographic and geographic Ensuring demographic and geographic

representation.representation. Low participation of practices in inner citiesLow participation of practices in inner cities Problems with categories- particularly class Problems with categories- particularly class

and ethnicity.and ethnicity. Generalisability. Age, gender, ethnicity and Generalisability. Age, gender, ethnicity and

social class.social class.

Illsley and Le GrandIllsley and Le Grand

Illsley and Le Grand- Criticised Illsley and Le Grand- Criticised studies based on Under 65’s- studies based on Under 65’s- proportion of deaths in this age proportion of deaths in this age range has changed significantly in range has changed significantly in last 70 years.last 70 years.

Many deaths now take place over Many deaths now take place over age of 65, findings/ results from age of 65, findings/ results from under 65’s not generalisable to older under 65’s not generalisable to older age groups.age groups.

Objections to this:-Objections to this:-1. Although deaths under 65 are a minority, they are 1. Although deaths under 65 are a minority, they are

usually premature deaths, premature death an usually premature deaths, premature death an indicator of disadvantage as it is often preventable.indicator of disadvantage as it is often preventable.

2. New evidence on health of people over 65 tends to 2. New evidence on health of people over 65 tends to confirm patterns of inequality found among confirm patterns of inequality found among younger people.younger people.

General problems with ‘Official Statistics’- How? General problems with ‘Official Statistics’- How? Where? When? Who By? Who For? For What Where? When? Who By? Who For? For What Purpose?Purpose?

No Universalisable Concepts.No Universalisable Concepts. Problems with comparing studies.Problems with comparing studies. a number of problems here, some of them relating a number of problems here, some of them relating

to interpretation and detection and the recording of to interpretation and detection and the recording of H & I and others relating to access and H & I and others relating to access and participation. participation.

Problems with disease Problems with disease labels 1labels 1

Disease labels not created in a vacuum (Foucault, Disease labels not created in a vacuum (Foucault, Turner etc). Turner etc).

The interpretation of disease and Disease labels The interpretation of disease and Disease labels arise within a particular socio-political contextarise within a particular socio-political context

different contexts produce different conceptions different contexts produce different conceptions of causes and what counts as normal and of causes and what counts as normal and pathological states. pathological states.

Foucault interested in the way that certain kinds Foucault interested in the way that certain kinds of behaviours came to be defined as 'normal' of behaviours came to be defined as 'normal' while others came to be defined as while others came to be defined as

Medical struggles around the individual Medical struggles around the individual bodybody

Problems with disease Problems with disease labels 2labels 2

bio-politics of populations in modern bio-politics of populations in modern societies. societies.

Medical knowledge not an objective Medical knowledge not an objective science for Foucaultscience for Foucault

direct relationship between the direct relationship between the discourse of scientific knowledge and discourse of scientific knowledge and the exercise of professional power. the exercise of professional power.

Linked to social controlLinked to social control

Problems with disease Problems with disease labels 3labels 3

Link between between knowledge and exercise of Link between between knowledge and exercise of power power

disease entities the product of mediacl discourses disease entities the product of mediacl discourses Brian Turner uses example of anorexia- Brian Turner uses example of anorexia-

depending on the dominant discourse within a depending on the dominant discourse within a society in which anorexic conditions are present it society in which anorexic conditions are present it could be viewed as a behavioural disorder of the could be viewed as a behavioural disorder of the hormonal system of young women, or a spiritual hormonal system of young women, or a spiritual quest foe perfection etc quest foe perfection etc

job of sociology to determine how these socio-job of sociology to determine how these socio-historical processes have given rise to certain historical processes have given rise to certain sets or ideas and perceptions that have been sets or ideas and perceptions that have been taken to count as knowledge.taken to count as knowledge.

The Social patterning of The Social patterning of Health and Illness Health and Illness

BackgroundBackground Mortality and Morbidity rates vary Mortality and Morbidity rates vary

significantly between societiessignificantly between societies Also variations between groups Also variations between groups

within societies. within societies. emphasis is usually on social class, emphasis is usually on social class,

gender and ethnicity. gender and ethnicity. also enormous variations between also enormous variations between

societiessocieties

Health and Social Class.Health and Social Class. Key literature- Key literature- The Black report (1980) The Black report (1980) Updated and Updated and

Republished (1992).Republished (1992). The Health divide (1988 The Health divide (1988 37 recomendations ranging from improving 37 recomendations ranging from improving

information, research and organization so that more information, research and organization so that more effective healthcare planning could be instituted, effective healthcare planning could be instituted, redressing the balance of health care system so redressing the balance of health care system so that greater emphasis would be palced on that greater emphasis would be palced on prevention, primary care and community healthprevention, primary care and community health

most importantly recommended improving the most importantly recommended improving the material conditions of life for disadvantaged groups, material conditions of life for disadvantaged groups,

conclusions of the two reports essentially the same.conclusions of the two reports essentially the same.

The Black report (1980)The Black report (1980)

SummarySummary

1. There remained a marked class 1. There remained a marked class gradient in health.gradient in health.

2. That such class differences were 2. That such class differences were more marked in Britain than in many more marked in Britain than in many other countries.other countries.

3. That in certain respects these class 3. That in certain respects these class differences were increasingdifferences were increasing

The Black report (1980) The Black report (1980) contcont

gap between the classes had continued to widen.gap between the classes had continued to widen. words high mortality rates positively correlated with poverty.words high mortality rates positively correlated with poverty. lower occupational groups more vulnerable to almost all the lower occupational groups more vulnerable to almost all the

killer diseases killer diseases Peter Townsend ‘mortality rates for working class males were Peter Townsend ‘mortality rates for working class males were

higher in 65 out of 78 disease categories and for working higher in 65 out of 78 disease categories and for working class women in 62 out of 82’.class women in 62 out of 82’.

Malignant melanoma rates higher among the higher Malignant melanoma rates higher among the higher occupational groups. occupational groups.

For women in higher social classes rates of cancer of the For women in higher social classes rates of cancer of the brain and the breast were also greater. brain and the breast were also greater.

Accidental death by violence, injury and accident higher Accidental death by violence, injury and accident higher among the lower social classes.among the lower social classes.

In 1980's this gap continued to widen as death rates declined In 1980's this gap continued to widen as death rates declined faster among the higher occupational groups than the lower faster among the higher occupational groups than the lower

The Black report (1980) The Black report (1980) contcont

In 1980's this gap continued to widen as death rates In 1980's this gap continued to widen as death rates declined faster among the higher occupational groups than declined faster among the higher occupational groups than the lower the lower

lower socio-economic groups also experience more sickness lower socio-economic groups also experience more sickness and ill health throughout the life cycle. Poor children more and ill health throughout the life cycle. Poor children more likely to be born with low birth weightlikely to be born with low birth weight

their mothers are more likely to suffer complications in their mothers are more likely to suffer complications in pregnancy or childbirth. pregnancy or childbirth.

Poor children more likely to suffer from a range of health Poor children more likely to suffer from a range of health problems including obesity, cerebral Palsy, hearing and problems including obesity, cerebral Palsy, hearing and visual impairment, accidents and higher rates of tooth visual impairment, accidents and higher rates of tooth decay.decay.

differences between socio-economic groups become differences between socio-economic groups become increasingly marked in adulthood increasingly marked in adulthood

Working class people more likely to deem themselves to be Working class people more likely to deem themselves to be in poor health in self-assessment exercisesin poor health in self-assessment exercises

Illness also genderedIllness also gendered

Gender and Health.Gender and Health.BackgroundBackground

Throughout entire industrial world men Throughout entire industrial world men live shorter lives live shorter lives

Men more likely to die at any given age Men more likely to die at any given age than women of the same age. than women of the same age.

BUT females are more likely to experience BUT females are more likely to experience high morbidity rates high morbidity rates

women are far more likely to visit the women are far more likely to visit the doctor than men doctor than men

men generally underepresented in health men generally underepresented in health statisticsstatistics

Gender and Mortality.Gender and Mortality. over the last 100 years, in all contemporary over the last 100 years, in all contemporary

advanced industrial societies, life expectancy has advanced industrial societies, life expectancy has increased for both men and women increased for both men and women

but higher for women. but higher for women. (1994) average female life expectancy was (1994) average female life expectancy was

approximately 78 years compared to 72 years for approximately 78 years compared to 72 years for men. men.

Major causes of death among British men heart Major causes of death among British men heart disease, lung cancer, bronchitis, accidents and disease, lung cancer, bronchitis, accidents and other violent deathsother violent deaths

For women cancers of the breast cervix and For women cancers of the breast cervix and uterus are major causes of mortality. uterus are major causes of mortality.

coronary heart disease now a major cause of coronary heart disease now a major cause of female deathsfemale deaths

Gender and Morbidity.Gender and Morbidity. Women more likely to report both physical and Women more likely to report both physical and

psychological problems to their GP. psychological problems to their GP. higher rates of chronic disease such as strokes, higher rates of chronic disease such as strokes,

rheumatoid arthritis, diabetes and varicose veins rheumatoid arthritis, diabetes and varicose veins for women women also constitute two thirds of for women women also constitute two thirds of those with a disability. those with a disability.

Women more likely to have been hospitalizedWomen more likely to have been hospitalized women constitute the majority of those suffering women constitute the majority of those suffering

from neurosis, psychosis, dementia and from neurosis, psychosis, dementia and depressive disorders. depressive disorders.

women also more likely to suffer from Iatrogenic women also more likely to suffer from Iatrogenic diseasedisease

Health and Ethnicity.Health and Ethnicity. Data seriously inadequate. Data seriously inadequate. Before the 1991 census researchers had to Before the 1991 census researchers had to

rely on Birth and death certificates to rely on Birth and death certificates to identify ethnicity. identify ethnicity.

comparing the mortality rates of ethnic comparing the mortality rates of ethnic minorities born in the UK before 1991 is minorities born in the UK before 1991 is extremely problematic. extremely problematic.

still comparatively little known about the still comparatively little known about the health and morbidity of British born ethnic health and morbidity of British born ethnic minorities. minorities.

data is extremely limited and must be data is extremely limited and must be viewed cautiously.viewed cautiously.

Ethnicity, mortality and Ethnicity, mortality and Morbidity.Morbidity.

Despite the methodological difficulties a number of studies have Despite the methodological difficulties a number of studies have provided generally consistent data on the causes of mortality and provided generally consistent data on the causes of mortality and morbidity among minority ethnic populations. Provisional findings morbidity among minority ethnic populations. Provisional findings suggest the following.suggest the following.

Groups from India, Pakistan and Bangladesh - more likely than Groups from India, Pakistan and Bangladesh - more likely than white population to die from heart disease.white population to die from heart disease.

Groups from India, Pakistan and Bangladesh, Africa and the Groups from India, Pakistan and Bangladesh, Africa and the Caribbean - more likely than white population to suffer from a Caribbean - more likely than white population to suffer from a stroke (esp Africans and Afro-Caribbean's).stroke (esp Africans and Afro-Caribbean's).

Africans and Afro-Caribbean's suffer from very high rates of Africans and Afro-Caribbean's suffer from very high rates of hypertension, liver cancer, TB, diabetes and maternal mortality.hypertension, liver cancer, TB, diabetes and maternal mortality.

Afro-Caribbean's and 'Asians' (problematic category) suffer Afro-Caribbean's and 'Asians' (problematic category) suffer disproportionately from accidental and violent death, and disproportionately from accidental and violent death, and poisonings.poisonings.

Mortality rates for obstructive lung infections such as bronchitis Mortality rates for obstructive lung infections such as bronchitis and many types of cancer esp. lung cancer lower among Afro-and many types of cancer esp. lung cancer lower among Afro-Caribbean's and 'Asians'.Caribbean's and 'Asians'.

Ethnicity, mortality and Ethnicity, mortality and Morbidity. 2Morbidity. 2

All ethnic minorities have higher rates of still All ethnic minorities have higher rates of still births, perinatal moralities (death within 1 week), births, perinatal moralities (death within 1 week), and neo-natal mortality (within 1 month).and neo-natal mortality (within 1 month).

Only Afro-Caribbean's and Pakistanis continue to Only Afro-Caribbean's and Pakistanis continue to show 'excess mortality throughout infancy' show 'excess mortality throughout infancy' (Whitehead 1992).(Whitehead 1992).

Children from Asian families have higher rates of Children from Asian families have higher rates of rickets.rickets.

Afro-carribeans more likely to be admitted to Afro-carribeans more likely to be admitted to mental health units, men more so than women mental health units, men more so than women and more likely to be sectioned. Once there they and more likely to be sectioned. Once there they are more likely to receive harsh treatment e.g.- are more likely to receive harsh treatment e.g.- electro-shock therapy, anti psychotics.electro-shock therapy, anti psychotics.

Explanations.Explanations.

PovertyPoverty Stress of migration and racismStress of migration and racism Anomic explanationsAnomic explanations Cultural deficit modelsCultural deficit models

Gypsies, Travellers and Gypsies, Travellers and Health.Health.

not all Travellers are recognized in the eyes of the law as not all Travellers are recognized in the eyes of the law as an ethnic an ethnic

nomadic lifestyle compounds and intensifies the problems nomadic lifestyle compounds and intensifies the problems faced by other minority groups. faced by other minority groups.

Britains nomadic population is extremely diverse.Britains nomadic population is extremely diverse. Different problems for different groups Different problems for different groups considerable methodological problems associated with considerable methodological problems associated with

researching Travellers health researching Travellers health an invisible minority an invisible minority Gypsy and Traveller health research has usually been Gypsy and Traveller health research has usually been

conducted separately to that of other minority groups less conducted separately to that of other minority groups less in the way of funding devoted to research for this group in the way of funding devoted to research for this group

Traveller health needs are very different to those of other Traveller health needs are very different to those of other disadvantaged groups disadvantaged groups

Research Problems.Research Problems.

Researcher Access.Researcher Access. Trust.Trust. Geographical isolation.Geographical isolation. Mobility.Mobility. Gypsies rejection of officialdom.Gypsies rejection of officialdom. Truth.Truth. Negative stereotyping and cultural Negative stereotyping and cultural

insensitivity.insensitivity.

Nomadism, Mortality and Nomadism, Mortality and Morbidity.Morbidity.

Poor dental health.Poor dental health. Increased susceptability to tetanus, polio, TB, whooping cough Increased susceptability to tetanus, polio, TB, whooping cough

M, M, R, Diptheria.M, M, R, Diptheria. Low birth weight.Low birth weight. High rates of infant mortality, miscarriageHigh rates of infant mortality, miscarriage Spread of infectious diseases, respirartory infections, impetogo, Spread of infectious diseases, respirartory infections, impetogo,

other skin infections, lice, scabies, threadworm, gastroenteritis, other skin infections, lice, scabies, threadworm, gastroenteritis, (Link to environment and large families living in close proximity).(Link to environment and large families living in close proximity).

High rates of diabetes (Gypsies and trad Travellers)High rates of diabetes (Gypsies and trad Travellers) High rates of alcohol related illness.High rates of alcohol related illness. Limb deformity form fractures (low rates of follow up treatment).Limb deformity form fractures (low rates of follow up treatment). High rates of cardiovascular disease particularly among men.High rates of cardiovascular disease particularly among men. High rates of mortality among males as a result of Drug use and High rates of mortality among males as a result of Drug use and

overdose ( 'New-Age' Travellers)overdose ( 'New-Age' Travellers) High rates of drug induced mental illness ( 'New-Age' Travellers)High rates of drug induced mental illness ( 'New-Age' Travellers)

Explanations. 1Explanations. 1 Cultural erosion (Gypsies and trad Travellers)Cultural erosion (Gypsies and trad Travellers) Dangerous environments.Dangerous environments. Poor uptake of preventative care, (smear tests, Poor uptake of preventative care, (smear tests,

breast screening, health checks, child breast screening, health checks, child developmental screening, dental services, health developmental screening, dental services, health education,education,

Poor uptake of immunisations.Poor uptake of immunisations. Links to Poor access to health services Links to Poor access to health services

(Temporary residents).(Temporary residents). Poor ante-natal and post-natal care.Poor ante-natal and post-natal care. Lowuse of contraception (Esp Gypsies and trad Lowuse of contraception (Esp Gypsies and trad

Travellers)Travellers) Short birth intervals (Gypsies and trad Travellers)Short birth intervals (Gypsies and trad Travellers)

Explanations. 2Explanations. 2 Poverty.Poverty. Illiteracy (excepting New-Age Travellers).Illiteracy (excepting New-Age Travellers). Discrimination.Discrimination. Illness often dealt with within group (Folk Illness often dealt with within group (Folk

remedies)remedies) Suspicion of conventional medicine (esp 'New-Age' Suspicion of conventional medicine (esp 'New-Age'

travellers).travellers). Poor sanitation.Poor sanitation. Large families living in close proximity Large families living in close proximity Low uptake of immunisation.Low uptake of immunisation. Poor hygiene re dogs and food prep.Poor hygiene re dogs and food prep. Drug use ( 'New-Age' travellers)Drug use ( 'New-Age' travellers)

Explaining Health Explaining Health Inequalities .1Inequalities .1

1 Social constructionist approaches.1 Social constructionist approaches. take issue with the nature of the data take issue with the nature of the data

and evidence upon which studies of and evidence upon which studies of health inequalities are based. health inequalities are based.

Labelling theorists ‘disease labels are not Labelling theorists ‘disease labels are not always applied in the same way to all always applied in the same way to all groups in society’.groups in society’.

doctors apply specific disease labels doctors apply specific disease labels more readily to some groups than others. more readily to some groups than others.

Variations in morbidity rates a product of Variations in morbidity rates a product of differential labelling differential labelling

Explaining Health Explaining Health Inequalities . 2Inequalities . 2

2. 2. Natural and social selection approaches.Natural and social selection approaches. evidence essentially valid. evidence essentially valid. often used to explain the health differentials among often used to explain the health differentials among

gender and ethnic groups, gender and ethnic groups, differences rest upon supposed biological or differences rest upon supposed biological or

physiological differences. physiological differences. ill-health a major ill-health a major causecause of low social position rather of low social position rather

than a consequence of it. than a consequence of it. social mobility can be explained by reference to social mobility can be explained by reference to

good health. good health. Based on false suppositions about ‘natural’ Based on false suppositions about ‘natural’

difference. difference. Surprisingly feminist accounts of the ‘natural’ body Surprisingly feminist accounts of the ‘natural’ body

have been influenced by selectionist approaches.have been influenced by selectionist approaches.

Explaining Health Explaining Health Inequalities 3Inequalities 3

3. 3. Materialist-Struturalist approaches.Materialist-Struturalist approaches. rates of morbidity and mortality linked to rates of morbidity and mortality linked to

individual or group’s location in the individual or group’s location in the social structuresocial structure

This approach accused of being overly This approach accused of being overly deterministic deterministic

fails to take into account the meanings of fails to take into account the meanings of the social actors themselvesthe social actors themselves

fails to acknowledge that health and fails to acknowledge that health and illness labels are negotiated on an illness labels are negotiated on an ongoing basis.ongoing basis.

Explaining Health Explaining Health Inequalities 4Inequalities 4

4. 4. Cultural- behavioural approaches.Cultural- behavioural approaches. differentials in health status linked to individual differentials in health status linked to individual

or group norms, values, attitudes, knowledge or group norms, values, attitudes, knowledge and behaviours. and behaviours.

cultural deficit models cultural deficit models deficit in knowledge or inappropraite behaviours deficit in knowledge or inappropraite behaviours

or cultural practices are said to be the cause of or cultural practices are said to be the cause of unequal patterns of ill health. unequal patterns of ill health.

Eg high incidence of rickets, caused by vitamin Eg high incidence of rickets, caused by vitamin D deficiency, among some Asian cultures is a D deficiency, among some Asian cultures is a result of cultural norms and values which result of cultural norms and values which dictate that ‘Asian’ women must cover their dictate that ‘Asian’ women must cover their bodies in public (the body produces vitamin D bodies in public (the body produces vitamin D upon exposure to sunlight).upon exposure to sunlight).

Global InequalitiesGlobal Inequalities

Life expectancy at global level, continues Life expectancy at global level, continues to improve – UK insurers just had to make to improve – UK insurers just had to make new calculationsnew calculations

In Africa average age of death around In Africa average age of death around early 40s – same level as UK was at in early 40s – same level as UK was at in 19001900

Russian males around 59 years of ageRussian males around 59 years of age BUT outliers pull figures downBUT outliers pull figures down WHO report details the global gap WHO report details the global gap Many health issues the result of Many health issues the result of

undernutrition among the poor and undernutrition among the poor and overnutrition amongst the wealthyovernutrition amongst the wealthy

The AIDS PandemicThe AIDS Pandemic

AIDS now fourth biggest cause of death AIDS now fourth biggest cause of death 70% of the 40 million with HIV/AIDS 70% of the 40 million with HIV/AIDS

concentrated in Africaconcentrated in Africa Life expectancy at birth in sub-Saharan Life expectancy at birth in sub-Saharan

Africa is currently estimated at 47 years Africa is currently estimated at 47 years without AIDS it would be around 62without AIDS it would be around 62 treatment not available to those who treatment not available to those who

suffer mostsuffer most

Environment. Poverty and Environment. Poverty and HealthHealth

In both Africa and Asia, In both Africa and Asia, unsafe water, unsafe water, sanitation and hygiene,sanitation and hygiene, iron deficiency and iron deficiency and indoor smoke from solid fuels indoor smoke from solid fuels 10 leading causes of disease. All much more common in 10 leading causes of disease. All much more common in

poor countriespoor countries Link back to Gypsies and healthLink back to Gypsies and health 1.7 million deaths a year are attributed to unsafe water, 1.7 million deaths a year are attributed to unsafe water,

sanitation and hygiene mainly through infectious diarrhoea.sanitation and hygiene mainly through infectious diarrhoea. Nine of ten such deaths among childrenNine of ten such deaths among children Many of diseases suffered by those in poverty strongly Many of diseases suffered by those in poverty strongly

related to patterns of living, and particularly to related to patterns of living, and particularly to consumption – too much or too littleconsumption – too much or too little

Disease in the WestDisease in the West Overweight and obesity are important determinants of health Overweight and obesity are important determinants of health Increases in blood pressureIncreases in blood pressure Unfavourable cholesterol levelsUnfavourable cholesterol levels Increased resistance to insulinIncreased resistance to insulin Raises the risk of coronary heart disease, stroke, diabetes, and Raises the risk of coronary heart disease, stroke, diabetes, and

many forms of cancermany forms of cancer WHO say killing about 220,000 people in the US and Canada alone, WHO say killing about 220,000 people in the US and Canada alone,

and 320,000 in 20 countries of Western Europeand 320,000 in 20 countries of Western Europe Tobacco – nearly 5 million attributable deaths in 2000, mostly in Tobacco – nearly 5 million attributable deaths in 2000, mostly in

WestWest Alcohol – worldwide 1.8 million deaths, 4% of global disease Alcohol – worldwide 1.8 million deaths, 4% of global disease

burden, much of this in the West burden, much of this in the West (growing) Physical inactivity causes about 15% of come cancers, (growing) Physical inactivity causes about 15% of come cancers,

heart disease an diabetesheart disease an diabetes lack of fruit and vegetables they say responsible for 3 million deathlack of fruit and vegetables they say responsible for 3 million death globalization of Western diseases of affluenceglobalization of Western diseases of affluence In developing those countries that are more urbanized see In developing those countries that are more urbanized see

‘Western diseases’ ‘Western diseases’