the syllabus says |
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Describe the variations in health as reflected by changes in life expectancy at national and global scales since 1950.
Explain the patterns and trends in terms of differences in income and lifestyle.
Explain the patterns and trends in terms of differences in income and lifestyle.
what is 'health'?
The World Health Organisation defines 'health' as:
"a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." So, health could include a huge range of factors that indicate a person's well-being, and not just in terms of the physical status at any one time. Ultimately the IB has given you a clear way to intepret this wide area, but asking you to focus on life expectancy. Life expectancy is defined by the Population Resource Bureau as: "The average number of additional years a person could expect to live if current mortality trends were to continue for the rest of that person's life. Most commonly cited as life expectancy at birth." This means that if we talk about life expectancy, we are estimating how long a baby born this year would expect to live if the current trends continue for the remainder of that baby's life. So, in a country where disease is decreasing, a continued decrease in the future would be part of the calculation of life expectancy. This is the reason why some countries appear to have a life expectancy that increases extremely fast, such as Zambia. The graph on the right shows how Zambia's life expectancy has changed, but this is due to the AIDS epidemic and the recent improvements in both transmission rates and quality of care for patients. It does not reflect the actual number of years lived by a typical person in that country, but how long a baby born in that year could expect to live. More detail about different types of life expectancy and other measurements of health is given in the next section 'Measuring Health'. |
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comparing life expectancy around the world
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The graph on the left is snapshot of the changes in life expectancy in selected countries around the world. Clicking on the graph takes you to the Google Public Data Explorer which allows you to choose your own countries to compare.
In all countries, life expectancy has increased. In most countries the increase has been steady, but poorer countries are more likely to have experienced a sudden increase in life expectancy as opposed to a steady increase. Only one country, Ethiopia, has experienced a drop in life expectancy, but this was short lived. |
Explaining life expectancy: Income or lifestyle?
The main thing to recognise is that lifestyle is itself heavily dependent on income. However, this is not a simple correlation. With low income, people struggle to purchase basic necessities such as clean water or good quality food. As income increases, lifestyle choices about those purchases begin to be more important than the level of income itself. This means that despite an increasing income, a poor choice (e.g. to smoke, eat fast food, or avoid exercise) may lead to a drop in life expectancy due to lifestyle factors.
Explaining life expectancy: income
National changes in life expectancy can often be correlated to an increase in GNI per capita. It's important to recognise other income factors too:
- Some countries have increased their public (state) spending on healthcare at a faster rate than GNI growth, leading to better health
- Some countries have experienced population growth that outstrips any increase in health spending, leading to poorer health
- Increased state spending on health infrastructure, including training of professional medical operatives
- Aid programmes allow for increase in health regardless of the country's economic growth
- The difference between state spending and private spending makes it hard to compare national income in terms of spending on healthcare
- Most countries now have a mixed health economy, meaning some services (frequently issues like sexual health and congenital or inherited conditions) are paid for by the state, while 'lifestyle' health problems such as injuries and disease caused by specific activities are paid for by individuals. Other 'lifestyle' health problems include dental health, especially cosmetic issues
EXPLAINING LIFE EXPECTANCY: lifestyle
Lifestyle means the way in which a person lives their life. Fundamentally, lifestyle is about the choices a person makes. It therefore is not related to ethnicity, sexuality, gender, schooling (because parents make that choice for the child), and congenital ('from birth') diseases. It is also severely limited depending on income. However, lifestyle does include choices about diet, household expenditure, activities such as sports, smoking, drug use, housing, post-childhood education, and many other factors.
Ways in which lifestyle affects life expectancy
Activities associated with risk - smoking is the main risk activity associated with early death. Historically this would apply mostly in HICs but since the 1950s the link between smoking and cancer has been well documented and recently there have been significant campaigns to encourage a less risky activity thorugh increasing tobacco taxes, raising the legal age for smoking, banning cigarette advertising, and introducing plain packaging for cigarettes. Meanwhile in LICs and MICs, smoking remains a very cheap activity and is an affordable luxury for many people. Cigarette companies continue to expand in these markets, encouraging a risky lifestyle.
Healthcare provision- Most countries have a mixed healthcare economy, meaning that they have some private healthcare as well as state healthcare. Some countries have entirely state provided healthcare, such as Cuba, while some have the vast majority provided by the state, such as the UK. However, even in countries where the state officially provides very little healthcare directly, such as France, mandatory insurance schemes effectively ensure that everyone is covered. Within this framework, there is an element of choice as to the amount of insurance cover required, and this can be seen as a lifestyle issue.
Diet - the choice of food and the amount to eat is a major lifestyle factor that explains life expectancy. Malnutrition can be in terms of calories (too many or too few) or a lack of balance in the diet. In poorer countries, this is harder to achieve and is more likely to be income based than a lifestyle choice.
Activities associated with risk - smoking is the main risk activity associated with early death. Historically this would apply mostly in HICs but since the 1950s the link between smoking and cancer has been well documented and recently there have been significant campaigns to encourage a less risky activity thorugh increasing tobacco taxes, raising the legal age for smoking, banning cigarette advertising, and introducing plain packaging for cigarettes. Meanwhile in LICs and MICs, smoking remains a very cheap activity and is an affordable luxury for many people. Cigarette companies continue to expand in these markets, encouraging a risky lifestyle.
Healthcare provision- Most countries have a mixed healthcare economy, meaning that they have some private healthcare as well as state healthcare. Some countries have entirely state provided healthcare, such as Cuba, while some have the vast majority provided by the state, such as the UK. However, even in countries where the state officially provides very little healthcare directly, such as France, mandatory insurance schemes effectively ensure that everyone is covered. Within this framework, there is an element of choice as to the amount of insurance cover required, and this can be seen as a lifestyle issue.
Diet - the choice of food and the amount to eat is a major lifestyle factor that explains life expectancy. Malnutrition can be in terms of calories (too many or too few) or a lack of balance in the diet. In poorer countries, this is harder to achieve and is more likely to be income based than a lifestyle choice.
EXPLAINING LIFE EXPECTANCY: MDGs
Separate to income has been the global attention focused on life expectancy in poorer countries by NGOs, foreign governments and multi-national organisations. The MDGs have no specific goal related to life expectancy, but several of the indicators of health - such as access to safe water, child mortality and access to health services (for pregnant women) - are in the MDGs. Look back to your work in Core 1 for more details.
Want to keep going to the next section in the order we did the lessons? Click here for Measuring Health.