Contemporary threats to health

1. Contemporary threats to health

2. Session aims • To develop your understanding of how health threats can be conceptualised • To analyse how changing patterns of health relate to key societal events • To identify the main public health issues within contemporary society

3. Conceptualising and determining threats to health • Defining what we may see as a threat to health will be intrinsically linked to how we define health. • If we define the influences on our health as biological in nature, leading to ill-health and malfunctioning of the healthy physiological state of the body, threats will be conceived as factors influencing our biological states. • If we subscribe to the social model of health and acknowledge the importance of socio-economic factors in determining well-being and disease then we will view threats more broadly and shaped by the social world in which we live

4. Causal pathways • Examining the causal pathways for health and illness can aid our understanding of the diversity of threats to health. • Bhopal (2008) provides a useful model for analysing the complexity of causal pathways called a web of causation which visualises the interconnectedness of factors that influences health and illness. • Bhopal’s (2008) diagram represents a complex group of health determinants such as the environment, behaviour and the workplace. It also shows the inter-relatedness of these factors in terms of how they contribute to the occurrence and spread of disease.

5. Contemporary discourse • The dominant contemporary discourse for health is one of threats and disease. • Gidden's (2009) argues that the societal focus upon health risks leaves both governments and individuals debating the outcomes of such risks because there are no definitive answers. • Generating positive health is often a less important priority than preventing and reducing mortality and morbidity. • Most ‘health’ targets which underpin practice are framed around reducing illness. • There are some examples of targets that consider the wider determinants of health e.g. the Millennium Development Goals

6. Magnitude and severity • Other factors that can influence what issues are seen as threats to health are the number of people affected and the seriousness of the threat. • Large and visible dangers tend to receive more attention and are therefore more likely to be categorised as threats to health. • Pandemics can be classified as stronger threats because of their scope being across continents and the world. • Notions of mortality (death), morbidity (burden of diseases), impact on quality of life and chronic and acute disease can also be brought to bear on how threats are conceptualised • However, some issues that are perceived by society as stigmatised or shameful can go under-reported, under-investigated and unrecognised, for example disability.

7. Media construction and moral panics • The way that health issues are reported within the mass media influences understandings of the nature of these threats. • Media generated scares often emphasise both physical and emotional threats that are posed by everyday occurrences such as sunbathing, using a mobile phone and vaccinations like Measles, Mumps and Rubella (the combination of three vaccines into a single injection known as MMR) despite the lack of science behind many of the claims that are made (Wainwright, 2009). • The media plays a role in the social amplification of risk, where risks categorised as minor by scientific experts actually elicit strong public concerns and even reactions, resulting in large scale impacts. • Health scares reported in the media arguably give rise to a heightened sense of public panic, creating more physical and mental vulnerability (Buckingham, 2009). • People often have higher levels of fear than are necessary (Buckingham 2009).

8. Changing threats across the 20th and 21st Century • The types of diseases that affect populations change as countries develop, so risks shift from infectious diseases such as cholera in poorer countries to non-communicable and lifestyle associated health problems such as cancers and heart disease in richer countries. • Wainwright (2009) labels this as an ‘epidemiological transition’ • The WHO (2009) labels this as a ‘risk transition’ caused by improvements in medical care, the ageing of the population and successful public health interventions such as vaccinations and sanitation. • The impact of risks to health varies at different levels of socio-economic development.

9. Contemporary threats to health: Climate Change (Summerhayes 2010)

10. Contemporary threats to health: Degraded environments • Our health is linked to the environment and the destruction of the natural environment is therefore a threat to our health. • In destroying our environment, we threaten our basic needs such as food, shelter and clean air and water (Stone 2009). • Degraded environments are associated with health problems, and high levels of mortality. • WHO evidence suggests that each year 800,000 people die from causes related to air pollution, 3.5 million from malnutrition and 1.8 million from lack of clean water (WHO, 2005b; 2008). • All of these physical health problems certainly may impact upon mental health too.

11. Contemporary threats to health: population growth

12. Contemporary threats to health: Ageing population • The WHO (2007a) predicts that the world's elderly population (by which they mean people aged 60 years and over) will reach 2 billion by 2050. • Ageing populations can result in • changing patterns of illness and disease with increased conditions associated with fragility, chronic diseases and disorders such as dementia • An increase in poverty and therefore associated ill health for older age groups in society • Preparing health providers and societies to meet the needs of elderly people is essential

13. Contemporary threats to health: safety, security and fear

14. Contemporary threats to health: poverty • Poverty and inequality limit the achievement of full health. • As a result of poverty individuals experience under-nutrition, unsafe sex and poor sanitation (WHO 2009) therefore increasing their health risks significantly. • Material deprivation plays a huge role in the causation of disease

15. Contemporary threats to health: inequality • Gender health inequalities, e.g. risk behaviours such as drinking alcohol are more prevalent among men • Social Class inequalities, e.g. people in high social classes having better health compared to lower social classes • Geographical inequalities, e.g. Health is generally poorer in the North of England compared to the South of England • Ethnic inequalities, e.g. suicide rates in young Asian women are more than double those for young white women in the UK • Age inequalities, e.g. many risk factors for poor health, such as obesity, hypertension, disability and poverty increase with age (Raleigh and Polato 2004)

16. Contemporary threats to health: mental health • Mental health issues are often neglected in a world that tends to prioritise physical health. • Achieving good mental health is fundamentally important in daily functioning, quality of life and integral to the health of individuals and communities (Brundtland, 2001) • The WHO (2001) suggests that approximately 450 million people worldwide are suffering from some form of mental disorder. • One in four people will be mentally ill at some point in their life, representing 13% of the global burden or morbidity (WHO, 2001). • A major issue for mental health sufferers is the serious stigma and discrimination associated with poor psychological and psychiatric status. Indeed, stigma is a major barrier to both mental health treatment and recovery (Pinto-Foltz & Logsdon 2009).

17. Contemporary threats to health: infectious diseases • There are many infectious diseases that threaten the health of humans such as rotavirus, Ebola, HIV and the more recently discovered SARs and H5N1, bird flu (Kaufmann 2009). • These epidemics are transnational and hard to control, so instil fear in many people. •  Experience varies according to where you live - about four million people die annually from respiratory infections, mostly in lower income countries.

18. Contemporary threats to health: re-emergence of infectious diseases • On some occasions, a number of infectious diseases have been declared to be ‘defeated’ and eradicated and then later reappear to once again pose a threat to the health of humans. • Tuberculosis is one such example within contemporary society (Kaufmann, 2009). • This is partly because of TB’s close relationship with those infected with the HIV virus, so people often develop TB as a result of their weakened immune systems • The situation has been made worse by the bacterium that causes TB becoming increasingly resistant to drugs and treatment. • The principle reasons for the re-emergence of the disease are overcrowded housing, increasing homelessness, rising immigration rates, poor urban living conditions and rising levels of HIV infection (Kaufmann 2009).

19. Contemporary threats to health: life-style diseases • The types of food we choose to consume, levels of inactivity, our sexual behaviour, attitudes to alcohol and recreational drug use as well as attitudes to risk are all having a huge impact on our health. • The prevalence of obesity in England is the highest in the European Union. So in 2005, 24.3% of UK females were obese and 22.1% of men were. • Changing life-styles are affecting health. • The idea of life-style choices as a threat to our health has been associated with victim blaming.

20. Summary • Identifying substantive health threats is constructed by definitions of health, considerations of determinants of health, magnitude and seriousness and media and moral panics about health threats. • Epidemiological transition has changed global patterns from infectious diseases at the start of the 20th Century to chronic diseases in the 21st Century and this pattern is predicted to continue. • Health threats in the 21st century will require global action around the major determinants of health such as poverty, inequity, climate change and population growth.