UNIT 4

1. UNIT 4 GLOBAL HEALTH AND HUMAN DEVELOPMENT Area of Study One Introducing Global Health and Human Development

2. 1.1 Characteristics of developed and developing countries, including high/low mortality strata Advice - It is important that you have a good understanding of the strata levels and it may be useful to know a couple of examples of countries from each strata

3. Characteristics of developed and developing countries

4. Mortality Strata • The World Health Organisation classifies countries into 5 mortality strata based on the mortality rates of children under the age of five and adult males 15 – 59yrs.

5. Exam Style Question Question 4 List two characteristics used by the World Health Organization (WHO) to describe a developing country. • __________________________________________________________________________________________________________________________________________ • __________________________________________________________________________________________________________________________________________ 2 marks VCAA 2010 Question 4 Section A

6. Exam Style Answer Question 4 Characteristics used by the World Health Organization (WHO) to describe a developing country include (any two of): • under-five mortality rate • adult mortality • child mortality • infant mortality • Income • adult literacy • life expectancy • level of economic development • gross domestic product.

7. Exam Style Question The following information is about Ethiopia – a country located in Africa. • Ethiopia ranks 27th in the world in under-five mortality rates, with a rate of 210 per 1000 and an infant mortality rate of 69 per 1000. • Ethiopians have a life expectancy of 55 years. • One third of the population survive on less than $US1 per day. • Children in Ethiopia are orphaned as a result of HIV/AIDS. This has increased the number of child-only household families and the burden on the elderly, particularly the grandparents and the community. Ethiopia has the largest HIV/AIDS infected population in the world, contributing to very high adult mortality. • Access to basic and quality education and educational materials in Ethiopia is generally low. Female enrolment/attendance compared to males is low. • The total literacy rate is 36%. • Children in Ethiopia die from childhood diseases that could easily be prevented through immunisation and basic health services. • Access to clean water and sanitation facilities are inadequate. • Malnutrition affects a large proportion of the population. Children in particular are highly affected by malnutrition • Identify the mortality strata that Ethiopia belongs to according to the WHO classification and justify your choice. Mortality Strata ______________________________________________________________________________________ Justification ______________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ (1 + 2 = 3 marks) VCAA 2010 Question 6 Section B

8. Exam Style Answer Question 6a. • Ethiopia would belong to mortality strata D or E because: Justification • Ethiopia has very high child mortality, ranking 27th in the world in the under-five mortality rate, with a rate of 210 per 1000 and an infant mortality rate of 69 per 1000 • Ethiopia also has the largest HIV/AIDS-infected population in the world, contributing to very high adult mortality rates • children in Ethiopia die from childhood diseases that could easily be prevented through immunisation and basic health services. It was important that students used the data from the stimulus material to justify their answers.

9. Exam Style Question • Select one developing country from the table and use the data to justify whether it represents a developing country with high or low mortality strata. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 2 marks VCAA 2012 Question 7 Section b

10. Exam Style Answer Question 7 Following is a possible approach to answering this question. • Afghanistan is a high-mortality strata developing country. The life expectancy is low, the Under-5 mortality rate per 1000 people is very high and maternal mortality is high, which supports high mortality strata. • Students needed to select a developing country – Afghanistan, Bhutan, Burkina Faso, Chad – or no marks could be awarded. Many students were able to state that the developing country was Strata E or D, given the statistics.

11. 1.2 Definitions of sustainability (including elements of appropriateness, affordability, equity) and human development (including the human development index) according to the UN Advice • Students should be able to define all of these terms (in their own words with the same meaning) • It is also important that you are able to understand all elements of SHD

12. Sustainability • Meeting the needs of the present without compromising the ability of future generations to meet their own needs (VCAA) Dimensions of Sustainability Social • This refers to the ability of future generations to have equal or better access to resources that improve their quality of life such as human rights and equality, social cohesion, political stability where the community provides democratic structures and good governance, and education. Economic • This refers to the capacity of future generations to earn an income and the way in which the limited resources that are needed to improve peoples’ lives are distributed and used to allow economic growth to continue over time. Environmental • This refers to the way in which the natural environment is utilised by humans to ensure the natural resources are preserved for use by future generations.

13. Human Development • Human development is ceatingan environment in which people can develop to their full potential and lead productive, creative lives in accord with their need and interests. It is about expanding people’s choices and enhancing capabilities (the range of things people can be and do), having access to knowledge, health and a decent standard of living, and participating in the life of their community and decisions affecting their lives. (VCAA)

14. Sustainable Human Development • a process of people striving to achieve their full potential, lead productive lives, expand their choices and meet their needs without compromising the opportunities for future generations

15. Human Development Index A tool developed by the United Nations to measure and rank countries’ levels of social and economic development. It provides a single statistic based on three dimensions – health, education and living standards, and four indicators – life expectancy at birth, mean years of schooling, expected years of schooling and gross national income per capita. (UN Development Programme, 2011)(VCAA) The Index is divided into three categories; • High Human Development – countries scoring 0.80 or higher • Medium Human Development – countries scoring between 0.50 and 0.79 • Low Human Development – countries scoring below 0.50

16. Exam Style Question • Define Human Development Index (2 marks) • Using one of the countries in the table above, explain the relationship between a high Human Development Index and the level of human development (2 marks) VCAA 2011 Question 1 Section A

17. Exam Style Answer a. A measurement of human development that combines indicators of life expectancy at birth, mean years of schooling, expected years of schooling and Gross National Income per capita. The human development index provides a single statistic that can be used as a reference for both social and economic development. It provides a rating from 0 to 1, according to the level of development.

18. Exam Style Answer b. A possible answer would have been: Australia has a high Human Development Index (HDI) and therefore has a high life expectancy, and high levels of income and education. Australians can therefore develop to their full potential, having access to knowledge, health and a decent standard of living. This allows them to participate in the life of their community and decisions affecting their lives. • Many students wrote that because the country has a high Human Development Index it had high human development, but did not explain the relationship. • Students need to choose one of the countries listed to explain the relationship between HDI and the level of human development The following is an example of an adequate student response. • Australia has a high HDI ranking of 0.937. This means they have a high health status (life expectancy at birth), high level of knowledge (mean years of schooling and expected years of schooling) and high wealth (gross national income per capita) all of which contribute to a high level of human development as they have access to an environment where they can develop to their full potential and lead productive and creative lives

19. Exam Style Question Question 5 (4 marks) Identify two indicators of the Human Development Index (HDI) and outline how they lead to variations in the HDI between Australia and a developing country. Indicator 1 ___________________________________________ Outline ______________________________________________ ____________________________________________________________________________________________________________________________________________________________ Indicator 2 ___________________________________________ Outline ______________________________________________ ____________________________________________________________________________________________________________________________________________________________ VCAA 2013 Question 5 Section A

20. Exam Style Answer • Students needed to select any of the two indicators of the Human Development Index (HDI) and outline how each one could lead to variations in the HDI between Australia and a developing country. • Students should note that only the current indicators were relevant to this question, and they needed to show the relationship between the indicators selected and variations to the HDI, which many students failed to do. • Possible answers included • life expectancy at birth: Australia has a high HDI, which would suggest that Australian’s life expectancy is higher than that of people living in a developing country and this would contribute to a lower HDI • gross national income per capita (average income): Australia has a high income per capita, meaning it has more money available to spend on healthcare services leading to a high HDI compared to a developing country with a low gross national income contributing to a low HDI • mean years of schooling: Australia has a high number of students completing more years of schooling compared to a developing country. Education gives opportunity for employment and improved health, leading to a higher HDI for Australia • expected years of schooling: Australia has compulsory attendance at school until the age of 16 years. A developing country may have children completing primary schooling, but not compulsory attendance at school, and fewer children go on to complete their secondary education. The following is an example of a good response. • (Standard of living) Gross National Income per capita (GNI) –individuals in developing [countries] have a considerably lower GNI than Australia, so are less likely to afford nutritious food and access to health. They are therefore more likely to become malnourished …than Australia causing a variation in the HDI. • Life expectancy at birth – developing countries have a lower life expectancy relative to Australia. This is due to poverty and high rates of communicable diseases – which relates to GNI as well, and ability to attend school leading to variation in HDI with Australia.

21. 1.3 Similarities and differences in health status and human development between developing countries and Australia in relation to morbidity, mortality, life expectancy, burden of disease and human development index Advice • Use, interpret and analyse data to draw informed conclusions about the health status and human development of developing countries compared to Australia • You do not need to memorise data, however it is appropriate that you are aware of trends eg: rates of communicable disease and U5MR, so that you are able to draw informed conclusions

22. What Expect when looking at Data • Developed • High Non-communicable • Low communicable • Developing • High communicable • Rising Non-communicable • Injuries • Similar in developed and developing

23. Exam Style Question 6. Define the following terms. Under 5 mortality rate ________________________________________________________________________________________________________________________________________________________ Morbidity ________________________________________________________________________________________________________________________________________________________ (2 marks) VCAA 2011 Question 6 Section A

24. Exam Style Answer • The under 5 mortality rate is the number of deaths of children under five years of age per 1000 live births • Morbidity is (one of): • Ill health in an individual and the levels of ill health in a population or group • Levels of ill health or illness in a population

25. Exam Style Question Identify the variations in health status evident in the table, between Australia and developing countries

26. Possible Answers Australia have the highest level of health status compared to the other countries in the table • Australia has the highest life expectancy (81) ahead of Gua 70, Bang 63.5, Timor 60.2, Zambia 41.2 and Moz 42.4 • Australia has the lowest Infant Mortality Rate (5 per 1,000 live births) in front of Gua 29, Bang 47, Timor 77, Zambia 103 and Moz 115 • Australia has the lowest U5MR (6 per 1,000 live births), beating Gua with 39, Bang 61, Timor 97, Zambia170 and Moz 168. * Note: The question asked for Health Status, so only Health Status data should be used in the answer

27. 1.4 The influence on the health status of developing countries compared to Australia of income, gender equality, political stability/peace, education, access to health care, political stability, global marketing (of alcohol, tobacco and fast-processed foods) and physical environments Advice • Compare factors that influence the health status and human development of Australia and developing countries • Health Status (use terminology – incidence, morbidity) • Human Development (link to key words – increased knowledge, enhancing capabilities, decent standard of living)

28. Income

29. Gender E quality

30. Education

31. Peace and Political Stability

32. Health Care

33. Physical Environment

34. Global Marketing

35. Exam Style Question Question 4 a. In developing regions most of the burden of collecting drinking water falls on women and girls. Explain how this burden may impact on human development. _____________________________________________________________________________________________________________________________________________________________________________________ (2 marks) b. Explain how increasing access to safe drinking water promotes health and sustainable human development. Health _____________________________________________________________________________________________________________________________________________________________________________________ Human Development _____________________________________________________________________________________________________________________________________________________________________________________ Sustainability _____________________________________________________________________________________________________________________________________________________________________________________ (6 marks) Vcaa 2010 Question 4 Section B

36. Exam Style Answer a. Possible answers included the following. • Most of the women spent a large proportion of their time collecting water. These women are not compensated for the large amount of time allocated to sustaining their family, and this means that they do not have the choice to spend time on paid work, education, childrearing, family care or relaxation, which may be more productive or rewarding. It means that an environment in which women can develop to their full potential and lead productive and creative lives according to their needs is not created. • Women may collect the water at the same time as other women. It can be a social time where they exchange knowledge, learn how to participate in their community and take part in decisions that affect their lives – they can work together to better their environments. It can create an environment in which the women can develop their potential and lead productive and creative lives. • Many students focused on individual human development rather than on human development as defined by the United Nations (UN). The UN definition of human development is provided in the study design.

37. Exam Style Answer b. Possible answers included the following. • Increasing access to safe drinking water promotes health as it means there is less likelihood of diarrhoea and other water-borne diseases that can be deadly, especially for children. It also means that there is less of a burden on women collecting water, and their time can be spent on more productive activities that can promote their physical, social and mental health, such as childrearing, relaxation or paid work. If people are healthy and they have more time available as they are no longer collecting water, then they are able to earn a living, be productive and contribute to economic development, which contributes to all dimensions of health. • Sustainable human development is about having choices. Having access to safe drinking water means women can lead productive and creative lives according to their needs and interests. Women in particular will have greater choice about and freedom to engage in productive activities. This will result in opportunities for women to develop to their full potential and contribute to the ongoing development of their community, including environmental, social and economic objectives of sustainability. • Many students answered the question by providing a definition of sustainable human development and were unable to explain how increasing access to safe drinking water enabled sustainable human development. The following is an example of a high-scoring response. • By increasing access to safe drinking water, women and girls (especially) will no longer experience physical health issues (eg sore backs, necks) due to having to carry heavy buckets of water over long distances. Furthermore, as the water is safe disease is prevented which in turn enables social health to improve as individuals can interact with one another without the burden of injury or sickness. People no longer need to stress about having access to water ensuring an improvement in mental health. • Through increasing access to safe drinking water, all dimensions of health are significantly improved for women and girls as well as the community. As a result, the community can develop to its full potential, enhancing its capabilities and expanding its choices. Access to safe drinking water provides a better standard of living and therefore enables communities and individuals to become empowered. With access to safe drinking water (eg wells) sustainability can also be met as the needs of the present for water is met without compromising the access to water in the future.

38. Exam Style Question The following information is about Ethiopia – a country located in Africa. • Ethiopia ranks 27th in the world in under-five mortality rates, with a rate of 210 per 1000 and an infant mortality rate of 69 per 1000. • Ethiopians have a life expectancy of 55 years. • One third of the population survive on less that $US1 per day. • Children in Ethiopia are orphaned as a result of HIV/AIDS. This has increased the number of child-only household families and the burden on the elderly, particularly the grandparents and the community. • Ethiopia has the largest HIV/AIDS infected population in the world, contributing to very high adult mortality. • Access to basic and quality education and educational materials in Ethiopia is generally low. Female enrolment/ attendance compared to male is low. • The total adult literacy rate is 36%. • Children in Ethiopia die from childhood diseases that could easily be prevented through immunisation and basic health services. • Access to clean water and sanitation facilities are inadequate. • Malnutrition affects a large proportion of the population. Children in particular are highly affected by malnutrition. b. Explain the likely influence of income and gender equality on health status in Ethiopia: Income ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ Gender equality ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ (6 marks) VCAA 2010 Question 6 Section A

39. Exam Style Answer Possible answers included the following. Income • Ethiopia is a very poor country, with one third of the population surviving on less than $1 USD per day. This will have a significant impact on health status. When families are living in poverty, it is difficult for them to afford to buy food, water, adequate housing, health care and education. • Women and children are often most affected by a lack of food. Children become undernourished, which reduces their immunity to a range of communicable diseases such as measles, influenza, pneumonia, tuberculosis, pertussis, diphtheria and tetanus. These diseases contribute to high rates of death and disability in children. • A lack of water results in high levels of diseases such as diarrhoea and cholera, which contributes to high rates of death and disability in children and adults. • Poor housing can contribute to high rates of infectious diseases and respiratory infections. • With low income levels, the capacity of the Ethiopian government to collect taxes that can be used to provide essential infrastructure such as clean water supplies, basic health care and educational opportunities is limited. • This makes it more difficult for individuals and families to attain good health. Gender equality • Women in Ethiopia have a lower status than men, with female enrolment/attendance at school being low compared to males. • Without gender equality, the health status of women is reduced. Women are often valued only for their role in childbearing and domestic work. • Women often have children when they are young. This increases the risk of infection and death and often leads to long-term reproductive health issues. • Women often have to work long hours doing hard physical work even when they are pregnant, which affects their physical health. They are often exhausted, have a low immune system and high rates of illness. • Without gender equality, women are likely to suffer ill health due to domestic violence. • Gender inequality also contributes to poor social and mental health. Women are excluded from social events and feel disempowered and lack control over their lives. It appeared that many students misread this question.

40. Exam Style Question Question 5 In low income countries the leading cause of death is pneumonia, followed by heart disease, diarrhoea, HIV/AIDS and stroke. In high income countries the leading cause of death is heart disease, followed by stroke, lung cancer, pneumonia and asthma. Briefly explain how income may influence differences in the causes of death between low income and high income countries. __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ (2 marks) VCAA 2011 Question 5 Section A

41. Exam Style Answer Possible answers included: • Compared to high income countries, low income countries lack the financial resources needed to provide safe water and sanitation facilities for their population. This contributes to higher rates of death from diseases such as diarrhoea in low income countries • Compared to high income countries, low income countries lack the financial resources needed to provide community immunisation programs. This contributes to higher rates of death from diseases such as pneumonia in low income countries • Compared to high income countries, low income countries lack the financial resources to provide health care facilities, which reduces the opportunities to diagnose and treat diseases such as heart disease and HIV. Other examples could have included: food insecurity, subsidised medications, health education, levels of literacy and housing. Students needed to link their answer to the comparison between high and low income countries and to the relationship in the differences for leading causes of death due to income.

42. Exam Style Question Question 7 a. Select one developing country from the table and use the data to justify whether it represents a developing country with high or low mortality strata. (2 marks) b. Discuss two factors that could account for the differences in health status between Australia and the developing country selected in part a. on page 20. ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ (6 marks) VCAA 2012 Question 7b Section B

43. Exam Style Answer Factors included: income, gender equality, global marketing, peace, education, physical environment, access to health care, political stability. A possible way of answering the question is provided below. • Access to health care: immunisation is difficult to access in Afghanistan compared to Australia, as shown by the number of people in Afghanistan with tuberculosis – 337/100 000 compared with 8/100 000 in Australia, where immunisation is readily available. Lack of availability of maternal and child health services in Afghanistan may be shown by the level of maternal mortality – in Afghanistan it is 1400/100 000, while in Australia it is 8/100 000. • Political stability: Afghanistan has an unstable government, with conflict evident, while Australia has a stable political environment. The lack of stability may be reflected in the fact that life expectancy in Australia is 87 years, compared with 68 years in Afghanistan. Many students did not use the data in their answer and instead discussed the data in terms of maternal health, for example. To answer the question well students should have used the data given in the stimulus material to support their answer. The following is an example of a high-scoring response. • Chad, a developing country doesn’t have access to primary health care systems and therefore are less likely to have the children immunised against communicable diseases (measles, diptheria) increasing the under five Mortality rates associated with infectious and parasitic diseases. However Australia does have access to primary health care and immunizations are government funded reducing the risk of children having communicable diseases accounting for a much lower U5MR in Australia than in Chad. • Chad suffers from a lack of education facilities therefore people do not have health related knowledge such as safe sex increasing adult mortality associated with sexually transmitted diseases (HIV/AIDS. Unlike Chad Australia has government funded public education systems and therefore all children acquire health knowledge (safe sex, condom protection) and as a result have lower adult mortality rates than Chad from sexually transmitted diseases.

44. 1.5 The eight UN’s Millennium Development Goals, their purpose and the reasons why they are important Advice • Describe the eight UN’s Millennium Development Goals, their purpose and the reasons why they are important • Evaluate the progress towards the Millennium Development Goals • You are not expected to be able to recall, word for word, each target for the MDGs, but the targets do form the basis of the ‘purpose’. You effectively need to know a ‘watered down’ version (e.g. ‘to reduce the under 5 mortality rate’ is enough detail for MDG 4).

45. E A P R I C E D • E – Eradicate Extreme Poverty and Hunger • A – Achieve Universal Primary Schooling • P – Promote Gender Equality and Empower Women • R – Reduce Child Mortality • I – Improve Maternal Health • C – Combat HIV/AIDS, Malaria and other diseases • E – Ensure Environmental Sustainability • D – Develop a Global Partnership for Development

46. Eradicate Extreme Poverty and Hunger

47. Achieve Universal Primary Education

48. Promote gender equality and empower women

49. Reduce child mortality

50. Improve Maternal Health