Today's lecture: Fair Health? Health Inequities within and between countries: a global challenge by Michael Marmot, UCL.
- Women in Botswana live, on average, to the age of 34, while women in Japan live to 86.
- Men from the most deprived areas of Glasgow, Scotland have a life expectancy of 54, while those from the most affluent areas have a life expectancy of 82.
- Even in the poorest countries, a social gradient for life expectancy exists. It is not just a problem of the very poorest people. This argues for universalist approaches rather than just policies aimed at the poorest.
- The % probability of dying between the ages of 15 and 60 for men is:
- 8.2% in Sweden
- 48.5% in Russia
- 84.5% in Lesotho
- Have to look at social determinants of health. Not just the causes of ill health, but the causes of the causes. We need to create the social conditions for health.
- The only area of the world for which life expectancy dropped between the early 1970s and early 2000s was the former Soviet states (69 to 68.1). But while life expectancy increased from 52.1 to 66.9 in Arab states and 50.1 to 63.2 in south Asia, it increased only from 45.8 to 46.1 in sub-Saharan Africa.
- The United States spends $5,274 per capita on medical care (15% GDP). The U.K. spends $2,164. Yet for white men between the ages of 55 and 64, even the wealthiest Americans have more cancer and diabetes than the poorest citizens of the U.K., and the wealthiest Americans have more heart disease than all but the poorest citizens of the U.K. (Wealthiest Americans have, by far, better health than middle-income or poor Americans).
- Compared to other nations, the United States ranks 33rd for men and 36th for women in the probability at birth of surviving to age 65.
- In nutrition, from 1985-2000, prices for fresh fruits and vegetables increased by 40% (according to the USDA) while prices for soft drinks dropped by 30%.
- If you haven’t yet seen the CDC map of obesity in America, take a look.
Too Many Men – a time bomb for China? by Therese Hesketh
(speaker is a pediatrician who has worked and lived in China for 20 years)
- At birth, normal sex ratio is 103-107 males/100 females, with a median of 105.9. This number has been stable across populations and time.
- The population sex ratio is 98-102 males/100 females, with a median of 100.
- The population sex ratio is influenced by the sex ratio at birth (which favors males), differential mortality at different ages (which favors females), and migration.
- Deviations from normal sex ratios result from a strong tradition of preferences for males. Before birth, this is largely accomplished through selective abortion. After birth, it is accomplished through infanticide, neglect, abandonment.
- The numbers:
- 112 males/100 females in India
- 120 males/100 females in China.
- China & India have 1/3 of all births globally, nearly 40% of the world population. As a result, the global sex ratio is becoming skewed.
- At the time of the implementation of the one child policy in China, and before abortion for purposes of sex selection was readily available, the sex ratio was 106 males/100 females – a bit high, but in the normal range.
- The one child policy is not uniform across China. It applies to urban areas. In rural areas, families are allowed 2, but the second may be allowed only if the first is a girl. Some ethnic groups are allowed more.
- For families having their second child, the sex ratio is normal (103 boys for every 100 girls) if the first child was a boy. If the first child was a girl, there are 156 boys born for every 100 girls, indicating that sex selection is common.
- Sex selection in China is not just a rural problem:
First child: 111 boys/100 girls urban 106 boys/100 girls rural
Second child: 130 boys/100 girls urban 123 boys/100 girls rural
Third child: 130 boys/100 girls urban 145 boys/100 girls rural
- By 2020, up to 15% of adult men in China will be single and childless, most of whom are poor and uneducated. This may lead to societal problems, such as an increase in the sex industry, increased trafficking of women, increased violence. Some speculate there could be potential for large-scale domestic or even international violence.
- For men who are married, they tend to be more monogamous, have more stable families, and have a low divorce rate.
- In China, few obvious problems have surfaced so far. Crime rates are relatively low, migrants are generally well absorbed.
- Short-term solutions being seriously discussed in China include greater recruitment into the armed forces, sending unmarried men to remote border areas, and employing them on dangerous projects. (Another Great Wall, anyone?)
- Long term solutions include enforcing the existing legislation on sex-selective technologies, giving women equal rights in inheritance & income, providing supportive measures for elderly people without sons, and increasing public awareness about the value of daughters.
- South Korea has already grappled with this problem. In 1992, the sex ratio of 3rd births was 212 boys for every 100 girls. After enforcement of laws on sex selection techniques, the rates have dropped so that 3rd births are 124 boys for every 100 girls. (It’s 106 for first children and 108 for second.)
Shell Shock (a history of public health lecture at the London School for Hygiene and Tropical Medicine)
- The number of psychiatric casualties in war is closely related to total casualties. The mediators are morale, training, food, leadership.
- In WWI, many psychiatrists believed that war was only a trigger of shell shock, but that the general degeneration of society was the cause.
- In WWI, only 16.9% of soldiers treated at forward psychiatric units were able to return to duty.
- In Iraq, we seem to have forgotten the lessons of the last century. We are still looking for a physical cause for shell shock (what the U.S. is calling Minor Traumatic Brain Injury), while we learned in WWI that a debate between physical and psychological explanations is not helpful to treatment or recovery.