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Higher Geography

Global Issues

Development and

Health

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Development and Health

Development

What is Development?

It is somewhat easier to say which countries are richer and which are poorer, but indicators of wealth, which reflect

the resources available to a country, provide no information about the allocation of those resources. For instance,

the shares of resources used to provide free health and education services.

Countries with similar average incomes can differ substantially when it comes to people’s quality of life: access to

education and health care, employment opportunities, availability of clean air and safe drinking water, the threat of

crime, and so on. With that in mind, how do we determine which countries are more developed and which are less

developed?

World Development Map

Measuring Development

Development is measured using indicators of development. These indicators have several uses:

They allow us to use a figure for comparing different countries

Countries can be ranked in an attempt to fairly allocate aid payments

Indicators give us an idea about what the country is like economically, socially even environmentally

There are three main types of indicators:

1. Single indicators

Economic indicators

Social Indicators

2. Composite indicators

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1. Single Indicators

Economic

Economic indicators reflect the wealth of a country e.g. Gross Domestic product per capita, average income,

%employed in agriculture and energy consumption per capita. More industrialised countries are wealthier due to

their earnings from exporting goods; this is reflected in the GDP/ capita.

Rank Country GDP / capita (US$)

1 Monaco 159 400 2 Lichtenstein 139 300 3 Luxembourg 117 600 4 Qatar 104 300 5 Norway 101 400

26 UK 39 600 187 Niger 400 188 Liberia 400 189 Burundi 300 190 Democratic Republic of Congo 300 191 Malawi 300

Gross Domestic Product is the value of all goods and services produced within a country. It is usually measured in

US$ and calculated per capita. This makes comparisons between different countries easier. GDP is probably the most

widely used indicator. It implies a lot about the country. If the figure is high it suggests they have a large number of

productive industries producing goods. It also suggests that the service industry is well developed (services include

things such as hospital and schools). If the figure is low it suggests that the country has few industries and few

services so therefore a poor standard of living.

Advantages of Using GDP Disadvantages of Using GDP

A useful figure for comparing countries. Often used to rank countries to establish a fair system of aid payments.

Can hide inequalities as it does not show the distribution of wealth.

Is a good indicator of the state of the economy and provision of services.

Can be manipulated by governments who want to appear poor to collect more aid.

Fairly easy to calculate from official government figures

Does not take into account subsistence or informal economies which are very important in less developed countries.

It gives no specific indication of social welfare It may be inflated by export revenues e.g. in OPEC

countries

Monaco Malawi

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Social Indicators

Social indicators reflect quality of life e.g. birth rate, death rate, infant mortality rate life expectancy at birth, adult

literacy rate and number of people per doctor.

Infant mortality is the average number of children per 1000 who die before they reach the age of one.

This indicator shows the state of the countries health service, food provision and water quality.

Rank Country Infant Mortality Rate

1 Monaco 1.81 2 Japan 2.17 3 Bermuda 2.47 4 Singapore 2.59 5 Sweden 2.73

46 UK 4.5 187 Guinea - Bissau 92.66 188 Central African Republic 95.04 189 Somalia 109.91 190 Mali 106.49 191 Afghanistan 187.5

Advantages of Using Infant Mortality Disadvantages of Using Infant mortality

Indicates quality of health care, water quality, food supply

Hard to get an accurate figure as many births in the less developed countries would be un-registered

Very easy indicator to understand Evidence from some countries that the level of infant mortality is well above that disclosed

Focuses on one of the most significant aspects of development

High infant mortality could be a result of social or political factors.

Adult literacy rate is the percentage of the adult population that can read and write. It is a clear indication of the

availability of education and also the quality of the education provided.

Rank Country Adult literacy rate (%)

1 Monaco 100 1 Japan 100 1 Bermuda 100 1 Singapore 100 1 Sweden 100

28 UK 99 212 Mali 33.4 213 Burkina Faso 28.7 214 Niger 28.7 215 Afghanistan 28.1 216 South Sudan 27

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Advantages of Using Adult Literacy Disadvantages of Using Adult Literacy

Indicates the ability of a country to provide education to the population.

Takes no notice of other skills the people may have which are equally valuable - for example a good understanding of farming techniques.

Shows how many children could/couldn't attend school

When used on its own doesn't tell us whether the figure is a consequence of too few schools or the fact that children are having to work

Problems with single indicators:

Indicators are averages and they can hide huge differences that

exist in every country. Differences exist between areas of the

country. Differences also exist within cities - some people live in

poor housing and have a lower standard of living than others who

live just a few miles away, in poorer cities the differences are even

more marked. The conditions in which people live mean that for

some people birth rates and death rates will be higher, life

expectancy will be lower and their income will be far below

average.

National indicators in developing countries also hide rural/urban differences that exist. Generally people in rural

areas live in poorer conditions than those living in urban areas. They may not have the same access to doctors,

education or clean water.

2. Composite Indicators

Comparing countries’ GDP per capita is one of the most common approaches to assessing their level of

development.

But a higher per capita income in a country does not always mean that the people are better off than those in a

country with lower income, because there are many aspects of human wellbeing that only using one indicator does

not capture.

Organisations like the UN use different methods of integrating economic and social data on average data to provide

a clearer picture of development within a country. These methods make it possible to assess a country’s

achievements in both economic development and human development.

The Human Development Index (HDI)

The most commonly used composite indicator is the HDI (Human Development Index). HDI is measured on a scale of

0-1, with 1 being the most developed.

The HDI combines:

• Life expectancy at birth (health) • shows the possible life span for each person which provides a measure of the health and well being

within a country

Rio Favela

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• people who live in developed countries will live longer as they will have access to good health care, regular food supplies and are economically better off whereas people in an developing countries do not have the same access to these services will have a low life expectancy

• Years of schooling for adults aged 25 years and more and expected years of schooling for children of school entering age (education)

• economically more developed countries would be expected to have a high figure reflecting compulsory primary and secondary schooling whilst the least economically developed countries would be characterised by lower figures

• GDP per capita at purchasing power parity (PPP) (wealth) • This indicator uses exchange rates to equalise purchasing power and takes into account the cost of

living in a country • indicates the wealth generation of the population which provides a measure of the

wealth/prosperity of the country • people in developed countries are more likely to have a better life style as they will be able to afford

the costs of health care, good housing and the other basic necessities that make life easier as they have high earning jobs

• in developing countries the number of people on high incomes will be low so the average income per person will be low indicating that the majority of the population have no regular income to use to improve their lifestyle

The table below shows GDP/capita (similar to the table on page 2) but takes into account the cost of living. This makes it a more useful indicator for comparing wealth in a country. This indicator is measured using the Geary–Khamis dollar which is a hypothetical unit of currency that takes into account PPP.

Rank Country GDP / capita (Int$)

1 Qatar 98 814 2 Luxembourg 78 670 3 Singapore 64 584 4 Norway 54 947 5 Brunei 53 431

21 UK 37 307 187 Eritrea 707 188 Liberia 703 189 Democratic Republic of Congo 648 190 Burundi 642 191 Central African Republic 542

Doha, Qatar Bangui, Central African Republic

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Explaining Variations in Development That Exist Between Developing Countries

There are variations in levels of development between different countries in the developing world.

Indicator China Egypt

Iraq Nigeria Nepal Ethiopia

GNP per captia

6,747 3,225 6,594 1,692 692 541

Life Expectancy

72.71 72.51 67.32 50.26 67.42 57.21

Birth Rate 11.9 30.4 31.0 36.9 24 35.7

Infant Mortality

Rate 15.20 23.30 38.86 72.97 41.76 58.28

HDI 0.698 0.662 0.59 0.471 0.463 0.396

These variations exist due to a number of physical and human factors:

Exam tip: make sure you include lots of named examples in your answer for this question.

1. Physical Factors

Climate:

Any extreme will hinder development: for example being too hot, too cold, too wet or too dry.

Such extremes will make life difficult e.g. difficult to build houses

and roads, difficult to farm the land, difficult to attract industry

and generally difficult to earn a living.

Example: 2012 drought triggered a food crisis in Somalia (HDI

0.364)

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Relief:

Mountains and steep slopes restrict communication and make farming difficult.

Example: Nepal is one of the most rugged

landscapes in the world (HDI 0.463).

Natural disasters:

Those areas likely to be hit by floods, hurricanes, volcanic

eruptions, earthquakes or by drought tend to remain less

developed. Money is spent on repairing infrastructure and

humanitarian aid.

Example: Typhoon Haiyan tore through the central

Philippines November 8th 2013, killing nearly 6,000 people

and displacing more than 3.6 million (HDI 0.654).

Natural Resources:

Countries may have mineral reserves which can help development and trade. Oman and similarly positioned Middle

East countries have vast reserves of oil. They also have stable (if despotic) government regimes/monarchies that

leads to the generation of huge wealth. This wealth can ‘trickle down’ to a wide sector of the population. Other

countries may have no reserves of minerals in demand by developed countries e.g. Burkina Faso

Examples: Oman (HDI 0.731), Burkina Faso (HDI 0.343)

Landlocked countries:

15 countries in Africa are landlocked. This means it is more difficult to trade

as goods have to be driven through other countries to get to the coast for

shipping. It is also more difficult for new technology to reach a landlocked

country, as the fibre optic cables are laid under the ocean.

Example: Burundi (HDI 0.355)

Endemic Disease E.g. Malaria, HIV/AIDS

Endemic disease affects life expectancy and infant mortality. It also affects

the ability of people to work and earn money. Restricted health services

make little impact.

Example: Botswana (HIV/AIDS) (HDI 0.634)

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2. Human Factors

Type of Economy:

GDP is higher in newly industrialised countries e.g. Tiger economies in SE Asia, where there is an emphasis on hi-tech products. Other NICs are richer due to steel making, shipbuilding, car manufacturing, clothing etc. Some poorer economies have to rely on the exportation of primary products which bring less money to the country. Example NIC: Indonesia (HDI 0.629) Primary export example: Bangladesh (HDI 0.515)

Encouragement of Entrepreneurial Skills:

This encourages the ability to attract major world companies e.g. by offering an educated, resourceful and relatively cheap work force and/or incentives e.g. 10 years rent free factory sites in Vietnam. Example: Vietnam (HDI 0.617) Political Instability / Governance: Many developing countries have unstable regimes or are suffering from border wars and/or civil wars e.g. Zimbabwe, Sudan and Indonesia. Corrupt governments may prevent wealth from reaching the poor e.g. Nigeria, for decades the government has accrued huge oil revenues, yet the country suffers from a lack of basic infrastructure, and tens of millions live in poverty. Example: Nigeria (HDI 0.471)

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Low status of women: In some developing countries there is a lack of education for females and high birth rates, this can be due to religious or cultural reasons.. This results in a large untapped workforce which could occupy highly paid jobs. Example: Afghanistan (HDI 0.374)

Historical development: Colonialism hindered a developing country's level of development. A colony helped supply food and minerals to countries like Britain and France. There was investment in colonies, but this was focused on things that would help the trade between the countries. Borders of some colonial countries were set without attention to tribal and cultural differences, causing tensions and instability. Example: Cameroon (HDI 0.495) Tourism: Countries with a tropical climate, attractive landscapes or cultural attractions can earn foreign currency through tourism. This provides an economic boost and can improve living standards and create new job opportunities. Example: Thailand (HDI 0.690)

0

10

20

30

40

50

Male Female

Literacy in Afghanistan

Adult LiteracyRate (%)

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Health Health is central to human happiness and well-being. It also makes an important contribution to economic progress, as healthy populations live longer, are more productive, and save more. Many factors influence health status of a population and a country's ability to provide quality health services for its people. Water Related Disease Case Study: Malaria How Common is Malaria?

Compared to some parts of the world, malaria in the UK is a minor issue. However, globally it remains a major

problem. Malaria was significant enough to become part of the Millennium Development Goals; MDG Goal 6 Target

3 states that the spread of malaria should ‘have halted by 2015 and begun to reverse’. In2006, the World Health

Organisation (WHO) estimated that:

• there were 247 million cases of malaria globally, killing 881,000 people.

• malaria killed a child somewhere in the world every 30 seconds.

Map showing the global distribution of malaria. The size of each continent or country is in proportion to the number of cases.

Distribution of Malaria Malaria is usually found between the Tropic of Cancer in the North and the Tropic of Capricorn in the South. Malaria (the parasite is called plasmodium) is spread via the bite of a female anopheles mosquito. There are a number of human and physical factors which contribute to the worldwide distribution of malaria.

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1. Physical Factors

Malaria is found in location where the anopheles mosquito can survive and breed. The mosquitoes require:

Hot, wet climates such as those experienced in tropical rainforests of monsoon areas of the world

Temperatures of between 15°C and 40°

Areas of shade where mosquitoes can digest human blood

Stagnant water in which mosquitoes can lay their eggs

Mosquito Larvae

2. Human Factors

Human activities can encourage the spread of malaria. For example:

Increasing the available breeding habitat

o Reservoirs

o Ponds

o Irrigation channels

Settlement near to breeding habitats provide a ‘blood reservoir’

Exposure of bare skin increases the risk of bites and therefore the spread of malaria

Increasing population growth can encourage people to live in affected areas

Greater mobility of people means malaria can be easily transmitted or even reintroduced

Poverty

o Preventing and treating malaria costs money

Impact of Malaria

3,000 people a day die from malaria but it also has another consequence. People who survive can suffer many

serious bouts of illness caused by the disease. As well as making people sick, malaria has a much wider effect on

countries. With so many people infected and falling ill the earning power of the countries is greatly reduced, as sick

people cannot work. As a result there are not the funds to successfully care for and treat the sick or eradicate the

disease once and for all.

The economic impact of malaria is estimated to cost Africa $12 billion every year. This figure factors in costs of

health care, absenteeism, days lost in education, decreased productivity due to brain damage from cerebral malaria,

and loss of investment and tourism.

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Cycle of Malaria

Person becomes

weak

Person becomes

ill

Unable to work

Poverty

Little food to

eat

Ghana Case Study:

Ghana is a hyper-endemic country with a large malaria burden. Malaria control interventions have had

some impact in recent years, but a lack of financial resources and insufficient human resources are

hindering further success.

Of the 3.2 million reported cases of malaria in Ghana, 900,000 were children under five years old. Malaria is hyper-endemic in all parts of the country, with the entire population of 23.5 million at risk. The geography of Ghana encourages malaria as the three main areas consist of: the northern savannah; the tropical rainforest; and the coastal savannah and mangrove swamps. The annual economic burden of malaria is estimated 1-2 per cent of the Gross Domestic Product in Ghana. Malaria-stricken families can spend an over one quarter of its income on malaria treatment, as well as paying prevention costs and suffering loss of income. Malaria-afflicted families on average can only harvest 40 per cent of the crops harvested by healthy families. In hyper-endemic areas such as Ghana, as much as 60 per cent of children’s schooling may be impaired as a result of repeated bouts of malaria

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Controlling Malaria There are a wide range of strategies that can be employed to control malaria; some are more effective than others. Strategy 1: Eradicate Mosquitoes

Strategy Effectiveness

Use of Insecticides:

The use of DDT in malarial countries in the 1960s and 1970s almost eradicated malaria

The use of newer, oil based insecticides such as Malathion

Insecticides destroy the mosquito nervous system

Environmentally harmful

Impact on food-chains widely publicised and DDT subsequently banned

Mosquitoes can quickly develop a resistance to insecticides

New insecticides are expensive and therefore difficult for developing countries to afford

Genetic Modification:

Breeding genetically modified sterile mosquitoes and mercenary male mosquitoes were also attempts to kill off the mosquito for good, and so stop the spreading of the disease

This would be incredibly labour intensive to perform over large geographical areas

Traps:

Specially designed mosquito traps, which mimic animals and humans by emitting a small amount of carbon dioxide in order to lure the mosquitoes into the trap where they are killed

Mosquito traps have been effective at a small scale, but mosquitoes breed so quickly that it is impossible to trap them all

Kill mosquitoes at the larval stage:

Mustard Seed Bombing on breeding grounds causes the surface of the water to become sticky and drags larvae underwater drowning them

Egg white sprayed on the water surface clogs larvae breathing tubes

BTI bacteria produce a toxin lethal to mosquito larvae. BTI can be produced locally using coconuts. BTI is inserted into a coconut and sealed. After the coconuts have fermented for two-to-three days, the villagers take them to a nearby pond, break open the fruit, and toss it into the water

Larvae eating fish such as guppies or muddy loach can be introduced to eat the mosquito larvae

Bearing in mind many of the world’s poorest countries suffer from malaria, these strategies are wasteful, costly and fairly impractical

2/3 coconuts will control a typical pond for up to 45 days

The method is cheap as coconuts are widely available in many affected countries

This strategy is also environmentally friendly as BTI is only lethal to mosquito and black fly larvae

This is cheaper than using insecticides and fish can also be eaten and provide extra protein in peoples diets

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Drainage of swamps removes large areas of stagnant water

Plant eucalyptus trees to soak up excess water

Labour intensive and not practical in the tropics (high rainfall)

Strategy 2: Treat affected with drugs

Strategy Effectiveness

People affected by malaria can be treated with drugs such as chloroquine

Other drugs such as larium and malarone can also be used to treat malaria

This was effective for a time but in many affected countries plasmodium is now becoming resistant to chloroquine and other anti-malarial drugs

There are some side effects associated with anti-malarial drugs and newer drugs can be expensive to buy from pharmaceutical companies

Qinghaosu extract from the artemesian plant – a traditional Chinese cure

Cannot be made artificially

Growing plants cannot keep up with demand

Develop a malaria vaccine Attempts are ongoing to develop a vaccine that could eradicate malaria for good, but so far this has not been successful

Strategy 3: Education and International Campaigns

Strategy Effectiveness

Educate local populations regarding preventative measures:

Using insect repellent e.g. autan

Covering skin (especially at dusk when mosquitoes are most active)

Sleeping under an insecticide treated net

Installing mesh screens over doors and windows

These strategies have been effective, in particular plays and other non-written forms of education

Using insecticide treated nets is particularly effective as mosquitoes are most active at dawn and dusk

It’s still difficult to reach the most rural areas in many countries

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International Campaigns:

WHO ‘Roll Back Malaria’ launched in 1998 by WHO, UNICEF, UNDP and the World Bank, to provide a coordinated global response to the disease

Bill and Melinda Gates Foundation

These has been some success but reports suggest that in certain countries e.g. South Africa the rate of malaria have actually increased perhaps due to climate change

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Primary Healthcare

Primary health care is defined by the WHO as:

"Essential health care based on practical, scientifically sound and socially acceptable methods and technology,

made universally accessible to individuals and families in the community. It is through their full participation and

at a cost that the community and the country can afford to maintain at every stage of their development in the

spirit of self-reliance and self-determination".

In other words, PHC is an approach to health beyond the traditional health care system. PHC includes all areas that

play a role in health, such as access to health services, environment and lifestyle.

This ideal model of health care was adopted in the declaration of the International Conference on Primary Health

Care held in Alma Ata, Kazakhstan in 1978 (known as the "Alma Ata Declaration"), and became a core concept of the

World Health Organization's goal of Health for all.

Primary Healthcare Strategies

1. Use of ORT (Oral Rehydration Therapy) to tackle dehydration –

especially amongst babies. This is an easy, cheap and effective

remedy for diarrhoea/dehydration.

Adopted by UNICEF and WHO in the late 1970s, ORT has been

successful in helping manage diarrhoea among children. It is

estimated that in the 1990s, more than 1 million deaths related to

diarrhoea may have been prevented each year.

2. Use of barefoot doctors – trusted local people who can carry out treatment for more common illnesses –

sometimes using cheaper traditional remedies.

3. Provision of vaccination programmes against disease such as polio, measles, cholera.

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In 1988, when the Global Polio Eradication Initiative was formed, polio paralysed more than 350 000 people a year.

Since that time, polio case numbers have decreased by more than 99% (with only 406 polio cases reported in 2013).

4. Encouraging preventative medicine rather than (more expensive) curative medicine.

5. The development of health education schemes in

schools, community plays/songs concerning AIDS, with

groups of expectant mothers or women in relation to

diet and hygiene. Oral education being much more

effective in illiterate societies.

6. Sometimes educational initiatives are backed up by

the building of small local health centres staffed by

visiting doctors.

7. PHC can also involve the building of small scale clean

water supplies and improved sanitation.

For example, PlayPump International installs roundabouts that pump water to the surface.

Blair toilets/pit latrines provide a cheap and effective way of preventing sewage contaminating local water supplies.

8. The use of local labour and building materials is often cheaper; it also provides transferable skills for the

participants and gains faster acceptance in the local and wider community.

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Primary Healthcare Case Studies

1. China and the 'barefoot doctors'

This is one of the earliest examples of primary health care, from the 1960's. Local people were trained in basic medical care, so that only the more serious cases were referred to central hospitals. This allowed hospitals to concentrate on the very sick. The 'barefoot doctors' lived and worked part-time in the community who paid for their services; they were understood and trusted by their neighbours. Because local medicines were used in addition to western drugs, the cost of drugs was reduced.

Effectiveness

very successful in early years at reducing disease/illness/deaths in rural areas too few health workers trained to supply all the rural communities lack of funding in the local community to pay for the training lack of volunteers who are willing to do community work rather than work in private practice in wealthier

urban areas

2. Nicaragua

A government run programme in the 1980's built 500 new health centres in rural areas. As in case study 1, basic medical care and health education were practised in the heart of the community.

Effectiveness

infant mortality rates reduced from 30% to 9% polio was eradicated by a vaccination programme malaria was reduced from 40% to 3% of rural population more recently war, economic depression and natural disasters have reduced the effectiveness of the scheme

3. The Bamako initiative

With UNICEF support, 34 countries (Benin, Burkina Faso, Chad, Guinea, Niger and Sudan being examples) are developing their primary health care systems. Links are established between hospitals, rural social services, schools, religious groups, women's and youth groups to encourage, develop and strengthen any health care and health education initiatives.

In Benin, in West Africa, for example:

200 health centres, covering 58% of the population, spread their costs among the local communities a vaccination programme for BCG, polio and DPT (diphtheria, polio and tetanus) was introduced in 1993 infant mortality rates were tackled by a programme of pre- and post-natal health education

Effectiveness (Benin)

86% of the population received a BCG immunisation 71% of the population received a Polio/DPT immunisation 75% of pregnant women obtained medical consultations 63% of births were attended by skilled medical staff costs to the community were kept down to $0.50 per visit