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CHAPTER OUTLINE
I. The chapter begins with the stark contrast between Denmark and Sierra
Leone in terms of general health, with the help of anecdotes and health indica-
tors. It clari es that low incomes explain much, but not all, of the disparity in
health outcomes across countries and regions. Health mea sures are captured
by mortality and morbidity statistics. The most common summary statistic is
life expectancy, derived from data on mortality. An alternative mea sure is the
health- adjusted life expectancy, which takes into account disability- impaired
living.
II. All regions of the world have experienced gains in life expectancy since 1960,
but some countries in sub- Saharan Africa have recorded declines since the
1990s due to HIV/AIDS. In many developing countries, life expectancy has
risen and fertility has fallen; the age structure of the population has changed
and so have the patterns of diseases. These changes have resulted in an epide-
miological transition. High- income countries have greatly reduced mortality
from communicable diseases, but these diseases remain a challenge to over–
come in developing countries.
III. Why do the indicators demonstrate improved health? Improved advances in
agriculture and food distribution; rising incomes that allow for better nutri-
tion, housing, and sanitation; public health mea sures such as clean water; and
spillovers of discoveries from science, technology, and education. The rela-
tionship between health and income growth is bidirectional. Higher income
boosts health because individuals and society can increase both the quantity
and quality of food. Society can also use funds to train doctors and nurses and
run immunization campaigns. Better health translates into higher income (but
at a diminishing rate) because of increased productivity and investment.
Health
CHAPTER 9
Health | 61
IV. The authors cover three of the best– known infectious diseases: HIV/AIDS,
malaria, and tuberculosis (TB). Combating HIV/AIDS requires strong national
and international commitment with both po liti cal and economic initiatives.
Malaria can have substantial economic costs, but on the positive front, malaria
intervention programs are very cost– effective. TB can be controlled with a
directly observed treatment short course (DOTS), which combines a regular
TB drug dosage with clinical observation visits.
V. The last section provides case studies on successes in global health. These
include the use of condoms in brothels in Thailand, which prevented the
spread of HIV/AIDs; controlling TB in China through the use of DOTS; and
preventing deaths from diarrheal disease with oral rehydration therapy
(ORT). One of the main lessons learned is that much of the intervention in
health is not very costly but needs to be administered properly. The challenge
for the twenty– rst century is to continue the battle against communicable
diseases while developing strategies to combat epidemics of noncommunica–
ble conditions.
Boxed Examples
Box 9– 1: Life Expectancy
Box 9–2: “How Bene cent Is the Market? A Look at the Modern History of
Mortality”
Box 9– 3: Malaria, Yellow Fever, and the Panama Canal
Box 9–4: HIV/AIDS, Malaria, and Tuberculosis: Some Basics
Box 9– 5: Making Markets for Vaccines
There are ve examples in this chapter. The rst example provides a detailed look
on the dif culties of calculating life expectancies with data from Malaysia. The
second provides a summary of economic historian Richard Easterlin’s work on
the issue of mortality and the role of the market in improving life expectancy.
The third box provides an interesting case study on the completion of the Panama
Canal and how it relied on the eradication of yellow fever and reduction of malaria.
The fourth box provides a short introduction to the de nitions of HIV/AIDS,
malaria, and TB. Finally, the fth provides an overview of the intriguing new idea
proposed mainly by Michael Kremer on providing incentives for private rms to
produce vaccines.
In the New Edition
The seventh edition updates the material and now includes an extended discussion
of the relationship between income and health. The Preston curve, showing therela-
tionship between life expectancy and per capita income, is presented, and the debate
over causality is more fully developed. Finally, Box 9–5 has been signi cantly
62 | Chapter 9
updated and discusses creating markets for vaccines for diseases that primarily
affect populations in low- income settings.
Class Notes
While famine grabs the headlines, health and nutrition problems in developing
countries are far broader in scope and vastly more prevalent. Chapter 9 views
health conditions broadly, covering the facts, the development effects, and the
policy considerations. This material is presented in a nontechnical manner that
students can easily follow.
The text touches on another analytical point that can be expanded into lecture
topics: national food consumption and the application of cost– effectiveness analy–
sis to health and nutrition policy evaluation.
Chapter 9 covers many provocative topics you can discuss in class: the remark–
able health progress achieved by most developing countries; how life expectancy
is linked to infant mortality rates; the types of health problems prevalent in low–
income countries (most of which will be unfamiliar to your students); the interac-
tion between health care, environmental conditions, and nutrition; the concept of
food entitlements; the disadvantages of food subsidies; and the gains that can be
achieved through primary health care and preventative medicine. Michael
Kremer’s site has additional information on markets for vaccines. Some of the
papers are very accessible and nontechnical, providing good talking points for
class. The author provides an examination of all the diseases af icting many of the
developing nations of the world today and what progress is being made in com-
batting or eliminating them. Included in this discussion are prevention techniques
and the ongoing battle to eliminate HIV/AIDS, TB, polio, diarrhea, and one that
appears to have been successfully eliminated— smallpox.
Finally, the author discusses the thesis presented in the book Millions Saved:
Proven Successes in Global Health by Ruth Levine and the What Works Working
Group. This serves as a statement to what the health sector can accomplish, even
in the poorest countries. It provides a good basis for discussing how “everyone can
play a role” in helping to eliminate diseases— even in the poorest countries of the
world.
QUESTION BANK
Concept Map
What Is Health?
Health | 63
Malaria, Yellow Fever, and the Panama Canal
HIV/AIDS
Malaria
Making Markets for Vaccines
Preventing HIV/AIDS in Thailand
Eliminating Polio in Latin America
Preventing Deaths from Diarrheal Disease
Multiple- Choice Questions
1. The World Health Or ga ni za tion (WHO) de nes health as:
a. the absence of illness or disability that prevents one from engaging in
normal functions.
b. a condition of physical well- being, consistent with the standards of one’s
national culture.
c. a state of complete physical, mental, and social well- being.
d. the absence of a serious need for medical attention.
2. The WHO de nes health as a state of complete mental, physical, and social
well- being and not merely the absence of disease. However, this construct or
formula, in this end, is:
a. obsolete.
b. proving all former mea sure ment of health as faulty.
c. being discounted and rendered worthless by the World Bank.
d. more dif cult to mea sure.
3. Which of the following mea sures rates of disease or illness?
a. mortality
b. morbidity
c. life expectancy
d. none of the above
4. Health– adjusted life expectancy (HALE) reduces life expectancy by years
spent:
a. in an unhappy marriage.
b. remaining single.
c. working in high- risk occupations.
d. with disabilities.
5. In developing countries, major gains in life expectancy have been achieved
primarily by reducing mortality rates for which population group?
a. the el der ly
b. rural workers
c. the very young
d. women of childbearing age
6. As societies age and health improves, the pattern of disease and causes of
death also shift in a generally predictable pattern; this shift in disease pattern
is known as the:
a. epidemiologic transition.
b. survival de cit.
c. diminishing returns to health.
d. Hippocratic paradox.
7. With a few exceptions, famine no longer seems to be a threat in Asia; how–
ever, this country marks a clear exception to that premise:
a. China.
b. Vietnam.
c. North Korea.
d. Laos.
8. Health has improved worldwide due to all the following major reasons
EXCEPT:
a. improved advances in food distribution.
b. improvements in education.
c. vaccine development for tropical diseases.
d. public health discoveries.
9. Increased income allows people, particularly the poor, to buy more of the
following EXCEPT:
a. clothing and apparel.
b. better housing.
c. food.
d. health care.
10. According to a famous study on the impact of rising incomes on health, a 10
percent increase in income is associated with which percent decline in child
mortality rates?
a. 2–4 percent
b. 8–10 percent
c. 15–20 percent
d. 100 percent
11. Higher life expectancy translates into greater economic growth later:
a. at the same rate.
b. rst at the same rate but then later at a diminished rate.
c. at no time because of the costs involved.
d. only for developed countries.
12. Which of the following statements about the Panama Canal construction is
NOT true?
a. Yellow fever was eradicated.
b. Malaria was eradicated.
c. Both yellow fever and malaria were transmitted through mosquitos.
d. Before the United States had the right to build the canal, many workers
died from yellow fever and malaria.
13. HIV/AIDS is different from other diseases because:
a. it attacks primarily young adults, an eco nom ical ly active segment of the
population.
b. its therapy need not rely on po liti cal and economic initiatives.
c. the international community was slow to respond to the growing crisis.
d. it is a chronic disease.
14. Almost one- fth of the deaths in children under ve in Africa are from:
a. malaria.
b. HIV/AIDS.
c. tuberculosis.
d. none of the above.
15. This continent suffers from 91 percent of the world’s malaria deaths:
a. Africa.
b. South America.
c. Asia.
d. Eu rope.
16. Research by economists John Gallup and Jeffrey Sachs concluded that the
presence of a high malaria burden in a nation reduces its economic growth by:
a. 0.7 percent.
b. 1.3 percent.
c. 5.8 percent.
d. 15.7 percent.
17. Vaccines for illnesses that af ict the poor countries of the world are slow to
be researched and developed by the private sector because:
a. there is a severe backlog in the research and development sector of phar-
maceutical companies.
b. there is little nancial incentive because the nations with these diseases
are poor.
c. the emphasis in disease prevention is undergoing a transition from
vaccines to medical patches and sprays.
d. most scientists believe all diseases mutate, and cures will never be truly
found.
18. Health statistics on morbidity refer to the:
a. incidence of mental- health problems.
b. incidence of disease and illness.
c. fraction of deaths caused by preventable disease.
d. incidence of unnatural death due to accidents, crime, and war.
19. Which of the following was NOT an important aspect of preventing the
spread of HIV/AIDS in Thailand?
a. The use of condoms was mandatory in brothels.
b. Health of cials provided free boxes of condoms.
c. Local police held meetings with brothel own ers and sex workers.
d. A program encouraged teens and young adults to use condoms in non-
commercial sex.
20. The last reported case of polio in the Americas occurred in 1991 in the
nation of:
a. Canada.
b. Nicaragua.
c. Paraguay.
d. Peru.
21. Oral rehydration therapy (ORT) is a simple and inexpensive treatment that
can prevent most deaths from:
a. drowning.
b. diarrhea.
c. malaria.
d. roundworm parasites.
IDs and Paired- Concept Questions
These terms can be used individually as short- answer identi cation questions, or
they can be used in pairs. In the latter case, ask students to explain (1) the meaning
and signi cance of each of the two terms and (2) the relationship between them.
2. Life expectancy, double burden of disease
4. Market failure, diseases
6. HIV/AIDS, antiretroviral drugs (ARVs)
8. Diarrhea, oral rehydration therapy
10. Epidemiologic transition, developing countries