Ebola recently resurfaced in Democratic Republic of Congo, and has now infected more than 2500 people in the Eastern part of the country, near the border with Uganda.
Ebola is one of the world’s most infectious and deadliest diseases: as of 22nd July 2019 the World Health Organisation reported 2503 cases in this latest outbreak, with 1764 deaths. (Source: Relief Web).
The World Health Organisation first declared an Ebola outbreak in the DRC in August 2018, but the number of cases have increased dramatically since Spring of 2019. This is now the second largest Ebola outbreak after the 2014-16 epidemic in Liberia, Guinea and Sierra Leone, which killed 11, 300.
Health workers have a new vaccine which appears to work to deploy to help keep the disease under control but they face the following barriers to treating people:
There is ongoing conflict in Eastern DRC. This extends to attacks on health care facilities – there have been around 200 such attacks reported which have killed 5 people.
Local people are being displaced as a result of the conflict – at least 300 000 so far, and some of these are heading across the border to Uganda, where there have been some reported cases of Ebola.
There is a local rumor that aid workers are actually infecting people with Ebola because they are ‘paid by the corpse’ – and in a country mired by corruption and conflict, I guess this sounds plausible.
It remains to be seen whether the Ebola outbreak can be kept under control: the ongoing conflict and local suspicions are certainly going to hamper efforts, and it seems aid agencies are going to have to spend a lot of time working with locals and building trust in order to keep things under control!
Relevance to A-level Sociology
This recent tragedy should be of interest to any students studying the Global Development module in A-level sociology. The case of Ebola in the DRC illustrates the relationship between conflict and health problems and it also shows some of the local challenges Aid agencies face when trying to deliver emergency aid.
The new ‘safe’ level of alcohol consumption should be none, at least according to a recent study into the health risks of alcohol published by the The Lancet.
This contradicts the current official government guidelines on the ‘safe’ level of drinking: currently around 14 units per week for women, and 21 for men.
The findings of this research study were widely reported in the mainstream media:
The Daily Mail reported that ‘just one glass of wine a day increases your risk of various cancers’.
Even The Independent reported that ‘the idea that one or two drinks a day is good for you is a myth’.
But what are the actual statistical risks of different levels of alcohol consumption?
The actual risk of developing a drink related alcohol problem for different levels of drinking are as follows:
No drinks a day = 914/ 100 000 people
One drink a day = 918/ 100 000 people
Two drinks a day = 977/ 100 000 people
I took the liberty of putting this into graph form to illustrate the relative risks: blue shows the proportion of people who will develop alcohol related problems!
This means that statistically, there is only a 0.5 % greater risk of developing an alcohol related illness if you have one drink a day compared to no drinks, which hardly sounds significant!
Meanwhile, there is a greater increase in risk if you have two compared to 1 drink a day, which suggests the government guidelines have got this about right!
(NB, despite the headlines, The BBC and Sky did a reasonable job of reporting the actual stats!)
So why did some news papers report these findings in a limited way?
This could be a classic example of News Values determining how an event gets reported: it’s much more shocking to report that the government has got its advice wrong and that really there is no safe level of drinking!
Or it could be that these newspapers feel as though they’ve got a social policy duty to the general public… even if there is only a slight increased risk from alcohol consumption, maybe they feel duty bound to report it in such a way to nudge behaviour in a more healthy direction.
In terms of why some newspapers did a better job of reporting the actual findings: it could be that these are the papers who rely on advertising revenue from drinks companies? Maybe the Mail and the Independent don’t get paid by drinks companies, whereas Sky does>?
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The documentary is hosted by the ever-reliable Richard Bilton, who seems to be the BBC’s go-to guy for these social injustice documentaries.
Teeside has the largest life expectancy gap in the country. Those in poorest boroughs of the region have a life expectancy of just 67, the same as Ethiopia. Those living just a couple of miles away in the wealthiest boroughs live until 85, 4 years above the national average.
This means that the life expectancy gap between the poorest and richest boroughs in Teeside is 18 years.
The inequalities are literally written on the gravestones, where in some graveyards, 60 years seems like a ‘good innings’
Richard Bilton points out early on that most babies in the U.K are born healthy, but a baby’s health is shaped by what comes next, and a crucial variable which influences health and life expectancy is wealth, or lack of it.
He also suggests more than once that leading an unhealthy life is not simply a matter of individuals making poor choices. Rather, being socialised into poverty restricts the kinds of choices people can make, and in extreme cases results in stress which seems to literally take 10 years off an individual’s life.
The first of the three emotionally charged case studies focuses on a 46-year-old male whose life is nearly over. He has fluid on the lungs, sciatica, and type 2 Diabetes, among other things, and is dependent on breathing apparatus.
There’s quite a lot of footage of his 4/5 kids musing about how he hasn’t got much time left…. And I guess that’s the ultimate negative consequence of his dying in his late 40s: a partner left to bring up 4 distraught kids on her own
His Illnesses are down to smoking and poor diet: people are four times more likely to smoke than those from wealthy areas.
The second case study focuses on a gran mother who is bringing up her daughters two children because she seems to be a hopeless crack addict. We see an interview with the drug-addict daughter who just appears to have given up the will to look after her kids. (Possibly because she knows her mother will do it?).
Drug deaths in Stockton have doubled in a decade and nationally they are substantially higher in the more deprived areas.
The grandmother attends a support group for grandparents who look after their grandkids because their children are drug addicts…. And we can see clearly how the stress she’s under is reducing her own life expectancy.
Finally, the documentary visits a middle-aged woman suffering from depression and anxiety who has made multiple (unsuccessful) suicide attempts. Suicides are twice as common in the poorest areas.
One of the problems here is that mental health services have been cut. There’s nowhere for her to go. If it were not for a voluntary support group, she’d probably be another early death statistic.
So how do we tackle low life expectancy?
This is a very short section towards the end of the documentary which visits a school in a deprived area. The headmistress of the Carmel Education Trust thinks she can turn things around. She doesn’t believe the poor-health life path of those in poverty is fixed.
She believes that therapies help kids to better at school, and if they do better at school, they get better jobs, and that seems to be the key to a healthier life…
NB the documentary doesn’t actually go into any depth about what these ‘therapies’ are. This section is very much tagged on the end of the gawp-fest.
Final critical appraisal of the documentary
What I like about the documentary is that it’s rooted in what you might call micro-statistics. It ‘digs down’ into the sub-regional variations in life expectancy in Teeside. It even distinguishes between life expectancy and health life expectancy.
However, the documentary spends too much time ‘gawping’ at the poor sick poor people rather than analysing the deeper structural causes of poverty related health problems.
There’s no real mention of the longer term historical downturn in the North East of the U.K. which highlights the high levels of unemployment, for example.
I’m also not entirely convinced by the (too brief) look at the solutions on offer. Therapeutic interventions in schools was offered up as the solution. Relying on the education sector yet again to sort out this social mess of extreme in equality in life expectancy just isn’t practical.
Having said that, if the mission of the documentary was to alter us to the extent of the problem and shock us, I think it did a reasonable job overall.
Possibly most shocking of all is that men in the poorest boroughs have a life expectancy of just 64: the average man doesn’t even make it to retirement age. And this isn’t the only region in the UK where this happens. In the very poorest regions, men work hard, pay their National Insurance, and get nothing back for it. There’s something not quite right about that!
Ultimately, I agree with the message the documentary puts out, even if it gets somewhat lost in the emotionalism of the three case studies: the reasons people die young are complex, but the most common reason is poverty – low income limits your choices. There is also no reason why anyone should be getting a chronic illness and dying in their 40s. All of the likely soon-to-be deaths in the documentary are entirely preventable!
Relevance to A-level sociology
This documentary offers some us some qualitative insights into the causes, but mainly the consequences of low life expectancy in the poorest regions of the United Kingdom and so should be relevant to the ‘ life expectancy and death rates‘ aspect of the families and households module.
It’s also quite a useful reminder of how we need qualitative data to give us the human story behind the statistics.
If you want to find out more about variations in life expectancy in the UK, you might like this interactive map as a starting point.
In a recent BBC documentary: ‘The Doctor Who Gave Up Drugs’ Dr Chris Van Tulleken (Dr CVT) set out to answer the above question. Here I summarise this documentary and throw in a few links and additional commentary
You can watch the documentary on BBC iplayer until Late June 2018, although TBH you may as well save yourself 50 mins and just skim read what’s below.
There has been a dramatic increase in prescriptions for children with Cow’s Milk Allergy (CMA) in recent years: A 500% increase in the 10 years to 2016 in fact!
A ‘prescription’ basically means that children with CMA get put on a specialist cow milk free ‘alternative milk’ formula, which costs twice as much as regular milk formula for children, and costs the NHS £64 million/ year.
In this section of the second episode of the series: ‘The Dr Who Gave Up Drugs, Dr CVT asks why there has been such a rapid increase in prescriptions for specialist formula to treat Cow’s Milk Allergy.
He says that as a new parent, he keeps hearing about it, which is odd because only 2% of children suffer from it, and so he’s wondering whether or not the above increase in prescriptions is due to increase in the underlying numbers of children who actually have cows milk allergy (or better detection) or whether there is something else fuelling the increasing public awareness of the condition.
The Normalisation of diagnosing and treating CMA
The documentary also visits one parent who thought her child had CMA when he developed XMA (one of the possible symptoms, but also something which 20% of babies suffer from), she visited her GP, who confirmed he didn’t have CMA. However, when she took her child to hospital for a bump, the pediatrician there noticed the XMA and prescribed specialist formula for CMA.
The child hated it, and so often went to be hungry. It too a visit to a Dr Robert Boyle (in the skeptical about CMA camp) who confirmed the child didn’t have CMA and so normal milk service was resumed.
The worrying thing about the above case is that alternative formula is being pushed on parents against their will, the normalisation of the diagnoses and treatment for a condition which in this case didn’t actually exist.
Industry lead education for NHS staff
One of the reasons Dr CVT is sceptical about the increase in awareness and prescription being linked to an actual underlying number of cases of children with CMA is that a lot of the education provided to Doctors about food allergies among children is sponsored by the companies who make alternative, specialist formulas to treat allergies.
To illustrate this point, the documentary visits a training day for NHS staff in Newcastle, aimed at educating staff about food allergies in babies – the event is sponsored by Danone, the company which makes one of the specialist CMA formulas, and what Dr CVT finds is advertising literature (various ‘glossy mags) and product samples alongside proper medical advice.
Another ‘test’ for the involvement of industry in educating about food allergies is to simply Google ‘cows milk allergy’ – which Dr CVT does and finds that most of the advice websites which help parents to self-diagnose their children are run by the companies who make specialist formula to treat the condition.
He also explores the web sites which parents and professionals use to diagnose for CMA, again run by the companies, and finds that the ‘symptoms’ which indicate Cow’s Milk Allergy are pretty much the kind of symptoms which every child has at some point, whether or not they have the allergy – things such as ‘colic’ and ‘vomiting’
Finally, he interviews Dr Adam Fox, who is a consultant for the ‘Allergy Academy’, sponsored by Danone, and he doesn’t seem able to convince Dr CVT that there isn’t a conflict of interests between the companies who profit from increased diagnoses of Cow’s Milk Allergy providing education on how to diagnose for the condition.
Application to Sociology
There are lots of applications – mainly centering around labelling theory and the power of corporations to shape agendas! Also risk society.
The Daily Mail and their Tory beneficiaries would have you think that the current crisis within the NHS are caused mainly by a combination of the following variables:
HOWEVER, this is not the case according to some more in-depth analysis by Ravi Jayaram, an NHS consultant (in The Guardian), who instead blames several years of chronic underfunding by the Tory government which have had the following effects:
Firstly, Primary Care services have been decimated by funding cuts, and as a result there are fewer GPs per patients, and so people feel they have to go to A and E rather than seeking help from their local GP.
Secondly, the recent conflict over Junior Doctors’ pay and the removal of the nurses bursary has left a sour note in the NHS, with those who are able to do so retiring early or leaving the country, meaning that the staff left behind struggle to provide safe and effective care.
Thirdly, whole wards of some hospitals have been closed by hospital trusts in order to stay in the black, meaning there is a decrease in supply.
NB – all of this has been going on while, as is well known, there is an increasing demand for NHS services by an ageing population!
And the deeper cause of all of this….well it’s a blinkered commitment to a neoliberal ideology which champions lower taxation and tight control on public spending….
Health is a crucial indicator of development – The International Aid community believe that health is the most important thing to spend money on – with more than 90% of the aid budget being spent in this area.
There are four basic measurements of health in development
Life Expectancy – The average number of years people are expected to live in a country (which if you remember makes up one of the three indicators of the Human Development Index).
Child Mortality – The number of children which die before their first birthday (measured per thousand).
Maternal Health – The number of women who die as a result of pregnancy or childbirth.
Disease indicators – The proportion of the population that has AIDS, Malaria, diarrheal and other infectious diseases.
On all of the above four ‘indicators of health’, things are considerably worse in lower income countries than higher income ones.
Life Expectancy – in the UK average life-expectancy is 81.5 years (some commentators would expect this to go down as the effect of Tory policies leads to increasing inequality and worse health care with the NHS privatisation.), while in At the other end of the scale, life expectancy is still less than 55 years in nine sub-Saharan African countries – including The Democratic Republic of the Congo, Nigeria and Sierra Leone.
Child Mortality – In Low income countries – 40% of those dying in any one year are children aged 0-15. In high income countries, only 1% of deaths are among people between 0-15 years of age. (Source – World Health Organization)
The highest levels of under-five mortality continue to be found in sub-Saharan Africa, where one in eight children die before the age of five (129 deaths per 1,000 live births), nearly twice the average in developing regions overall and around 18 times the average in developed regions. With rapid progress in other regions, the disparities between them and sub-Saharan Africa have widened. Southern Asia has the second highest rate—69 deaths per 1,000 live births or about one child in 14.
As with child mortality, maternal deaths are concentrated in sub-Saharan Africa and Southern Asia, which together account for around 85% of such deaths globally. A crucial factor in explaining maternal deaths (and improving this is part of MDG5 is that less than half of women giving birth are attended by a health care professional – in sub Saharan Africa – 64% of women, compared to 28% in Asian and less than 2% in the developed world.
In 2013, 35 million people were living with the AIDS virus— nearly a 30 per cent increase over 1999. Sub-Saharan Africa remains the most heavily affected region, accounting for around 70 per cent of new HIV infections, people living with HIV and AIDS deaths.
According to a 2015 World Health Organisation report, Malaria death rates have plunged by 60% since 2000, translating into 6.2 million lives saved.
“Global malaria control is one of the great public health success stories of the past 15 years,” said Dr. Margaret Chan, Director-General of WHO. “It’s a sign that our strategies are on target, and that we can beat this ancient killer, which still claims hundreds of thousands of lives, mostly children, each year.”
Despite tremendous progress, malaria remains an acute public health problem in many regions. In 2015 alone, there were an estimated 214 million new cases of malaria, and approximately 438 000 people died of this preventable and treatable disease. About 3.2 billion people – almost half of the world’s population – are at risk of malaria.
Some countries continue to carry a disproportionately high share of the global malaria burden. Fifteen countries, mainly in sub-Saharan Africa, accounted for 80% of malaria cases and 78% of deaths globally in 2015.
Many of the above diseases are ‘infectious diseases’ (aka ‘communicable’ diseases) – they are typically spread through either sharing bodily fluids or by parasites – often picked up from coming into contact with dirty water or raw sewage.
Relating back to the previous ‘health indicator’, the last three on the list are ‘maternal health issues’ and relate to either very young children or mothers dying in childbirth – if you add up the three figures then you get a figure of 9% of deaths due to poor maternal health).
The main social indicators of development include education, health, employment and unemployment rates and gender equality, and this post introduces students to the specific indicators which institutions such as the World Bank and United Nations use to measure how ‘developed’ a country is, and the main indices which are used to compare the levels of development of different countries.
Indicators Used to Measure Education and Development
The World Bank uses the following eight core indicators to measure how developed a country is in terms of education:
The net enrolment rate for pre-primary
The net enrolment rate for primary*
The net enrolment rate for secondary education
The gross enrolment ratio for tertiary (further) education.
Gender parity for primary education (using the gross enrolment ratio)**
primary completion rate for both sexes
The total number of primary aged children who are out of school.
Government expenditure on education as a percentage of GDP.
*The net enrolment rate for primary is ‘the number of pupils of official primary school age (according to ISCED97) who are enrolled in primary education as a percentage of the total children of the official school age population’.
**The gross enrolment rate for primary school The number of children enrolled in primary school (of any age) as a percentage of the total children of the official school age population