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.
A recent study in The Lancet contradicts official guidelines, suggesting there is no ‘safe’ level of alcohol consumption. While a single daily drink raises the risk of alcohol-related illness by only 0.5%, two drinks represent a more significant risk increase. The media’s portrayal of these findings varied, possibly influenced by relationships with drinks companies or a perceived duty to promote healthier behavior.
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 a week being dubbed low risk drinking for both men and women.
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>?
What are the causes and consequences of low life expectancy in the UK?
Get rich or Die Young (BBC, Panorama 2018) explores the causes and consequences of low life expectancy in Teeside, in the North East of the United Kingdom. It focuses on the experiences of three people who are living through three of the main causes of low life expectancy: smoking and poor diet, drug addiction and mental ill health.
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:
Winter Viruses
Inefficiency
Immigrants
Lazy Staff
Drunks
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 around 90% of the aid budget being spent in this area.
Four basic measurements of health in development
It is possible to classify these indicators differently, but for the purposes of A-level sociology, I think four are sufficient:
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 generally worse in lower income countries than higher income ones.
Life Expectancy
in the UK average life-expectancy is 81.25 years and while this has been reduced by one year due to coivd-19). It is still far better than in the poorest countries on earth. According to statistics from Our World in Data Life Expectancy in Nigeria is 54.7 years, and in neighbouring Central African Republic it is 53.3 years.
Child Mortality
According to the World Health Organisation substantial global progress has been made in reducing child deaths in the last three decades. Since 1990, the global under-5 mortality rate has dropped by 59%, from 93 deaths per 1,000 live births in 1990 to 38 in 2019.
However, Sub-Saharan Africa remains the region with the highest under-5 mortality rate in the world, with 1 child in 13 dying before his or her fifth birthday. Nigeria and India alone account for almost a third of all deaths. Half of all under-five deaths in 2019 occurred in just five countries: Nigeria, India, Pakistan, the Democratic Republic of the Congo and Ethiopia.
Maternal Health
According to the World Health Organisation in approximately 295 000 women died from preventable causes related to pregnancy and childbirth, equivalent to almost 900 per day.
Women die from complications such as severe bleeding (mostly bleeding after childbirth), infections (usually after childbirth), high blood pressure during pregnancy (pre-eclampsia and eclampsia) complications from delivery and unsafe abortions.
86% of these preventable deaths were in Sub-Saharan Africa and young adolescent women aged 10-15 are especially at risk of dying maternal related deaths.
Most of the above causes of death are preventable and linked to poverty, poor nutrition and low standards of maternal care.
The main cause of death ‘neonatal conditions’ is clearly related to the relatively high child mortality rates and poor maternal health in low-income countries.
Lower Respiratory Infections – means mainly pneumonia, a complication which can develop from having the flu if you have a more immune system, in turn due to a poor diet.
Diarrhoeal diseases are linked to poor water and sanitation.
Heart Disease and Stroke are the main causes of death in high income countries, so the fact that these are increasing (kind of ironically) is a sign of economic development taking place!
Progress in improving health…
It’s worth noting how much progress has been made on improving health since the year 2000 and the start of the Millennium Development Goals.
In 2015 the main causes of death were:
Lower respiratory infections11.3%
Diarrheal diseases8.2%
HIV/AIDS7.8%
Heart disease 6.1%
Malaria 5.2%
Tuberculosis 4.3%
Prematurity and low birth weight 3.2%
Birth asphyxia and birth trauma 2.9%
Neonatal infections 2.6%
Note how today Malaria and HIV have fallen down the league tables and Heart Disease and stroke, both diseases associated with longer life expectancy, have entered the top 10!
The main social indicators of development include education, health, employment rates and gender equality.
Some examples of social indicators of development include:
Education – for example how many years of schooling children have.
Health – often measured by life expectancy.
Employment Rates
Gender equality
Peacefulness
Democracy
Corruption
Media freedoms
Civil Rights
Crime/ social unrest
Suicide Rates
Composite indicators of all of the above
A well known example of a social indicator of development is the Human Development Index, which combines one economic indicator (Gross National Income) with two social indicators: life expectancy and years of schooling into one score and ranks countries accordingly.
Social Indicators of development give a much broader picture of how developed a country is compared to purely economic indicators such as GDP which merely focus on economic productivity. Social indicators are more useful in showing us the extent to which income generated in a country actually benefits ordinary people.
The World Bank provides the most comprehensive data on social indicators of development, and you can also find many specific social indicators of development within the United Nations Sustainable Development Goals.
The Sustainable Development Goals selectively uses some World Bank data and is a much more accessible way for the lay person to monitor social development precisely because it is more limited in scope than the World Bank data.
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.
For each indicator, firstly we look at some of the indicators the World Bank uses and then we look at the Millennium Development Goals. Where appropriate we will also look at other sources of data.
The purpose of this post isn’t to assess the validity of the different indicators, just to provide an overview of HOW MUCH data there is out there!
Indicators of Education and Development
The World Bank uses several 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 World Bank also monitors the quality of education systems and finance focussing indicators such as how effectively students are monitored and quality of decision making.
*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.
The United Nation’s Sustainable Development Goals has ten targets for education development (with a heavy focus on gender equity and also ensuring all students are taught about sustainable development) and twelve main indicators to measure these targets including:
Flows of official development aid for scholarships
The proportion of teachers with qualifications.
The proportion of schools providing safe facilities.
Indicators of Health and Development
The United Nations has 13 targets and 28 indicators for health and development including
maternal mortality ratio
proportion of live births attended by a health professional
under five mortality rate
Neo natal mortality rate
number of new HIV infections per 1000
Tuberculosis, malaria and Hepatitis B rates per 1000
Deaths from diseases such as heart disease, cancer and diabetes
Suicide rates
treatments for drug addiction
alcohol consumption
deaths from road traffic injuries
adolescent birth rates
effective access to family planning
death rates from air pollution and poor hygiene.
Smoking rates
proportion of populations vaccinated and with access to vaccinations
Health worker density and distribution
Health emergency preparedness.
Other social indicators to be covered in a future post…..
Later on I will also cover the following:
Health
Employment Rates
Gender equality
Peacefulness
Democracy
Corruption
Consumption
Leisure/ Media
Civil Rights
Crime/ social unrest
Suicide Rates
Composite indicators of all of the above!!!
I might also cover some of the more subjective indicators of development:
Life satisfaction (‘happiness’ indicators)
Trust
confidence
well-being
perceived security
Signposting and related posts
This material is mainly relevant to the Global Development and Globalisation module, taught as part of the AQA’s A-level sociology specification.
