Development, Health & Poverty

1. Development, Health & Poverty Anth 597.01

2. Epidemiological Transitions • H-G origins • low fertility + high infant mortality • = low avg. life expectancy • Low pop. Density • High mobility • Chronic helminth infections • 1st Epi Transition – Agr • high density sedentary pop. • High Fertility • Avg. age at death increases • Animal domestication • Endemic infectious zoonosis • Acute & Communicable diseases • Influenza, smallpox, measles, tuberculosis, etc

3. 2nd Epidemiological Transition • Increased life expectancy • Sanitation & healthcare • Chronic non-Infectious diseases • High energy & fat diet • Low PAL’s • Ex: CVD/CHD, cancers, diabetes • Used to be • “diseases of affluence” • Western disease on the rise in developing nations

4. What do transitions illustrate? • Dominant disease patterns are result of interactions between factors: • Cultural • Social • Political • Economic • Biological • Why the early success in combating infectious diseases?

5. U.N. Millennium Development Goals • 8 Goals to achieve in the new millenium: • Eradicate extreme poverty & hunger • achieve universal primary education • Promote gender equality & empowerment • Reduce child mortality • improve maternal health • Combat HIV/AIDS, malaria & other diseases • Ensure environmental sustainability • develop a global partnership for development

6. Epidemiology: developed vs. developing nations • The Good: • global life expectancy 50 yrs ago = 46 yrs • now = 64 yrs • The Bad (inequalities in health): • global life expectancy is an aggregate average • Disability Adjusted Life Years (DALY) • premature mortality + yrs of productive life lost owing to mortality & disease. • 1 DALY = 1 yr of healthy life lost • Comm. diseases account for 7% DALY in developed nations • 57% in developing nations

7. What is causing the disparity in DALY? • Health care infrastructure • Europe 3.9 per 1,000 • U.S. 2.7 per 1,000 • Sub-Saharan Africa 0.1 per 1,000 • Basic Research on diseases of Poor • small fraction of research papers dedicated to diseases of importance for developing nations • Drug Development • Of 1,233 drugs licensed (‘95-97), 13 (1%) tropical diseases • only 4 of 13, developed specifically for Tropical diseases of humans 4. Pharmaceutical Sales • N. America, Europe & Japan = 82% of sales • Africa = 1%

8. Cultural Vectors • Set of cultural characteristics that allow transmission (often from immobilized hosts to susceptibles) • care giving • irrigation, sewage & wells • boats, ships, trains & cargo • Forces of modernization can have important consequences for disease transmission • virulence • emerging diseases & susceptibility

9. Technological Change • increased Transportation • economic centers • population centers • Mixing & movement of peoples over short time • faster travel over larger areas • globalization fosters cheap air travel • Spreads new diseases or variants • Ex: SARS, Avian Flu, West File • large monoculture raising operations • Confined Animal Feeding Operations • animal feed, hormones, & antibiotics

10. Culture Change & Virulence • Virulence • Magnitude of neg. effect of a parasite on host • measured by mortality & morbidity • Insufficient time hypothesis • Not benefit of parasite to kill host • Evolve to be benign • High virulence = insufficient time to evolve • evolutionary epidemiology model of virulence: • virulence the product of host-parasite interactions • niche • transmission vectors • behavioral practices

11. Virulence: host-parasite relationship • Coevolution • Btw host-parasite/prey-predators • Resistance vs. Virulence • Why are vectorborne diseases more virulent? • Malaria, Chagas, Schistosomiasis, sleeping sickness • Case Study: Malaria • +ed breeding grounds (cultural) • +ed host density (social)

12. HIV/AIDS Epidemic in Africa • Found in OWM & Apes • Genetic evidence for 100 - 1000+ yrs of human infection • Sexual reproduction = mode of transmission • increased promiscuity = more virulent • Less partners = less virulent • Globalization = breakdown of traditional African culture • High Mobility in male wage workers • High levels of prostitution • Low levels of condom use

13. HIV/AIDS Epidemic in Africa • High levels & Virulence of HIV • Sub Saharan Africa • 25 mil living w/ HIV • 3 mil newly infected • 2.2 mil died in 2003 • Anti-viral Drugs • AZT • virus mutates rapidly

14. The Downward Spiral:Infectious Disease & Poverty • Unhealthy living conditions + likelihood of contracting diseases • Poor sanitation • Overcrowding & population growth • Poor infrastructure for prevention • malnutrition & hunger • Infection/Malnutrition Cycle Infection/parasite Load Malnutrition/Hunger Low Production

15. “Medicalization of Disease” • Cultural beliefs that many of today’s diseases can be “cured” by medicine • 20th Cent. Positivist ideals • Hunger/Malnutrition • Nervos • Antibiotics • Resistant strains - incomplete regiment • “cure alls” - viral infections

16. Rebirth of Tuberculosis • 20th Cent. antibiotics nearly eliminate TB • Few cases in Developed nations & controllable • Social & Economic chaos of Soviet Collapse • Overcrowding & few antibiotics • Improper healthcare in Russian prisons • Antibiotic resistant “Super Strain” • Slowly spreading from Russian Jails across world • May 2007, TB super strain patient travels from Atlanta to Paris after being warned by U.S. Govnt

17. Infectious Disease & Environmental Changes • Destruction of Environment • Logging, pasture, Dams, irrigation, etc • Bush meat trade & emerging infectious diseases • Destruction of local ecosystems • Balance of prey/predator interactions • +eszoonoses • Climate Change • Spread to new habitats • South moves North • West Nile, Malaria

18. Next Generation of Healthcare • Greater emphasis on prevention • Save more lives • Long-term = cheaper • Healthy people • “Evolutionary Epidemiology” • Prevention over treatment • Stress more control of disease transmission • Active role in selective forces of pathogens • Proposed Example: Influenza • Now: vaccine = most prevalent strain • Future: vaccine = only most virulent strains