Disease Dilemmas Case Studies

Epidemic of HIV/AIDS in Botswana

HIV/AIDS = is a virus that weakens the immune system and leaves the victim vulnerable to other life threatening diseases. At the end of 2016, it was estimated that 36.7 million people were living with HIV. 35 million poeple have died from HIV since iit's outbreak in 1981. In 2016, 360,000 people in Botswana wereliving with HIV.

International Strategies = The National AIDs Coordinating Agency increased funds from $274 million to $339 million in 2030. Many international donors have withdrawn funding due to Botswana becoming a EDC. For example, PEPFAR has halfed its funding from $84 million in 2014 to $39 million in 2015.

Government Strategies = Provides universal fee antiretrovial treatment for people with HIV. Provides HTC (HIV testing and counselling) through a network of public and private health facilities. Governments and external funders have supported voluntary testing services for people aged 18-49. Mandatory testing became legal in Botswana in April 2013.

Education Programmes = A programme called Talk Back was aired and TV and shown to 20,000 teachers and 460,000 students in Botswana. The Ministry Health and United Nations Development Programe (UNDP) was launched to improve teachers' knowledge to demystify and reduce stigma surrounding HIV. Makgabaneng, a radio serial drama in Botswana addresses a rage of themes related to HIV such as: faithfulness, cultural traditions and treatment. It also conducts roadshows and health fairs which has reached more than 20,000 people since 2013.

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Malaria in Ethiopia

Malaria = is a communicable disease caused by a parasite and is spread through vectors. North-East part of Africa. Ethiopia has a population of 86 million.

Patterns of the Disease = Malaria is at risk in the Western and Eastern lowlands and central mainlands like Guba. In places with an altitudes of 2000m and above such as Afar and Somali, there are less cases of Malaria. Places with open water sources have more cases.

Environmental Causes = high temperatures of approx. 21-32 degrees celsius, humidity, open water sources (breeding ground for vectors). Indirect effects are altitude, rainfall and vegetation.

Human Causes = high levels of urbanisation- more garbage dumps, discarded containers (beeding grounds), internal migration during harvest frin the highlands to the lowlands- which is peak malarial transmission period (monsoon), harvesting continues overnight and workers sleep in fields when mosquitos are most active, irrigation projects in Awash Vally - construction of canals, microdams, ponds and cultivation of rice.

Socio- Economic Impacts = kills 70,000 people a year, causes absenteenism from work- slow economic growth, cycle of poverty, cost to health services, damage to tourism which curtails inward investment, meagre farming sources overexploited- widespread land degredation.

Strategies to Control Malaria = DIRECT - eradicating mosquitos through destrying breeding sites, spraying insecticides on dwellings. INDIRECT - mass publicity campaigns, early diagnosis and treatment, distributing insecticide treated bednets. Death rates from Malaria have halved between 2000 and 2010.

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Haiti Cholera Outbreak 2010

Background Info = is an acute intestinal infection that causes sickness, diahorrea and dehydration. Haiti is on the Caribbean island of Hispaniola. It is surounded be Caribbean Sea and is East of Mexico. The outbreak was caused by an earthquake of Magnitiude 7 as an Aid Worker brought the disease into Haiti.

Environmental Factors = Haiti is a tropical climate- a hurricane followed the earthquake, lack of clean water and sanitation services caused a rapid spread of Cholera- only 69% of population had access to an imporved water source, rainfall and flooding contributed to the spread of contaminated water, elevated air tempratures produced optimal conditions for Cholera.

Human Factors = poverty- majorrity of people live in shanty towns which are overcroded meaning disease spreads quicker, public services are limited and ill eqipped, lack of general awareness regarding the importance of sanitation and hygine, over population- 10 million residents, high levels of internal migration- disease spreads to ne area, damage to infrastructure from earthquake meant that people used te river for cooking,cleaning and toilet, refugee camps. Haiti is the poorest country in the Western hemisphere.

Impacts of Cholera  = farmers and labourers rely on harvest rice but refuse to go into marsh like paddies due to the fear that they will get Cholera, less food available, no jobs for those that assist farmers, meat prices in the local markets have tripled as peple are afraid to eat fish from the river, labourers that are willing to work are charging premium so farmers have no money.

Strategies to Minimise Impacts = vaccinate the population at risk in vulnerable areas, education on sanitation, establish local community health clubs, construct and repair water supply networks,remove waste, ensure all health professionals are trained in the fundamentals of combating Cholera.

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British Red Cross Responses (to Cholera Outbreak i

Delivering Clean Drinking Water - to 300,000 people living in refugee camps in Port-au-Prince. - = clean drinking water won't last  only short term.

Treating Cases of Cholera - 18,700 cases of Cholera treated in treatment units in La Piste refugee camp in  Port-au -Prince. - = 7,000 peple in Haiti died from Cholera, could not get to everyone.

Massive Hygiene Programme - building 100 latrines to serve 250,000 people. - = latrines will need to be maintained and are time consuing to build.

Providing Medical Supplies - to the main hospital in Saint Marc in the affected area. - = medical supplies needed to be provided in other areas also.

Raising Awareness - on how to avoid infection and the symptoms of Cholera. - = locals may treat Cholera as a taboo and not want to talk to them.]

In 2011, there was 35,000 cases of Cholera each month n Haiti. In 2014, there was only 2,200 cases of Cholera each month- work has been EFFECTIVE.

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Opium Poppy

Growing Conditions and Locations - grows in clay, sandy, sandy loam and sandy clay soils with a pH of 6-7.5. Flourishes in dry,warm climates. Mountainous regions, with precipitation of 150-300mm/ year. LEGAL LOCATIONS= India, Turkey, Australia. ILLEGAL LOCATIONS= Afghamistan, Thailand, Vietnam.

International Trade -HISTORIC- in the 1800s, East India Company began smuggling Opium into  China. There were Opium wars during the 19th century. LEGAL - up to 100,000 small scale Opium farmers in Turkey cultivating 0.4 hectares, in Australia, cultivation is restricted to Tasmania which produces 49% of the World's legal supply.

Medicinal Importance - HISTORIC - in 1803, Morphine was extracted from Opium resin and has since been widely used by physicians for pain relief. Codeine (component of Morphine) is medically prescibed for the relief of moderate pain and cough suppression. The manufacture of Morphine has increased rapidly. No drug has beem dicovered that equals the anagelsic effect of Opium.

Sustainable Use - CONSUMPTION - eduction prevention campaigns focus on women, youth and prisoners. Media campaigns to raise the awareness of the dangers. Treatment and rehabilitation for those who become addicted to Opium. Criminalisation of Opium Use so less people take it. PRODUCTION - provide alternative incomes for those inrural poverty that produce illicit opium that could produce nuts and fruits instead. Legalise Opium production as there is a global shortage of pain killers. Destruction of Opium crops so farmers are not abused anymore by drug lordes.

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GlaxoSmithKline (GSK)

Background Info - Vaccines= deliver 2 million vaccine doses per day to people living in over 160 countires. Pharmaceuticals - development and research into new medicines. Consumer healthcare = business develops and markets consumer preferred and expert recommended brands in many categories e.g. pain relief.

Scientific Breakthroughs- inhaler innovation as over 200 scientists and engineers created the dry powder inhaler Ellipta, which allows up to 3 medicines to be taken via 1 inhaler. + = studies on Ellipta in comparison to Diskus inhalers show people prefer the Ellipta due to the ease of use, the dose counter and the feels and fit of the device. - = is expensive to produce.

Patents- new patent policies created by GSK make it easier for the world's poorest countries to access drugs- up to 127 developing countries. + = could encourage generics manufacturers to invest in providing cheaper medecines.

Drug Manufacturing- GSK set up a manufacturing base in Iraq in 2011. They said producing drugs closer to the customer would improve their cost base and enable them to sell products at an 'access price.' + = more jobs. Enables doctor's to bring more of GSK's cutting edge medecines into the private market.. - = GSK was called to review it's manufacturing operation globally after US Drug Association found that its Canadian subsidary violated quality requirements during the manufacture of FluLaval.

Global Distribution Flows- based in the UK. some products require chemical comounds bought from Scotland, Singapore, The Netherlands and Germany. About 95% of inhalers produced are exported to the likes of China, South Korea and USA. += more countries are recieving medecines which improves medical care. - = staff members have been slashed by 50% in the past 2 years.

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Cancer in UK

Cancer is a disease caused by an uncontrolled division of abnormal cells in a part of the body.

Causes of Cancer - SOCIAL= obesity,poor diet, lack of exercise, smoking, alcohol abuse and use of sunbeds. Also if the occupation involves more exposure to radiation or asbestos. ECONOMIC= growing wealth means people can afford to go on holidays and sunbathe, more disposable income to buy alcohol and food. CULTURAL= lifestyle of drinking alcohol, smoking, eating unhealthy foods and tanning (North).

Distribution -the highest incidences of cancer are in the North west and the North east. London has the lowest number of incidences followed by East of England. Yorkshire and The Humber have the highest rate of incidences of the disease. (highest in the North).

Why worse in North-there is more deprivation, unhealthy lifestyles and smoking. NE is the fattest area in the country. NE's rates of smoking in pregnancy are the worst in England- 2014 there were 1829 cases.

Direct Strategies to combat- reduce waiting time between diagnosis and treatment, investment in advanced medical technology, radiotherapy and chem,otherapy, Cancer UK conduct research pm causes, prevention and treatment of Cancer.

Indirect Strategies to combat - legislating to control the commercial use of sunbeds, advice on sunscreens and self examination for cancerous lesions. Education and health campaigns on the dangers of smoking, drinking and an unbalanced diet. MET Office regularly forcasts on UV intensities amd safelimits of exposure.

360,000 people in the UK are diagnosed with Cancer every year

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Air Pollution in India

Causes of Air Pollution - fuel and biomass burning- used for cooking and heating. 200 million tonnes of biomass is burnt annually. Emission standards- many cars lacked catalytic converters which meant vehicle emissions are high. Fuels were toxic because government regulations were lax. Traffic congestion- lack of divided lane highways, poor enforcement of traffic laws and increased car ownership causes this. Greenhouse gas emissions- India was the third largest emitter of CO2 in 2009.

Impacts of Air Pollution - reduces average life expectancy of 660 million Indians by more than 3 years. Indoor air pollution is responsible for 1 million premature deaths per year. Respiratory problems such as asthma, bronchitus and lung disease. Respiratory symtoms such as chest discomfort. Lung function in Dehli is 40% reduced compared to 21% in rural areas.

National and Global Solutions - GOVERNMENT STRATEGIES- launching CAM-India (Clean Air Mission) to monitor amd reduce pollution air levels cross power, transport, residential,energy, industry and agriculatural sectors. Develop ERP (Emergency Response Plan) to reduce emissions during periods of high levels of pollutants. TRANSPORT SECTOR STRATEGIES- shift freight transport from road to lower-emission modes such as rail, inland waterways amd coastal shipping. RESIDENTIAL SUPPORT STRATEGIES- provide cleaner fuels such as LPG or 50% more efficient biomass stoves for those that can't afford LPG. AGRICULTURAL SECTOR STRATEGIES- convert agricultural waste and manure to electricity for rural areas. INDUSTRIAL SECTOR STRATEGIES- deploy national Emission Trading Schemes (ETS) with cap-and-trade for power generation and other large polluting industries.

Air Pollution causes 1.2 million deaths in India annually.

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