I chose this video (http://www.youtube.com/watch?v=4eJs5bqmJ-c) to look into.

Dr. Colin Soskolne talks about what epidemiology is, and what its connections to environmental health are. He begins by defining epidemiology as "a study of diseases as they affect populations" and adds that in addition to diseases, it is also concerned with general social well-being. It is his view that epidemiology has always been important, but emphasizes the re-emerging concern for infectious diseases from the 1980s as one of the reasons it is gaining in importance in recent years.

According to Soskolne, the link between epidemiology and environment is the effect bad quality soil and water, and environment in general, have on the well-being of people, and what can be done about it. He explains that the job of an epidemiologist is to find out how bad the situation is, how badly the environment is effected, and how much time do we have to correct the situation we ourselves have caused.

Soskolne thinks that the problem with our society today is that we do not think far enough. That we are too occupied with today and tomorrow while we should be paying attention to ten or twenty or indeed decades ahead. He says we ought to think about what kind of world we will be leaving for those who come after us. He sees his own role, as well as the role of his colleagues, is to make people see the kind of situation we are in because of the damage done to the environment, and to prevent the worst-case scenario from happening.

Although the underlying factor for malaria and many other infectious diseases, spreading is poverty and can be controlled by reducing poverty, there is a cheap and easy way to prevent malaria on a more specific level. The use of insecticide-treated nets for especially children and pregnant women is very effective. To spread information about the nets and their use is a good way of preventing malaria. In addition to this, the indoor residual spraying of insecticides helps, as well as getting an early diagnosis and quick treatment for the disease. Also, controlling the environment to control mosquitoes, is a way to prevent malaria.

In order for us to fight against infectious diseases on a global level, there are several issues we must take into consideration. Firstly, there is the poor condition of health care systems in developing countries which often prevents treatment and information from reaching people. If more development assistance would be directed at improving health care systems, it would be of immense help in preventing infectious diseases. Also, money should be used to ensure primary heath care.

Increasing access to effective drugs is one of the main strategies to fight infectious diseases. The attitude of developed countries and medicine corporations should be changed for the better, so that development of new, more effective drugs would be done.

http://www.unmillenniumproject.org/documents/TheLancetHealth.pdf

http://www.who.int/features/factfiles/malaria/malaria_facts/en/index.html

http://www.who.int/features/factfiles/tb_facts/en/index.html

It could be said that the main cause for child mortality is poverty and everything that comes with it. Firstly, malnutrition makes children weak against diseases. Pneumonia, diarrhea etc. are a major cause for child mortality. In addition to hunger, children also suffer from lack of proper medication, with which their deaths could be prevented. Secondly, poverty often means poor public health services, lack of sanitation and lack of clean water. Because of the latter two, children will get ill, and because of the first, they will not get treatment. Also, there is a strong possibility that the personnel in a hospital is not qualified. All in all, poverty seems to be underlying reason behind most deaths.

In addition to the above, there a few factors which worsen the situation. Rural areas, for example, are often without decent health facilities and are hard to reach. This puts the children in rural areas at a disadvantageous position. Also, in countries in which there is conflict, or which is moving from war to peace time, the conditions for children are bad and lead to health problems.

As far as mothers are concerned, the greatest threat to their health seems to be insufficient or unskilled care during pregnancy and delivery. Most women in developing countries do not get proper care. This could be due to , for example, remote location, lack of education or, as already mentioned, to unqualified personnel at the health centre. And so women die of things which could have been prevented.

Women are also threatened by genital mutilation, unsafe abortions, early marriage, violence and lack of medicine. They may also suffer health problems as children and never quite recover well enough. As with children, poverty is a major reason for many of the problems, and added to that there is often social pressure on women to do things which are not good for them in general and in pregnancy and delivery in particular.

http://www.childinfo.org/mortality_challenge.html

http://www.who.int/features/factfiles/child_health2/photo_story/en/index6.html

http://www.childinfo.org/maternal_mortality.html

http://www.who.int/mediacentre/factsheets/fs241/en/index.html

There seem to be several issues which affect the percentage of school attendance in general and particularly attendance by gender. I will address two of the most obvious ones here.

Firstly, and perhaps most obviously, there is the matter of conflict in the area. This does not only effect overall attendance rates, but gender-specific rates as well. There are many examples of this. In Afghanistan, the net primary education attendance ratio is 66 for boys and 40 for girls. In Pakistan the corresponding figures are 62% for boys and 51% for girls. It seems natural enough, that if it not safe to go to school, parents are not willing to send their children to school.

Secondly, there is the poverty factor. In countries where poverty is a major problem, attendance rates are not as high as in richer countries. This seems to be in accordance with the idea that better education has, on the long run, a positive impact on economy. I suppose when one is very poor indeed, one does not see the big picture, as they say. Maybe it does not seem to make much sense to send children to school when their effort is needed, e.g. in the fields, for the meal of the day. If one looks at the figures for Niger, for example, one can see that only 36% of boys attend school, and only 25% of girls do the same.

In addition to these two major factors, there are other things which affect school attendance. These include culture (whether education is highly regarded and whether women are thought to be in need of education), how long comprehensive education has been around in the country (If the parents, especially the mother, have not gone to school, it might not be clear to them what benefits education can bring.) and accessibility (if there are few schools in the rural area for example)

Sources:

http://www.unicef.org/sowc08/docs/sowc08_table_5.pdf

http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTEDUCATION/0,,contentMDK:20298916~menuPK:617572~pagePK:148956~piPK:216618~theSitePK:282386,00.html

http://news.bbc.co.uk/2/hi/country_profiles/default.stm

Farmer et al (2006) introduce in their article the idea of structural violence. Rather than the usual conception of violence as an individual doing bodily harm to another, structural violence is described as the harm to people caused by social structures such as educational and economical institutions. They explain that, for example, certain health policies may prevent or at least make it very difficult for some social groups to get proper treatment. They suggest, that recognising structural violence as what it is, and applying our knowledge of it, we are much better able to channel our resources for human development.

As I see it, the idea of structural violence is yet another proof of health and poverty being very complex issues which should be acted upon on many levels. If even defining poverty is difficult, then fighting against it effectively must be all the more difficult. What is needed, then, is solid theoretical framework, proper statistics and sound policies on various issues affecting poverty and health. What the concept of structural violence can help with, is theoretical framework. It helps finding out what the problem areas are in our society.

Sources:

Dying for change. Poor people's experience of health and ill-health. WHO & The World Bank.

Farmer, P., Nizeye, B., Stulac, S. & Keshavjee, S. 2006. Structural Violence and Clinical Medicine. PLoS Medicine, Vol. 3(10).

Poverty in Focus 2006. What is poverty? Concepts and measures.

Sanchez, P. & Swaminathan, M.S. 2005. Hunger in Africa: the link between unhealthy people and unhealthy soils. The Lancet, Vol. 365, 442-444.