Statistical Analysis: Causes and Death and Illness

Statistical Analysis: Causes and Death and Illness Meagan Atcheson The statistics around causes of death are imperative as well as vital in determining and monitoring the health status of populations as well as for identifying critical priorities for various health systems. Most industrialized countries have effective systems in place to determine the main causes of death. In contrast to this, developing countries are not as advanced in placing such systems which proves detrimental in trying to improve the overall health of the nation. Indeed, there are vast differences in the top causes of death within developed countries versus the developing countries. This essay will compare and contrast the top five causes of death in the United States of America and in South Africa as well as provide evidence and explanations for these differences. Moreover, it will critically discuss the risk factors, health policy, disease progression and treatment advances or lack thereof with regard to particular causes in each context. Finally, it will address certain app roaches needed to improve the health of populations. The most fundamental aspect of any health policy looks at methods to maintain as well as improve the health status of a population. Defining the health of a nation as well as how health is measured is critical to any health care system (Kronenfeld, 2002). The World Health Organization defines health not only in terms of the negative definition where health is seen as the absence of disease but also incorporates physical, mental and social well being (World Health Organization, 1948). Mortality rates are the basic form of measurement needed to asses health status. By counting the number of deaths in a year and comparing it to preceding years, the health status of various populations can be determined (Ogden, 2007). Health statistics have shown that diseases, their occurrence as well as mortality rates differ from one country to the next; more specifically developed countries as opposed to developing countries (Tool Tool, 2004). Developed or industrialised countries such as the USA are typically more economically advanced with a high level of economic growth and standard of living as well as advanced technological infrastructure. In contrast to this, developing countries like South Africa have a lower standard of living, are under industrialised and have poorer economic growth (Szirmai, 2005). Ranking causes of death is an extremely useful method for representing mortality statistics (Ogden, 2007).The U.S department of health and human services released a report at the end of 2009 on the leading causes of death in the United States by age, sex and race. The top five causes death in rank order were found to be; diseases of the heart; malignant neoplasms; chronic lower respiratory diseases; cerebrovascular disease and accidents (unintentional injury). It is imperative to note the differences in ranks for age. For example the leading causes of death for infants were accidents; congenital malformations; deformations; chromosomal abnormalities and malignant neoplasms. This differed to the age group of between 2-44 years where the leading causes were unintentional injuries, homicide as well as suicide. For individuals over 45, the primary causes of mortality respectively were heart disease and cancer. Certain variations and similarities exist between the different genders. For b oth genders, heart disease and cancer were the first and second leading causes of death. The third cause for men was unintentional injury versus stroke for women. The fourth leading cause for both sexes was chronic lower respiratory disease followed by stroke for men and Alzheimer’s for women. Little deviation was found among the different races (Heron, 2012). These results remained the same for data collected in 2011 (Hoyert Xu, 2012). The South African statistical release for 2010 showed Tuberculosis (TB) to be the leading natural cause of death. The second leading cause of death was influenza and pneumonia. The third primary cause was intestinal infectious diseases followed by other forms of heart disease (not Ischaemic) and then cerebrovascular diseases. The first two causes; tuberculosis and influenza and pneumonia were the top two causes for both male and female. The third leading cause for women was cerebrovascular disease followed by intestinal infectious disease and then other forms of heart disease. This differed to that of the male group whose third leading cause of death was intestinal infectious disease followed by other forms of heart disease and then cerebrovascular disease. The age group as well as the various provinces in South Africa were included in this statistical report to illustrate slight differences in the top causes of death. In the Free State as well as in Limpopo, the leading cause of dea th was influenza and pneumonia unlike all other states where tuberculosis remained the main cause of death. The major death cause for children below the age of fifteen years was intestinal infectious disease compared to the age group 15-64 whose main reason for death was due to TB. For those aged over 65, cerebrovascular disease caused the most deaths (Statistics South Africa, 2010). Being a developing country, South African individuals face a high risk of contracting and dying from Tuberculosis. Tuberculosis is a disease where bacteria enters and invades various body tissues such as the lungs, brain and kidney. It is spread from individuals who contain the untreated, active form of the Tuberculosis bacteria through droplets releases into the air via coughing, sneezing or speaking (Wouk, 2010). Although there are numerous risk factors for TB, it mostly affects poorer individuals who are living in rural areas with a lack of affordability for transport as well as treatment, people with weak immune systems, those who lack access to Directly Observed Treatment, Short course (DOTS) as well as those who are uninsured. Furthermore, the strongest risk factor for the development of TB is HIV. These two diseases continue to have a deadly association as each drives the development of the other. Drug resistant strains of the TB bacteria is a huge risk factor leading to the e normous amounts of deaths in South Africa (Davies, 2005). Moreover, the poor health care system as well as the limited number of properly trained health workers in South Africa threatens the majority of people who contract Tuberculosis (Downing, Gwyther, Mwangi-Powell, 2012). The National Department of Health in South Africa implemented the National Tuberculosis control programme which aimed to reduce mortality due to TB as well as prevention of drug resistance development by 2005. However, the health policy surrounding TB in South Africa needs to be strengthened considerably in various areas. Firstly, public health services need to improve DOTS implementation as well as more emphasis needs to be placed on access and utilisation of health services (World Health Organization, 2009). Moreover, different approaches need to be taken in regard to the HIV on TB relationship. Furthermore, higher quality strategies are needed for better TB diagnosis and treatment (South African Department of health, 2004) Although TB is curable, it is the progression from latent TB infection to multidrug- resistant TB that results in the high mortality figures in South Africa. Individuals with latent TB infection show no signs and symptoms of the disease as it is still in the harmless stage. However, if these individuals do not receive proper treatment, reflecting majority of the cases present in South Africa, it develops into TB disease. It usually starts out with damage to lung tissue but often lands up affecting many body tissues and organs. Moreover, TB is extremely resilient and adaptable. Often in developing countries, the right combination of drugs are not taken for the right amount of time due to a large number of reasons such as poverty and this then leads to multidrug-resistant TB. If left untreated multi-drug resistant TB can be fatal (Dyer, 2010). There have been major efforts to improve TB control and treatment in South Africa. Fixed dose combination tablets (FDC’S) were introduced in 2000 in the hope of prevention of resistance and easier administration. Together with the combination tablets, directly observed treatment is enforced to ensure treatment adherence and to help prevent emergence of drug resistance (South African Department of health, 2004). Despite these efforts, the TB incidence and fatality rates still continue to increase. It is therefore not a lack of treatment that hinders South Africa from reaching their target for TB control, but rather a lack of appropriate infection control measures in public health settings together with the high prevalence of HIV that results in increased numbers of drug resistant TB cases (Weyer, 2007). Heart disease in developed countries like the United States is mostly attributed to individual behaviour and lifestyle unlike TB in South Africa. This disease can be linked to risk factors such as smoking, unhealthy diet, alcohol abuse, diabetes, lack of physical activity as well as high blood cholesterol and blood pressure. Age, heredity and gender also play a role in the development of heart disease (Brannon Feist, 2010). In contrast to developing countries, Americans face very different risk factors which can often be attributed to their fast paced and busy lifestyles. America implemented a public health action plan to prevent heart disease and stroke which addresses an urgent need for the action of prevention. This is in contrast to South Africa’s health policy that still needs to be strengthened. Public health agencies together with the general public of America are needed to help promote the national goals of preventing heart disease as support for these health programmes continue to remain low. The American health action plan aims to improve cardiovascular health through prevention, early detection as well as treatment of various risk factors. This plan also includes developing new health policies that includes innovative intervention programmes for especially high risk groups that will result in measurable impacts (U.S. department of health and human services, n.d.) Heart disease is a chronic condition that tends to get worse over time. Unlike TB, heart disease is not infectious and cannot be spread from one person to the next which is often the case in small areas such as the townships in developing countries. Heart disease is mostly a direct result of lifestyle choices. Furthermore, the progression of heart disease can become extremely unpredictable as it is different for each person. In some instances, the symptoms of the disease can remain stable over months or even years before becoming worse, while in others these symptoms may rapidly development. In America, early stages of heart disease are seen as early as age 15. Hypertension as well as other cardiovascular risk factors has all been linked to the progression of heart failure (Abraham, 2001). New treatments for heart disease have dramatically improved the life expectancy of these individuals in America. Drugs such as statins, antihypertensive agents, thrombolytic agents, anti-platelet as well as anti-coagulation therapies have all proved to be effective treatments. Moreover, novel device based therapies is an advancement in treatment that has contributed to a decline in cardiac mortality in the United States. Through being a developed country, they have access to modern genetics and genomics that will allow for more targeted use of drugs to emerge in the future which will greatly improve the effectiveness of therapy. This is in contrast to South Africa’s limited resources and modern medical advances that still allow drug resistant TB to be a major cause of death (Weisfeldt Zieman, 2007). Apart from cerebrovascular disease and some forms of heart disease, the leading causes of mortality differed significantly between the United States and South Africa. These variations can be explained by the different risk factors, health policies, disease progressions as well as treatment advances or a lack thereof between the two countries. In contrast to developed countries, developing countries have vastly different health priorities due to a diverse set of risks. The many factors such under industrialization, high unemployment rates, underdeveloped health care system as well as the low standards of living is the answer to why causes of death are so unalike. Moreover, the problems in the quality of health care need to be addressed in order to see the health of South Africans improve. In America, additional intervention programmes need to be introduced to help better the health status of the nation. Furthermore, through the comparisons of the approaches South Africa takes in regar d to Tuberculosis versus the approach to heart disease taken in America, proper explanations of the mortality cause differences can be seen. References: Abraham, W. T. (2001). Anti- adrenergic therapy in hypertensive patients with concomitant  disease. In L. Ryden (Eds.). Disease progression throughout the cardiovascular continuum. (pp. 25-26 ). Germany: Springer- Verlag Berlin Heidelberg. Brannon, L., Feist, J. (2010). Health psychology: an introduction to behaviour and health  (7th Ed.). USA: Wadsworth Cengage Learning. Davies, P.O. (2005). Risk factors for Tuberculosis. Monaldi Arch Chest Dis, 63(1), 37-46. Downing, J., Gwyther, L., Mwangi- Powell, F. (2012). Public health and palliative care: a  perspective from Africa. In L. Sallnow, S. Kumar, A.Kellehear (Eds.). International perspectives on public health and palliative care. (pp. 69- 84). Oxon: Routledge. Dyer, C.A. (2010). Biographies of disease: Tuberculosis. California: Greenwood Press. Heron, M. (2012). Deaths: Leading causes for 2009. National vital statistics reports, 61(7).  Hyattsville, MD: National Centre for Health Statistics. Hoyert, D.L., Xu, J.Q. (2012). Deaths: Preliminary data for 2011. National vital statistics  reports; vol 61 no 6. Hyattsville, MD: National Centre for Health Statistics. Kronenfeld, J.J. (2002). Health care policy: issues and trend.USA: Praeger Publishers. Ogden, J. (2007). Health Psychology (4th Ed.). England: Open University Press. South African Department of Health. (2004). The South African National Tuberculosis  Control Programme: Practical guidelines. Retrieved from http://www.kznhealth.gov.za/ Statistics South Africa. (2010). Mortality and causes of death in South Africa: findings from  death notification (P0309.3). Pretoria: Statistics South Africa. Retrieved from www.statssa.gov.za/publications/P03093/P030932010.pdf Szirmai, A. (2005). The dynamics of socio-economic development. UK: Cambridge  University Press. Toole, G., Toole, S. (2004). Essential AS Biology for OCR. UK: Nelson Thornes Ltd. U.S. Department of Health and Human Services, Centers for disease control and  Prevention.(n.d.). A public health action plan to prevent heart disease and stroke. Retrieved from www.cdc.gov/dhdsp/action_plan/pdfs/action_plan_full.pdf Weisfeldt, M. L., Zieman, S.J. (2007). Advances in the prevention and treatment of  cardiovascular disease. Health Affairs, 26(1), 25-37. doi: 10.1377/hlthaff.26.1.25 Weyer, K. (2007). Case study: South Africa. Bulletin of the World Health Organization,  85(5), 325-420. World Health Organization. (1948) Preamble of the Constitution of the World Health Organisation as adopted by the International Health Conference. Geneva: Switzerland.   World Health Organization. (2009). WHO policy on TB infection control in health care  facilities. Geneva: WHO Wouk, H. (2010). Tuberculosis.NY: Marshall Cavendish Corporation. Is Globalisation Undermining State Sovereignty? Is Globalisation Undermining State Sovereignty? Is globalization undermining state sovereignty? Throughout the years it has been argued that globalization has a significant effect on state sovereignty. That ongoing debate between scholars and social scientists is trying to determine whether or not state can still maintain its own sovereignty. Weiss (1998) suggests that there are certain factors such as investments in international economy, multinational corporations and non-governmental organizations which undermine the state sovereignty. On the other hand, Krasner (2001) argues that in the past similar things such as free trade existed and state sovereignty was able to dominate. The essay will focus on defining globalization and sovereignty. Then it will observe how multinational corporations, inter-governmental organizations, open market economy and international crime can reduce state’s power and therefore undermine sovereignty. Sovereignty is a very broad term which Barkin and Cronin (1994, p.107-30) simply defines as the power of state to make and amend any law within its own state boundaries. Moreover, sovereignty is defined as the â€Å"absolute supremacy over internal affairs within its territory, absolute right to govern its people, and freedom from any external interference in the above matters† (Martinez, 1996; Wang, 2004, p.473). The state is the supreme political authority within its territory and therefore it does not recognize any higher political authority outside it. With this definition it would be easier to determine whether or not globalization affects certain aspects of it. Beekens (2003, p.130) illustrates globalization as the â€Å"world-wide interconnectedness between nation states supplemented by globalization as a process in which basic social arrangements (such as power, culture, markets, politics, rights, values, norms, ideology, identity, citizenship, and solidarity) become disembedded from their spatial context (mainly, the nation-state) because of the acceleration, massification, flexibilisation, diffusion, and expansion of transnational flows of people, products, finance, images, and information.† Therefore, first we are going to observe how economic factors of globalization – free market, increasing power of multinational corporations affect the state sovereignty. The end of the World War Two and the Cold War led to a more open world economy market to countries and individuals as a result of globalization. Therefore, international trade between countries increased significantly where foreign direct investments and multinational corporations participated too. Since there was an open free market some countries reached GDP as never seen before. For example, a drastic changes can be seen in countries such as France where the GDP export ration rose almost four times and in the United States where it doubled (Michie, 2011, p.30-40). Michie (2011, p.40-43) also mentions that these examples show us that international trade has grown with time leading to economic dependency between countries which undermine state sovereignty. This dependency gives the power of other countries to manipulate and control the economy of another country. For example, in order to attract more consumers for its goods and services, China buys US bonds to maintain the US dollar currency high. This undermines states sovereignty, because it undermines the â€Å"absolute power of a state over internal and foreign affairs within its own boundaries† (Wang, 2004, p.474-76). In this way US is dependent on China to buy their bonds. Multinational corporations and their foreign direct investments are another part of globalization which undermines state sovereignty. The investments only in the developed countries have risen from 17 to 25 percent between 1990 and 2000 which simply shows that the multinational corporations are a big part of the production and manufacturing of goods and services in few countries (Michie, 2011, p.45-50). Furthermore, between 1960s and 1970s there was an increase in foreign direct investments by EU and US multinational corporations which attracted other countries to get involved too. Strange (1996, p160-80) argues that globalization has increased the powers of multinational corporations making the state sovereignty weaker. Furthermore, Strange notes that the advancements in technology, wider communications, international trade and transportation are parts of the globalization process which is also seen as an impact on state sovereignty. For instance, states do not have full authority o ver individual businesses which operate in the free market economy. As a result of globalization there is an increased competition between international businesses and therefore, state sovereignty is undermined because it questions the power of the state over its internal affairs (Strange, 1996, p181-99). The biggest challenge which state sovereignty is facing even now is international crime. This is when the state cannot protect its citizens from external or internal affairs as for example terrorism. To prevent that governments form inter-governmental organizations. These organizations are not profit organizations and their target is to resolve concerns and problems that affect the world. Such organisation is the United Nations. A good present example of an international group which pose a threat to state sovereignty is Al Qaeda. As Aydinli (2006, p.35-45) says, the attacks on US and Spain in 2000 undermined their state sovereignty because they were not able to protect their citizens. On the other hand, in the same year the United States also intervened Iraq and Afghanistan ignoring the United Nations. This could also be seen as international crime because they ignored state sovereignty and just went into these Middle East countries blaming them for supporting terrorism. Despite the fact that the inter-governmental organizations are supposed to promote peace, sometimes they violate state sovereignty too. For example, in 1999 NATO intervened Federal Republic of Yugoslavia in order to prevent more â€Å"humanitarian suffering and more repression and violence against the civilian population† (Solana, 1999). This can be seen as an example of countries, members of NATO, trying to stop this humanitarian catastrophe. Although NATO’s actions were legal and justified, the government of Yugoslavia undermined sovereignty by putting its own citizens in danger. This contradicts to one of the aspects of state sovereignty in which the state should protect its own population. Another example is Mali. France, which is a key ally in NATO and UN, started a military campaign in Mali again the jihadists which led to an â€Å"intensive airstrikes† in order to block them (Hammond, 2013). In this case NATO affects the state sovereignty because they intervene to protect the people, whereas the state has to govern and protect its own citizens. This intervention might lead to further violations of human rights or even ethnic conflicts, even though the purpose of this intervention was to stabilize the country. Therefore, as Albala (2005) says, the actions of these inter-governmental organizations undermine the aspects of state sovereignty as they move into other state`s territory and also participate in the internal and external affairs of the state. Also the international community is currently condemning Russia for undermining the sovereignty of Ukraine. It is unclear if internal sovereignty will be possible. Furthermore, Russia will support protests against the new government even if they have to use military power. Russia has also withdrawn their loans from Ukraine making them dependent on Western financial support. At the same time, the territorial integrity of the country is partly at stake as long as pro-Russian parts of Ukraine might feel threatened by the clear pro-Western course of the new intermediate government.This can also be seen as another example of undermining state sovereignty. Globalization is not just a threat to state sovereignty, it is more like a threat to culture and national identity. For example, at no point in the history of the EU or ECC as it was called erasing borders and merging states have been seriously considered. Despite the fact that the European Union is an inter-governmental organization seeking for peace and development, it opens the borders between the member countries. Free market economy, free trade and immigration have shaped the EU more as one state than an organization. That occurs because the open boundaries lead to merging the cultures and national identity is fading away. All this can raise questions to Member states whether or not their national identities and state sovereignty are undermined. Moreover, it does undermine the state sovereignty but in a different way – throughout international law. International law has been affected by globalization in terms that it makes the international law into a global public law (Garcia, 2005, p.1-2). What it means is that globalization is actually trying to expand the â€Å"domain of justice† (Garcia, 2005) from domestic to global. An example is the European Union. When a country in the EU wants to make a law, firstly they have to follow the agreements on European Law and regulations. Garcia (2005, p3) says that â€Å"International harms to individuals are understood within a framework of harm to a state’s rights†. Simply, the state cannot claim laws as it wishes and it also has no sovereign power on internal and external affairs Furthermore, other form of international organizations are the international non-governmental organizations. They start as small community groups where some of them work also with the government, aiming to help where the government is struggling (Baylis, Smith Owens; 2011). However, these organizations have spread their work on a global scale and their influence has risen. Inter-governmental and international non-governmental organizations have one target which is global governance – where transnational actors aim to solve problems that affect more than one state. Such organizations are the Red Cross, Care International, Oxfarm International. When one of these international NGO goes into a country with a stated purpose as for example to give medical help or fight against violence as Amnesty International does in Somalia, they agree not to get politically involved in anyway. If their work is, for example, then stopped by the government who accuses them of showing a bias in whi ch they treat and expel them from the country then the NGO can complain to the UN and ask for support to continue their work. Recently, Amnesty International has requested the UN Security Council to â€Å"tighten arms control embargo on Somalia† (Amnesty International publication; 2014). Last year the UN Security Council allowed Somalia to import small arms and light weapons (Amnesty International publication; 2014)). The intergovernmental organization weakens the state sovereignty in that case because despite the fact that they have stabilized the country on first place, their actions have made the government weaker to defend its sovereignty. To summarize, we first looked at what state sovereignty and globalization mean followed by criticism about the influence of globalization over states. We saw how foreign investments by the multinational corporations and the increasing dependency between economics markets as such as the case with United States and China. State sovereignty was undermined because governments became more unstable and lost control over international businesses becoming dependent on them for proving jobs and taxes. This also undermines one of the main principles of state sovereignty which was the absolute power of the state over its internal affairs, citizens and freedom (Martinez, 1996; Wang, 2004, p.473). Globalization has also brought international crime and international organizations which undermine state sovereignty in different aspects. Terrorism as we mentioned weakens the state making it unable to protect its own citizens. Globalization has been also seen to undermine national identity and state v alues as with European Union where the European Supreme Court acts as highest law within the European Union. Since some governments cannot guarantee protection there are inter-governmental and international non-governmental organization such as NATO, Amnesty International, United Nations which intervene to help those countries such as Yugoslavia, Mali and more recently Ukraine and Somalia. Although they have been also seen to undermine state sovereignty because sometimes as with Somalia, the international organizations have even worsen the situation. With all these factors of globalization – free market economy, multinational corporations, foreign direct investments, international crime and international law it can be concluded that state’s sovereignty and control over its territory has declined throughout the years due globalization. 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