18.2 Health and Medicine in International Perspective

International Disparities in Health and Illness

Two-thirds of the 33 million people worldwide who have HIV/AIDS live in sub-Saharan Africa. This terrible fact illustrates just one of the many health problems that people in poor nations suffer.

khym54 – AIDS Orphans and their Guardians in Sophia Village – CC BY 2.0.

The nations of the world differ dramatically in the quality of their health and health care. The poorest nations suffer terribly. Their people suffer from poor nutrition, unsafe water, inadequate sanitation, a plethora of diseases, and inadequate health care. One disease they suffer from is AIDS. Some 33 million people worldwide have HIV/AIDS, and two-thirds of these live in sub-Saharan Africa. Two million people, most of them from this region, died in 2008 from HIV/AIDS (World Health Organization, 2010). All of these problems produce high rates of infant mortality and maternal mortality and high death rates. For all of these reasons, people in the poorest nations have shorter life spans than those in the richest nations.

A few health indicators should indicate the depth of the problem. Figure 18.1 “Infant Mortality for Low Income, Lower Middle Income, Higher Middle Income, and High Income Nations, 2008” compares an important indicator, infant mortality (number of deaths before age 1 per 1,000 live births) for nations grouped into four income categories. The striking contrast between the two groups provides dramatic evidence of the health problems poor nations face. When, as Figure 18.1 “Infant Mortality for Low Income, Lower Middle Income, Higher Middle Income, and High Income Nations, 2008” indicates, 80 children in the poorest nations die before their first birthday for every 1,000 live births (equivalent to 8 out of 100), the poor nations have serious problems indeed. Figure 18.2 “Percentage of Population With Access to Adequate Sanitation Facilities, 2008” shows how the world differs in access to adequate sanitation facilities (i.e., the removal of human waste from the physical environment, as by toilets). Whereas this percentage is at least 98% in the wealthy nations of North America, Western Europe, Australia, and New Zealand, it is less than 33% in many poor nations in Africa and Asia.

Chapter 9 “Global Stratification” presented an international map on life expectancy. That map was certainly relevant for understanding aging around the globe but is also relevant for understanding worldwide disparities in health and health care. We reproduce this map here (see Figure 18.3 “Average Life Expectancy Across the Globe (Years)”). Not surprisingly, the global differences in this map are similar to those for adequate sanitation in the map depicted in Figure 18.2 “Percentage of Population With Access to Adequate Sanitation Facilities, 2008”. North America, Western Europe, Australia, and New Zealand have much longer life expectancies (75 years and higher) than Africa and Asia, where some nations have expectancies below 50 years. The society we live in can affect our life span by more than a quarter of a century.

Health Care in Industrial Nations

Industrial nations throughout the world, with the notable exception of the United States, provide their citizens with some form of national health care and national health insurance (Reid, 2009). Although their health-care systems differ in several respects, their governments pay all or most of the costs for health care, drugs, and other health needs. In Denmark, for example, the government provides free medical care and hospitalization for the entire population and pays for some medications and some dental care. In France, the government pays for some of the medical, hospitalization, and medication costs for most people and all of these expenses for the poor, unemployed, and children under the age of 10. In Great Britain, the National Health Service pays most medical costs for the population, including medical care, hospitalization, prescriptions, dental care, and eyeglasses. In Canada, the National Health Insurance system also pays for most medical costs. Patients do not even receive bills from their physicians, who instead are paid by the government.

Although these national health insurance programs are not perfect—for example, people sometimes must wait for elective surgery and some other procedures—they are commonly credited with reducing infant mortality, extending life expectancy, and more generally for enabling their citizenries to have relatively good health. In all of these respects, these systems offer several advantages over the health-care model found in the United States (Hacker, 2008) (see the “Learning From Other Societies” box).