Question
Define the term health-adjusted life expectancy.[2]
State one reason why health-adjusted life expectancy is a better measure of the health of a population than child mortality.[2]
Referring to one or more diseases, explain how three geographic factors influence the spread of disease.[2+2+2]
“Affluent societies are less affected by disease than those with a high level of poverty.” Discuss this statement.[10]
▶️Answer/Explanation
Markscheme
Health-adjusted life expectancy (HALE) is the life expectancy [1 mark] adjusted for time spent in poor health due to disease and/or injury [1 mark].
It can also be defined as the equivalent number of years of full health [1 mark] that a newborn can expect to live [1 mark], based on current rates of mortality and ill-health.
There are many possibilities. Child mortality reflects the health of mothers and young children, whereas HALE reflects the entire population, including the elderly. The costs and policies associated with the provision of health services in a society are probably better judged by HALE than by child mortality. Award 1 mark for a valid reason with an additional 1 mark for further development, such as quantification or exemplification.
Depending on the disease(s) chosen, many different geographic factors may be relevant, including climate, relief, transport lines and connections, incidence of hazards such as flooding, availability and access to methods of prevention (for example, vaccination) or cure, population density, mobility, religion, politics, poverty.
Award 1 mark for each valid factor, with an additional 1 mark for further development, clearly linked to the spatial diffusion/spread of the disease. Award a maximum of 2 marks if no diseases are named.
There are few simple relationships between poverty/affluence and the incidence of disease. At a global level, a distinction is recognized between the so-called “diseases of affluence” (type 2 diabetes, heart disease, cardiovascular disease, some forms of cancer, asthma, allergies, depression, some psychiatric illnesses) and the “diseases of poverty” (AIDS, malaria, tuberculosis, pneumonia, measles, cholera, typhoid, malnutritional diseases, dysentery, diarrhoeal diseases). In practice, both groups of disease often co-exist in any one society, with their incidence depending on income levels and other socio-economic characteristics.
Higher life expectancies in affluent societies may explain the higher incidence of diseases of affluence, most of which are degenerative, chronic and non-communicable. Diseases of poverty tend to be linked to infections, inadequate environmental health regulations or poor hygiene; they are often communicable. Rapidly developing countries may have relatively high levels of both groups.
Candidates should discuss the statement not only in terms of the distribution or incidence of disease, but should also look at other effects. These include the financial costs associated with disease prevention, treatment options and public health facilities, the possible economic consequences of disease in terms of reduced workforce productivity, and the social costs of any disease linked especially to a particular age group, such as women of childbearing age.
Answers with developed examples or case studies are likely to be credited at bands E/F.
Marks should be allocated according to the markbands.
Examiners report
This posed little difficulty for most candidates.
This posed little difficulty for most candidates.
It was sometimes difficult to distinguish three factors in rambling accounts where ideas often overlapped or that explained the occurrence of the disease rather than its spread. Weaker responses were superficial and revealed a very limited understanding, even of diseases they had selected as examples.
There were some outstanding responses that looked at all the possible nuances of the question, including the occurrence of diseases of poverty in poorer areas of economically developed countries and offered lots of evidence in support. At the other extreme, the weakest discussions were very, very superficial and often were just a list of diseases found in poor and affluent societies.
Question
Briefly describe what is meant by “obesity”.[2]
Suggest why heart disease is considered a “disease of affluence”.[4]
With the aid of a diagram or diagrams, explain the spatial process of a disease spreading through “diffusion by relocation”.[4]
Examine the factors which have led to more food becoming available in some areas in recent years.[10]
▶️Answer/Explanation
Markscheme
BMI (Body Mass Index) over a certain number / a form of malnutrition [1 mark], usually resulting from energy (calorie) intake exceeding the amount required [1 mark].
Rates of heart disease are lower in poorer countries than in richer/wealthier/more developed countries [1 mark]. Award [1 mark] for each factor that is explained. These may include dietary factors e.g. a high fat intake (especially high saturated fat), high levels of “bad” cholesterol, and obesity. Lifestyle factors include insufficient physical exercise, stress levels, preference for sedentary occupations, reliance on powered forms of movement such as motor vehicles rather than walking, and decision to spend discretionary income on particular kinds of food.
For [4 marks] both dietary factors and lifestyle factors should be addressed. A wide range of suggested factors may compensate for depth of explanation.
Relocation diffusion involves the movement of individuals [1 mark], taking the disease with them to new locations [1 mark] where it continues to spread through contact with then more people (e.g. airline passengers) [1 mark]. Credit other valid points, including an example of a disease such as SARS for [1 mark]. Responses which do not include a diagram may not be awarded more than [3 marks].
Numerous factors can result in more food becoming available.
The first major group of factors is those related to the improved productivity and/or total production of food-related agriculture. These factors include: increased area under cultivation as a result of land clearance and/or irrigation; higher yields due to better technology (e.g. drip irrigation instead of flood irrigation), mechanization, improved varieties (including GM crops and livestock).
Distribution and storage is also important. More food may become available because less is lost or damaged in transit as a result of improvements in the distribution network (highways, rail, planes) or in the vehicles used (e.g. refrigeration). Improved packing methods may also be important. Subsidies to local farmers for food crops, and reductions in food exports may also raise the amount of food available locally. Equally, a rise in income may also increase the availability of food within some sectors of society. Increased food imports also play a part, and this means that increased availability of food may depend on the success of harvests a long way away from their eventual destination.
While changes of climate may bear some responsibility for increased food availability in some areas, this will normally be restricted to those areas which were previously suffering from a prolonged condition such as an extreme drought.
It is expected that responses reaching markbands E/F will consider a variety of factors, and support their ideas with accurate examples.
Marks should be allocated according to the markbands.
Examiners report
Most candidates understood obesity as the result of excessive food intake but references to the BMI were less common.
Well-recognized factors were included but there was failure to elaborate sufficiently for all four marks.
A common error was the disease seemed to be travelling by plane to another country with no mention of the vector. Or people carrying malaria to another country and passing it on. Most candidates attempted a diagram of some sorts. Generally, the process of diffusion was not well understood and there were few diagrams that related well to the concept.
Answers tended to be superficial and were narrowly focused, with few candidates being able to refer to a range of factors other than those related to the Green Revolution, which is hardly a recent phenomenon. Failure to examine in depth was the main issue with this question. Many concentrated just on improved productivity, for example, mechanization, high yielding varieties, and did not really explain how they led to more food availability.
Question
(i) Outline what is meant by the term “diseases of affluence”.
(ii) Briefly describe the global distribution of diseases of affluence.[4]
Referring to one named water-borne or vector-borne disease, distinguish between policies relating to its prevention and policies relating to its treatment.[6]
Examine the effects of transnational corporations (TNCs) and fair trade on the level of sustainability of agriculture.[10]
▶️Answer/Explanation
Markscheme
(i)
Award [1] for each valid point from the following:
- mainly affect wealthier people
- due to longevity/sedentary lifestyle/diet/lifestyle choices
- or an example, eg cancer.
(ii)
Primarily economically wealthy countries [1], but also in some socio-economic groups within less wealthy countries [1].
Award maximum [3] if no specific disease named, or disease is not either water-borne or vector-borne, eg HIV/AIDS, Ebola.
Award maximum [4] if policies only relate to either prevention or treatment.
For example:
Malaria is a vector-borne disease, carried by mosquitoes [1].
Policies related to malaria prevention include: Award [1] each.
- removing/covering open bodies of still water (ponds, buckets, puddles)
- eradicating mosquitoes (spraying)
- encouraging use of bednets, preferably pre-sprayed with mosquito pesticide
- encouraging use of anti-malarial tablets.
Policies related to malaria treatment include: Award [1] each.
- ensuring rapid diagnosis (provision of laboratories, training of medical staff, including doctors) ensuring easy access to medical attention and medicines needed to treat malaria (healthcare systems, education, purchase of stockpiles of malarial medicines)
- establishing a national database of malarial patients so that they might be treated more effectively and appropriately.
The relationship between TNCs and sustainability is complex. While some TNCs probably increase agricultural sustainability, others probably decrease it. Equally, the actions of some TNCs probably have no effect on sustainability whatsoever.
An example of how sustainability might be increased is when TNCs introduce/adopt more efficient irrigation techniques (such as drip feed instead of flood irrigation) to grow crops. However, sustainability is only increased if the pumping of water for the new irrigation system does not involve using large amounts of additional energy coming from non-renewable sources.
On the other hand, TNCs that introduce GM herbicide-resistant crops may decrease sustainability. For example, some TNCs have patented or otherwise protected their rights to certain types of seed, meaning that farmers have to purchase new seed every year and are no longer allowed to use seed from a previous crop, as is normally done in conventional farming. This may be economically unsustainable, especially over the long term. In other cases, for example where the seed of some hybrid crops will not germinate and grow new crops, the changes brought by TNCs may be ecologically unsustainable.
The adoption of fair trade is designed to increase sustainability, especially the social and economic aspects of sustainability. The discussion of fair trade might extend into considering the sustainability of marketing and supply chains. This should not be penalized but is likely to be self-limiting given the wording of the question.
TNCs and fair trade are not always mutually exclusive. One example of an overlap between TNCs and fair trade is Starbucks coffee. The firm is a TNC, but it advertises and commercializes fair trade products.
Candidates are expected to show some awareness that the concept of sustainability has several strands, including economic, environmental and social. It is also likely that many candidates will refer to ways in which sustainability can be measured/assessed. The strongest responses are likely to include references to food miles and/or energy efficiency as measures of sustainability.
It is not necessary for TNCs and fair trade to be discussed in equal depth for the award of full marks. A strong, evidenced discussion of TNCs may well offset a weaker discussion of fair trade, or vice versa.
Responses at band D are likely to describe some ways in which TNCs and/or fair trade affect sustainability of agriculture.
At band E, expect either greater explanation of how TNCs and fair trade affect sustainability of agriculture or some explicit examination of what is meant by sustainable agriculture.
At band F, expect both.
Marks should be allocated according to the markbands.
Examiners report
(i/ii) There were few problems with this. Relatively few candidates recognized that diseases of affluence can occur in less wealthy countries.
This was generally well answered. The question specifically required one named water-borne or vector-borne disease*; Ebola is neither, although some credit was given. Policies of prevention were often answered better than treatment. Unfortunately, some candidates wrote (erroneously) that there is a vaccination for malaria.
* The geography guide requires case studies of two diseases, chosen from two of the following three: vector-borne, water-borne, or sexually transmitted.
This question required an understanding of TNCs, fair trade and sustainability of agriculture. There were some very good, detailed responses, using examples. Others had an imperfect understanding of fair trade, confusing it with free trade. Many focused on environmental impacts and sustainability, with less consideration of social and economic aspects. Some recognized that TNCs and fair trade are not mutually exclusive.