POVERTY AND HEALTH

Teacher’s Guide
Topics:
1. What is health?
2. What is poverty?
3. Social indicators
4. Types of social indicators
5. Social indicators and development
6. Voices of the poor
7. Overview of global health risks
8. Four problems with the system
9. Health for all
10. Different views on health
11. Communicable diseases
12. Tuberculosis
TB and Burma
13. Malaria
Malaria statistics for India, Thailand and Burma
14. HIV/AIDS
HIV/AIDS statistics
HIV/AIDS and Poverty
HIV/AIDS – The case of Uganda
HIV/AIDS - Burma
15. Child health
16. Primary health care
17. Heroin and Burma
18. Burma’s social indicators
19. Burma – A country in crisis
20. Women’s health in Burma
21. Crossword

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1. What is health?
Ask:

What does ‘health’ mean?

Encourage the students to give their own understandings of health, and not dictionary
definitions. Write the answers that they give on the board.

Explain:

Throughout history and across different cultures people have understood

‘health’ in different ways.
To some people health means ‘the absence of illness or disease.’
But to others, health is more than this. It means living in a good physical
environment and a good social environment, being able to cope with
everyday life, being mentally and emotionally well.

As a class brainstorm:

What do we need to be healthy?
Write the students’ ideas on the board.

Possible answers: Clean environment, clean water, nutritious diet,

sanitation, exercise, hygiene, fresh air, safety, no stress, etc.

Explain:
So when we are thinking about health, we cannot just consider causes and
treatment of disease, we also have to think about the environment we live in
and our social situation.
If doctors or nurses are treating patients they will not only think about the
physical signs of what is wrong with a patient, but they will think about the
patient’s lifestyle and social situation.

The world has seen huge developments in improving the level of people’s
health, and improving health care. But despite these developments there are
still millions of people who suffer from diseases and illnesses that are very
easy to prevent or to treat. The majority of these people come from poor
countries, and are living in poverty.

Read ‘What is health?’ and answer the questions below.

Discuss the students’ definitions of ‘illness’.

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2. What is poverty?

Ask:
What is poverty?
What are causes of poverty?

Write the students’ ideas on the board.

Discuss:
Many people live in poverty all their lives, and cannot improve their standard
of living. Why do you think it is so difficult for poor people to improve their
lives?

Encourage the students to come up with as many reasons as they can.

Read ‘What is Poverty?’ and answer the questions below.

Answers to reading:
1. France would have a higher poverty line. This means that the basic
standard of living expected in France is higher than in India.
2. 20% on less than $1 per day and nearly 50% on less that $2 per day.

Inpairs ask the students to make lists:

What do you think are considered the basic needs for a person living in India?
What do you think are considered the basic needs for a person living in France?

Discuss the students’ ideas.

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3. Social indicators

Ask:
Which countries have good / bad health (care)?
How can we compare the level of health in different countries? What should
we look at?
How has health changed over time? Why has it changed? How do we know
health has changed over time?

Explain:
When we compare health or living standards in different countries we often
use social indicators.
Social indicators are data and information that have been collected about
each country.
One example of a social indicator is GDP per capita (Gross domestic product
per capita).
This is the total value of the production of the country, divided by the
population.
(Per capita = per person)
This information gives us an idea of how rich different countries are.

Write the list of countries below on the board. Ask the students to arrange them in the order
they think they should be in from richest to poorest.
Hong Kong, Japan, United Kingdom, Pakistan, Burma, Iraq, USA, Bhutan,
Thailand, China, India, Nepal, Afghanistan, Argentina, Australia

Answers:
These answers are based on GDP per capita in US$ for 2001 – that means
the total amount of money made by the country, in US$ in 2001, divided by
the population of the country.
USA 34,788
Japan 32,281
United Kingdom 24,281
Hong Kong 23,499
Australia 19,056
Argentina 5,267
Thailand 1,865
China 918
Iraq 881
Burma 717
India 467
Pakistan 411
Bhutan 241
Nepal 226
Afghanistan 98

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Ask the students: What doesn’t this information tell us?

It doesn’t tell us how the wealth in the country is distributed (i.e. how many
people are very rich and how many are very poor).

A good example of this is India. India’s GDP is increasing, as it develops

more industry and business. But in India there are millions of people who
are extremely poor. While the lives of the wealthy and middle class are
improving, lives of the poor have not changed.

Read ‘Social indicators’ and complete the vocabulary exercise.

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4. Types of Social Indicators

Elicit from the students:

What can we compare / measure using social indicators?

*Note - don’t let them look at the next reading for the answers
Possible answers:
Death rate; how many people get sick, have enough food, get malaria, have
clean water, have health care etc.

Explain:
There are many different types of social indicators used to understand
societies. Social indicators can look at areas including health, standard of
living, education and environment.

Read ‘Types of social indicators’, then work in pairs to do the exercises from the ‘Social
indicators - worksheet’.
Encourage the students to think deeply about the answers to the questions.
Possible answers:
1. Afghanistan. Armenia.
2. Niger. China. In many countries parents have a lot of children to be
sure some children survive to support them later in life. Poor countries often
have no family planning. Rich countries have family planning. People in rich
countries do not want big families. In rich countries the life expectancy is
longer so there are more old people in the population. In many poor countries
the life expectancy is short. China has a ‘one child policy’.
3. Afghanistan. Urban populations have a higher percentage of access to
clean drinking water than rural populations
4. Women tend to live longer than men. Life expectancy is longer in
countries that are more wealthy, have better health care, have access to
clean drinking water and sanitation.
5. Low infant mortality – good health care, good diet, maternal health
care education. High infant mortality – poverty, poor/lack of health care,
poor diet, no maternal health education.
6. Iraq and Mali. Education for girls is not seen to be as important. Some
families will give priority to boys. Some cultures state that girls should stay
in the home. Girls are expected to care for the home/family.
*Note – In most countries around the world girls and boys spend the same
amount of time in school.

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7. Cambodia has a very small population. A lot of the people in Cambodia
are subsistence farmers.
*Note
Is the percentage in Cambodia really this small? Cambodia has a large number
of beggars (often who have been injured by land mines), are these people
included as unemployed?
In this category there were no rates for India, Burma or Afghanistan.

Draw these two graph outlines on the board. Ask the students to complete them.

Bar graph showing % population under Pie chart showing % population under
15 years of age. 15 years of age in Burma.

Get the students to draw bar charts for:

Life expectancy in all five countries.
Number of years in school in Burma, UK and Mali.
GDP per capita in all five countries.

And a pie chart showing:

% total population with access to clean drinking water in Ethiopia

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5. Social indicators and development

Explain:

Average Life expectancy:

When researchers want to compare the life expectancies of different countries,

they find the average life expectancy for each country. This is the average age
that people live to.

Let’s imagine a very small country and in that country, in the year 1985, 20
people died. And let’s imagine that the ages of these people when they died,
in years, were: 29, 42, 51, 55, 59, 63, 63, 64, 66, 67, 67, 67, 68, 70, 70, 73,
75, 77, 77, and 80.

What is the average life expectancy?

To find this we need to add all the ages together and divide the answer by the
number of people:
= 1283 / 20
= 64.15 years
So, 64.15 years would be the life expectancy of a people living in that country.
Of course, some people live longer, and others live less long, this is the
average.

The life expectancy in developed countries is higher than in undeveloped

countries, so people in developed countries are expected to live longer. Also,
people live longer today than they did in the past.

But, in Africa today, HIV/AIDS is having a big effect on life expectancy.

Let’s think about our very small country again, and suppose that over a period
of twenty years it has developed a high level of HIV/AIDS among the
population (as has happened in many countries in Africa).
Because of HIV/AIDS many people are dying earlier. Let’s imagine that the
ages of the 22 people who died in the year 2005 were: 25, 27, 28, 31, 31, 34,
35, 38, 39, 45, 50, 56, 60, 62, 65, 68, 70, 71, 74, 77, 78, and 81.

What is the average life expectancy?

= 1145 / 22
= 52.05 years
So, the life expectancy has now fallen to 52.05 years. Of course, some people
still live a long time, but more people died at a young age.

So, life expectancy has been used to indicate the impact that HIV/AIDS has on
different countries.

Read ‘Social indicators and development’ and answer the questions in the reading.

Possible answers:
1. People in poor countries have less access to family planning, or health
education. They may not know about contraception or birth spacing. Culturally
they may be expected to have large families. They may want large families to
be sure some of their children survive to support them later in life.
3.
2. Often thebad
Civil war, poor live in remote
governments, areas,disasters,
natural so are very fareconomy
poor from clinics;
could they
all been
cannot
reasonsafford to travel;
why child theyrates
mortality cannot afford to pay for treatment.
increase.
4. The poor are more dependent on the land for their survival; they more
often live in areas that are affected by natural disasters; they do not have
financial resources to rebuild their lives; they do not receive enough support 8
from governments.
5. Diarrhea, dysentery, typhoid, cholera.
6. Voices of the Poor

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In small groups make lists to answer these questions:
What do people / communities need for:
Material well-being (i.e. possessions and belongings)
Physical well-being (i.e. what do we need to keep us alive and healthy?)
Security
Freedom of choice and action
Social well-being

What are the effects of not having these needs met?

*Note – when the students think about the effects of needs not being met, make sure they
think carefully and list as many answers as they can think of.
For example, a lack of food could cause: malnutrition, underweight, vitamin deficiency,
exhaustion, illness, loss of job, no income, death etc.

Discuss the students’ answers.

Are there differences in the groups’ answers? For example, do some groups have very basic
material needs such as, shoes, stove etc; while others include more luxury items such as, cars,
telephones and televisions? Can the class agree on which items are needs and which are
wants?

Read ‘Voices of the poor’.

In pairs, answer these questions, writing each answer as a list or cluster
diagram:
1. What does the reading say people need for material wellbeing?
2. How does poverty affect physical wellbeing?
3. What do people need to have security?
4. What do people need to have the power to control their lives?
5. What problems do people face regarding social wellbeing?

Answers:
1. Food, shelter, housing, clothing, livelihood, land, capital, access to
loans
2. Causes hunger sickness, weakness, disability, exhaustion; cannot
work; become poorer
3. Peace of mind; no corruption, crime, violence; police protection; no
wars; no natural disasters; good climate; law and justice; no fear;
no domestic violence; no poverty
4. Freedom of choice and action; empowerment; skills, education,
loans, information, services, resources; moral responsibility.
5. Stigma of poverty; feel shame accepting charity; cannot
participate fully in society; discrimination; denied opportunities.

Discuss: Were the needs listed in Voices of the Poor similar to the needs the students listed
in their groups? Are there any needs that the students didn’t think of? Did the students have
any needs that weren’t in the reading? Are the material needs in the reading similar to the
students’ lists of material needs?

7. Overview of global health risks

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Explain:

Health standards in developed countries have improved a huge amount in the

past century.

There have been many reasons for this:

Medical advancements / Immunization / Health education / Birth control and
maternal health
Higher standard of living / sanitation / clean water / nutritious diet /hygiene

Whilst medical advancements and immunization have greatly improved levels

of health, improvements in standard of living including improved diet, hygiene
and sanitation have had a huge impact on reducing the spread of disease.

Because of these improvements in health people (mostly in wealthy countries)

become sick less often and are more often cured. This means that people
today live longer than they did in the past (increasing life expectancies). This
is one reason for the rapid increase in population that has occurred in the
world in the last one hundred years.

But despite this development there are still many diseases that are affecting
people around the world. Often there is a big difference between the diseases
that people suffer in rich countries to those in poor countries.

Ask the students –

What do you think are the most common diseases affecting people around the
world?
What are the main causes of these diseases?
What diseases do you think kill the most people?

Write the students’ answers on the board.

Now ask the students to look and the diseases they have listed.

What diseases mostly affect poor / undeveloped countries?

What diseases affect rich / developed countries?
Can you think of other diseases that are common in rich countries?

Possible answers:
Diseases of undeveloped countries (diseases of poverty): malnutrition,
typhoid, malaria, TB, HIV, dysentery, diarrhea, dengue fever, scabies,
hepatitis, polio, anaemia, beri beri, leprosy, vitamin deficiencies etc.

Diseases of developed countries (diseases of excess): obesity, high blood

pressure, heart disease, diabetes, cancer, liver disease, anorexia etc.

Explain:

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 So, rich countries and poor countries face different health problems.
We live in a world where, while millions of people suffer from diseases caused
by poverty and lack of food, millions of others suffer from diseases caused by
excess (too much).
While people in some parts of the world face malnutrition and starvation,
people in other parts face diseases caused by obesity.
However, some developing countries are now facing a double burden. This
means that the diseases caused by poverty are still a big problem in the
country, but obesity and the diseases related to excess are also becoming a
problem.

Discuss:
What do you think of the fact that while some people suffer diseases of
poverty, others suffer diseases of excess?
Why do you think this problem happens?
Why is it difficult to solve this problem?
What could be done to try to solve the problem?

Ask the students to work in pairs and make a list:

What do you think are the ten biggest risks to health in the world?

*Note – this is not the names of diseases, but the causes of ill health.

Compare the students’ answers.

Look at the list in ‘Overview of global health risks’.

Read ‘Overview of global health risks’.

Answer these questions:
1. How many children are underweight? How many adults are clinically obese?
2. Where is the AIDS epidemic biggest? Where is it increasing most quickly?
3. What are the common causes of disease in Africa and Asia?
4. Why are mothers and children affected by iron deficiency?
5. What are the effects of indoor air pollution?
6. What diseases are caused by overweight and obesity?

Answers:
1. 170 million children are underweight. 300 million adults are clinically obese.
2. The AIDS epidemic is biggest in Africa, but it is increasing in Eastern
Europe and Central Asia.
3. Unsafe sex, unsafe water, poor sanitation and hygiene, iron deficiency,
indoor smoke from solid fuels.
4. Children need more iron because they are growing; mothers need more iron
during pregnancy.
5. Lower respiratory infections, chronic obstructive pulmonary diseases (lung
disease)
6. Increases blood pressure, high cholesterol levels, heart disease, strokes
(illness caused by blocked blood vessel in the brain), diabetes, cancer.

Answer the questions in the reading.

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Possible answers:
1. In poor countries there is a lack of health education, people have
not heard of HIV/AIDS, or they do not know how the disease is spread;
there is less access to testing and protection from the disease;
governments do not take enough action to reduce the spread of the
disease; the countries do not have enough money, or a good enough health
service to fight the disease.
2. Coal, wood charcoal
3. Esophageal cancer, liver disease, epilepsy, driving accidents,
homicide, etc.
4. Some developing nations now face diseases of poverty (malnutrition
etc) and diseases of excess (obesity etc).

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8. Four Problems with the System

Divide the class into small groups. Explain:

We’ve already discussed how millions of people live in poverty while others live
in excess.
And we talked about why this happens.

Now make a list of all the political, social and economic reasons you can think of,
why people are forced to live in poverty.

Discuss the groups’ ideas.

Read ‘Four problems with the system’.

Are there any extra reasons in the reading that the groups did not include in their lists?

Answer the questions in the reading.

Possible answers:
1. Student’s own answers.
2. The police are not properly controlled by the government; the police can
make money intimidating the poor; the police act on behalf of the poor; the
police know the poor cannot complain or fight back.
3. It means; outsiders set up projects to help the poor. These outsiders
do not ask the poor what how they think the projects should be done, but tell
the poor what they should do. Despite good intentions, the projects are often
of little benefit to the poor.
4. Students’ own answers.

9. Health for All

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Read ‘Health for all’.
Answer these questions:
1. How does the WHO define ‘health’?
2. How do countries become members of the WHO?
3. Who have the right to a high level of health?
4. Is health for all being achieved?
5. What was the ‘renewal process’?

Answers:
1. Health is a state of physical, mental and social well-being, not
just the absence of disease.
2. They are members of the UN, and they accept the WHO’s
constitution.
3. Every human being, of all races, religions, political beliefs and
economic and social conditions.
4. No.
5. The renewal process is a new process to help countries achieve
health for all in the 21st century, and to make sure health for all
remains a central vision.

Explain:

The Alma Ata

In 1978 there was an International Conference on Primary Health Care, held
in Alma Ata, USSR. The result of the conference was the Declaration of Alma
Ata.

The Alma Ata states:

There is a need for urgent action by all governments, health and
development workers, and the world community to protect and promote the
health of all people around the world.

Health is the state of physical, mental and social well-being.

Not just the absence of disease. It is a human right.
The existing inequality of health status in the world is unacceptable and
should be concern of all countries.
Economic and social development is important for health for all.
People have right to participate in planning of their own health care.
Governments are responsible for the health of their people.

It was agreed that an acceptable level of health for all should be attained by
the year 2000, and that it would be attainable if the world’s resources were
better used. (e.g. too much money is spent on arms and military conflicts.)
Unfortunately health for all still has not been achieved.

Divide the class into small groups to discuss these questions:

15
 1. The WHO believes that achieving health for all people is important
for the world to have peace and security. Do you agree with this
statement? Why / why not?
2. Do you think it is possible to eliminate poverty and achieve ‘health
for all’? Why / why not?
3. What would rich / poor countries need to do?
4. What factors / problems prevent ‘Health for all’?

Discuss the groups’ ideas.

10. Different views on health

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Discuss:

Why do we get sick?

What do scientists and doctors say cause ill health?
What do people believe causes ill health in Burma? What are the beliefs of
people in the towns / in the rural areas?

Explain:
There are many different beliefs explaining why we get sick.
Modern beliefs are based on science and medicine, and these beliefs are
spreading around the world.
But there are many regions where people still hold traditional beliefs, for
example, in villages in rural areas in Burma.

Ask the students about traditional beliefs from rural areas in Burma, to explain the causes or
treatment of ill health.

Some answers from past students:

Eating orange or papaya causes malaria.
Don’t eat orange or papaya if you have flu.
A new mother should not take a bath for one week.
Paying respect or making a sacrifice to natural spirits.
Wearing sunglasses to stop the spread of an eye infection.

Explain:
Many rural communities have very different beliefs to western medicine, for
example, believing that ill health is caused by spirits.
Because of this it can be very difficult for communities to accept western
ideas about medicine.
Sometimes western medical ideas will contradict traditional beliefs. For
example: there is the traditional belief that it is not good to eat orange and
papaya if you have flu, but western medicine believes it is very good to eat
this as it is high in vitamin C, which helps the body fight illness.

Read ‘Different views on health’.

11. Communicable diseases

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In pairs, make two lists of diseases and illnesses; diseases that can be transmitted to other
people, and diseases that cannot be transmitted to other people.

Possible answers:
Can be transmitted Cannot be transmitted
Common cold Cancer
Flu Heart disease
Typhoid Diabetes
TB High blood pressure
Hepatitis Migraine
HIV/AIDS Anaemia
Malaria Alzheimer’s
Dengue fever Goitre
Polio Beri Beri
etc etc

Explain:

Some diseases are caused by microorganisms. Microorganisms are tiny

living things, so small that we need a microscope to see them.
Some microorganisms cause disease. And they can be passed from one
person to another, for example, in the air or in water.
If a disease is caused by a microorganism and it can be passed from
one person to another it is called a communicable disease.
These diseases are more of a concern in areas of poverty, since these
areas have poor environments and unclean water, and therefore people
are more likely to be exposed to the microorganisms that cause
disease.

Other diseases, such as cancer and heart disease, cannot be passed

from one person to another.
And they are not caused by microorganisms. Causes of cancer or heart
disease are usually linked to lifestyle or heredity.

Read ‘Communicable diseases’. Complete the summary of ‘common illnesses’.

Answers:
Influenza – flu
Cause Virus
Symptoms Fever, headache, muscle ache
Transmission By infected droplets from coughs or sneezes

Dysentery
Cause
Common Cold Bacteria or parasite
Symptoms
Cause Diarrhea
Virus (often with blood) and abdominal pain
Transmission
Symptoms InRunny
waternose,
or contaminated
sore throat, food
headache, cough
Transmission By infected droplets from coughs or sneezes

Malaria
Cause Parasite 18
Symptoms Fever, shaking, chills, headache
Transmission Carried by mosquitoes
12. Tuberculosis

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Divide the class into small groups. Ask the groups to brainstorm a list:

Which diseases are common in Burma?

Which diseases are most common in Burma?
Which diseases are the most dangerous, or are the biggest problems?
Are any of these diseases more common in rural areas, or in urban areas?
Why?

Discuss the groups’ answers.

Explain:

We are going to look at three diseases; TB, malaria and HIV/AIDS. They are
three of the biggest threats to health around the world, and are all diseases
which affect the poor far more than the wealthy.
The spread of these diseases is increased because of poverty.
TB, malaria and HIV/AIDS are all major health concerns in Burma

Brainstorm:
What do you know about tuberculosis (TB)?

Write the students answers on the board.

Explain:

Tuberculosis is caused by bacteria.

It is communicable, so it can be passed from person to person.
It is transmitted by airborne droplets when a sufferer coughs or
sneezes.
If someone breathes in the droplets, the bacteria enter the lungs and
begin to multiply.
Usually people’s immune systems can fight the bacteria. But in 5% of
cases the bacteria survive and spread – and the person develops the TB
disease.

At first when people are infected with they do not show any symptoms.
But as the disease develops the symptoms occur.
Symptoms include chest pain, shortness of breath, fever, poor appetite

Read ‘Tuberculosis’.
Answer these questions:
Answers:
1. 1. Bacteria
Whatcalled
causesMycobacterium
TB? tuberculosis.
2. 2. People
Whowhoarespend a lot likely
TB most of timetowith a sufferer,
be spread to? such as family
3. What is latent TB?
members, friends and co-workers.
4. Which people are more vulnerable to TB disease?
3. Latent TB occurs when a person is infected with TB bacteria. The
5. What is a problem with TB treatment?
body is able to stop the bacteria from growing but cannot kill it. Therefore
the bacteria become inactive, and can become active and develop into TB
diseases later.
4. People with weak immune systems, such as babies, young children,
and people infected with HIV.
5. Some people do not take the course of drugs correctly, and this can 20
make the bacteria resistant to the drugs, making the disease difficult to
cure.
Ask: What are reasons why TB is a big problem in poor countries, but not in developed
countries.

Possible answers:
Developed countries have good health systems; can vaccinate against TB;
can test for and diagnose TB; have good health care to treat the disease.
Developing countries have poor health systems; many people are not
vaccinated; many people do not have access to health care – so lack
diagnosis and treatment; people live in crowded conditions.

Explain:
TB is a disease that affects people in developing countries far more
than developed countries.
In developed countries people are vaccinated against the disease. As
a result TB is almost completely eliminated in developed countries.
But in developing countries TB is still a big problem, due to poor
health services and poverty.

TB is a big problem in South-east Asia, particularly in Bangladesh,

Burma, India, Indonesia, and Thailand.
One problem with TB treatment is the TB bacteria become resistant to
the drugs used to treat the disease.
If the bacteria become resistant then the drugs cannot kill them, and
it is very difficult to cure the sufferer.
One reason why this happens is that sufferers do not take the
medicine correctly. They forget to take it, or stop taking it before they
have completed the course.
Directly Observed Treatment Short Course (DOTS) is a way to
overcome this problem. This means that health workers monitor
sufferers to make sure they take their medicine correctly, and for the
correct length of time. This has improved the success rate of curing
people with TB.

Read ‘TB and Burma’.

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Answer true or false to these sentences:
1. More than 3 million people in Asia are suffering from TB.
2. Non-governmental organisations agree with the Burmese
government’s statistics on new TB cases.
3. Although TB treatment in Burma should be free, people
have to pay.
4. There are no patients in Burma with multi drug resistant TB.
5. If people forget to take their medicine it cannot work
properly.
6. DOTS strategy ensures people take their medicine correctly.
7. DOTS strategy does not reduce the mortality rate or rate of
infection.
8. The Burmese government spends too much money on
treating TB.

Answers:
1. True 2. False 3. True 4. False
5. True 6. True 7. False 8. False

13. Malaria

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In small groups brainstorm; everything you know about malaria.
Get one or two groups to present their brainstorms.

Explain:

Malaria is not caused by the mosquito. It is caused by a parasite called

Plasmodia.
The mosquito is a vector of malaria. This means it carries the parasite
that causes malaria, transmitting it from one person to another.
Vector = carrier of a disease.

There are many types of mosquitoes. The type of mosquito that carries
malaria is called Anopheles.
Only the female Anopheles mosquitoes bite humans. This is because
the female needs the proteins in blood to be able to produce eggs.
If the mosquito bites a human who has the malaria virus, it will take in
the malaria virus in the blood. If that mosquito then bites another
human, it will pass the malaria virus to that person.

Read ‘Malaria’.
Answer these questions:

1. How many types of Plasmodia cause malaria?

2. What are the symptoms of malaria?
3. What happens to the malaria parasite after it enters the human
body?
4. What causes fevers and anaemia?
5. How is malaria diagnosed?
6. What is a problem with treatment of malaria?

Answers:
1. 4 types
2. Fever, shivering, pain in the joints, headache, and maybe vomiting
3. They go into the blood stream and are carried to the liver. In the liver
they reproduce and then return to the blood cells, and reproduce again.
4. The destruction of blood cells.
5. By symptoms and examining blood under a microscope.
6. In some regions the parasites are becoming resistant to some of the
drugs used.

Read ‘Malaria around the world’

Complete these sentences.

1. It is difficult to control malaria in Africa, Asia and Latin America

because …
2. It used to be believed that malaria …
3. Laveran discovered the malaria parasite and Ross …
4. Malaria has been eliminated in many parts of the world, but …
5. Eighty percent of malaria … 23
6. The problems of malaria are associated with …
7. Malaria parasites are becoming resistant to drugs because …
 Answers:
1. …the countries are poor and have inadequate health care structures.
2. …was caused by bad air or gas from swamps.
3. …demonstrated that the mosquito carried the malaria parasite.
4. …it can never be completely eradicated.
Or …it is still found in 91 countries.
5. …cases occur in tropical Africa.
6. …with poverty and deteriorating social and economic conditions.
7. …sufferers self-administer drugs, and often take incorrect or
incomplete treatments.

Look at the statistics on malaria in Thailand, India and Burma. Answer the questions below.
Make graphs to compare the statistics of the three countries.

Answers:
1. India
2. Burma
3. The reported number of cases is much less than the estimated
number of cases in each country.

Brainstorm – how can people try to reduce malaria?

Use mosquito nets, wear clothes with sleeves, avoid being bitten by mosquitoes, try to
reduce areas where mosquito larvae grow, educate people about malaria etc.

Extra information:
- Chloroquine is the most popular drug for treating malaria since it is cheap
and has less side effects. But there is now the problem of resistancy.
- People have tried to develop malaria vaccines, but have not been successful.
- Malaria was eradicated in the USA, USSR and southern Europe mainly by
vector control (killing mosquitoes). Vector control is believed to be the best
way to control malaria in other countries. Often this involves spraying the
inside of houses – usually DDT is used.
- DDT is cheap and its effect lasts for six months to a year.
- In some areas – Sri Lanka, parts of India, Pakistan, Central America –
mosquitoes have become resistant to DDT. Then other, more expensive
compounds are used.

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14. HIV/AIDS – General information

Ask: Is HIV caused by bacteria, a parasite or a virus?

A virus
What are the long forms of HIV and AIDS?
Human Immunodeficiency Virus
Acquired Immune Deficiency Syndrome
What are the differences between HIV and AIDS?
HIV is a virus. It is the virus that causes the disease, AIDS.
AIDS is the disease caused by the HIV virus. It means the
immune system can no longer work properly.

Explain:
HIV is the virus that causes AIDS.
When a person is first infected with the HIV virus they may have no
symptoms, but some people may get mild flu-like symptoms.
If someone has the HIV virus in their body, we say that they are HIV
positive.
HIV enters the body through contaminated blood transfusions, non-
sterile needles, sexual intercourse or breast milk.
HIV is not spread by being close to infected people, by contact, or by
sharing plates, cups etc.
People with HIV infection can take antiviral drugs to slow the spread
of the virus. But no medicine to destroy the virus has yet been
discovered.

AIDS is the disease caused by the HIV virus.

Currently there is no cure for the disease.
AIDS usually develops 8-9 years after HIV infection. However,
antiretroviral drugs can increase this time.
AIDS does not develop in all people infected with HIV.
The virus enters the blood stream and infects the cells that fight
infection.
The virus reproduces in the cells, and the cells die.
As the cells are destroyed, the body’s ability to fight diseases
decreases.
When people develop ‘full blown AIDS’ they may develop disease
such as; cancer, pneumonia, and diarrhea.
Protection from HIV includes; safe sex, not sharing needles, screening

Read ‘HIV/AIDS’.
Answer these questions:

1. How does the HIV virus harm a sufferer?

2. How long does it take after infection for symptoms of AIDS to
develop?
3. How is AIDS diagnosed?
4. How can the HIV virus be transmitted?
5. How can HIV be treated?
6. What is voluntary counseling and testing?

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Explain:
HIV/AIDS was first identified in the early 1980s. But because it takes
about eight years for people infected with HIV to develop AIDS, it was
another ten years before the world realized how serious the disease is.

Today HIV/AIDS is a major health problem, particularly in Africa.

70% of HIV/AIDS sufferers are in Africa.
HIV/AIDS is also a huge problem in Asia, 15% of sufferers are found in
South and South-east Asia.

As with many other diseases, it is the poor who are most affected by
HIV/AIDS. Rates of the disease are far higher in developing countries.
Of the more than 36 million people living with HIV/AIDS only an
estimated 1.6 million are in high income countries.

Read ‘HIV/AIDS statistics’ and ‘HIV/AIDS and poverty’.

Ask the students to write 6 questions of their own from the readings.

Explain:

People with HIV/AIDS don’t just have to live with a disease. They also
have to live with the stigma associated with this disease.

Stigma: ‘feelings of disapproval that people have about a particular

illness or ways of behaving’.

This means that people who have HIV/AIDS are often viewed in a
negative way by, and face discrimination, from mainstream society.

Ask:

What kinds of people are HIV/AIDS sufferers often believed to be?

What kinds of discrimination do they face?
Why do you think there is so much stigma and discrimination
surrounding HIV?

Possible answers:
Stigma – AIDS sufferers are all drug addicts, homosexuals or promiscuous.
Good people don’t get HIV. Etc.
Discrimination - Less access to health care, less respect. Could lose jobs or
homes. Cannot get insurance.
Why – People are very afraid of HIV, it is a deadly disease. It is a new
disease. Sufferers are looked on badly since it is associated with sex and
drugs. Sufferers often become outcasts. Therefore, people don’t just get
the disease, they also get the social problems that come with HIV.

Stigma and discrimination are two big problems surrounding HIV and AIDS.

Read ‘Human rights and HIV/AIDS’.

26
Ask the students if they know of any myths about HIV. If they do not know any, ask them
what they know/believe about HIV – maybe they have some wrong beliefs.

Explain:
Another problem with HIV/AIDS is the misunderstandings and myths
that surround the disease.
A myth is something that many people believe, but is incorrect.

Some examples of myths:

The myth HIV is a disease that affects homosexuals.

The reality The majority of people with HIV are heterosexual.

The myth I’m safe because I am married.

The reality If your partner is unfaithful, or was HIV positive before you
met, you can still get HIV.

The myth HIV can be spread through tears, sweat, mosquitoes,

swimming pools or casual contact.
The reality HIV can only be transmitted through infected blood, sex, or
mother to child. The most common ways for HIV to be
transmitted are through unprotected sexual contact and/or
sharing needles with an HIV+ person.
HIV cannot be contracted through:
1) causal contact
2) hugging
3) handshakes
4) coughs or sneezes
5) sweat
6) tears
7) insect bites
8) swimming pools or saunas
9) toilet seats
10) spitting
11) utensils
12) food prepared by someone else

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Explain:

Perinatal HIV
Perinatal HIV
Perinatal means the period right before, and right after, birth.
The words "perinatal HIV" mean that HIV has been passed to the new
baby from the mother. In general, babies born to mothers who have HIV
have a 25% to 30% chance of being infected with HIV.

Maternal transmission is the primary mode of HIV acquisition in

children.
A way to prevent transmission was discovered in 1994. Taking the drug
AZT during the last six months of pregnancy, during labour, and the
first six weeks of neonatal life, has been found to reduce transmission
of HIV from mother to infant by nearly 70%.

Voluntary counseling and testing

VCT stands for ‘voluntary counseling and testing’.

One problem with the spread of HIV is many people do not know they
have the disease and are afraid to take a test to find out.
VCT aims to encourage people to take HIV tests, to find out whether
they have the virus.

VCT allows for people to voluntarily take a confidential HIV test.

Before the test they are counseled about the facts of the disease and
the implications if they are positive.
After the test, if someone is found to be positive, they can get support
and advice on how to cope with the disease.
Where drugs are available they will receive medical support.

HIV/AIDS - Uganda

In small groups, make a plan:

If you were the government of a country, which was facing a big problem with HIV/AIDS,
what would you do to reduce the spread of HIV in your country?

Discuss the groups’ ideas

Read: HIV/AIDS – The case of Uganda

Answer the questions below the reading.

Answers:
1. The silence may have contributed to the rapid spread of HIV in the
country.
2. The huge AIDS prevention campaign led to increased fears among the
population, and discrimination and stigmatization of people with HIV/AIDS.
There was a lack of care for sufferers.

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 3. Educating about prevention of transmission; encouraging people to love
carefully and love faithfully; community support groups; advocacy for care
and support for sufferers and their families; counseling and testing; legal
advice; moral support; technical guidance; sterile and disposable syringes and
needles; protective gloves for TBAs; changing the tradition of circumcision;
VCT.

HIV in Burma

Read ‘HIV/AIDS and the extractive industries in Kachin State’ and ‘Myanmar’s secret
plague’.
Discuss the reasons the readings give for the problem of HIV/AIDS in Burma.

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15. Child health

Explain:
The health and well-being of children in a society is considered very
important, for two reasons:
1. Children are more vulnerable to the effects of poverty, disease
and problems in society.
Children are dependent on adults for survival. They suffer more in
situations of poverty, pollution and lack of clean water.

2. Today’s children will shape the future of society.

The way we raise our children will determine the way they behave in
the future, and the future society that they will create.
Living in areas of poverty or conflict can have lasting damaging effects
in the minds of children.

For these reasons the protection and care of children is considered

extremely important. The Convention on the Rights of the Child is the
most widely accepted human rights document.
It has been signed by every country in the world except two.

Read ‘Child health’.

Divide the class into small groups. Each group should create a poster using only words (not
pictures) to promote child health.
Get the groups to present their posters.

30
16. Primary Health Care

Explain:

Health care can be divided into two main groups: Curative and
preventative.

Curative = People are treated after they become sick to make

them better. This method usually relies on surgery and medicines,
takes place in clinics and hospitals, by doctors, medics and nurses.

Preventative = This method aims to stop people from becoming

sick (therefore reducing the demand on curative health care). This
usually involves improving people’s living standards and awareness of
causes of health problems.

In small groups ask the students to make brainstorms / lists / fish diagrams:
One side should be anything to do with curative health care and the other side should be to do
with preventative health care.
Fish diagram:

Curative

Preventative

Get one or two groups to present their diagrams.

Explain:
Primary Health Care is essential health care based on practical,
scientifically proven methods, it allows full community participation,
and is at a cost communities can afford.

Modern medicine has many benefits, in curing people and saving lives,
but it also has some problems:
1. Modern medicine is expensive and therefore many poor
countries and communities cannot afford to provide sufficient
medical care.
2. Modern medicine is not trusted by many remote communities
around the world, and contradicts traditional beliefs.
3. Modern medicine often does not promote community
participation. It is provided by outsiders, and therefore
communities become dependent on outside help.

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 Primary Health Care aims to reflect the needs of a community, taking
into account the economic, cultural and political characteristics of
different communities.
It addresses main health problems of the different communities.
It includes education, methods of prevention of illness, promotion of
food supplies and nutrition, safe water, maternal and child health,
family planning, and immunization.
It involves all areas of the community.
It promotes self-reliance.
It relies on local staff

Elicit:
What are the basic ideas you could teach a rural community to help improve their standard of
health?
Benefits of eating fruit, nutritious foods, washing your hands, cleaning
wounds, drinking clean water, sleeping under a mosquito net, mosquitoes cause
malaria, basic sanitation, how conjunctivitis is spread, washing dishes, etc.

What could be introduced into rural communities to improve the standard of health?

Sanitation, clean water, immunization, health education, family planning, basic

health care (first aid), reducing malaria.

Divide the class into small groups. Give each group two of the following questions to
brainstorm:
1. How could sanitation in a rural community be improved?
2. What do people need for a nutritious diet?
3. How can villagers make sure they have clean water?
4. How can malaria be reduced?

Possible answers:
1. Education on the importance of sanitation, building toilets (away from
food areas, away from water sources), cleaning up rubbish, not throwing
waste water in water sources, system to remove rubbish (e.g. burying) etc
2. Fresh fruit, vegetables, meat, rice, clean water – vitamins, minerals,
carbohydrates etc
3. Don’t build toilets near water sources, don’t throw rubbish in water
sources, rivers, don’t wash in water sources, boil water, cover water to keep
out mosquitoes, filter water.
4. Mosquito nets, mats, cover water, insect repellant spray, mosquito
coils, wearing long sleeved clothes, getting rid of stagnant water etc

Read ‘Primary Health Care’.

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In small groups get the students to produce a poster to promote health / to educate people
in a village.
Since many villagers are illiterate, students cannot use any words on the poster, only
pictures.
Then get students from another group to explain how they understand the poster.
Which poster do students think is the best? Why?

Immunisation
Explain:
The immune system is a system in the body that works to protect the
body from harmful microorganisms such as bacteria, viruses and fungi.
Often our immune system is able to fight harmful microorganisms, but
sometimes it cannot, and we need to take medicine.
For example, if we have an infection of bacteria, we take antibiotics to
help the body fight the bacteria.

Another way to prevent disease is to help the body to develop

immunity to a bacteria or virus, before the person becomes infected.
This is done through immunization (often also called vaccination).
Usually immunisations are given by injection.

Sometimes immunization lasts for a short time – a few years then, the
immunization must be repeated. Other immunizations can last much
longer and are only given one time.

The first vaccination was developed 200 years ago.

Edward Jenner developed a vaccine for a disease called smallpox, which
was a very infectious disease. Fatality rates from smallpox were about
10%, and most the fatalities were children.
Today smallpox has disappeared. It no longer exists.
At first, many people were afraid to take the smallpox vaccination
because they were afraid it would have bad effects. This is a similar
problem to today, where many people in developing countries do not
understand about immunisation and therefore are afraid.

Birth control and maternal health education

Another factor that has improved health standards in developed
countries is birth control and maternal health education.
Maternal health education teaches mothers how to keep themselves
and their children healthy.
It also teaches that having too many children, or children born in a
short space of time, is bad for the mother’s health.

Family planning and birth control allows women to reduce the number
of children they have, and therefore improves their health. It also
enables them to space out births of children so that they do not have
several children within a short space of time.

Child health and primary health care

33
 As we discussed before, protecting children’s safety and health is
considered to be very important.
One strategy for primary health care focuses on improving health for
children. It recommends:
- education concerning prevailing health problems, their prevention and
control
- promotion of food supply and good nutrition
- safe water and basic sanitation
- maternal and child health care which included family planning
- immunization against major infectious diseases
- prevention and treatment of locally endemic diseases
- appropriate treatment of common diseases and injuries; and provision
of essential drugs

However, many countries lack the money and resources to achieve all
the activities listed above. Subsequently, the concept of “selective
primary health care” was proposed. It involved defining strategies
focusing on priority health problems, using interventions that were
possible to implement, of low cost, and with proven efficacy:
− growth monitoring
− oral rehydration therapy for diarrhea
− the promotion of breastfeeding and childhood immunizations
− birth spacing/family planning
− food supplementation
− the promotion of female literacy

17. Heroin and Burma

Possible
Ask: Whatanswers:
different types of drugs are there? Which are legal / illegal?
Legal - Medical, pain killers, antibiotics, caffeine, nicotine, alcohol etc
Illegal - heroin, opium, marijuana, amphetamines etc
34
Note – caffeine (from coffee and tea), nicotine (from cigarettes) and alcohol
are all considered to be drugs.
Ask: What is drug abuse? Which drugs are used in drug abuse?

Drug abuse is taking drugs for non-medical purposes; this does not just mean
illegal drugs, but also misuse of legal drugs. Also activities like sniffing glue
or solvents are a form of drug abuse.

Explain:

Drug addiction is habitual (regular) use of chemical substances to alter

the state of the mind or body for other than medical purposes.
We say a person is addicted if they have a dependence on a drug, and
experience withdrawal symptoms when they don’t take the drug.
Some drugs cause physical dependence, which means the person’s
body becomes dependent on the drug.
Other drugs cause psychological dependence, which means the
person’s mind ‘thinks’ it needs the drug.

Some common illegal drugs and their effects:

Narcotics – morphine, opium, heroin
Narcotics change a person’s mood and behaviour. They can also relieve
pain and induce sleep.
Side effects – vomiting, allergic reactions; slow respiration, coma and
death (large amounts)

Depressants – alcohol, sedatives

Depressants have a tranquilising effect, which means they make a
person feel relaxed, and can induce sleep.
Side effects – psychological dependency, death from overdose

Stimulants: cocaine, amphetamine, marijuana

Stimulants give a person energy, and can make them feel wide awake
and talkative, and happy.
Side effects – insomnia (unable to sleep), irritability, high blood
pressure, prolonged use can effect nervous system, weight loss
Produced in factories on Thai-Burma border (yaba)

Marijuana does have medicinal benefits – It can be used to treat effects

of cancer chemotherapy, glaucoma, arthritis

Read ‘Heroin and Burma’.

Answer the questions below the reading
Answers:
1. Burma, Laos and Thailand.
2. Because they share needles.
3. 400,000 to 500,000
35
4. Phensidyl, methaqualone, diazepam
5. Students’ own answers.
18. Burma’s social indicators

Look at the social indicators for Burma. Most of the indicators are from the years 2000 and
2001.

36
 1. GNI per capita was $220 for the year 2001. How much does this work
out as per day?

2. How have infant mortality rates and under 5 mortality rates changed
since1960?

3. Draw bar graphs to show: access to clean water

access to sanitation
government expenditure

19. Burma – A country in crisis

Read ‘Burma: A country in Crisis’

Get each student to write 6 questions from the reading.

37
As the students write their questions go around the class checking the grammar and clarity of
the questions.

Give each student a numbered piece of paper and ask them to write one of their questions
on the paper.
Stick all the pieces of paper on the walls of the class room.

Ask the students to go around the class room and write down the answers to the questions on
the pieces of paper (they could work individually or in pairs).

Go through the answers to the questions – get the student who wrote each wuestion to give
you the correct answer.

20. Woman’s health in Burma

Read ‘Women’s health in Burma’

Answer the questions in the reading.

38
 Answers:
1. High maternal mortality, illegal induced abortion, lack of reproductive
health knowledge, iron deficiency, anaemia, goiter, low birth weight babies,
miscarriage, still-birth, lack of midwives or TBAs etc.
2. Unable to find work, lack of money, poor education, trafficking,
threatened, repayment of debts etc.
3. Electric fences, guards, fear, don’t know where they are, can’t speak
Thai language, don’t know how to escape etc.

In small groups discuss:

Why are women and children often considered to be more vulnerable to poverty and disease
than men?
Why can malaria be more harmful to women and children than to men?
What could be done in the current situation to try to reduce the numbers of women being
trafficked into prostitution?

Discuss the groups’ answers.

39
Crossword

Answers:

A N T I B I O T I C D
L B A B M R
C A C H E M U
O T S L U M G
H I V E E N
O C R H E R O I N
L T I D
I A E P L V
C A R E A H A I
N I N D I C A T O R
K E U
L N S
E M O R T A L I T Y

40
1 2 3 4 5 ** ** 6
** ** ** ** ** ** **
** ** 7 ** ** ** **
** ** ** ** 8 ** **
9 10 ** ** ** ** ** ** **
** ** ** ** 11
** ** ** 12 ** ** ** ** ** **
** ** ** ** ** 13 ** 14 ** 15
16 17 ** ** ** ** **
** ** ** 18
** ** ** ** ** ** ** ** ** **
** ** ** ** ** ** ** ** ** **
** ** 19 **

Across
1. Medicine to kill bacteria
7. A type of pain
8. Where people live in poverty
9. Virus that causes AIDS
11. A drug produced in Burma
16. Health ____ worker
18. Data and information. A social ____
19. Death rate. ____ rate

Down
1. Someone who drinks too much
2. Short for Tuberculosis
3. These cause sore throats and pneumonia
4. Very fat
5. System that fights disease
6. Opium is a type of ___
10. HIV/AIDS program
12. Not alive
13. Preventative care
14. When the bacteria from 2 down are not active
15. This causes the common cold and flu

41
17. Joins your foot to your leg

42