The Geography of Food and

Health

Revision Notes
Paper 2
 Syllabus
Health is defined by The World Health Organisation as ‘a state of complete physical, mental and social well-being’.

Food miles: A measure of the distance that food travels from its source to the consumer. This can be given either in units of
actual distance or of energy consumed during transport.

HALE: Health-adjusted life expectancy, based on life expectancy at birth but including an adjustment for time spent in poor
health (due to disease and/or injury). It is the equivalent number of years in full health that a newborn can expect to live, based
on current rates of ill health and mortality.

Transnational corporation (TNC): A firm that owns or controls productive operations in more than one country through foreign
direct investment.

Life expectancy - The average number of years a person born today would be expected to live given constant mortality
conditions.

Infant Mortality Rate - The number of infant deaths – deaths of children below 1 year old – per 1000 live births per year

Calorie Intake - The amount of energy intake from food per person per day. Measured in kilocalories per person per day

Access to safe drinking water - Where the source of water is 1km from its place of use and can reliably provide 20 liters of
water per member of the household. The water must meet the World Health Organization or national standards for drinking
water quality.

Access to health services - Access to health refers to the number of healthcare facilities per 10 000 people or healthcare
expenditure per capita.

Malnutrition - A state of poor nutrition. This usually results from a deficiency of proteins, energy or minerals. May lead to
one of a range of diseases depending on the particular nature of the malnutrition.

Temporary hunger - Hunger is both a state where there is a desire for food and an absence of food. This is a short term
need for food, triggered by physiological responses caused by food deprivation.

Chronic hunger - A state where the desire for food becomes extreme, due to prolonged food deprivation, to the point
where normal bodily functions begin to be affected.

Famine - Famine is determined by the United Nations, and is a ‘legal’ definition. In this respect it is similar to the definition
of a pandemic: certain numerical conditions need to be met. The recent famine in Somalia in 2011 was the first ‘real’ famine for
some time. We will look in more detail at this event later in the unit. Famine is defined technically as: “a situation where acute
malnutrition rates among children exceed 30%, more than 2 people per 10 000 die per day, and people are not able to access
food and other basic necessities...”

Prevalence: The number of cases of a disease per 10,000 of the population

Incidence: The risk of developing a disease or condition, measured by the number of new cases confirmed annually
Infectious: the quality of a disease being caused by an infectious agent which is directly or indirectly transmitted from a
source of infection – living or non-living – to a susceptible host.
Non-communicable: the quality used to describe a disease that cannot be transmitted from an infected host.
Degenerative: a quality of a disease where the structure and function of the infected tissue worsens over time.
 E.g. osteoporosis, Alzheimer’s Disease, Huntington’s Disease

Viral: A disease that is caused by the presence of a virus

 E.g. HIV (Human Immodeficiency Virus), H1N1

Parasitic: A disease caused by the presence or because of reaction to a parasite

 E.g. Schistosomiasis (Bilharzia snail), Malaria (mosquitoes), Dracunculiasis (Guinea worm)

Endemic: A disease that occurs frequently in a specific geographic location or within a species.
 E.g. how HIV/AIDS is endemic in Sub-Saharan Africa, avian flu is largely endemic to birds and certain strains (e.g. H5N1)
are endemic to humans

Bacterial: A disease caused by the presence of bacteria

  E.g. Cholera, E. coli, Staphylococcus

Superbug: A strain of bacteria that has become resistant to normally used antibiotics
 E.g. Methicilin resistant Staph aureus (MRSA) and extensively drug resistant tuberculosis (XDR TB), which is resistant to
drugs such as isoniazid

Re-emergent: a disease that had previously decreased in incidence due to being controlled or eliminated, which has
recently increased in incidence
 E.g. Lyme disease (Endemic to Northern Hemisphere, transmitted by deer ticks, re-emerged in Italy, 2008), West Nile
Virus (Endemic to Uganda and East Africa, transmitted by mosquitoes, re-emerged in NYC in 1999 and became global)

Variations in
health
Variations in health – reflected by life expectancy (LE) – since 1950
 Describe the
variations in health as
reflected by changes
in life expectancy at
national and global
scales since 1950.
 Explain the
patterns and trends in
terms of differences
in income and
lifestyle.
 In 1948, the income and LE disparity between countries was wider than ever
o Asian and African countries were still poor and had low LEs (below 45)
 However! Japan was catching up with the wealthier nations after WW2
o Europe in top right corner of the graph w/ N Amer (LEs around 70-80)
 After 1950
o Asian colonies gained independence and their national incomes and LEs began to
improve.
 However! South Asian countries are further behind
o European and N Amer countries still remain healthy and wealthy
 LE increased towards the 80s
 Middle Eastern and N. African countries had higher incomes and higher LEs due to the
revenue earned from oil exports.
o Sub Saharan countries are still poor and sick
 1970s
o Asian and S. American countries (e.g. Mexico, Malaysia, South Korea) became
emerging economies and caught up with the developed N. American and European
countries.
 1980s till 21st Century
o Emerging economies in Asia and S. Amer continue to see improvements in income
and LE.
o Some African countries (e.g. Ghana) see improvements in income and LE.
o However, African countries such as the Congo and South Africa/Botswana do not
see large improvements due to civil war (Congo) and HIV/AIDS (S. Africa)
 Without HIV/AIDS, it is estimated that S. Africa would have an LE of 69
instead of the current 41 years
 Currently in the 21st Century
o Estimated that ALL countries now have LEs above 40
 However, not all countries have income per persons above $3000
o Middle income countries or emerging economies (EEs) are able to compete with
high income countries in terms of LE and income due to the 2007-8 financial crisis.
 European and N. American countries experience lower incomes
  Low income countries in Africa hit hard
 EEs predicted to see improvements in economic growth and development
of healthcare.
o Huge income differences between developed countries and developing countries
 e.g. comparing Luxemburg and the Congo
o Inequalities within countries
 E.g. Shanghai, China has the equivalent LE and income of Italy
 However! Rural areas in Guizhou, China have the same LE and income of
Ghana

Patterns & trends in health with respect to income & lifestyle

Wealth
 Affects whether people are able to afford high quality healthcare treatment.
o Low wealth = inability to access high quality healthcare treatment
 E.g. only have access to general use drugs, no specialized drugs
o High wealth = access to more advanced forms of treatment
 E.g. radiotherapy and chemotherapy treatments for serious diseases e.g.
cancer.
 Affects diet – quantity and quality of nutrition obtained
 Affects location & access to healthcare
OVERALL: Wealth is a factor that affects health in a multitude of ways.

Rural or urban location

 Rural areas: harder to access healthcare facilities
o Low frequency of clinics and hospitals
o Opportunity cost of travelling to seek treatment would be time used to earn
income and provide food via agriculture
 Affects whether ppl in rural areas can afford the time and money to seek
healthcare
o Fewer doctors in rural areas because population does not meet the threshold
population for a clinic or healthcare center (not enough people to support a clinic)
 Longer waiting lists for doctors
o Quality of healthcare facilities and doctors
 Availability of preventative measures such as vaccinations
 Urban areas: relatively easier access to healthcare
o Higher population density = more clinics and facilities located there
o Many types of transport infrastructure
 Easy access

Quality of sanitation and sewage systems

 Availability and quality of sanitation facilities e.g. toilets.
o Affects how sanitary the environment is
o Spread of diseases
 Poor quality toilets – long-drop or open defecation – are often found in poorer, rurall areas
that lack amenities.
o These areas also often have open sewage systems
 Conversely, richer areas tend to have better sanitation infrastructure – namely toilets and
sewage systems.
 o Most urban areas have closed-sewage systems and flushable toilets
 Availability of sinks/clean, running water

Provision of clean water and food

 Whether the water comes from a clean, purified source.
o Water from ground wells – found in poorer, arid countries (sub-Saharan) – are
from an open source that allows it to be easily contaminated and to breed disease-
causing bacteria or parasites

Major events affecting LE

 1810: Most countries were in bottom left corner of the graph – sick and poor
o LE below 40 in all countries
o Income less than $3000
o UK and the Netherlands were better off, but not by much
o LE fluctuated due to famines and disease
 Industrial revolution at end of 19th century
o Europe and N. America first began to grow richer due to industrialization
(development of new technologies)
o Health in Europe an N. America then began to improve
 Movement away from the sick and poor area, makes them richer and
healthier
o Asian colonies and Sub-Saharan African countries remained sick and poor
 LE still remained below 40 towards the end of the 19 th century
 Spanish Flu and WW1 in early 20th century caused massive drops in life expectancy
 In 1948, the income and LE disparity between countries was wider than ever
o Asian and African countries were still poor and had low LEs (below 45)
 However! Japan was catching up with the wealthier nations after WW2
o Europe in top right corner of the graph w/ N Amer (Les around 70-80)
 After 1950
o Asian colonies gained independence and their national incomes and LEs began to
improve.
 However! South Asian countries are further behind
o European and N Amer countries still remain healthy and wealthy
 LE increased towards the 80s
 Middle Eastern and N. African countries had higher incomes and higher Les due to the
revenue earned from oil exports.
o Sub Saharan countries are still poor and sick
 1970s
o Asian and S. American countries (e.g. Mexico, Malaysia, South Korea) became
emerging economies and caught up with the developed N. American and European
countries.
 1980s till 21st Century
o Emerging economies in Asia and S. Amer continue to see improvements in income
and LE.
o Some African countries (e.g. Ghana) see improvements in income and LE.
o However, African countries such as the Congo and South Africa/Botswana do not
see large improvements due to civil war (Congo) and HIV/AIDS (S. Africa)
 Without HIV/AIDS, it is estimated that S. Africa would have an LE of 69
instead of the current 41 years
 Currently in the 21st Century
 o Estimated that ALL countries now have LEs above 40
 However, not all countries have income per persons above $3000
o Middle income countries or emerging economies (EEs) are able to compete with
high income countries in terms of LE and income due to the 2007-8 financial crisis.
 European and N. American countries experience lower incomes
 Low income countries in Africa hit hard
 EEs predicted to see improvements in economic growth and development
of healthcare.
o Huge income differences between developed countries and developing countries
 e.g. comparing Luxemburg and the Congo
o Inequalities within countries
 E.g. Shanghai, China has the equivalent LE and income of Italy
 However! Rural areas in Guizhou, China have the same LE and income of
Ghana

Factors affecting health (based on LE)

Wealth
 Affects whether people are able to afford high quality healthcare treatment.
o Low wealth = inability to access high quality healthcare treatment
 E.g. only have access to general use drugs, no specialized drugs
o High wealth = access to more advanced forms of treatment
 E.g. radiotherapy and chemotherapy treatments for serious diseases e.g.
cancer.
 Affects diet – quantity and quality of nutrition obtained
 Affects location & access to healthcare
OVERALL: Wealth is a factor that affects health in a multitude of ways.

Rural or urban location

 Rural areas: harder to access healthcare facilities
o Low frequency of clinics and hospitals
o Opportunity cost of travelling to seek treatment would be time used to earn
income and provide food via agriculture
 Affects whether ppl in rural areas can afford the time and money to seek
healthcare
o Fewer doctors in rural areas because population does not meet the threshold
population for a clinic or healthcare center (not enough people to support a clinic)
 Longer waiting lists for doctors
o Quality of healthcare facilities and doctors
 Availability of preventative measures such as vaccinations
 Urban areas: relatively easier access to healthcare
o Higher population density = more clinics and facilities located there
o Many types of transport infrastructure
 Easy access

Quality of sanitation and sewage systems

 Availability and quality of sanitation facilities e.g. toilets.
o Affects how sanitary the environment is
o Spread of diseases
  Poor quality toilets – long-drop or open defecation – are often found in poorer, rurall areas
that lack amenities.
o These areas also often have open sewage systems
 Conversely, richer areas tend to have better sanitation infrastructure – namely toilets and
sewage systems.
o Most urban areas have closed-sewage systems and flushable toilets
 Availability of sinks/clean, running water

Provision of clean water and food

 Whether the water comes from a clean, purified source.
o Water from ground wells – found in poorer, arid countries (sub-Saharan) – are
from an open source that allows it to be easily contaminated and to breed disease-
causing bacteria or parasities
o In more developed countries – esp. urban areas – water has been purified at
treatment plants.
 Sufficient water infrastructure
 Quantity & quality of food consumed
o Quantity: amount of food (measurable by kilocals/day)
Quality: whether food is clean and provides sufficient nutrients.
o Developing vs developed countries: MEDCs generally hv greater qty of food per
person than LEDCs.
 Due to higher incomes and availability of food that is imported
o Quality of food tends to be better in MEDCs due to ppl’s ability to vary their diet
and have food from all food groups.

Education
 Affects how educated members of population are about diseases
o Poor education on diseases: inability to identify diseases by symptoms or how to
treat them.
 Often in LEDCs because low access to education from high rural popns or
low incomes.
 Education regarding hygine practices

Quality of working conditions

 Affects the amount of risk at work – would affect LE
o LEDCs where work tends to be in the pri. & sec. sectors involves manual labour – risk of
injury involved
 Low standard of living = poorer working conditions
 Working conditions may be poorer due to government lacking funds and time to
regulate these.
o MEDCs: occupations in the tertiary & quaternary sectors don’t involve heavy labour –
less risks & hazards at occupations.
 Good working conditions due to high standard of living
 Government or external bodies to regulate working conditions.

Infant care and maternal care

 Affects infant mortality, child mortality & mortality rate in general (for mothers): thus
affecting LE, the avg. # of years a person is expected to live from their date of birth
o E.g in Sierra Leone: 1 in 8 women die in childbirth – contributes to higher mortality rate
 Developing countries vs developed countries
 o Developing: lack of access to high quality medicines and medical facilities = higher
IMR, CMR & maternal deaths.
 Poorer quality post natal care
 Shortage of doctors & nurses – reliance on midwives or family births (more
unsanitary)
o Developed: higher quality medical treatment and facilities = better quality post natal
care

Life expectancy (LE)

 LE definition: the average number of years that a newborn can be expected to live

Comparing 2 countries: Burundi, Central America (50) & Sweden (81)

Burundi
 If conditions remain at 2007 conditions
 2 out of 5 people can live past the avg life expectancy of 50

Sweden
 If conditions remain at 2007 level
 1 dies in adulthood, 4 die at old age

In LE, one must consider the infant mortality as well, as it will affect patterns in the LE.
 LE is low when infant & child mortality rates are high – higher probability of dying at an
earlier age

LE is an average, although most ppl in Burundi live past the age of 50, some may die at infancy or
during childhood years.

Measuring health Life Expectancy

Pros
Evaluate life  Considers various factors in measuring life expectancy – e.g. gender, history of related
expectancy, infant diseases, alcohol consumption and hours of sleep received.
mortality rate (IMR)  Serves as a measure of the overall health of a country’s population
and child mortality,  Average life expectancies can be compared across different countries in order to compare
HALE (health- the level of health.
adjusted life  Encompasses all three aspects of health: physical, social and mental well-being
expectancy), calorie Cons
intake, access to safe  May be difficult to collect data in developing countries due to low government funding and
water and access to larger amount of local run clinics that are not accounted for.
health services as  As life expectancy is an average figure for a country, within the country there may be large
indicators of health. regional or ethnic variations.
 In some cases, countries may measure life expectancy differently, making it difficult to
compare the health of different countries.
 For example some countries measure life expectancy from birth, while others may measure
life expectancy from another age.
 Life expectancy does not measure the quality of life in terms of how many years of one’s
life is spent in poor health.
Conclusion
 Life expectancy serves as a good measure of the general health of a country.
 Provided that the measure of life expectancy is standardized across countries, can serve as
a method to compare health.
  However, this only examines the ‘quantity’ aspect of health in terms of how long people
live

Infant Mortality rate

Pros
 Considered a more accurate measure of a country’s health because the first year of infancy
is a sensitive, vulnerable period of time where the infant requires sensitive care. Shows the
quality of a country’s healthcare system.
 Infant mortality rate can reflect the quality of a country’s sanitation, household income,
nutrition and other factors
 Infant mortality rate also links towards the life expectancy of a country.
 E.g. a high infant mortality rate usually correlates with a lower life expectancy due to higher
chances of dying before age of 1.
 Data for infant mortality can be acquired mostly from hospital records, making data
collection relatively easy
Cons
 Factors such as emigration or conflict can cause inaccuracies in the infant mortality rate
data.
 Some families might not register children or gave birth to children via unofficial means e.g.
midwives.

Conclusion
 Infant mortality rate is a more sensitive, possibly accurate indicator of health as it deals
with post-natal care, which is a very delicate area due to the number of factors affecting an
infant’s health.
 Although there may be inaccuracies, infant mortality serves as an effective comparison of
health standards.
Health Adjusted Life Expectancy (HALE) - HALE is calculated using Sullvian’s method, which
measures the real health of a population when adjusted for mortality levels and is independent of
the age structure. Specifically, Sullivan’s method measures the number of years an individual of a
particular age is expected to live in a healthy state.
Pros
 Unlike life expectancy, HALE measures both the quantity and quality of health as it takes
the average number of years lost to disability or poor health into account.
 Shows the influence of chronic diseases or degenerative diseases, e.g. arthritis or
Alzheimer’s Disease, on a country’s health.
 Demonstrates how health can be affected by both external factors from the environment
and internal or endogenetic factors – that relate to genetic diseases.
 Calculation of HALE also produces additional statistical data of DALYs – disability adjusted
life years – which measure the number of years of productive life lost to disability.
Cons
 Data gathered for HALE may be more unreliable. This is because data needs to be gathered
via health surveys or reported data from hospitals. Survey data may be harder to obtain –
especially in LEDCs due to the time and monetary cost.
 Serves as an average indicator of years expected to live in full health, there would still be
regional or ethnic variations in HALE within a country.
  Difficult to measure morbidity – which relates to the frequencies of diseases – because it
relies again on reported data.
Conclusion
 Compared to life expectancy, HALE serves as a far more specific indicator of health by
measuring quantity and quality of health.
 However, because the HALE uses more specific data, there is a higher chance that this data
is inaccurate. This may be especially true in developing countries where it may be harder to
conduct household surveys due to lack of government funding.
Calorie Intake
Pros
 Used to measure the degree of undernourishment in a country – the state of people having
not enough food to eat.
 By using the current recommended calorie intake of 2000kcal/day for women and
2500kcal/day for men, one is able to identify countries that have higher degrees of
undernourishment.
 Shows the access to food or food supply in different countries and allows for international
comparison between countries

Cons
 Proxy data – does not measure health itself, but measures a factor that affects health.
 Does not measure malnourishment – whether individuals have nutrient deficiencies or
nutrient imbalances, which could have serious impacts on health.
 Following from previous point, one does not know the source of the calories consumed,
and they may come from foods that are high in fat.
 When comparing calorie intake across countries, the caloric requirements in each country
will differ due to factors such as age structure or weather.
 E.g. Calorie intake in colder countries – e.g. Canada – will be higher because of the colder
climate. In Asian countries caloric intake tends to be lower due to smaller stature and
physique of people.
 Within countries there would be variations in terms of ethnicity, gender, occupation and
other factors. E.g. a Tour De France cyclist will require up to 10,000kcal/day during a race,
would be significantly higher than average calorie intake of the rest of the population.

Conclusion
 Calorie intake may not serve as the most effective measure of health, however it does
provide a suitable indicator for the degree of undernourishment across countries.
 Although similar to other indicators of health in the sense that it may hide regional or
ethnic patterns in the data for one country, calorie indicator also hides variations
depending on the type of occupation or profession, e.g. whether individuals are
professional atheletes.
 Major limitation would be that it does not show what kind of food the calories are obtained
from, hides whether the population has nutrient deficiencies or imbalances.
Access to safe drinking water
Pros
 Access to safe drinking water has direct links to sanitation and is a key factor affecting
health.
 Indicates the quality of sanitation and sewage systems in a country – which both link to
health.
  Low access to safe drinking water would mean a higher incidence of water borne diseases
e.g. schistosomiasis (bilharza) and cholera.
Cons
 Proxy data – does not measure health but instead measures a factor affecting it
 Data may contain inaccuracies – difficult to measure the distance away from a water source
for each community, especially in a rural area of an LEDC. Data collected in LEDCs would be
less reliable due to low government funding combined with high time and monetary cost.
 The drinking water quality standards used by certain countries may be more strict or lower
than the WHO drinking water standards, causing difficulty in comparing access to safe
drinking water.
 Distance of 1km away from the water doesn’t measure how easy it is to travel that for that
1km, it could be mountainous or flat for example.
Conclusion
 Access to safe drinking water provides proxy data with a stronger link to a country’s health,
as water is seen as vital for human life (e.g. one can only survive 3 days without water).
 In addition, because unsafe drinking water can carry such a variety of potentially dangerous
microbes and diseases, access to safe drinking water is seen as a more sensitive and specific
source of proxy data linked to health.
 However, one must bear in mind that access to safe drinking water is proxy data and only
serves as a factor affecting health.

Access to Health Services

Pros
 Access to healthcare facilities is a factor that has direct effects on the health of a
population. Shows whether individuals in a country are able to seek effective treatment for
diseases or preventative care.
 Hospital beds & physicians per 10 0000 people show the level of strain placed on
healthcare services.
 A standard measure of 23 doctors/nurses/midwives per 10000 people is used as the
minimum number of healthcare workers per 10 000 to ensure a coverage rate that
maintains adequate healthcare. This can be used to compare various countries.
 Healthcare expenditure shows the level of investment and development in healthcare
systems – affecting the overall health of a country.
Cons
 Proxy data – does not actually measure health, rather it measures a factor affecting it.
 In LEDCs the figures may not be as accurate due to unlicensed healthcare workers or
unofficial healthcare centers.
 Number of physicians per 10000 does not indicate the quality of the healthcare services
offered.
 Within a country there would be large variations in the number of healthcare workers per
10000 based on location. I.e. rural areas would have fewer physicians per 10000 than in an
urban area.
 The age structure of a country’s population could affect the health expenditure per capita.
Conclusion
 Access to healthcare facilities is proxy data linking to the health of a country. Provides a
direct link to whether members of the population have the access to preventative
treatments or medicines to treat disease.
 However, in the case of physicians per 10000 population – the most common method of measuring
access to healthcare facilities – it does not measure the quality of the services provided by the
physicians
Prevention relative Most nations of the world emphasise curative health care facilities. In other words, governments
to treatment spend money on hospital and medical facilities which are designed to cure illnesses rather than
prevent them. Curative health care needs large numbers of hospitals, doctors, medicines and
facilities. The results can be impressive where enough resources are allocated, with heart
Discuss the transplants, surgery and other techniques saving lives. However, the sums of money involved are
geographic factors beyond the resources of many of the world’s countries if curative healthcare is to be adequate.
that determine the
relative emphasis Primary Health Care is different to health care in that it combines prevention with cure. Many
placed by policy- nations of the world are coming to realise that to it is better to prevent diseases where possible than
makers, in one to wait for people to get sick. Keeping people well enables them to work productively, feel better
country or region, on and not be a drain on government spending by being in hospital. Screening for diabetes, doing pap
smears to detect cervical cancer in women, using TB detecting tests and mass inoculations for
prevention as
diseases such as polio and Hepatitis B are cheap and could save millions of lives in LEDCs. It is
opposed to treatment estimated providing all the primary health care needed in the world would cost an extra $50 billion
of disease per year for the next 20 years. This sounds like a lot of money, but it is only a small percentage of
what is spent on cigarettes or arms and the military.

In the 1960s China introduced widespread primary health care. Thousands of paramedics, called
barefoot doctors, where trained in the use of basic medicine and sent to work in rural areas to care
for farmers and their families. Similar systems have since been established in many countries,
including Iran, Sudan and Sri Lanka. Many LEDCS have realised that it is impossible, and
inappropriate, to copy overseas health care systems without questioning basic assumptions and
financial demands. It i s usually better to develop a system of healthcare which is affordable and
suited to the specific needs of the country concerned.

Reflecting (or perhaps contributing to) the differences in the quality of health care standards around
the world is the distribution of health care. There are vast differences between the ratio of doctors
to the people of the nations of the world. The countries with most people per doctor are Ethiopia
(60,000 people per doctor) and Burkina Faso (57,200) whilst in Russia it is 180 and Italy 230.

In most countries one of the greatest differences occurs between urban and rural areas.

Your case study for this should be based on your notes on HIV/ AIDs (see later section). Prevention
of HIV/AIDs involves stopping people getting HIV in the first place. This has occurred through:
 Screening of people for HIV
 Giving medication and education to HIV+ pregnant mothers to stop them passing it onto
their unborn babies.
 Promotion of abstinence
 Education about contraceptives that prevent HIV (e.g. condoms)
 Distribution of free or subsidised contraceptives
 Publicity campaigns

Prevention of HIV in Uganda – ABC Campaign (Abstinence, Be Faithful, Condoms)

The very high rate of HIV infection experienced in Uganda during the '80s and early '90s created an
urgent need for people to know their HIV status.

In Uganda developed a national HIV/AIDS policy in 1992. A variety of approaches to AIDS education
have been employed, ranging from the promotion of condom use to 'abstinence only' programmes.

To further Uganda's efforts in establishing a comprehensive HIV/AIDS program, in 2000 the MOH
implemented birth practices and safe infant feeding counseling. According to the WHO, around
41,000 women received Preventing Mother To child Transmission (PMTCT) services in 2001. Uganda
was the first country to open a Voluntary Counselling and Testing (VCT) clinic in Africa called AIDS
Information Centre and pioneered the concept of voluntary HIV testing centers in Sub-Saharan
Africa.

The Ugandan government has promoted this as a success story in the fight against HIV and AIDS,
arguing it has been the most effective national response to the pandemic in sub-Saharan Africa.
Though equally there has in recent years been growing criticism that these claims are exaggerated,
and that the HIV infection rate in Uganda is on the rise, perhaps linked to over-emphasis on
abstinence at the expense of condom use.

An overarching policy known as "ABC", which consisted of abstinence, monogamy and condoms,
was set up with the aim of helping to curb the spread of AIDS in Uganda, where HIV infections
reached epidemic proportions in the 1980s. The prevalence of HIV began to decline in the late 1980s
and continued throughout the 1990s. In fact, between 1991 and 2007, HIV prevalence rates declined
dramatically from about 15% in 1991 to about 6% in 2007.

Shortly after he came into office in 1986, President Museveni of Uganda spearheaded a mass
education campaign promoting a three-pronged AIDS prevention message: abstinence from sexual
activity until marriage; monogamy within marriage; and condoms as a last resort. The message
became commonly known as ABC: Abstinence, be faithful, use a condom if A and B fail. This message
also addressed the high rates of concurrency in Uganda, which refers to the widespread cultural
practice of maintaining two or more sexual partners at a time. Mass media campaigns also targeting
this practice including the "Zero-Grazing" and "Love Carefully" public health messages in the 1990s

The government used a multi-sector approach to spread its AIDS prevention message: it developed
strong relationships with government, community and religious leaders who worked with the
grassroots to teach ABC. Schools incorporated the ABC message into curricula, while faith-based
communities trained leaders and community workers in ABC. The government also launched an
aggressive media campaign using print, billboards, radio, and television to promote abstinence,
monogamy and condom use.

Some reports suggest that the decline in AIDS prevalence in Uganda was due to monogamy and
abstinence, rather than condom use. A 2004 Science study also concluded that abstinence among
young people and monogamy, rather than condom use, contributed to the decline of AIDS in
Uganda.

However, some studies have suggested that a large part of the decline in prevalence of HIV-AIDS is
due to the premature death of those who have contracted it. This led to the popular play on the ABC
campaign, 'A-B-C-D', with the D standing for Death. Because only prevalence is measured, incidence
can actually increase while prevalence decreases if those who contract HIV are not treated for the
disease, thereby dying younger. Later studies have seriously questioned the veracity of Uganda's
miraculous HIV-AIDS claims

In the 1990s there had been limited access to treatment in the form of anti-retrovirals for those who
are HIV positive. Through the combined effort of US PEPFAR, the Government of Uganda and
international agencies (Clinton HIV/AIDS Initiative, the Global Fund, UNITAID) this has improved. The
country's HIV-AIDS campaign focuses solely on prevention rather than cure, and that prevention is of
questionable success.

Criticism

The scope of Uganda's success has come under scrutiny from new research. Research published
in The Lancet medical journal in 2002 questions the dramatic decline reported. It is claimed statistics
 have been distorted through the inaccurate extrapolation of data from small urban clinics to the
entire population, nearly 90% of whom live in rural areas.

Alternatively, the Roman Catholic organization Human Life International says that "condoms are
adding to the problem, not solving it" and that "The government of Uganda believes its people have
the human capacity to change their risky behaviors."

It is feared that HIV prevalence in Uganda may be rising again; at best it has reached a plateau
where the number of new HIV infections matches the number of AIDS-related deaths. There are
many theories as to why this may be happening, including the government’s shift from abstinence-
based prevention programmes, and a general complacency or 'AIDs fatigue'. It has been suggested
that antiretroviral drugs have changed the perception of AIDS from a death sentence to a treatable,
manageable disease; this may have reduced the fear surrounding HIV, and in turn have led to an
increase in risky behaviour.
Global availability
of food

 Identify
global
patterns of
calorie intake
as one
measure of
food
availability.

This shows the global distribution of calorific intake by nation. This is shown as kcal which represents
1000 ‘small calories’. If you look at any food wrapper you will see the energy value of the food
shown in these 2 forms.

According to the National Health Service of the United Kingdom the average man should consume
around 2500 kcal per day to maintain his weight, and the average woman should consume around
2000 kcal. These figures are guidelines, and would need to be adapted according to the age, and
physical activity of the person, but they give a sense for what would be a reasonable consumption of
food. Of course the distribution of access to calories is not equal, and even within countries that
would be considered to be economically developed not everyone is always well fed. How does this
variation in calories impact on people?

Global distribution of calorie intake

America: 3770kcal per day, highest calorie intake of all countries.
Countries w/ high calorie intake concentrated around N. America and areas in Europe. Specific
countries include USA, Canada, Greece and Romania
Countries w/ lowest calorie intake concentrated in Sub Saharan Africa, Southern Asia.
South Amer. has high disparity in calorie intake: with most having above 2000kcal. Except for Bolivia
 Dem. Republic of the Congo: 1590kcal, has the lowest calorie intake of all countries.
DRC has 12th largest population of countries, possibility that there are ppl that consume far below
the avg calorie intake.
State of health in specific countries
DRC – high prevalence of underweight, undernourished people.
USA – high calorie intake above recommended average. Seems to suggest better quality of health,
however people might be overweight or overeating.

 Distinguish Malnutrition - A state of poor nutrition. This usually results from a deficiency of proteins, energy or
between minerals. May lead to one of a range of diseases depending on the particular nature of the
malnutrition, malnutrition.
temporary
Temporary hunger - Hunger is both a state where there is a desire for food and an absence of food.
hunger,
This is a short term need for food, triggered by physiological responses caused by food deprivation.
chronic
hunger and Chronic hunger - A state where the desire for food becomes extreme, due to prolonged food
famine. deprivation, to the point where normal bodily functions begin to be affected.

Famine - Famine is determined by the United Nations, and is a ‘legal’ definition. In this respect it is
similar to the definition of a pandemic: certain numerical conditions need to be met. The recent
famine in Somalia in 2011 was the first ‘real’ famine for some time. We will look in more detail at
this event later in the unit. Famine is defined technically as: “a situation where acute malnutrition
rates among children exceed 30%, more than 2 people per 10 000 die per day, and people are not
able to access food and other basic necessities...”

Hunger map
Measures # of people that are undernourished in order to measure hunger
Over 35% of population undernourished – high prevalence of hunger
Areas with high prevalence of hunger
 Sub Saharan Africa
 Areas in South Asia and towards Ctrl Asia
 Usually applies to landlocked countries
 No water resources for fishing
 No trade
 More arid
  Discuss the Unless your parents have put a padlock on the fridge, you are likely to be fairly secure. For millions
concept of of people in the world, however, feeding themselves and their family is far less certain. Concern over
food security. where the next meal might be coming from creates a physiological stress on the body. Over time,
uneven access to food impacts on the health of individuals, particularly young children, for whom
this can have life-long impacts.

You may have had to wait longer than you wanted for a particular meal, but globally, millions of
people are uncertain of the source of their next meal, and have to travel for many miles to increase
their food security. This is a major driving force in global migration, as well as leading to land use
change and pressure on resources such as water.

Food security “exists when all people, at all times have access to sufficient, safe and nutritious food
to meet their dietary needs and food preferences for an active and healthy life..."

Map showing food security around the world. Food security will be discussed further in the next
sections

Areas of food 1) Increased productivity

sufficiency and
deficiency Land use per capita has shown decreasing trend
 0.44 ha per capita in 1964
 Explain how  0.25 ha per capita in 1984
changes in  0.21 ha per capita in 2001
agricultural  OVERALL: Trend shows increased amount of yield per plot of cultivated land =
systems, increased productivity
scientific and
technological 5 reasons why productivity increased
I. Adoption of high yielding varieties of crops (HYVs)
innovations,
the expansion
of the area
under Definition: crop varieties that are genetically engineered to have higher yields, increased
agriculture resistance to diseases and pests as well as shorter growing cycles.
and the  HYVs of rice and wheat have shorter, thicker stems that allow each plant to hold a
growth of heavier head of grain.
agribusiness  Increased resistance to disease and pests = less crops lost and more grain/produce is
have harvested
increased the  Shorter growing cycles = crops can be harvested twice or thrice each year, increasing
availability of yield per year
food in some  India quadrupled food production between 1955 and 2005 mainly due to HYVs
areas, starting
with the 2. Improved irrigation systems
Green  Allows more cultivated land to have adequate supply of water to support a larger
Revolution amount of healthier crops, resulting in more yield.
and
continuing Between 1980 and 2000, % of world’s irrigated cropland incrased from 15.7% to 19.7%
since.  Largest increase: Asia (from 31.3% to 37.9%)
Specific e.gs
o Bangladesh: 17% to 33%
o Nepal: 22% to 35%

3. Increased use chemical fertilizers and pesticides

 Fertilizers supply crops with vital nutrients – nitrogen, phosphorous and potassium –
that ensures healthy growth of crops and thus increased yield.
 Pesticides ensure pests do not attack crops and ensure that more is able to be
harvested.

Global increase in fertilizer use:

 1964: 29kg of fertilizer/ha of cropland
 1981: 87kg of fertilizer/ ha of cropland
 2003: 101kg of fertilizer/ha of cropland

4. Increased improvements and access to mechanical farming technology

 Use of more efficient farming machines results in greater productivity per plot of land,
less labour required
o HWVR! Results in unemployment of farmers that are made redundant by
machinery

Global increase in use of tractors and harvesters

 1980 to 2002: increase in number of tractors by 16.6%
Increase in nmbr of harvesters by 11.5%
Specific e.gs
o 903% increase in S. Korea from 1980 to 2002
o 353% increase in Indonesia from 1980 to 2002

 Changing nature of agricultural workforce

 Decrease in total number of workers involved in agriculture, esp. noticeable in
developed economies (low proprtn employed in agriculture) and emerging economies
(falling proprtn employed in agriculture).
 Despite this, increased improvements to mechanical technology mean fewer workers
are required
 Farm amalgamations: a large neighboring farm/corporation buys surrounding plots of
land to increase farm size and fully utilize farming machinery (e.g. combine harvesters).

5. Increasing importance of free trade and Fair Trade

Free trade: lowering/elimination of most trade barriers between countries

 Resulted in lower prices of imported food and increased ease to purchase.
 Farmers increase yields due to increased size of market

Fair trade: ensures that farmers are treated equitably and receive a fair price for their
produce, minimizing the need for middlemen and allowing farmers to supply directly to
overseas economies.
 Incentive to increase yield and productivity.

The Green Revolution

The Green Revolution is the name given to the approach that was developed by Norman
Borlaug and others to increase the productivity of agricultural land in key countries of the
world by educating farmers and introducing new technologies. Genetic engineering was
used to produce higher yielding varieties of crops. This also needed mechanisation,
pesticides, herbicides, chemical fertilisers and irrigation water.

Through the 1960 and 1970ss a range of techniques were introduced, some of which were
based on techniques that had been used successfully in Mexico. These techniques
increased productivity so much that Mexico became a net exporter of cereals.

One of the major aspects of the Green Revolution was the use of technology.

Another success was achieved in Punjab state in India, where wheat and rice production
doubled (using the IR8 Mexican rice which had a shorter stalk and a larger head and yielded
twice as much rice. It could also be cropped twice a year rather than the one crop that they
were used to achieving). The Punjab became known as the ‘bread basket’ of India. India is
fed using an area of land seven times smaller than the land needed to ‘feed’ a similar
population in Africa.

Things that worked

Using hybrid grain seeds (mainly rice, wheat and corn).

These hybrid seeds produced plants with shorter stalks. Instead of putting the energy into
growing taller, energy went into the grain. These HYVs (high yielding varieties) of staple
crops were produced by genetic engineering. In some cases, several harvests were possible,
rather than just one.
Things that didn't work so well

Inputs into the farm system were increased. These include the things that are needed for the farm
to operate successfully.

Artificial fertilisers were needed to ensure high yields. Whereas the traditional methods used
animal manure and didn’t need any additional inputs, the HYVs needed artificial support, as they
were sometimes more prone to pests and disease due to the genetic manipulation that went into
their production.

Costs were higher as there were fees for these artificial additions to the farm system. Farmers in
these areas found it difficult to access loans and additional funding, and didn’t want to get into
debt. Richer farmers ended up getting richer but the poorer farmers who could not afford the new
technology were often forced off their land (or made to pay higher rents) and ended up worse off.

Some crops also needed improved irrigation, which was required for maximum yields. In areas of
water scarcity this was not always easy to guarantee. Salinisation occurred in some areas because
of inefficient irrigation. There was also increased eutrophication and increased amounts of cancer
which is believed to be because of the increased amounts of pesticides in the water.

Changes in agricultural systems

Traditionally, farming has a simple system of inputs, processes and outputs. Although different farms will
generally have variations on a theme, this pattern is reproduced on each farm. There are usually limiting
factors such as climate, soil, topography etc. plus the historical use of that particular piece of land. Many
farmers are driven by the necessity to feed the family, or make a profit to please shareholders.

There have been many changes to agriculture over the years. Agriculture also requires investment of vari
kinds. Many countries have prioritised other areas over agriculture, and only a small percentage of foreig
tends to be spent on agricultural projects

Commercial: crops are grown and the produce is sold for the purpose of selling to other markets
Subsistence: produce from crops grown is largely consumed by the farmer and his or her family. Crops ar
grown in order to sustain ones household’s own food consumption. More farmers turning to commercial
farming: selling their produce instead of using it to feed themselves and storing the surplus
Commercial farmers receive several advantages
 Affected more by political and economic influences.
o E.g. government policies or grants, falling costs in farm equipment or transport to markets
o Commercial farms benefit more from such policies or improvements.
 Farmers have increased incomes
 Knock on effect to the entire economy: increases a country’s GDP
 Farmers have higher disposable income to purchase more consumer goods, necessities and gain acc
to svcs e.g. healthcare and education.
 Increase in demand stimulates rural non-farm economy (i.e. industries & businesses in rural areas th
are not related to agriculture). Multiplier effect = increased standard of living in rural areas
o OVERALL: Improved standard of living
o
 Commercial farmers can overcome constraints of biophysical environment.
o Mainly due to the fact that commercial farmers have more money and access to more adva
farming technologies/equipment.
o E.g. commercial farmers can afford more fertilizers and better irrigation systems, compared
subsistence farmers. Results in plants receiving nutrients and water despite poor conditions
o In more developed areas, commercial farmers can have greater control of biophysical
environment w/ controlled greenhouses.

Increasing specialization
Increased income due to commercial farming = farmers can buy their own food from other markets. Do n
need to grow own food.
 Thus, farmers can specialize into growing one type of crop.
 Specialization into a cash crop = more money earned.

Increased spatial integration

Increased integration between farmers and the markets they sell to
 Improved transportation infrastructure to nearby market towns
o Increase efficiency in selling produce
 Increased development of ancillary financing services: ensure that farmers can effectively utilize the
money they earn
o E.g. development of banks, insurance providers, marketing firms

Increased rural electrification and communication infrastructure

 Results in more farmers having access to televisions, telephones, computers and the Internet
 Allows for increased spread of globalization and allows farmers access to world information
 Link to increased commercialization: access to such global information gives farmers opportunities to
learn about new, efficient farming techniques and innovate agricultural techniques.
 Aids in the diffusion (spread) of an idea and the impact it has.

Increased farm sizes

Due to rise in mass production technologies, farm sizes must be larger to ensure their optimal usage
 Land plots used are rectangular, increase efficiency of farming machinery
 Larger area of cultivated land = more profit made

E.g. commune system from 1950s to 1980s

 After the rise of CCP, land was confiscated from landlords and redistributed to peasants. Land was la
bought by government and amalgamated into large communes.
  Abandoned in 1980 in favour of responsibility system: farmers give fixed amount of produce to govt.
do as they please w/ remainder

The Growth of Agribusiness

Imagine a hundred small fields owned by separate farmers. They are responsible for their own cultivation
harvesting. They all need machinery. They all need to find a market and negotiate a price for their crops.
There is likely to be additional effort expended, and because of their small size they will have less bargain
power. Now imagine the same area of land combined into one huge field.

Agribusiness is the name given to the aggregation of farmland under the control of a single business. The
are often owned in turn by large trans-national corporations. Companies such as Nestle also control food
production in large areas, as do companies that produce tea and coffee.

Economies of scale are usually mentioned as a key benefit of this approach to agriculture. Costs are reduc
when scale is increased. One associated issue here is that of monoculture. Generally, businesses will focu
growing one crop, having secured a favourable position. Large fields are generally planted with one crop.
means that after harvesting the soil over a large area is bare and disturbed, and may be prone to soil eros
Large areas of a single crop may also be more prone to disease and therefore require extra spraying of
pesticides. Large companies may also negotiate favourable prices, and the terms under which they opera
within a region. How big can these fields be ?

Scientific and Technological Innovations

The image on the next page shows that some fields have crops which are ‘stressed’ through lack of
water. These fields could then be targeted for irrigation, thereby saving water, and ensuring that
yields didn’t suffer.

The images could be obtained from commercial satellites, or from flyovers by drone planes
equipped with camera able to capture images at certain wavelengths. There is also the use of GIS
(geographical information systems) to accurately map farms. Not only does this enable more
accurate claims for subsidies, but also maps the area that is used for conservation, and can result
in better calculations of orders of seeds and chemicals. With nitrogen based fertilisers costing
hundreds of pounds per tonne it is important that they are not wasted.

Accurate weather forecasts can avoid waste where rainfall or high winds might reduce the impact
of freshly applied chemicals.

Link to increased productivity: access & development of more efficient farming equipment
improves efficiency of farming and ensures higher yield per plot of land.
 Farmers can perform tasks more easily and quickly

E.g. walking tractor developed in China

 First introduced from Russia in form of handheld plow
 Was developed into a walking tractor, substituted people manually transporting farm eqpmt
and produce. Saves individuals time and effort that can be invested in other areas.
 Also serves as form of transport in rural areas

E.g. Japan: rice farming technology

 Carries out more menial tasks e.g. ploughing, planting, harvesting and winnowing
o Allows Japanese farmers to seek other part time jobs to earn additional income
 Allows for optimization of rice growing: machines plant 5 rows of rice crops at 1 time, with the
distance from each seedling optimized at 20cm.
o However this means there is need for standardized conditions, can increase time lags
in farming.
 Increases efficiency in rice paddys

Increased purchased inputs

 More purchases of machinery, fertilizers and pesticides
o Also more purchases made to repair machinery

Linked to increased productivity and increased commercialization. People can afford to purchase
more inputs to help increase production

Increased control of biophysical environment

Availability of fertilizers, pesticides and irrigation systems can overcome poor soil nutrition, pests,
lack of water.
 Use of controlled greenhouses in developed regions

E.g. China’s scheme to eradicate birds

 Done in 1954 to prevent speard of encephalitis, a disease fatal to rice & wheat crops
 People asked to go in rotating shifts to stand outside and create loud noise to scare away
birds, preventing them from landing.
 Caused birds to die from heart failure mid-flight. Was effective: in 3 days there were almost no
birds in Beijing
 HOWVR! Disrupted natural ecological balance - caused

Change in social strucutres

 Increased organization among farmers, follows China’s commune system
 Commercialization has caused traditional culture to erode.
 Loss of importance of growing crops to households, seen as a means to income rather than a
tradition or a way to sustain ones living.
 Loss of religious festivals related to agricultural growing cycles.
 Increased control over physical environment = less respect for physical environment

Expansion of the area under agriculture

From 1980 to 2002, amount of land used to grow crops increased on a global scale of 33.5%
 Largest increase in amount of cultivated land was in Asia, with an increase of 73.3%
 Africa had a more modest increase in the amount of cultivated land, at 30.3%
 Other regions had even smaller increase in the amount of cultivated land.
o Europe: 16.7% increase
o Latin America: 13.7% increase
o North America: 11.8% increase

Large increase in food prdctn in Asia can be explained by the rapidly growing populations in
emerging economies, namely China and India, as they entered the 21st century.
 Both China and India have high populations, meaning these countries must have higher food
production as well.
 N. America and Europe had lower increases in amt of cultivated land because of:
o Shift towards tertiary and quaternary sectors due to higher wages and less
physical labour
 o Ability to import cheaper food from developing countries
o OVERALL: Decreasing importance of agriculture

An obvious way to increase food production would seem to be to put new land under the
plough. There are several issues with doing this for a number of locations. Because agriculture
has been taking place for centuries it is not surprising perhaps that the ‘best’ land has already
been identified, and many other areas are urbanised and cannot be used.

Similarly large areas have been taken out of production as a result of land ‘improvement’ or
reclamation such as grazing marshes in some coastal areas. Changing land use is often a
secondary impact of major engineering schemes which reduce the potential flood risk of an area.

In Japan there is very little available flat land due to the nature of the terrain. This puts added
pressure on the few available areas of flat land. This means that farmers have to be very precise,
and have developed a range of machinery which is on a smaller scale than most commercial
farms in the developed world. Land reclamation has also taken place, although this is usually so
expensive that the land it creates is used for residential use, or for developments such as Kansai
airport near Osaka.

On a much smaller scale, communities have looked to make use of available plot of land to grow
food. One small-scale initiative is ‘Incredible Edible Todmorden’. Todmorden is a small town in
West Yorkshire, England. The local community have identified small areas of land in and around
the town, and secured permission for them to planted up with food crops. Bollywood Veggies in
Singapore is another example here.

 Examine the One issue which may lead to food issues is the land that is required to feed a single person,
environmental depending on their diet and lifestyle. Changing diets and lifestyles are one consequence of the
, greater economic prosperity that some countries have been enjoying for the first time. Changes
towards including more meat and dairy mean that the land is not used as efficiently.
demographic,
political,
Putting food on the table has always been a struggle for people in many of the world’s countries.
social and Sometimes parents go without food, so that their children have enough. In some locations, young
economic children miss out on education to find employment in the informal sector to enable food to be
factors that purchased. As food prices continue to rise globally, more people than ever go to bed hungry, and
have caused even in the more ‘developed’ nations of the world, a higher proportion than ever are struggling to
areas of food feed their family appropriately.
deficiency and
food There are a number of factors that have been suggested for the inequalities in food supply which
insecurity. have meant a greater number of families are relying on food banks.

There are two important terms to bear in mind here: food availability deficit (FAD) and food
entitlement deficit (FED)

Food availability deficit suggests that food shortages were caused by local difficulties in supply,
perhaps the result of drought or floods (two extremes of water availability).

Amartya Sen applied economics to the problem of food supply, and suggested that there were
actually famines in areas where food production had been increasing. The problem was with the
political and economic framework in the area. Rising costs of food relative to average incomes, Sen
said, were a major factor in the availability of food. It is this situation that, remarkably, is facing
many families in what are recognised as being ‘developed nations’. A lack of wages/income means
the term food entitlement deficit (FED) has been introduced as well.
  Definition of food insecurity: no access to safe, sufficient and nutritious food in order to live
an active, healthy lifestyle and to meet dietary needs
 Areas of food insecurity: Sub Saharan Africa, central Asia and southern Asia
o Statistics
 Factors that contribute to food insecurity: social, political, economic, environmental,
demographic

Social

Food wastage: retailers and consumers dispose of perfectly edible food

1/3 of global food production for human consumption is wasted per year: 1 billion tonnes of food
High waste in developed regions of N. Amer and Europe: 100kg per consumer. Compared to only 6-
11kg in Asia and sub-Saharan Africa
Often is due to fresh food being thrown away because it does not appear fresh, when it is actually
still edible
1 for 1 promotions
Food could be sent to developing countries
Investment in women for food security in poorer areas.
In poorer areas, men often emigrate to urban areas to seek employment. Women left behind in
rural areas.
If women were given access to same access to resources as men:
Agricultural yields from women increase from 20% to 30%
National food production: 2% to 4.5%
Malnourished reduced by 12%

Providing education to females, reducing gender inequalities in terms of inheritance laws for land
and access to credit

Political

High standards of imported food (bad)

Trade barriers (bad)
Tariffs on imported food from developing countries affect the amount of food bought
Agricultural subsidies
e.g. Common Agricultural Policy in the EU
EU government guaranteed local farmers that they would buy a fixed amount of their product:
caused large food surplus.
Food surplus sold cheaply in developing economies
Although provides cheap food in these developing countries
Forcing farmers to grow cash crops instead of their own food

Economic

Rising global food prices

Farmers cannot afford food
Affects farmer’s revenues from food exports
Caused by increased demand in countries e.g. China
Higher transportation costs due to rising oil & fuel prices
Biofuels – decreases supply of produce exported as food
Increased demand for food increases scarcity
Increased demand for food
Global economic recession
Lower incomes: affects economic access to food

Environmental

Droughts
Changes in rainfall regularities
Floods
Soil degradation
Pest outbreak
Use of appropriate farming techniques to overcome biophysical environment
Salinization/Saltwater intrusion
Climate change:
Desertification in Australia
Increases in global temperature affect
More extreme natural disasters – loss of more produce and crops

Demographic
Increasing global population: 9 billion by 2050
Places great strain on food production - Some may go hungry
Increasing urbanization

Essay Plan

Discuss the statement: “Poverty is the main cause of food insecurity” [10 marks]
Introduction
 Define food insecurity – the state of people being unable to access a sufficient, safe supply
of nutritious food to meet food preferences and dietary needs at all times.
o 870 million people in the world do not have enough food according to UN World
Food Program
 98% of world’s hungry population lives in the developing world.
o Asia & Pacific region holds approx. 570 million hungry people.
 Poverty is often seen as the leading cause of food insecurity because of the lower GDP per
capita in these regions and the large amount of people living below the poverty line of
$1.25 PPP
 However there are several other factors that contribute towards food insecurity, such as
internal conflict/civil war, poor environmental conditions or natural disaster.

I will be discussing the importance of each of these factors with reference to examples

Poverty is the main cause of food insecurity: Haiti, the Caribbean

Haiti: Located directly east of the Dominican Republic and south east of Cuba
 Population: 10.12 million

Poverty statistics:
 GDP per capita: USD $660, second poorest country in the Caribbean
 54% of all Haitians live on below US$1 per day

Malnutrition statistics:
 World Food Program reports that the food supply in Haiti only covers 55% of the population
 24% of children under 5 suffer from chronic malnutrition
 Hunger responsible for almost 60% of all deaths of those under 18

Why is Haiti poor?

  Main reason: most of Haiti’s population impoverished due to great political
mismanagement under two of its presidents, Francois and Jean-Claude Duvalier.

Link between poverty and food insecurity

 Low income = many households are unable to afford food
 Low levels of education = households that use subsistence farming do not have knowledge
on how to fully utilize land
 Lack of access to inputs such as land, credit or tools and machinery = subsistence farmers
find it difficult to grow food
2) Inputs may be available in certain areas, but cannot be afforded or accessed due to poor
infrastructure

Conflict as main cause of food insecurity: Demographic Republic of the Congo (DRC), Africa
DRC: Located in central-southern region of Africa, north east of Angola and south west of Sudan
Food insecurity
 United Nations Food & Agriculture Organization estimates 30% of DRC is food insecure
 Over 4 million people facing severe food and livelihood crisis
 6 out of 11 of DRC’s provinces have acute malnutrition rates above 10%

Conflict
 Ravaged by conflict in the past: First and Second Congo Wars
 Conflict erupted in Kivu region in eastern DRC recently in 2012

Link between conflict and food insecurity:

 Displacement of people affects access to constant, reliable sources of food.
o 1.7 million people displaced in 2011
o 2.4 million in mid-2012
 Conflict has disrupted harvesting patterns of farmers
 People afraid to visit markets due to possibility of attack – prevents people from accessing
food
 Destruction of crop storage facilities prevents possibility of storing food
 Poor transport infrastructure limits access to markets and other sources of food.

Natural disaster as main cause of food insecurity: Madagascar, Africa

Madagascar: Located off the eastern coast Africa, east of Mozambique
 Population: 21 million

Natural disasters
 Madagascar is a very natural disaster prone region, in the past 35 years it has experienced
46 natural disasters, including floods, drought and cyclones
 Avg of 3 to 4 cyclones per year
 Recently affected by Cyclone Haruna: for every 25 ha of crops an estimated 10 ha were
destroyed by the subsequent flooding
 35% of households are affected by chronic food insecurity

Link between natural disaster and food insecurity

 Possibly due to the effects of climate change, such as the rising sea level causing flooding
o Contributes towards direct destruction of crops currently being cultivated
o Loss of stored produce surpluses
 Obstruction or destruction of infrastructure prevents access to food
 Locust swarms also constantly plague Madagascar. Estimated that locust swarms will affect
2/3rds of the country by September 2013 if unchecked
 o Causes destruction of crops and decreases the amount of yield available.

Conclusion
 In conclusion, it can be identified that there are 3 main causes for food insecurity: poverty,
conflict and natural disasters.
 Most major factor contributing: poverty. Thus I agree with the statement in the question.
o Most of example countries are highly impoverished
 However, unable to determine which is the main cause in situations e.g. Haiti, which is both
impoverished and experienced a natural disaster.
 Important to determine the main cause in order to provide appropriate aid.
o However it is often a mix of different causes, may hinder provision of aid.

Case study

Examine the variety

of causes responsible
for a recent famine

What is the difference between a 'food emergency' and a 'famine'?

Most aid agencies including the UN use the five-stage Integrated Phase Classification system of food
emergencies.

Phase 4, a 'Humanitarian Emergency', is when up to two people per 10,000 are dying each day,
when acute malnutrition rates are between 15 per cent and 30 per cent, almost all livestock have
been lost and there is less than 7.5 litres of water available each day per person.

Phase 5, 'Famine/Humanitarian Catastrophe', means more than two people per 10,000 die each day,
acute malnutrition rates are above 30 per cent, all livestock is dead, and there is less than 2,100 kcal
of food and 4 litres of water available per person per day.

Other factors in a famine include large-scale and concentrated movement of people from their
homes looking for help, and widespread armed conflict.

To what extent were human factors responsible for a recent famine?

Introduction
Famine is not simply a wide outbreak of hunger, it is classified as a nation or region wide disaster
and can even result in affected countries declaring states of emergency.
Definition of famine:
 20% of the popn receive less than 2100 kcal per day
 Malnutrition prevalence among children exceeds 30%
 2 deaths per 10,000 people occur each day

Debate of whether famines are human caused or natural caused.

E.g. some may argue that widespread poverty leads to famine, whereas others claim it would be
caused by lack of rainfall or a large natural disaster.
I will be using the case study of the 2011 Horn of Africa (HOA) famine to explore the extent which
human factors were responsible for a famine.
Body
HOA: Located in Northeastern Africa where the continent juts into the Arabian Sea
Comprised of countries e.g. Eritrea, Ethiopia, Somalia and Kenya
Covers 2 million km2
With 40% of the region’s population living in food shortage prone areas, the 2011 famine has further
exacerbated the food insecurity in the region.
Human causes: broken into political, social, economic and demographic factors
Political: Governments e.g. Ethiopia’s have begun leasing farmland to overseas investors in China,
India and Saudi Arabia. Deprives locals of arable land to grow crops.
Internal conflict in countries, e.g. Somalia and the Al-Shabab militant group. They may cause direct
destruction of food stores and also force almsgiving on farmers, taking some of their harvest or
livestock. Also prevents access to food aid, 2.8 million of the 3.7 million that need food can’t be
accessed.
Social: displacement of households due to conflict
1.4 million internally displaced people in Somalia
These displaced individuals are forced to migrate to urban areas or refugee camps, do not have
access to food during journey.

Economic: rising food prices due to poor harvests and rising fuel prices. In Ethiopia, maize prices
have tripled in some areas. Prevents locals from affording food.
Loss or destruction of farmers’ assets results in lower incomes, e.g. loss of cattle due to conflicts
between ethnic groups in Kenya. Unable to purchase enough food for family.
Demographic: high levels of population growth in these developing countries
Large population live in rural areas of these countries, limiting their access to food.
Environmental causes:
Irregular rainfall patterns: normally there are 2 seasons of rainfall, one during Mar to May and the
other from September to December. Rainfall failed in the fall from September to December. El Nino
causes spring rains to be very heavy, exceeding 800mm, and caused damage to crop harvetsts.
Soil degradation from poor, inefficient farming techniques used, e.g. slash n burn, land in Somalia is
experiencing a decline in quality
Deforestation:loss of 19% of tree cover between 1990 and 2010. This causes increase in the amount
of land exposed to directly sunlight to increase, increasing the ariditu. 60% of the HOA considered
food insecure.
Global climate change: rise in temperatures in Kenya and Ethiopia are 1 and 1.3 degrees Celsius
respectively. Increases the aridity of the area and causes rainfall patterns to change.
Conclusion:
Conclude that human factors are more responsible.
Lack of access to food appears to be the main problem
Government efficiency to solve food insecurity. Amartya Sen, a Nobel Prize winner, observed that
famines do not occur in functioning democracies
However one must not deny that environmental factors are a cause as well, it affects the availability
of food.
In order to combat famine, a mix of techniques must be used to combat it.
Production and Food is produced in numerous locations around the world. It is not always available to everyone
markets who lives in that area, and this results in inequalities and, potentially, conflict.

Examine the impacts Some of the food that is produced is not intended for the domestic market. These cash crops are
intended to be exported, which provides foreign exchange for the government, and guarantees jobs
at a variety of scales
are maintained as long as the relationship with the overseas market is maintained, and the price is
of trade barriers, guaranteed. This is not certain.
agricultural subsidies,
bilateral and At times of increasing global pressure on food production and markets, countries are concerned to
multilateral ensure food security, while keeping an eye on the price of this security. Transnational Corporations,
agreements, and mindful of their markets are involved at this point in negotiations to ensure that they are part of any
transnational future equation. When many countries are no-longer self-sufficient in food, these huge companies
corporations (TNCs) play an important role in our daily experience of food, and spend billions on marketing to ensure
on the production and that they remain an important presence in our lives. Every day, food is moved in huge quantities
around the world. Who produces it, where is it sold, and how does it get to us?
availability of food
There are numerous strict EU standards for imported food products, including hygiene and health
standards as well as regulations for size, form and colour of a certain product. While the regulations
are supposed to protect European consumers, they can have devastating impacts on small farmers
in export countries. These standards have prompted many stories in some newspapers who are
concerned at the apparent silliness of some of the standards, which have been relaxed in recent
years after concerns over food waste that they were partly to blame for.

These regulations may have serious consequences for some producers elsewhere. In Morocco for
instance, a report suggested that in one year’s crop, around 40% of the tomatoes that had been
cultivated to be exported to Europe failed to meet the European standards. Instead of being shipped
abroad, the tomatoes were sold cheaply on Moroccan markets. Small local farmers have a hard time
competing with the cheap produce and struggle to survive. Such a practice is sometimes called ‘food
dumping’ and can be an unintended consequence of food aid.

Trade Barriers

Trade barriers are often put in place around specific countries or areas. These barriers are not necessarily
‘physical’ barriers, although they may be in some circumstances due to the nature of the relationship
with surrounding countries. Some physical barriers would include the restrictions facing some contested
areas of the Middle East, or enclaves within countries.

Trade barriers include tariffs (additional charges), subsidies (support from government for domestic
industries restricting other countries from trading freely) and quotas (limits on what can be imported or
exported).

One problem that faces farmers wanting to import their products into the EU is the restrictions, some of
which we explored during the starter activity. They have to meet certain standards, some of which are
not based on the taste or quality of the food, but its physical dimensions. There have also been examples
of products having to undergo inspections which delay its arrival on the market, which may mean it is not
competitive in price.

Sometimes barriers are put up for political reasons, at other times they may be to protect consumers.
Russian food import standards were raised after the country became a favoured ‘dumping ground’ for
meat and fish products produced by EU countries that had failed to meet EU standards for sale within
the EU. Agriculture is an industry that has often required financial support, particularly given the
globalised nature of the world, and the material flows of food around the world.

In the European Union, there has been a history of additional investment. In many parts of the world,
agriculture is not a profitable activity due to the low prices that farmers are paid for their produce.
Farmers have to look a year or two ahead and predict what the likely market conditions will be when
deciding how to farm their land. They are also dependent on the vagaries of the weather.

Some parts of the British Isles, for example receive additional support and payments. Hill Sheep farmers
get additional payments due to the harsh nature of the land which they farm, which restricts the density
of animals, and therefore the profit they can gain from farming the land. Their work maintains a
landscape which is of high amenity value. Other payments are related to the environment, so that
farmers may be paid for planting hedges, draining land or repairing stone walls.

Bilateral Agreements

A bilateral agreement is one made between two different ‘parties’, which could be countries, which
benefits both.

Some of these agreements relate to former colonies of European countries, which developed a
relationship involving the production of foods, some of which might have a particular cultural
significance. Recent bilateral negotiations took place between the EU and India.

India is one of the world’s largest potential markets for EU products, and there were discussions over
furthering links between the two areas.

Can also occur when a consumer such as a large supermarket makes a decision e.g. the Co-op decided to
only sell Fairtrade bananas which meant those countries which had more producers signed up to the
scheme benefited.

Multilateral Agreements

A multilateral agreement is one that involves many countries. Agriculture can also be protected by the
tariffs that are introduced when countries group together to form a Trading Bloc.

Countries merge together for various reasons. This is usually for the benefit
of the participating countries. The EU is obviously one example of a trading
bloc, but there are many others.

There have also been multilateral agreements which have been agreed
between these organisations and other NGOs (Non-governmental
organisations).

These include the Lome and Cotonou Conventions which date back over 30
years and were intended to support producers in the less developed parts of
the world. These included agreements on the import of tropical produce
such as bananas, which clearly cannot be grown in the EU.

These agreements are particularly important when a country is dependent

on a single crop or product for a large proportion of its total exports. There
are also problems when production is greater than consumption: for
 example more coffee is grown each year than is drunk, despite the rapid
growth of coffee chains such as Starbucks and Costa.

Another organisation involved here is the World Trade Organisation (WTO) –

this has been in existence since 1995 when it replaced GATT (General
Agreement on Tariffs and Trade.

TNCs: Transnational Corporations

Many of the world’s biggest companies have become that way by offering a basic necessity which we
cannot stop buying.

TNCs are driven by profits rather than the desire to provide us with the best possible food. Decisions are
not made on the grounds of existing arrangements, and firms are not necessarily sympathetic to changes
in local conditions.

McDonalds have a strategy which focuses on a one-brand image, but some of these other food
companies own lots of brands, and their involvement is less obvious. This can mean that their overall
operations are not always subjected to the same public focus.

Large companies have increased their involvement in more aspects of the production chain.

This has increased their profits. Felicity Lawrence in her book Not On the Label: What Really Goes into
the Food on Your Plate says: “Fifty years ago, 50-60p of every pound spent on food and drink in the UK
went to the farmers, now it is just 9p in every pound.”

Food Inc. Notes

 Way we eat has changed recently in the past 50 years. Food now produced in factories and
assembly lines
 Modern America: 47000 products
 Information not revealed to public, fear that it will discourage them from eating products.
 Industrial food system began with the development of the fast food restaurant
 Began with the development of the drive-thru in America, 1930s
 Fast food restaurant: brought assembly line techniques to kitchens, workers and staff specialize
into spec. McDonalds is one of the largest purchasers of beef, potatoes
 Top 4 beef packagers control 80% of the market for beef
 In modern times, it takes 48 days to rear a chicken from birth to maturity, compared to 70 days
in the 1850s. Chickens are larger at maturity as well.
 Mechanization of chicken farms: chickens now highly regulated in size and amount of meat
 Allows for increased production from a fixed plot of land
 Chickens – up to 300,000 – are contained within chicken farms. Chickens are kept in the dark,
not exposed to sunlight. Highly contaminated surroundings: dust and faeces
 Although chickens grow more quickly in terms of muscle (meaning more meat), their bones and
internal organs cannot keep up with their growth, causing brittle bones.
 Chicken feed contains antibiotics: however bacteria and micro-organisms build up increased
resistance to the antibiotics.
 Farmers controlled by corporations by debt, most farmers borrow $500000 and earn $18000
per year. This is because of high start-up cost of setting up farms, corporations give farmers
loans.
 Farmers progressed from growing 20 to 200 bushels of corn per year.
 30% of USA is used to plant corn. Corn produced in surplus
 Most products contain corn products: due to versatility of corn to be processed into various
substances
 Corn also used as feed for livestock for animals due to low cost of corn
  Corn diet is not cow’s natural diet: has caused development of E-coli in the cow’s stomach.
 Cows are standing in their own manure = hides become caked in manure.
 Thus in slaughterhouses, manure is able to escape into processed meat. Causes transmission of
E-coli
 Runoff from meat processing plants results in contamination of other agricultural products.
 200 pounds of meat per person in America
 FDA conducted 50000 food inspections in 1960, number fell to 9100 in 2002
 Microbiological tests for salmonella, e-coli and other diseases conducted by the FDA. Allowed
FDA the power to close meat production plants producing large amounts of contaminated meat.
 Kevin’s Law: FDA able to shut own meat processing plants
 Ammonia and ammonia hydroxide used to treat E-coli from meat instead of returning animals
e.g. cows to their natural diet of grass.
 Processed food products – e.g. hamburgers, fast food – are cheaper than fresh fruits and
vegetables. Due to the subsidized given to the ingredients of such processed food products,
namely corn. Reflects dominant corn agriculture
 After 2000, 1 in 3 American will contract early onset diabetes.
 Use of corn feed for cows: contributes towards more CO2 emissions. Need to harvest, collect,
transport and process corn, results in more emissions of CO2. Compared to grass feeding,
involves fewer stpeps in the process.
 Most workers belong to low income minority groups from more impoverished areas in America
 Workers have lost most of their privileges, union rights and have much lower wages. This is due
to meat processing industries growing larger in size.
 Food is highly subsidized in order to create low food prices. Due to high costs in collection,
transportation and processing
 Organic food industry has high annual growth of 20% per year.
 Large MNCs in food processing industry are trying to gain foothold in organic food industry via
acquisition.
 Organic farmers willing to partner with large MNCs because of money from the
sale/compensation. Allows them to invest more in physical or natural capital that can be used to
improve their yield/product.
 Monsanto: one of the largest food processing company
 Developed Roundup: allowed plants to be more resistant to pesticides.
 Seed saving was tranditional practice used to ensure future crops have ideal traits. Now seed
saving is made almost illegal practice by farmers under Monsanto. Ensures that Monsanto has
the ideal seeds.
 Seed traders have been forced to close due to emergence of Monsanto.

Common Agricultural Policy (CAP)

“Africa needs more money, but if it's not linked to ending European agricultural subsidies, it's
blatant hypocrisy. The way to build lasting economic growth, healthcare and education is for
Europe to end the CAP. Stopping trade-distorting subsidies will allow African products to be
exported and stop European goods being sold more cheaply in Africa.” – Lord Digby Jones (2005)

The Common Agricultural Policy (CAP) introduced in the 1960’s was a system devised to offer financial
support for farmers in the European Union countries. It introduced a minimum price for part of what
farmers produced the aim being to increase productivity so that food security was increased and the EU
became more self sufficient, and less reliant on food imports. The knock on effect of this was for the
farmers to earn a decent living whilst being able to offer the customer a guaranteed supply at a
moderate price. In order to offer stability to the internal market, the EU guaranteed to ‘buy’ produce at a
predetermined price and impose charges on cheaper imports. Farmers started to produce more food
than before, and by the early 1980’s subsidised goods had become so overproduced they couldn’t sell
them all. The EU was unable to sell this surplus as it would impact on markets, which led to the storing of
food in warehouses. The phrase ‘wine lakes’ and ‘butter mountains’ raised this issue in the public
consciousness.

In 2007, information was revealed in the House of Commons that large amounts of products were still
being over-produced.

At the time the EU was apparently storing 12,187,741 tonnes of cereals, and there were 1,112,651
tonnes of sugar - enough for 445 billion cups of tea; 117,831 tonnes of butter and milk, which would
spread 78.5 billion sandwiches and fill 252 million pint bottles; and enough rice - 61,589 tonnes of it - for
615 million curries.

The policy has undergone reform several terms, partly as a result of concern over the cost of
implementing the policy compared with other aspects of EU membership. 2010 Budget for CAP: 44
billion Euros (around 30% of EU budget) – costs Britain around £10 billion a year.

When was the CAP introduced:

1960, after WW2

Original objectives of the CAP:

Improving agricultural production yields
Ensuring a fair living standard for farmers
Provide stability in agricultural markets
Ensuring food is available at reasonable prices

How much land area is affected by the CAP?

Two thirds of the EU’s land area

How much does each EU taxpayer contribute to the CAP per year?
80 Euros per year
Why has the CAP been reformed a number of times?
Disagreements between member countries on the distribution of subsidies per country
May have been reformed recently due to environmental damage from use of pesticides and fertilizer
International disagreements on the food surpluses created by the CAP: may result in lowering of
agricultural subsidies
Changing global food prices means EU will have to change the minimum buying price

Purpose of June 2003 reform

Subsidies are not granted based on food production, instead they are based on the amount of area
farmed.
Subsidies granted on cross compliance: farmers must met environmental & welfare standards
Diversion of funds away from agricultural subsidies to rural development projects

Difficulty to agree on reforms:

EU members with larger, efficient farms – e.g. Britain, Sweden, the Netherlands – do not require such
large grants and are in favour of reducing subsidies
However EU members with smaller, less efficient farms, namely France, are unwilling to accept
reductions in subsidies and are not in favour of making subsidies less accessible. This is possibly due to
worry of smaller farmers suffering or due to greed

Why are LEDCs critical of the CAP

The Common External Tariff on food products and the overly-rigorous food standard tests deny farmers
in LEDCs access to the EU food market. This is because the tariff causes the imported food to be
relatively expensive compared to local produce and that farmers may not meet all food standards,
leaving produce that is not accepted by the EU
 Agricultural surpluses bought by the EU government are dumped on LEDCs at below-market-prices, often
using the provision of food aid as an excuse. Dumping hurts the competitiveness of farmers in LEDCs
because they are unable to sell their produce at lower prices than the dumped food, and thus they have
reduced revenues.

E.g. of a group of countries that are critical of the CAP

The Cairns Group formed by countries e.g. Argentina, Brazil and the Phillippines in 1986 is critical of the
CAP.

Addressing Introduction
imbalances  Globally, there are 870 million people who do not have enough food to eat
 One of the causes would be food shortages, where the food supply in an area doesn’t meet
 Evaluate the the population’s nutritional and energy needs.
relative  Food shortages caused by factors e.g. internal conflict, poverty or global climate change.
importance of
food aid, free What is food aid?
trade and fair
trade in All food-supported interventions aimed at improving the food security of people living in poverty in
alleviating the short- and long-term, whether funded via international, national, public, or private resources.
food
shortages. If food aid constitutes less than 2 percent of global agriculture trade, 78 percent of which goes
directly to emergency situations, why is so much attention being paid to it?

Unjust international trade regulations and practices prevent the advancement of developing
countries. Developed countries have refused to liberalize their agricultural sectors due to domestic
pressure. This is a decision taken at the expense of the developing world where agricultural
production is often more efficient than in wealthy nations. The European Union argues that food aid
creates a production and price advantage, and thus a hidden subsidy, for (largely) American farmers.
Therefore, farmers in developing countries are placed at a disadvantage. There is also a perception
that food aid may distort markets in developing countries, thus undermining the potential for long-
term development.

Advantages

Provision of food aid can be useful in alleviating emergency food shortages. E.g. in 2011, Britain
aimed to provide food aid for 1.3 million people in 3 mths to relieve food shortage caused by
drought in Ethiopia.
In-kind commodity food aid is the free provision of food aid to a country, which ensures that it will
benefit lower income households. E.g. Action Against Hunger launched program in Haiti,
where food aid was provided to children through canteens, with each canteen serving 400
children and increasing avg meals from 1 to 2.34 per child.

Food aid can alleviate future food shortages, e.g. in the Democratic Republic of the Congo,
agricultural production was increased as food aid was distributed along with seeds.

Disadvantages

Providing food aid to markets in LDCs depresses food prices and can cause food production to
decrease. E.g. Malawi, 2002 to 2003, where 1 million metric tonnes food aid caused maize
 prices to fall from $250 to $100 per tonne and $15 mil in losses due to lower agricultural
production.
Rising fuel costs and rising food prices reduce the amount of food aid able to be provided to the
targeted country, reducing its effectiveness.
Food aid often suffers delays in reaching the targeted countries, e.g. it can take up to 4-5 months for
food aid to reach the intended country. The quantity and type of food provided may be
insufficient.

What are the structural impediments to food security?

The structural impediments to food security include: inadequate or nonexistent national food
security policies; lack of international action to address environmental degradation; unfair trade
rules; unpayable debts; and insufficient investment and development aid. These conditions force
developing nations into chronic food insecurity. Until these unjust policies are corrected, food aid
will be required. The central issue under discussion in multilateral negotiations is that of agricultural
subsidies and agreement on flexibilities for countries to promote food security in their communities.

Shouldn’t all food aid be locally purchased, therefore stimulating the local economy and pointing
the country toward long-term food security?

The nominal amounts of food aid procured locally would create negligible long-term benefit for an
economy. Only sustained production and inclusion in emerging regional/global markets will lift a
country out of poverty and into food security. The potential for negative market impact is similar for
in-kind and local purchase food aid. Commodity prices will be affected both through in-kind
distribution and cash purchase. Therefore, a detailed market analysis is required to accompany any
injection of “aid” into a country’s economy. This analysis has been required for all U.S. food aid
programs over the last 20 years. Secondly, the risk of corruption or mismanagement carried with all
aid provision is significantly increased with regard to direct cash compared to food commodities.
Using earmarked cash to buy food from rural, smallholder farmers is not as efficient in practice as it
is in theory. There is a significant chance that the cash will be appropriated for alternative uses or
never arrive at the targeted populations. It is easier to misuse $1,000 than it is to misuse 1,000
metric tons of food.

Can local cash purchase negatively affect developing country markets?

Yes. Purchasing food locally can have significant negative impact on local markets. Recent examples
in Niger and Uganda have demonstrated that purchasing quantities of food has in fact driven up the
price of local food, and made it impossible for many who did not receive aid to buy it themselves. In-
kind food aid must be made available to mitigate such market impacts.

Give an example of how in-kind food aid was a critical success factor in saving people’s lives.
--East/Northern Africa, 2000 – present (Sudan)
--Asia, 2000 – present (Mongolia, Cambodia)
--Caribbean, 1990s – present (Haiti, Dominican Republic)

The context of these situations required in-kind food aid as the short-term solution to meeting
people’s needs on account of several factors. Cash to purchase locally posed an equally, if not a
more, cumbersome process than cash for food. The situation in these populations had deteriorated
to such a grave extent that food aid resources intended for other ports were re-directed and sent to
these destinations. The C-SAFE consortium was an excellent example of a dedicated pipeline of food
for a consortium of NGOs across four countries (Zambia, Zimbabwe, Malawi, and Lesotho) over
multiple years.

FREE Trade

What is free trade?

The act of opening up economies is known as "free trade" or "trade liberalisation." It usually benefits
the larger, wealthier countries whose big companies are looking to expand and sell their goods
abroad. In the one sector where developing countries have the most to gain - agricultural goods -
wealthier countries maintain the highest level of "protection" of their own markets.

Globalisation has made the world a much smaller place. Global trade refers to the act of buying and
selling goods and services between countries. Today these goods and services can travel further and
faster so that - for instance - products from all over the world can be found at your corner shop. This
can be anything from fruits and vegetables, to cars, banking services, clothing, and bottled water.

The scale and pace of this kind of trade has only increased over time, and has become a very
powerful tool. International trade is considered a prime driver of how well a country develops, and
affects very much how well the economies of different countries are doing.

Free Trade - who is paying the price

The act of opening up economies is known as "free trade" or "trade liberalisation." Trade
liberalisation means opening up markets by bringing down trade barriers such as tariffs. Doing this
allows goods and services from everywhere to compete with domestic products and services.

But in practice the set-up of global trade rules and the way these are administered by the World
Trade Organisation, works best for those countries who are already rich, and increases the gap
between them and poorer countries who are already struggling to compete.

When trade is a weapon - tariffs and subsidies

Part of the problem is that trade is not always equal. It is not just a tool - it can also be a weapon.
When countries put restrictions, such as tariffs, on goods from other countries, imported goods
become more expensive and less competitive than goods from their own country.

Another thing that can be done is subsidising domestic businesses. This means that governments
give money or other forms of support to local or domestic businesses, to make sure that they are
cheaper over imported products and services. This can allow unsuccessful and inefficient businesses
to do well, since they receive all kinds of government support. And while these businesses continue
to grow, smaller or local producers, especially in many poorer countries - those that need support
the most - are being destroyed.

Any measure like this is called "protectionist," since it has the effect of closing off a country's
markets to goods from other countries. Many wealthy countries in Europe, as well as the US and
Japan use these tactics to support their own domestic economies, making it impossible for smaller,
or less developed countries to gain a foothold in the global marketplace.

As they go about protecting and closing off their own markets, many of these very same countries
are creating double standards, by forcing other countries to open up their markets.

Advantages
Removal of agricultural subsidies given to MDC farmers, e.g. US corn subsidies of $5bn USD per year,
improves competitiveness of LDC food products. Revenue can be used to reinvest in increasing
agricultural output.
Removal of trade barriers allows certain countries to export more food, and countries facing food
shortages to import this food. E.g. with rice, if voluntary export restrictions were removed the
percentage traded would increase greatly from the current level of 5-7%

Free trade allows farmers to earn increased revenues from exports, which can be used to afford
food in the short and long term. E.g. in Africa, if its share of global trade increased by 1%, it would
generate $70bn revenue.

Disadvantages

Only larger farmers may benefit from trade liberalization, as they can compete with farmers in MDCs
Limited access to markets in countries e.g. the Democratic Republic of the Congo with the recent
conflict in the Kivu region in 2012, results in households being unable to access the food
needed.

Countries may begin to produce cash crops for sale instead of food crops, which would not be
effective in increasing the supply of food.

Fair Trade

Definition - A not-for-profit organization that focuses on benefiting farming communities in less

developed countries by guaranteeing farmers a price for their products and ensuring more profit is
returned to the farmer

Advantages

FairTrade farmers are given a guaranteed price for their produce, regardless of market prices.
Therefore d guaranteeing them income during periods where food prices are low. This would in
turn allow them to purchase more food.
Consumers also pay a social premium on the FairTrade products, which is reinvested in rural farming
communities. Improvements can be made to alleviate future food shortages. E.g. In Mali, West
Africa, FairTrade cotton farmers used profit to construct grain warehouses in their villages.
Farmers operate in co-operatives, e.g. Kuapa Kokoo in Ghana, West Africa, covers 65,000 farmers in
1600 villages. Co-operatives can negotiate for higher prices, increasing farmers’ revenues and
allowing for more reinvestment in the community.

Disdavantages

FairTrade is ineffective at alleviating emergency food shortages because it does not focus on short
term food provision.
FairTrade does not focus on reducing costs of production received by farmers. Short term increase in
the prices of inputs can affect farmers’ food production.
Co-operatives may not be run efficiently by farmers alone, as they may not possess the education or
skills. Results in villages not receiving significant benefits

Conclusion
 In conclusion, it is complex to evaluate the importance of each measure on the whole.
 Food aid proves to be the most versatile, as it can alleviate short term shortages and
improve long term food insecurity.
  Fair Trade is a relatively new movement that can prove effective in guaranteeing farmers
higher revenues and improved protection against food insecurity.
 Free trade may not be beneficial to very poor countries because of farmers’ lower access to
capital and inputs.
 Food shortages difficult to combat because they have so many causes and they vary
enormously

Case Study

Geography of Food and Health: Black Gold

Intro to Ethiopia
 Ethiopia was the country where coffee was first discovered
 World’s largest coffee producer
o 15 million Ethiopians depend on coffee farming for their livelihoods
o 67% of export rev

Main problem: low coffee prices

 International Coffee Agreement used to regulate coffee prices until collapse in 1989
 Coffee prices at a 30 year low, due to countries encouraging more farmers to grow coffee,
increasing the supply of coffee and lowering the price.
o Falling prices of coffee has affected coffee industry: due to low prices people
become unwilling to work, resulting in unemployment.
 Many farmers are discouraged from working due to the unreasonably low
price of coffee
 Comparing prices of coffee in Ethiopia to Western World: 1 birr ($1.2) per kg in Ethiopia, 25
birr per kg ($2.90) in Western World
 International price determined in London and NY: e.g. NY Coffee Contract
o Futures market in NY allows for coffee that has not been grown to be bought at
future prices: guarantees certainty of coffee prices
o If price in NY falls by 5 cents, price in Ethiopia falls by 5 cents
 HOWEVER! Farmers in Ethiopia have lack of up to date price information on coffee price
o Selling price must be higher than buying price for farmers to profit, most often not
the case

Middlemen and the coffee supply chain

 Government coffee auctions e.g. in Addis Abba, Ethopia, are where coffee suppliers and
middlemen meet to agree on prices
o e.g. Volcafe (middleman) buys for Starbucks and Nestle
o Sidama region in Southern Ethiopia: region responsible for growing coffee for
Starbucks
 Middlemen inspect quality of coffee beans and agree on a price
o Chain of selling coffee also involves coffee exporters, roasters, retailers
 Coffee export processing workers – mostly female – earn 4 birr and 50
cents per day from working 8 hours, translates to less than 50 cents per
day.
o Middlemen often buy coffee at lower prices than farmers would want and may
take some of the farmer’s profits

Coffee co-ops and unions

 Since middlemen in the process of selling coffee take cuts of the profit, many cooperative
and coffee unions have developed to ensure farmers are paid more fairly.
 o E.g. Oromia Coffee Farmer Union represents 74,000 coffee producers
o E.g. Kilseo Mokonisa Co-op buys coffee from 101 farmers in Southern Ethiopia
o 60% of coffee chain removed via working with cooperatives
 Individual coffee exporters that work with coffee co-ops attempt to buy coffee at prices
outside NY lvl.
 Co-ops and coffee trade unions can help some Ethiopian coffee farmers break out of the
poverty cycle they are trapped in.
o Poverty cycle: coffee prices cause famers to fall into poverty, whole community
falls into poverty, cannot construct more schools train teachers, poor education
and continue to rely on coffee

Food insecurity and coffee farming

 Farmers grow coffee instead of food crops because they want to profit, results in lower
food supply for local villages
o Children are most affected, most suffer from malnutrition and various types of
vitamin or protein-energy deficiencies
 Therapeutic feeding centers in Sidama now admit adults in addition to young children, who
are the most vulnerable.
o Such feeding centers often have strict criteria for the children that are able to be
admitted to avoid overcrowding. Only allows for severely malnourished children to
be admitted.

Chat and coffee

 Chat – a narcotic plant – is often grown instead of coffee by coffee farmrers in Ethiopia:
sells for higher price than coffee and is consumed in East Africa
o Chat addicts in East Africa provide a large market for the coffee farmers who grow
chat, provides then with a livelihood.

Solutions
 Key to stimulating purchase of coffee beans from LDCs: increased advertising in coffee
conventions
o Increasing consumer awareness of the impact of low food prices on coffee
 Fair Trade: Social premium from fair trade Ethiopian coffee results in farmers receiving
increased profit.
o In agricultural communities, profit can be invested into improving the healthcare,
education and infrastructure in these communities.
 Increase free trade: If Africa’s share of WT increased by 1%, $70 bn revenue generated. x5
the amount they receive in aid

Interesting facts
 Coffee is world’s 2nd most actively traded commodity
 2 billion cups of coffee drank per day on a global scale
 Since 1990 retail coffee sales increased from $30 bn to $80bn
 4 multinationals dominate coffee market:
o Kraft
o Proctor and Gamble
o Sara Lee
o Nestle
Sustainable Sustainability is a relatively straightforward concept to define but it is harder to achieve. Think of it
agriculture as a 3 legged stool. The stool needs all 3 legs to remain standing.

Examine the concept

of sustainable
agriculture in terms
of energy efficiency
ratios and sustainable
yields

Is Sustainable farming possible?

Sustainability rests on the principle that we must meet the needs of the present without
compromising the ability of future generations to meet their own needs. Therefore, stewardship of
both natural and human resources is of prime importance. Stewardship of human resources includes
consideration of social responsibilities such as working and living conditions of labourers, the needs
of rural communities, and consumer health and safety both in the present and the future.
Stewardship of land and natural resources involves maintaining or enhancing this vital resource base
for the long term.

Energy efficiency ratios

EER is a measure of the amount of energy input into a system compared with the output. Measured
by energy outputs divided by energy inputs. An energy efficient system has an EER equal to or
greater than 1. Energy can be direct (e.g. labour, machinery) or indirect (e.g. fertilisers, seeds,
irrigation). Although outputs of some modern systems can be very high, this is usually because of
high inputs resulting in a low energy efficiency ratio. Traditional techniques have a low output, but
very low input resulting in a high EER.

Farmers can be seen as stewards of the land. The decisions they make can cause damage to the
topsoil or water balance and need to be taken carefully. This can be compromised when there is a
perceived need to produce as much food as possible as quickly as possible in response to food
insecurity or rapidly rising food prices.

Sustainable farming involves the production of food in such a way as to maintain the capacity for
growing food from the same land in the future. The sustainable yield is the amount of food (Yield)
that can be taken from the land without reducing the ability of the land to produce the same
amount of goods in the future, without any additional inputs. If the production of palm oil, for
example, reduces the nutrient availability in the soil or moisture in the soil it is not sustainable.

There are several key ideas which will be found on most farms which are attempting to work
sustainably. Generally, these farms try to copy natural processes, which often means that they are
organic, or are more likely to be organic. Areas that are commonly focused on include:

 Conservation and soil health

 Nutrient recycling e.g. animal waste being used for fertilizer
 Biodiversity – this is helped through a minimal use of chemicals on the land
 Animal welfare – more care taken with animals, and different diets perhaps
 Fair wages and treatment for workforce – farm is part of the rural community
Instead of pushing for the maximum yield from the land, these farm look to produce the sustainable
yield (the food that can be taken from the land without reducing the ability of the land to produce
the same in future without external support).

Maintaining soil health

One of the simplest ways of maintaining soil health is to

rotate the crops. This doesn’t mean turning your carrots
by 90 degrees each night, it means growing alternative
crops on land from year to year.

This also has the advantage of reducing the damage

caused by pests which may stay in the soil from year to
year. The secret to crop rotation is the use of leguminous
plants, such as beans or pulses. These help replace
nitrogenous compounds in the soil, and this is vital for
plant health. Many artificial fertilizers are nitrogen or
nitrate based.

The search for increasing profits can lead to some farmers

taking less care with the soil, even though it can take
thousands of years for a thin layer of topsoil to form. The
American Dust Bowl of the 1930s chronicled in John
Steinbeck’s ‘The Grapes of Wrath’ was the result of
unsustainable farming practices.

Crop rotation was developed by Charles Townshend, who had an

estate in Norfolk. His use of turnips in his four field rotation led to
him gaining the nickname ‘Turnip Townshend’.
Nutrient cycling

This might
involve animal manure, or ploughing the brash or waste
from harvest back into the soil. There may also be some
land which has to be left for a period of time to allow the
soil moisture to be replenished. In some marginal land,
even turning over the soil would lose the available
moisture so careful management and cropping techniques
need to be used.

Using chemicals
would not be seen as sustainable practice.

Free range
grazing encourages this nutrient cycling to take place
naturally

This is of increasing importance to consumers. Sales of food that has various animal
welfare related badging have increased. Local sourcing, organic and free-range foods are
popular, although there is often a price premium. With the increasing economic
uncertainty across Europe, will there be a reduction in demand for food produced in this
way, and more pressure to return to less sustainable practices ?
 Some farmers also see the benefit of engaging with project such as Fairtrade and
Rainforest Alliance certifications.

Organic farming

In the rich world, the damaging environmental effects of intensive commercial farming
have led to the promotion of more sustainable farming. These include:

 Applying manure or compost rather than inorganic fertilisers

 Using crop rotation to maintain soil nutrient status and allow recovery between
harvests
 Using biological controls rather than pesticides
 Reducing transportation and energy used in manufacture
 Allowing livestock to roam freely in open air.

Examine the concept Food miles are: A measure of the distance that food travels from its source to the consumer. This
of food miles as an can be given either in units of actual distance, or of energy consumed during transport. Food miles
indicator of have been steadily increasing over time. The concept of food miles serves as a useful reminder of
the need to control the amount of energy used to move food from one place to another. Food
environmental
distribution accounts for 40% of road freight. However the concept is simplistic and difficult to apply
impact. in a practical sense. For example, distance travelled is not necessarily determinant of the amount of
energy used to move food from one location to another, e.g. air travel v sea travel. Recent research
suggests that many parts of the world, eating locally grown food may lead to an increase rather than
a decrease in energy use and the carbon footprint. This is because certain areas are better suited
physically for producing particular foods than others, and this eating locally produced food may
increase energy use (e.g. in the UK tomatoes grown locally may need artificial heating, and large
amounts whereas tomatoes grown in Spain do not require this (therefore the imported Spanish
tomatoes end up being may energy efficient even when the transport is taken into consideration.
Different food are more energy efficient that others, e.g. producing rice is far more energy efficient
than producing all forms of meat. Farm animals account for 20% of greenhouse gas emissions.

Food miles fails to take into account the various other factors in the production of the food and the
energy required to get it to your plate, e.g. amount of fertiliser used, packaging, processing, storage.
Oxfam have suggested that a better way of calculating this is by using a Lifecycle Analysis where all
factors in the production of the food are taken into consideration (and the energy used).
Externalities are also not taken into account with food miles, e.g. has the food been farmed on
deforested land or are chemicals used in the growing damaging the local area and people.

Also, if consumers buy more locally produced food then it may have a damaging effect on some
LEDC countries who rely on selling food for income. An estimated 1 to 1.5 million livelihoods in sub-
Saharan Africa depend directly and indirectly on UK-based supply chains. Oxfam believe that people
should think more about the term Fair Miles which looks more at the overall amount of energy
needed to get the food to the plate and the impact that it might have on other parts of the world.
The spread of Diseases don’t stay put. They tend to move and spread. This is how they perpetuate themselves: by
disease replication.

 Explain how This section of the unit explores the way that diseases move. Diseases are more mobile than
previously, because we are more mobile than before as a species, and we carry diseases with us. The
the
network of communications by road, rail and air means that potential carriers of diseases (people
geographic who are still capable of infecting others with a particular disease) can travel across the globe in a
concepts of matter of hours. Less than two hundred years ago, diseases travelled slowly and it was possible to
diffusion by quarantine an area more easily.
relocation and
by expansion Whereas early plagues were carried by rats and their fleas squatting in the holds of sailing ships,
apply to the modern plagues are more likely to be brought in by a business traveller who’s just been on a mini-
spread of break.
diseases.
 Examine the
application of
the concept of
barriers in
attempts to
limit the
spread of
diseases.
 Describe the
factors that Diffusion
Methods
have enabled
reduction in Diseases are spread by contact between people, and the crowded and unsanitary
incidence of a conditions in many parts of the world encourage diseases to spread further.
disease.
It must also be remembered that the 1918 influenza pandemic (sometimes referred to as
Spanish Flu) killed an estimated 40 million people worldwide within just a few months,
with some estimates of casualties closer to 90 million. To put this into some sort of
context, the total number of battlefield fatalities in World War One in the previous four
years was around nine million, plus around six million deaths amongst civilians.

Diffusion is the method by which diseases spread.

There are various methods by which diseases spread, and these contribute to the
overall risk factors for different populations.

There is a reducing effect with distance from the original outbreak, and also a time
delay. Diseases tend to spread like a ‘wave’ from the central point.

Factors that slow down the spread of disease include physical barriers (these might
include mountains, water barriers such as seas or oceans, forests and difficult terrain)
plus political boundaries. Travel restrictions and screening of travellers can form part of
these more ‘human’ barriers. Public health advice can also help in some cases.

Disease will also change from an original infusion into a population, through inflection
and saturation, before it declines and leaves a population.
There are 4 main methods of diffusion:

EXPANSION - the disease has a source and diffuses outwards into new areas from
this original point

RELOCATION - the spreading disease moves into new areas, leaving behind its source
(often the result of global travel by an infected person)

CONTAGIOUS - the spread of an infectious disease through direct contact with the
affected individuals

HIERARCHICAL - the spread of a disease from place to place in an orderly way e.g.
from cities, to neighbouring villages, or vice versa

There may also be NETWORK diffusion, which follows land-based transport

networks e.g. road and rail.

There are some cases of malaria in the UK every year for example, and most
of those are close to airports. Mosquitoes survive in the plane just long
enough to bite someone when they leave. Climate change may allow them
to survive longer of course.
1) What is the difference between relocation diffusion and expansion
diffusion?
Diffusion by expansion refers to the process where a disease originates and
develops in a source area and spreads from this area, where the
prevalence and incidence of this disease is highest in the original source
area. An example of diffusion by expansion would be the spread of
cholera from its source in a dirty or contaminated well to other
neighbouring settlements. Expansion diffusion usually occurs in areas
where populations are in fixed settlements and have sedentary living
patterns.
Relocation diffusion differs from expansion diffusion in that the disease
evacuates the source area when carriers of the disease migrate
elsewhere. An example of a disease that spreads via relocation diffusion
would be the human immunodeficiency virus (HIV), where if the carriers
of the virus change location, the virus travels with them and HIV is no
longer present in the source area.

2) What is the difference between the contagious diffusion and hierarchical

diffusion (which are both subcategories of expansion diffusion)?
In contagious diffusion, the disease spreads from its source area in all
directions, where individuals are affected by the disease by coming into
contact with other carriers of the disease. An example of a disease that
spreads by contagious diffusion would be tuberculosis, where the source
area could be from a farm with contaminated milk and the disease is
spread through airborne means.
On the other hand, hierarchical diffusion occurs where there are channels of
diffusion where the people or groups in these channels have high
incidence and prevalence of the disease (more susceptible). An example
of this would be how sexually transmitted diseases such as chlamydia or
gonorrhea are more likely to be spread among sex workers or the more
sexually active, promiscuous population.
 3) What is time-distance decay?
Time-distance decay would be a natural barrier against the diffusion of
disease. The concept of time-distance decay states that the further the
distance and the longer the time period of the disease’s diffusion, the
lower the incidence and prevalence of the disease. This is caused by the
relationship between the distance travelled by the disease and the time
taken for diffusion. As the disease travels further, its time of diffusion
increases. In this time span, there is an increased likelihood that
individuals develop natural immunity or that artificial barriers can be put
in place to prevent the disease. Therefore, the prevalence and incidence
of the disease decreases.

4) Give examples of effective barriers to diffusion of diseases

Elimination of the vector:
Using indoor residual spraying (IRS) to combat malaria by reducing mosquito
populations. Often termed ‘fogging’, where pesticides, e.g. DDT, are
sprayed in large areas. Effectiveness was shown in the Malaria
Extermination Program launched by the WHO from 1955 to 1969, where
the population at-risk of contracting malaria was reduced by 700 million,
with malaria eradicated in regions e.g. Europe, the former USSR
countries and in certain Asian & Caribbean countries.

Provision of medication:
Treatments and antibiotics provided for diseases such as TB, e.g. with drugs
such as isoniazid (INH) or rifampin (RIF). By curing the disease in carriers,
prevents further spread of disease and lowers incidence.
Success: 85% of all TB cases successfully treated in 2010.

Vaccination:
Regarded as one of the most effective methods of completely eradicating a
disease, as it allows more individuals to become immunized and thus
have their immune systems combat the disease, preventing further
transmission.
Has been successful for diseases e.g. smallpox, which is the first globally
eradicated disease. From having a mortality of 30% after WW2, it was
totally eradicated in 1980. Also shown successful in developed countries,
e.g. measles in the USA. Measles cases fell from approx. 89,000 in 1941
to only 44 in 2002.

Effective screening
Allows carriers to be identified, isolated and treated, preventing any further
spread of disease among people that unknowingly carry the disease.
Use of screening or testing in the treatment of HIV/AIDS, where there are a
total of 119 countries that carry out HIV testing and councilling, with 95
million 15-49 year olds who received HIV testing and counseling in 2010

 Public Health Campaigns

Public health campaigns have been used for various diseases over the years. The
early AIDS campaigns have been criticised for being unduly negative in their imagery.

There have been a range of recent scares over possible pandemics. Every now and
then, a story emerges of someone who has died from avian flu.
A pandemic is a disease which has spread to affect a very large area, either several
continents or possibly most of the globe. Its name comes from the Greek meaning
“all the people” which gives you an indication of who is affected.

In recent years, there have been hysterical headlines warning of mass deaths from
various diseases. One of the more recent ones was a disease called SARS (severe
acute respiratory syndrome)

Case study: SARS in Singapore

Definition
Severe acute respiratory syndrome (SARS) is a severe form of respiratory infection
caused by a coronavirus, which is a common form of virus responsible for upper-
respiratory infections
Symptoms:
 Fever
 Headache
 Body aches
 Dry coughs
 Pneumonia

Area of origin:
Foshan City, Guangdong province, South China
Originated as a spread of a new strain of highly contagious pneumonia in November
2002
A physician treating pneumonia patients near Foshan City contracted the virus
himself and travelled to Hong Kong, spreading the virus.
How it spread overseas
Disease officially spread outside of China after a Chinese-American businessman in
the same hotel as the infected physician contracted SARS and travelled to Hanoi,
Vietnam.
Measures to prevent or reduce spread of SARS
Contact tracing: identifying infected individuals
Reducing the time between the onset of symptoms and the isolation of patients
Health screenings at airports: consists of a series of questions and temperature check
Travelers advised to consult doctors and identify whether they have histories of
pneumonia or fever. These individuals would be advised against travel
Community containment measures (non-hospital measures) and quarantine of
infected persons
How it spread to Singapore
Officially spread to Singapore via 3 guests who travelled from Hong Kong.
1 of the guests, Esther Mok, spread the SARS virus to 22 other individuals in the Tan
Tock Seng Hospital and started the SARS epidemic
SARS spread especially quickly among healthcare workers and taxi drivers due to
their job nature having them be in close contact with potentially infected customers.
206 cases reported in 2003, with 8 imported cases
Measures against SARS in Singapore
Postponement of travel to highly SARS afflicted areas: namely HK, Guangdong and
even to Toronto
Designation of Tan Tock Seng Hospital as a designated SARS hospital, where no
further admissions and public visits were allowed
Designated ambulances used to transport SARS patients to TTSH
No-visit rule extended to all public hospitals
Military personel used to aid contact tracing and to enforce quarantine
Closure of schools for a short period: 2 to 3 weeks
 Screening of visitors at airports and seaports
Singapore used a wide-net health screening where even mild symptoms related to
SARS – e.g. mild fever, chest radiograph anomalies – were treated as symptoms of
SARS, and patients were appropriately quarantined
Quarantine of all SARS infected individuals for at least 10 days, with the possibility of
electronic tagging in order to prevent people from breaking quarantine.
Fines used in order to enforce quarantine, in addition CISCO and military personnel
used to monitor quarantine areas
Handling and disposal of all bodies due to SARS within 24 hours
Intensive education and provision of protective personal equipment, e.g. face masks
(N95), gloves, hospital gowns, eyewear
Healthcare workers had temperature checks thrice a day

Geographic factors and What is HIV / AIDS?

impacts HIV + Malaria
HIV is human immunodeficiency virus. It is a disease which reduces the ability of the body to fight off
 Examine the other diseases. It reduces the efficiency of the body’s immune system.
geographic
factors Two-thirds of all people infected with HIV / AIDS live in Sub-Saharan Africa: over a million adults a
responsible for year die from the disease, despite improvements in treatments including antiretroviral drugs (ART).
the incidence Access to these drugs is not equal, and millions of people who would benefit from these treatments
and spread of don’t receive them. One in four schoolchildren in South Africa lives with the impact of HIV / AIDS.
two diseases.
 Evaluate the Former president of S. Africa – President Mbeki – denied the link between HIV and AIDS, limiting
geographic the dispersion of ARVs
impact of these 400,000 people unnecessarily died on president Mbeki’s rule
two diseases at New president, president Zuma, accepts the link between HIV and AIDS, allowing progress to be
the local, made.
national and Controversy – Zuma caught sleeping around
international Video 2
scales. Less than 65 million ppl had been affected in 2005.
 Evaluate the 25 million ppl in Africa diagnosed as being HIV positive
management 7000 HIV infection per day
strategies that LE in Sub Saharan Africa has fallen from mid 60s to mid 40s
have been In worst affected countries, e.g. Mozambique, Leosotho, LE is below 40
applied in any Affordable treatment – ARVs – and prevention are available.
one country or Lack of access to ARVS
region for one of 20% of HIV infected individuals that desperately need ARVs cannot receive the ARVs
these diseases. LE increases between 6 & 24 years on treatment from ARVs.
Gives HIV/AIDS affected children the opportunity to learn
Lack of infrastructure, education & health workers slow the distribution of ARVs around Africa
5% of HIV affected children receive treatment
10% of HIV/AIDS afflicted women receive they need
10% of the orphaned population from HIV/AIDS receives government support
HIV/AIDS has the most number of drugs that are able to treat it, largest number of preventative
measures.
Video 3 – Lack of access to reproductive health supplies in Sub Saharan Africa
Many have unplanned pregnancies and have no choice regarding the matter
Cannot access contraceptives
E.g. condoms, inter-uterine devices (IUD)
Lack of access would be the large amount of paperwork involved in ordering contraceptives
Can be improved through improved communication with pharma. companies and electronic filing or
pricing systems
Ineffective treatment for HIV/AIDS
Preventative measure: family planning
Transport is a major factor affecting access to preventative measures & ARVs
Solution: local family planning clinics used to provide population with family planning methods.
215 million women want to avoid pregnancies, cannot access contraceptives
53 million unplanned pregnancies

Video 4 – TED talk: HIV/AIDS in Sub-Saharan Africa

Uganda is the only African country with successful treatment of the AIDS epidemic
US President pledged $15 billion in 5 years to combat HIV/AIDS
50% to 6% prevalence from 1990s to 2005
ABC program used in Uganda – abstain, be faithful, contraceptive
Can’t develop effective policy without understanding the AIDS epidemic.
Uninfected male in Botswana doubles their chance of dying when getting a new partner
View health as an investment – if you do not have a long life, disincentive to invest in one’s health.
Low LE in most areas of Africa, means that people have disincentive to invest in their own health and
change the # of sexual partners they have as HIV prevalence increases.
This is because they feel that they will die quickly, see this as an excuse to have much more sex.
US president’s $15 billion program may not be effective due to the lack of incentive to change sexual
behaviour.
Inconsistent HIV prevalence data in Africa below 2003 because of improper testing.
AIDS kills people in their prime AIDS.
Comparing death rates from HIV/AIDS between Egypt and Botswana (more AIDS). Death rate of
people in 25-30 is much higher for Botswana
Areas in Africa with more transport infrastructure have higher HIV/AIDS prevalence, due to more
people transitioning through the area and spreading HIV/AIDS
Truck drivers & migrants have the highest HIV infection rates
Link between economic activity and HIV/AIDS prevalence
X2 export activity, x4 HIV/AIDS prevalence
LINK TO UGANDA: in 1990s, coffee prices fell, which led to the fall in # of new HIV infections.
Link between the two, decline in HIV infection would have declined by 25% without education
program.
4.1 million HIV positive women in S. Africa give birth per year
250 million deaths from HIV per year

Video 5 – link between HIV/AIDS and marriage

1/3 of new HIV infections in Uganda are amongst married couples in 2005
Zambia and Rwanda, more than ½ of new infections are among married couples (2004)
Danger of having multiple sexual partners – spread of HIV/AIDS amongst sexual partners
Many patriarchal societies in Africa, e.g. Kenya – men run the household
Cultural belief that if women control family planning, challenges the masculinity of the men in the
relationship
As such most women remain subservient
Between married couples in Kenya, majority do not use a condom. Viewed as a symbol of mistrust
(?)
Often, women are not concerned with the promiscuity of men unless they continue to support them
and their children.
Polygamy is still thriving in Kenya
43% of married women in Kenya report domestic abuse
2006, Kenya passed Sexual Violence Act to reduce the prevalence of sexual violence.
Promiscuity and sexual violence is a cultural issue
Men do not like being blamed for causing the spread of HIV/AIDS through promiscuity, stops
preventive measures from being put in place.
Effective treatment cannot be achieved without internalizing the issue of HIV/AIDS in Africa
Affect of political factors on spread of HIV/AIDS
Political factors
President Mbeki doubts link between HIV/AIDS
Due to his ignorance or possibly political corruption
Offered ineffective treatment for HIV/AIDS – garlic and sweet potato
Possibly due to Mbeki having fear of admitting his mistake, ignorance
Worry about the loss of control from S. Africa due to influx of foreign aid to reduce HIV/AIDS
Political alliance with other richer countries – e.g. Uganda & the USA. Allows
Uganda to receive ARVs and financial aid
Catholicism in Africa – prevents Africa from receiving contraceptives
However, new pope, Pope Francis, allows for the use of contraceptives for the prevention of
HIV/AIDS.
Muslim countries in Africa are more open to the use of contraceptives
Demographic factors
Economically active population has highest rates of HIV infections
Affects the dependency ratio in the economy – HIV afflicted become unable to work after awhile
HIV orphans many children – HIV/AIDS kills parents
Social issue – children may not receive adequate healthcare/education.
Increase in crime rates amongst children as they try to make a living
10% of women receive treatment
10% of orphans receive government support
5% of children receive the treatment they require
Large proportion of newly infected in S. Africa from babies born w/ HIV
Cultural factors
Men in S. Africa afraid to have their masculinity challenged
POSITIVE – Virginity test for young females discourages sexual promiscuity
Lack of education/cultural beliefs result in people being ignorant of treatments
E.g. belief that eating garlic & sweet potatoes cures HIV/AIDS, sex with a virgin will cure AIDS, having
a shower cures HIV/AIDS.
Male-female relationships in Africa have men wielding power over family matters
Polygamy still would be active in rural areas in S. Africa
Comparing religions between S. Africa and Northern Africa
Southern Africa
Environmental factors
Lack of access to healthcare facilities in rural areas
Limits access to contraceptives (prevention) or ARVs (treatment)
Women unable to check their HIV/AIDS status
Lack of transportation infrastructure
In rural populations, there is a disincentive to go to school due to the distance and the main industry
being agriculture.
Children do not become educated on preventative measures against HIV etc
Economic factors
HIV/AIDS is a largely poverty related disease
Lack of healthcare and educational facilities
Inability of large proportion of population to afford preventative measures e.g.
contraceptives.
Higher promiscuity due to poverty – possibly linked to higher rates of prostitution
Impact: renders people unable to work, HIV affects larger proportion of economically active
population.
Loss of economically active individuals due to poor health or death: slowdown in economic
growth.
Knock-on impact: children that become orphaned do not receive education = low
investment in children’s future, they end up w/ low paying employment in the future
However, there is a counterargument that there is higher HIV/AIDS prevalence in areas with higher
levels of trade & transportation.
E.g. migrants and truck drivers have highest rates of HIV infection
When coffee prices in Uganda fell, rates of HIV infection fell
Video #7 – Hans Rosling & HIV
Gapminder graph
Money per person on x axis
% of HIV infected adults on y axis
Size of bubbles = population infected with HIV
First heavily infected Asian country – Thailand
Uganda & Mozambique were first Asian countries to have
1% of all adults in the world are HIV infected – 30 to 40 million countries
Problem with graph: In richer countries e.g. Botswana, Africa, govt. can afford to treat HIV/AIDS
affected individuals with ARVs, thus % of population with HIV/AIDS remains constant
Emphasis placed on prevention of HIV treatment
Argue: HIV is considered a ‘disease of poverty’, there is a rough negative correlation between HIV
infected adults and income. HOWEVER, it is not very clear, e.g. richer countries such as S. Africa have
high HIV infection rates
Africa is a large continent – large variation in the countries with HIV infection
Southern Africa has 50% of all HIV infected adults – 4% of the world population

Examine the geographic factors responsible for the incidence and spread of HIV/AIDS. [10m]

Introduction
- HIV/AIDS is one of the world’s most significant health problems that is easily spread through
unprotected sex, breast milk, blood, and from mother to child. More than 34 million people
currently live with the disease, and 7000 are diagnosed each day.
- South Africa has one of the highest prevalence of HIV/AIDS, with 4.2 million people infected and
250,000 deaths each year. Southern Africa has the highest prevalence within Africa, in areas such
as Swaziland, Botswana, Lesotho, South Africa. In comparison, Northern Africa has low prevalence
of HIV/AIDS.

Political factors
- Mbeki government is unconvinced that HIV causes AIDS
- Ignorance about HIV/AIDS

Demographic
- Only 5% of children receive treatment
- 10% of women receive treatment
- 10% of orphans receive government support
- Affects economically active age group, increasing dependency ratio

Cultural
- Belief that contraception affects men’s masculinity
- Religion does not allow use of contraceptives
- Sex with virgins can cure HIV, leading to rape
- Virginity test in Kwazulunatal
- Polygamy and mistresses increases spread
- South Africa vs Northern Africa - difference in religion could account for difference in HIV
prominence

Environmental
- Distance to travel limits access
- Limits education on HIV/AIDS
- Lack of infrastructure

Economic
- Higher levels of trade increases HIV prevalence
- Impacts working population therefore impacting economy
- Patents hinder production of low cost alternatives
Conclusion
In conclusion, political, demographic, cultural, environmental and economic factors all contribute to
the spread of HIV/AIDS, but it is mainly misguided cultural beliefs that should be corrected in order
to reduce and possibly reverse the spread of the disease.

Malaria
Catchy opening lines
3 billion people are at risk from malaria
There were approximately 860,000 deaths from malaria in 2008, 89% of which occurred in Africa
Every 30 seconds a child dies from malaria

About 3.3 billion people - half of the world's population - are at risk of malaria.

There are 106 malaria endemic countries.

Every year, this leads to about 250 million malaria cases and nearly one million deaths. People living
in the poorest countries are the most vulnerable.

Malaria is especially a serious problem in Africa, where one in every five (20%) childhood deaths is
due to the effects of the disease.

An African child has on average between 1.6 and 5.4 episodes of malaria fever each year.

Every 30 seconds a child dies from malaria.

Malaria is the 4th leading cause of death for children globally.

Malaria has been estimated to cost Africa more than U.S. $12 billion every year in lost economic
productivity, and can cost households as much as 32 percent of their entire monthly income.

Insecticide-treated bed nets could prevent as many as 1 million deaths from all causes of malaria for
children under 5.

If universal malaria prevention could be maintained until 2015, an estimated 2.95 million African
children’s lives could be saved.

Describe where malaria would be found

 High prevalence of malaria in tropical regions between the Tropics of Cancer and Capricorn
 Highest prevalence of malaria in specific regions of West Africa, the northern area of South
America, parts of Southeast Asia towards Cambodia and Laos
 Low prevalence in North America, Europe and Northern Africa

Malaria Management
 Mosquitoes are more active at night
 Being inside a building does not guarantee protection

There are two obvious strategies which are used

 Protect humans from mosquito attack
 Reduce the population of mosquitoes

Nets for beds

Malaria nets are impregnated with insect repellent, as well as providing a physical barrier to the
insects at a time when people are particularly vulnerable. They are also known as Long Lasting
Insectidal Nets (LLINs) or Insecticide Treated Nets (ITNs). This technique is also sometimes linked
with Indoor Residual Spraying (IRS.

Anti-malarial drugs

Drugs are expensive and there are millions of people who would need to be taking them, which
could mean that they lose some of their natural resistance that they have. Drug companies make
millions of dollars from drugs, which are not necessarily supplied at the cheapest price. Many aid
agencies and organisations such as the Bill and Melinda Gates Foundation distribute drugs in places
where malaria is having a major impact.

How realistic is it to distribute drugs to all people living in countries where malaria is endemic? Do
drugs lose their effectiveness is used on a large scale and over a longer period of time.

Targetting mosquitoes and where they breed

This strategy involves reducing the areas of stagnant water where the mosquito might breed. Open
water should be covered, redundant irrigation channels should be filled in and open drains avoided.
Fish can also be stocked into ponds to eat the larvae. This has the added benefit of providing a food
supply. One issue is that many of the ponds where the mosquitoes breed are not permanent, but
are caused by seasonal rains, or intermittent flooding. When there is flooding on a massive scale,
stagnant water can sit around for months, and there is no chance of removing it. This strategy is
aimed at disrupting the life cycle of the mosquito and has been tried in Somalia, and is known as
“larval control”. The use of insecticides is expensive, and can contaminate groundwater. Insects also
build up a resistance to the insecticides over time.

Progress towards elimination of malaria

Increased proportion of children sleeping under mosquito nets, especially in Africa
Use of mosquito nets by children rose from 2% to 22% from 2000 to 2008
Attributed to increase in the production of mosquito nets: from 2004 to 2009 global production of
mosquito nets increased five-fold, from 30 million to 150 million
Increased funding for malaria endemic countries: increased from $0.1bn to $1.5bn from 2003 to
2009
Increased production of anti-malarial drugs – mainly artemisinin based compounds

Number of doses of artemisinin based combinations produced worldwide: from 0.5 million in 2001
to 160 million in 2009

Case Study – Malaria in Kenya

20 years ago 1 in 5 deaths in Kenya were caused by malaria. Mid to late 90’s malaria became
recognised as an issue of international importance. 28 million Kenyans live in areas that puts them at
risk of malaria. Ministry of Public Health and Sanitation has led the malaria eradiction event working
with other partners such as UNICEF and the World Health Organisation. Since 2003 $6 million has
been spend on ITNs and 21 million nets have been distributed. Pregnant women and children, who
are most at risk, have nets provided for free.

Community outreach programmes have also been started up to go into the most rural settings and
help provide education and nets. Support is also given in fitting the net successfully in their house.
The other focus area has been providing free drugs for people with malaria. As it is free treatnment
is occurring straight away, rather than only when the child gets very sick. ACT drugs are provided
free for all people confirmed with malaria. Hospital admissions have dropped by half. People are
now able to work more effectively as they are not getting malaria as much as before.

More money is needed to eradicate malaria from Kenya. There are still some rural areas where
further education, ITNs and drugs are needed to further reduce malaria.