Health geography & medical geography in brief but in depth

1. Mohammad Mohaiminul Islam (Bappy)
MS-2018, GES, CU
1
GEOGRAPHY OF HEALTH & ENVIRONMENT
Notion of Health and Illness
Health:
Health is the state of physical, mental and social wellbeing (WHO, 1946). The biomedical perspective of health focuses
on the absence of diagnosed diseases. But broader definition includes- the state of complete physical, mental and social
wellbeing and not merely the absence of disease or infirmity (WHO, 1946).
Concepts of health:
1. People use different conceptual framework to understand health-as the idea of health as balance or illness as a
balance.
2. The notion of a body as a machine and illness as the malfunction of the body.
3. Health or illness seems as the outcome of fate or divinely will.
4. The concept of health as resilience against of infection or hazards.
Illness:
Illness can be defined as the presence of diagnosed diseases. Illness is defined as the ill health the person identifies
themselves with, often based on self-reported mental or physical symptoms. In some cases this may mean only minor or
temporary problems, but in other cases self-reported illness might include severe health problems or acute suffering
(Wikman, Marklund, Alexanderson, 2004).
Differences between health, illness & disease
Health is the state of physical, mental and social wellbeing and disease, in broader definition includes- the state of
complete physical, mental and social wellbeing and not merely the absence of disease or infirmity (WHO, 1946).
Disease is a particular abnormal condition that negatively affects the structure or function of part or all of an organism,
and that is not due to any external injury (Dorland's Medical Dictionary).
Illness is defined as the ill health the person
identifies themselves with, often based on self-
reported mental or physical symptoms. In some
cases this may mean only minor or temporary
problems, but in other cases self-reported illness
might include severe health problems or acute
suffering. It may include health conditions that
limit the person’s ability to lead a normal life.
According to this definition illness is seen as a
rather wide concept.
Disease, on the other hand, is defined as a
condition that is diagnosed by a physician or
other medical expert. Ideally, this would include
a specific diagnosis according to standardised and
systematic diagnostic codes. This would in most cases also mean that the specific condition has a known biomedical
cause and often known treatments and cures (Wikman, Marklund, Alexanderson, 2004).
Medical and health geography
Health Geography: Health geography is a sub-discipline of human geography, which deals with the interaction between
people and the environment. Health geography views health from a holistic perspective encompassing society and space,
and it conceptualizes the role of place, location and geography in health, well-being and disease (Dummer, 2008).
The vital terms in health geography are- stigmatization (to avoid someone for unhygienic reason or diseases), emergence
of place (role of places in health) and health and human environment.
Medical Geography: A field of geography that considers the distribution of specific diseases and human characteristics
in relation to the geographical and topographical features of regions, countries, or the world (Mayhew, 1995).

2. Mohammad Mohaiminul Islam (Bappy)
MS-2018, GES, CU
2
Difference between Health Geography and Medical Geography: The difference between health and medical geography
is that, medical geography studies the health and outcome while health geography studies health variations with space.
Medical geography focuses on the role of geography of a particular location on health and health geography focuses on
the role of variation of locations and changing pattern of health effects/factors on health.
Medical geography= health & its outcome+ location and its relation to health & diseases
Health geography= variation/change of location/space & human health +social concerns of health and space
Therapeutic Landscape
According to Gesler (1992), Therapeutic landscapes are places that have achieved lasting reputations for providing
physical, mental and spiritual healing.
According to Andrews (2017), Therapeutic landscape is a particular type of well-being experience associated with healing,
recovery, restoration and place.
Triangle of Human Ecology
Human ecology comprises those biological, cultural and
environmental factors that influence the state of
human populations. These factors were presented by
Meade and Earickson as the “triangle of human
ecology”, which posits that an individual's population,
habitat and behavior together affect disease risk.
The triangle of human ecology is a holistic approach
that focuses on how habitat, population, and behavioral
relationships among interacting populations affect the
human state of health (Meade and Earickson 2000).
Disease ecology examines the relationships between
populations and the changing environment, and studies
how processes of population interactions support or
discourage disease (Meade and Earickson 2000).
Approaches in Health Geography
According to Anthony Gatrell (2002)-
1. Positive Approach
It emphasizes through mapping of a spatial analysis, what observable and measurable. It is a scientific study, it adopts
some methods of natural elements. The study relies on accurate measurement and recording and searches for statistical
regularities.
2. Social Interaction Approach
The emphasis is on the measure of illness or disease to the individuals and the task for researcher is to uncover or
interpret these understandings or meanings that makes it ‘rational’ to act in a particular way. In other words, it sees the
people point of view.
3. Structuralist Approaches
It wants to see a wide-ranging emphasis on conflict, or power relations, whether between social or ethnic groups,
between men and women, between people with different sexual orientations, between those owning the means of
production and those employed as laboring classes, or between societies.
4. Structurationist Approaches
Structurationism recognizes the duality of structure and human agency. That is to say, it acknowledges that structures
shape social practices and actions, but that, in turn, such practices and actions can create and recreate social structures.

3. Mohammad Mohaiminul Islam (Bappy)
MS-2018, GES, CU
3
5. Post-structuralist Approach
Structuralists criticize both groups for their neglect of the broad social and economic forces, while structurationists
acknowledge that both structure and agency matter. It is a summary of all terms but mainly focuses on the power
relations.
Approaches in Medical Geography
Bimol Kanti Paul (1985) made a model of approaches of medical geography. That includes-
1. Disease ecology/geographic pathology (Coldest approach) *
2. Man Environment Interactions
3. Disease mapping (mapping of diseases)
4. Associative analysis (Analysis of factors)
5. Disease diffusion
6. Geography of nutrition
7. Geography of healthcare
8. Ethno-medicine and medical pluralism
Explanations:
1. Disease ecology: A disease occurs when a disease causing agent, or pathogen, meets the right host organism under
environmental conditions favorable to disease development.
2. Man Environment Interactions: It is the interaction of man with his total environment. Diseases occur due to-
lifestyle, environment and heredity.
3. Disease mapping: Disease maps are visual representations of intricate geographic data that provide a quick
overview of said information. Mainly used for explanatory purposes, disease maps can be presented to survey high-
risk areas and to help policy and resource allocation in said areas.
4. Associative analysis: Analysis if the factors related to the cause and origination of the diseases to establish an
inter-relationship between the associative phenomena and the diseases.
5. Disease diffusion: Disease diffusion refers to the spread of disease from its source into new areas. It is well
documented that the incidence of disease is likely to be affected by distance so that places closer to the source of
a disease are most likely to see higher incidence.
6. Geography of nutrition: Geography of nutrition is associated with three factors to be considered with nutrition,
that is to say- cultural, economic and physical phenomena.
7. Geography of healthcare: It refers to the relationship of space and maintenance or improvement of health via the
prevention, diagnosis, and treatment of disease, illness, injury, and other physical and mental impairments in
people.
8. Ethno-medicine and medical pluralism: Ethnomedicine is a study or comparison of the traditional medicine based
on bioactive compounds in plants and animals and practiced by various ethnic groups, especially those with little
access to western medicines. And medical pluralism is a parallel system along with the traditional treatment system.
Methodology of Health Geography
1. Quantitative: Where the data are quantities e.g. numbers, close ended question, checklist etc. where the respondents
cannot answer anything out of the defined options.
Methods: Statistical analysis, modeling, visual presentation.
Advantage: Defined and large sample size, correct and details information about whole area, generalization of
ideas, answer of ‘what’.
Disadvantage: In-depth analysis is not possible.
2. Qualitative: Where the data are not quantified and respondents have the option to answer anything out of the defined
answers and the researcher are not certain about the possible outcome.
Methods: In-depth interview, FGD, case study, participant observation.
Advantage: Knowing the insight, answer of ‘why’, ‘how’.
Disadvantage: It is not quantified, no generalized data.

4. Mohammad Mohaiminul Islam (Bappy)
MS-2018, GES, CU
4
Epidemiological Information
Endemic: A disease is endemic when it is constantly present in an area.
In epidemiology, an infection is said to be endemic in a population when that infection is constantly maintained at a
baseline level in a geographic area without external inputs.
Example: HEV (Hepatitis E virus) was found in 2018 (roughly February to August) in Chittagong area of Bangladesh,
but not outside of it. The hospital record shows 970 patients were admitted by this time for HEV.
Epidemic: A disease is epidemic when it occurs at levels clearly beyond normal expectation and is derived from a common
source (more than 5% population).
An epidemic is the rapid spread of infectious disease to a large number of people in a given population within a short
period of time, usually two weeks or less.
Example: 1995 to 2000, the total number of diarrhoea patients were 27.4 million (Source: compiled from DGHS
yearly data) and by that time (2000) the population of Bangladesh was 131.6 million (Source: World Bank), which
is the 20.8% of the total population of Bangladesh. The disease can be said as epidemic.
Pandemic: A disease is pandemic when it occurs at global level.
A pandemic is an epidemic of disease that has spread across a large region; for instance multiple continents, or even
worldwide. A widespread endemic disease that is stable in terms of how many people are getting sick from it is not a
pandemic.
Example: Malaria is a pandemic disease. According to WHO (2017), there were 219 million people were affected
by Malaria and 435 thousand people died from it in the year of 2017.
Infection and Chronic Disease Model by Pyle
Salient features of Infectious and Chronic Model:
 The models were given by Pyle (1979) contrasting the infectious diseases origination and spread in the less developed
countries and the origination of chronic diseases in highly developed countries.
 Pyle has recognized cycles of infectious and chronic diseases which be associated with the level of economic
development. Economy is an influential factor for the nature of diseases.
 In the least economically advanced countries of the world, high facilities is often linked with high infant mortality
which is produced by infectious and parasitic diseases and general malnutrition.
 It contrasts in the economically advanced countries of the world, economic degenerative diseases are the major
killers with the bulk of the deaths occurring to people aged over 60.
 Precisely, Pyle contrasted the ‘infectious disease model’ found in poor, less developed countries with the ‘chronic
disease model’ found in high income countries.
Infectious Diseases Model-Low Income Countries:
 Weak, largely agrarian economies and limited industrial growth
 Rapid, uncontrolled growth of urban populations
 Weak players in the international economy
 High levels of national debt
 Malnutrition and poor living conditions
 Poor control of diseases by underdeveloped health care system
 High levels of mortality in early life, especially due to infectious diseases
 Dual burden of re-emergent/emergent infectious diseases and increasing chronic diseases
Chronic Diseases Model- High Income Countries:
 Highly developed post-industrial economies
 Limited, controlled urban growth
 Strong players in the international economy
 Relatively affluent living conditions
 Highly developed biomedical systems

5. Mohammad Mohaiminul Islam (Bappy)
MS-2018, GES, CU
5
 Impacts of infectious diseases relatively well controlled
 Low child mortality
 Mortality mainly due to non-communicable causes
International processes affecting poverty and wealth:
 Present and historical colonial relationships
 Industrialization and post-industrial trends
 Globalizing economies and cultures
 International conflict
 International financial institutions
Real world explanation of the model:
Infectious Diseases Model: The infectious disease model reflects the epidemiological situation found, for example, in
African countries, with high levels of child and adult mortality. These countries have conditions typical of the cycle of
poverty. Low levels of economic development, poorly regulated economies and weak agrarian economies cause food
shortages and malnutrition, resulting in greater susceptibility to infection and high mortality at early ages. The difficult
situation for these countries is often compounded by a disadvantaged position in the global economy (undermining the
operation of local markets), by high levels of national debt and by political and social instability.
Chronic Disease Model: Countries in regions such as North America and Western Europe, in later stages of the
epidemiological transition, and with low child and adult mortality, are typical of those experiencing the ‘cycle of
affluence’ and described by the chronic disease model. These industrial and post-industrial societies have relatively
strongly developed, highly regulated economies, are often locations of powerful interests controlling global circuits of
capital, and tend to be relatively stable in political terms. They have often benefited in the past from colonial
relationships with poorer countries. Levels of material poverty are less extreme than in poor countries and infectious
diseases are relatively well controlled. Chronic diseases are the major causes of death. The original versions of these
models represented a rather conventional view of the epidemiological transition. The revised version here is intended
to reflect more recent epidemiological trends such as the resurgence of infectious diseases, and the double burden
faced in many low income countries of growing chronic disease mortality as well as problems in controlling emergent
and re-emergent infectious diseases.
The Biology of Infectious Diseases
Communicable diseases have bewilder diversity and it is wise at the outset to offer a classification. It is possible to
produce a classification with a number of criteria, a classification based on the various types of organisms and their
differing means of transmission is most appropriate for our purpose.
There are 6 basic groups of organisms-
1. Virus: A virus is a biological agent that reproduces inside the cells of living hosts e. g. Influenza, measles, small
pox, yellow fever, dengue fever etc.
2. Bacteria: Bacteria are microscopic, single-celled organisms that thrive in diverse environments. These
organisms can live in soil, the ocean and inside the human gut. For example- TB, Diphtheria, Pneumonia,
Sinusitis, Typhoid, Cholera, Syphilis etc.
3. Fungi: A fungus is any member of the group of eukaryotic organisms that includes microorganisms such as
yeasts and molds, e.g. - Athlete’s Foot, Ringworm etc.
4. Protozoa: Protozoa is an informal term for single-celled eukaryotes, either free-living or parasitic. Malaria,
Chagas disease, Sleeping sickness etc.
5. Insects: Small insects like mosquito, flea, bed bug etc. e.g. Dengue, Malaria, Chikungunya etc.
6. Helminthes: Helminthes is a general term for worms e.g. STH (Soil Transmitted Helminthes) diseases
There are 5 modes of transmission of infectious disease-
1. By air (Cold, influenza, diphtheria, chicken pox etc.)
2. By physical contact (Syphilis, gonorrhea, herpes etc.)

6. Mohammad Mohaiminul Islam (Bappy)
MS-2018, GES, CU
6
3. By food (Cholera, hepatitis etc.)
4. By water (Cholera, hepatitis etc.)
5. By insects (Includes plague, which is produced when the germ is transferred to human from the rat by blood
sucking flees.)
Process of this transmission includes endemic, pandemic and epidemic stages of disease.
Health and Migration
There is evidence that migration especially to a new country leads to stress and depression as a result of come to terms
with a new culture. This is clearly gendered, migrant woman may have fear opportunities for social integration, as well
as working in unskilled occupation and low incomes (Kaplan, 1998).
There is problems for loneliness and home sickness especially for older women. The pressure to perform a variety of
roles (wife, carer, mother, home keeper and wage earner) exacerbated by the separations from friends and family and
the need to fulfil such roles in an unfamiliar setting.
Immigrants find themselves exposed to higher risk in the work place whether from individual accidents (occupational
hazards) or in domestic environment (physical and sexual abuse).
The forced dislocation of the people from their houses has drastic health consequences. Forced migration does not only
embrace refugees but also includes those compelled to leave because of major engineering projects such as dams (Ray,
1999). Kalipini and Oppong (1988) have reviewed the health impact of displacement of refugees in Africa considering
them affected under several headings. Firstly, this movement disrupts livelihood and the operation of health services
which results malnutrition. Secondly, the overcrowding of refugee camps caused further food shortage as well as poor
sanitation. As a consequence, disease such as cholera, dysentery, hepatitis and measles are likely to break out. Thirdly,
sexual violence in common, UNICEF reported wide rape of young girls during the Rwandan Genocide of 1994 where sex
may be exchanged for food among the most desperate hungry people which caused spread of HIV. Fourthly, the trauma
of watching people, often family members killed and injured has devastating consequences for long term mental health.
UNICEF reported a survey in Angola in 1995 which revealed that 2-3rds of the children have seen people murdered and
over 90% have seen dead bodies.
The world is witnessing the highest levels of displacement on record. An unprecedented 70.8 million people around the
world have been forced from home by conflict and persecution at the end of 2018. Among them are nearly 30 million
refugees, over half of whom are under the age of 18. There are also millions of stateless people, who have been denied
a nationality and access to basic rights such as education, healthcare, employment and freedom of movement (UNHCR,
2018).
Rohingya refugees in Bangladesh are Rohingya refugees from Myanmar living
in Bangladesh. For decades, the Rohingya have experienced ethnic and
religious persecution in Myanmar. Hundreds of thousands have fled to other
countries in Southeast Asia, including Malaysia, Indonesia, and Philippines.
The majority have escaped to Bangladesh, where there are two official,
registered refugee camps. Recently violence in Myanmar has escalated, so
the number of refugees in Bangladesh has increased rapidly. According to
the UN Refugee Agency (UNHCR), more than 723,000 Rohingya have fled to
Bangladesh since 25 August 2017. On 28 September 2018, at the 73rd United
Nations General Assembly, Bangladeshi Prime Minister Sheikh Hasina said
there are 1.1 million Rohingya refugees now in Bangladesh. Overcrowding
from the recent population boom at Bangladesh's Rohingya refugee camps
has placed a strain on its infrastructure. The refugees lack access to
services, education, food, clean water, and proper sanitation; they are also
vulnerable to natural disasters and infectious disease transmission.

7. Mohammad Mohaiminul Islam (Bappy)
MS-2018, GES, CU
7
Chronic and Infectious Diseases
Chronic Diseases: A Chronic condition is a human health condition or disease that is persistent or otherwise long-lasting
in its effects or a disease that comes with time. The term chronic is often applied when the course of the disease lasts
for more than three months. Example: Cancer, Asthma, Alzheimers, COPD, Diabetes etc.
Infectious Diseases: Infectious diseases are disorders caused by organisms — such as bacteria, viruses, fungi or parasites.
Many organisms live in and on our bodies. They're normally harmless or even helpful. But under certain conditions, some
organisms may cause disease. Some infectious diseases can be passed from person to person. Example: Influenza,
measles, small pox, yellow fever, dengue fever, TB, Diphtheria, Pneumonia, Sinusitis, Typhoid, Cholera, Syphilis.
Environmental Health
Definition: According to WHO, environmental health addresses all the physical, chemical, and biological factors external
to a person, and all the related factors impacting behaviours. It encompasses the assessment and control of those
environmental factors that can potentially affect health. It is targeted towards preventing disease and creating health-
supportive environments.
Environmental health Issues: Environmental health addresses all human-health-related aspects of the natural
environment and the built environment. Environmental health concerns include:
 Air quality, including both ambient outdoor air and indoor air quality, which also comprises concerns about
environmental tobacco smoke.
 Biosafety
 Disaster preparedness and response.
 Climate change and its effects on health.
 Environmental Racism, wherein certain groups of people can be put at higher risk for environmental hazards, such
as air, soil, and water pollution. This often happens due to marginalization, economic and political processes, and
ultimately, racism. Environmental racism disproportionately affects different groups globally, however generally the
most marginalized groups of any given region/nation.
 Food safety, including in agriculture, transportation, food processing, wholesale and retail distribution and sale.
 Hazardous materials management, including hazardous waste management, contaminated site remediation, the
prevention of leaks from underground storage tanks and the prevention of hazardous materials releases to the
environment and responses to emergency situations resulting from such releases.
 Housing, including substandard housing abatement and the inspection of jails and prisons.
 Childhood lead poisoning prevention.
 Land use planning, including smart growth.
 Liquid waste disposal, including city waste water treatment plants and on-site waste water disposal systems, such as
septic tank systems and chemical toilets.
 Medical waste management and disposal.
 Noise pollution control.
 Occupational health and industrial hygiene.
 Radiological health, including exposure to ionizing radiation from X-rays or radioactive isotopes.
 Recreational water illness prevention, including from swimming pools, spas and ocean and freshwater bathing places.
 Safe drinking water.
 Solid waste management, including landfills, recycling facilities, composting and solid waste transfer stations.
 Toxic chemical exposure whether in consumer products, housing, workplaces, air, water or soil.
 Vector control, including the control of mosquitoes, rodents, flies, cockroaches and other animals that may transmit
pathogens.
Climate change and health risk
Climate change affects the social and environmental determinants of health– clean air, safe drinking water, sufficient
food and secure shelter. Climatic conditions strongly affect water-borne diseases and diseases transmitted through
insects, snails or other cold blooded animals. Changes in climate are likely to lengthen the transmission seasons of
important vector-borne diseases and to alter their geographic range. Extreme high air temperatures contribute directly
to deaths from cardiovascular and respiratory disease, particularly among elderly people (WHO, 2018).

8. Mohammad Mohaiminul Islam (Bappy)
MS-2018, GES, CU
8
The climate change health risks are-
1. Heat stress and heat stroke
2. Heat wave and cold wave impact
3. Malnutrition and undernutrition
4. Food insecurity
5. Communicable diseases
6. Water borne diseases
7. Tropical diseases
8. Vector borne diseases
9. Respiratory and cardiovascular diseases
10. Extreme dehydration
11. Allrgens and sthma triggers
12. Certain age-sex group vulnerbailies
13. Mental health deterioration etc.
Health Inequality and Health Care
Health differences can be distinguished at all geographic scales from global differences between groups of countries to
local differences between small areas. Healthcare is the maintenance or improvement of health via the prevention,
diagnosis, and treatment of disease, illness, injury, and other physical and mental impairments in people. The inequality
of health care is observed along with the inequality of health.
Health inequality in Bangladesh-
1. Regional inequality of health
a) Urban-rural inequality
b) Rural-rural inequality
c) Urban-urban inequality
2. Economic inequality of health
a) Poor-middle class inequality
b) Middle class-rich class inequality
3. Private public health care inequality
Occupational Hazards
Occupational hazards is the danger to health, limb, or life that is inherent in, or is associated with, a particular
occupation, industry, or work environment. Occupational hazards include risk of accident and of contracting occupational
diseases.
Occupational illness normally develops over a period of time because of workplace conditions. Such conditions might
include exposure to disease-causing bacteria and viruses, for example, or to chemicals or dust.
According to Islam, Hossain & Siddique (2017), around 63.3% of workers were affected with at least one health problems.
Majority of the workers were suffering from skin problem (25.3%), gastrointestinal problem (8.5%), chronic headache
(8.2%), allergies (5.7%), respiratory system problem (6.3%), cardiovascular problem (6.3%) and eye problem (3.5%). Only
36.7% respondents used personal protective equipment (PPE). The tanneries did not have any effluents or wastes
treatment facilities. Smoking and monthly low household income were significantly associated with the morbidity of the
tannery workers. The government should take adequate measures to mitigate the health hazards in the tannery industry.
Health policy of Bangladesh
The Bangladesh health policy document was published in 2011 and adheres to the following : Health is defined as "A state
of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Every citizen has
the basic right to adequate health care.
Contents: The Bangladesh health policy document was published in 2011 and adheres to the following :
 Every citizen has the basic right to adequate health care. The State and the government are constitutionally obliged
to ensure health care for its citizens.

9. Mohammad Mohaiminul Islam (Bappy)
MS-2018, GES, CU
9
 To ensure an effective health care system that responds to the need of a healthy nation, health policy provides the
vision and mission for development.
 Pursuit of such policy will fulfill the demands of the people of the country, while health service providers will be
encouraged and inspired. People's physical well-being and free thought process have proved to be a precondition for
the growth and intellectual enrichment in today's human society
 Bangladesh expressed agreement on the following declarations:
i. The Alma Ata Declaration (1978)
ii. The World Summit for Children (1990)
iii. International Conference on Population and Development (1994)
iv. Beijing Women's Conference (1995)
Health care system:
The health care are designated to meet the health needs of the community through the use of available knowledge and
resources. The services provided should be comprehensive and community based. The resources must be distributed
according to the needs of the community. The final outcome of good health care system is the changed health status or
improve health status of the community which is expressed in terms of lives saved, death averted, disease prevented,
disease treated, prolongation of life etc.
 Health care delivery system in Bangladesh based on PHC concept has got various Level of service delivery:
 Home and community level.
 Union level,
 Union sub centre (USC) or Health and family welfare centre; This is the first health facility level.
 Thana level, Thana Health Complex (THC): This is the first referral level.
 District Hospital: This is the secondary referral level.
 National Level: This is the tertiary referral level.
A) Primary level health care is delivered though USC or HFWC with one in each union domiciliary level, integrated health
and family planning services through field workers for every 3000–4000 population and 31 bed capacities in hospitals.
B) The secondary level health care is provided through 500 bed capacities in district hospital. Facilities provide specialist
services in internal medicine, general surgery, gynecology, paediatrics and obstetrics, eye clinical, pathology, blood
transfusion and public health laboratories.
C) Tertiary Level health care is available at the medical college hospital, public health and medical institutes and other
specialist hospitals at the national level where a mass wide range of specialised as well as better laboratory facilities
are available.
WHO
The World Health Organization (WHO) is a specialized agency of the United Nations that is concerned with international
public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of
the United Nations Development Group. Its predecessor, the Health Organization, was an agency of the League of Nations.
The constitution of the WHO has been signed by 61 countries (all 51 member countries and 10 others) on 22 July 1946,
with the first meeting of the World Health Assembly finishing on 24 July 1948. It incorporated the Office International
d'Hygiène Publique and the League of Nations Health Organization. Since its establishment, it has played a leading role
in the eradication of smallpox. Its current priorities include communicable diseases, in particular HIV/AIDS, Ebola,
malaria and tuberculosis; the mitigation of the effects of non-communicable diseases such as sexual and reproductive
health, development, and aging; nutrition, food security and healthy eating; occupational health; substance abuse; and
driving the development of reporting, publications, and networking.
The WHO is responsible for the World Health Report, the worldwide World Health Survey, and World Health Day. The
current Director-General of the WHO is Tedros Adhanom, who served as Ethiopian Health Minister in the past.
WHO works in the following sectors-
 Communicable diseases
 Non-communicable diseases
 Environmental health
 Life course and life style

10. Mohammad Mohaiminul Islam (Bappy)
MS-2018, GES, CU
10
 Surgery and trauma care
 Emergency work
 Health policy
Mental Illness
According WHO, mental illness comprises a broad range of problems, with different symptoms. However, they are
generally characterized by some combination of abnormal thoughts, emotions, behaviour and relationships with others.
Examples are schizophrenia, depression, intellectual disabilities and disorders due to drug abuse. Most of these disorders
can be successfully treated. Some characteristics of mental illness are-
 There are many different mental disorders, with different presentations. They are generally characterized by a
combination of abnormal thoughts, perceptions, emotions, behaviour and relationships with others.
 Mental disorders include: depression, bipolar affective disorder, schizophrenia and other psychoses, dementia,
intellectual disabilities and developmental disorders including autism.
 There are effective strategies for preventing mental disorders such as depression.
 There are effective treatments for mental disorders and ways to alleviate the suffering caused by them.
 Access to health care and social services capable of providing treatment and social support is key.
HIV
The human immunodeficiency virus (HIV) infects cells of the immune system, destroying or impairing their function.
Infection with the virus results in progressive deterioration of the immune system, leading to "immune deficiency." The
immune system is considered deficient when it can no longer fulfil its role of fighting infection and disease. Infections
associated with severe immunodeficiency are known as "opportunistic infections", because they take advantage of a
weakened immune system (WHO).
 HIV continues to be a major global public health issue, having claimed more than 32 million lives so far. However,
with increasing access to effective HIV prevention, diagnosis, treatment and care, including for opportunistic
infections, HIV infection has become a manageable chronic health condition, enabling people living with HIV to
lead long and healthy lives.
 There were approximately 37.9 million people living with HIV at the end of 2018.
 As a result of concerted international efforts to respond to HIV, coverage of services has been steadily increasing.
In 2018, 62% of adults and 54% of children living with HIV in low- and middle-income countries were receiving
lifelong antiretroviral therapy (ART).
 A great majority (82%) of pregnant and breastfeeding women living with HIV also received ART, which not only
protects their health, but also ensures prevention of HIV transmission to their newborns.
 However, not everyone is able to access HIV testing, treatment and care. Notably, the 2018 Super-Fast-Track
targets for reducing new paediatric HIV infections to 40 000 was not achieved. Global targets for 2020 are at risk
of being missed unless rapid action is taken.
 Due to gaps in HIV services, 770 000 people died from HIV-related causes in 2018 and 1.7 million people were
newly infected.
 In 2018, for the first time, individuals from key population groups and their sexual partners accounted for over
half of all new HIV infections globally (an estimated 54%) in 2018. For eastern European, central Asian, Middle
Eastern and north African regions, these groups accounted for around 95% of new HIV infections.
 Key populations include: men who have sex with men; people who inject drugs; people in prisons and other
closed settings; sex workers and their clients; and transgender people.
 In addition, given their life circumstances, a range of other populations may be particularly vulnerable, and at
increased risk of HIV infection, such as adolescent girls and young women in southern and eastern Africa and
indigenous peoples in some communities.
 Increased HIV vulnerability is often associated with legal and social factors, which increases exposure to risk
situations and creates barriers to accessing effective, quality and affordable HIV prevention, testing and
treatment services.

11. Mohammad Mohaiminul Islam (Bappy)
MS-2018, GES, CU
11
 Over two thirds of all people living with HIV live in the WHO African Region (25.7 million). While HIV is prevalent
among the general population in this region, an increasing number of new infections occur among key population
groups.
 HIV can be diagnosed through rapid diagnostic tests that can provide same-day results. This greatly facilitates
diagnosis and linkage with treatment and care.
 There is no cure for HIV infection. However, effective antiretroviral drugs (ARVs) can control the virus and help
prevent onward transmission to other people.
 At the end of 2018, an estimated 79% of people living with HIV knew their status. An estimated 23.3 million (or
62% of all) people living with HIV were receiving antiretroviral therapy (ART) and 53% had achieved suppression
of the HIV virus with no risk of infecting others.
 Between 2000 and 2018, new HIV infections fell by 37% and HIV-related deaths fell by 45%, with 13.6 million lives
saved due to ART. This achievement was the result of great efforts by national HIV programmes supported by
civil society and international development partners.
Reproductive Health
Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease
or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health
implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the
freedom to decide if, when and how often to do so (WHO).
Different life stages are associated with specific women's sexual and reproductive health issues, including menstruation,
fertility, cervical screening, contraception, pregnancy, sexually transmissible infections, chronic health problems (such
as endometriosis and polycystic ovary syndrome) and menopause.
Some example of reproductive health related diseases are- Endometriosis, Uterine Fibroids, Gynecologic Cancer,
HIV/AIDS, Interstitial Cystitis, Polycystic Ovary Syndrome (PCOS), Sexually Transmitted Diseases (STDs).
Global Emergin Diseases
Emerging infectious diseases are infections that have recently appeared within a population or those whose incidence or
geographic range is rapidly increasing or threatens to increase in the near future. Emerging infections can be caused by:
 Previously undetected or unknown infectious agents
 Known agents that have spread to new geographic locations or new populations
 Previously known agents whose role in specific diseases has previously gone unrecognized.
 Re-emergence of agents whose incidence of disease had significantly declined in the past, but whose incidence
of disease has reappeared. This class of diseases is known as re-emerging infectious diseases.
According to WHO (2015), The initial list of disease priorities needing urgent R&D attention comprises: Crimean Congo
haemorrhagic fever, Ebola virus disease and Marburg, Lassa fever, MERS and SARS coronavirus diseases, Nipah and Rift
Valley fever. The list will be reviewed annually or when new diseases emerge.