State one other indicator besides infection rates which could be used to map the health of people in this city.

Referring to the map, describe the pattern of this disease in the city.

Explain three possible reasons, one environmental, one social and one economic, for the pattern considered in part (b).

“Poverty is the main cause of food insecurity.” Discuss this statement.

Award 1 mark for any valid indicator that might produce a spatial pattern. Possible answers include the number of people per doctor (or per clinic/hospital) in each zone; life expectancy or infant mortality rate in different districts. Accept other valid responses.

This disease is concentrated in the north-eastern sector of the city (Gajrawadi, Fatepura, City and Panigate) [1 mark]. Rates are low in the west of the city (Belbaug, Subhanpura and Sayajigunj) [1 mark]. Some responses may also identify the mid-range concentration forming a north-south belt (Raopura, Shiyabaug and Sindhvaimata Road). Award up to 2 marks for the recognition of the general pattern with 1 mark reserved for specific reference to the map.

Examples of possible reasons include:

Environmental: high rate areas may be at lower altitude, where water collects, or may be on unstable ground where water pipes frequently rupture, contaminating the water supply.

Social: people living in overcrowded conditions may be more likely to share contaminated water sources and catch the disease; different ethnic groups may have differing views about drinking untreated water.

Economic: people living in high-rate areas may be less affluent, and therefore unable to afford preventative measures such as water purification or vaccination, and may have to work even during an epidemic, increasing their chances of catching the disease.

Award 1 mark for each valid reason, and a further 1 mark in each case for any valid development or detail.

Answers are expected to consider both sides of this question. Poverty may cause or exacerbate food insecurity because families in poverty may be unable to afford food even though supplies are (physically) available. Poverty makes it unlikely that families can retain a reserve of food to tide them over bad times, or guarantee them seeds for planting the following year. On the other hand, food insecurity may also be caused by natural hazards, such as droughts reducing food availability, or by earthquakes and hurricanes disrupting food supply chains and normal distribution channels. Food insecurity may also result from wars, conflicts, and from external forces such as the actions of NGOs and effects of government subsidies.

While it is likely that most responses will conclude by agreeing with the statement, this is by no means the only possible conclusion. All responses should be judged strictly on their own merits.

Responses that discuss both sides of the question and arrive at a conclusion in line with the evidence selected are likely to be credited at bands E/F.

Marks should be allocated according to the markbands.

This was usually well done, though some answers wrongly used "calories" as a measure of health.

This was well done though some responses lacked references to places on the map even if they were able to describe the basic pattern of the disease.

Responses often referred to diseases that are not water-borne.

There were some strong answers at higher level and at both levels a number of candidates were unsure of the precise meaning of poverty or food insecurity. Some answers did not look at other possible causes of food insecurity. At standard level the responses were generally weak and many candidates descended into a stereotyped, blanket account as to why "Africa" has famines and poor diet, once again treating the entire continent as a single country.