Define the term health-adjusted life expectancy.

State one reason why health-adjusted life expectancy is a better measure of the health of a population than child mortality.

Referring to one or more diseases, explain how three geographic factors influence the spread of disease.

“Affluent societies are less affected by disease than those with a high level of poverty.” Discuss this statement.

Health-adjusted life expectancy (HALE) is the life expectancy [1 mark] adjusted for time spent in poor health due to disease and/or injury [1 mark].

It can also be defined as the equivalent number of years of full health [1 mark] that a newborn can expect to live [1 mark], based on current rates of mortality and ill-health.

There are many possibilities. Child mortality reflects the health of mothers and young children, whereas HALE reflects the entire population, including the elderly. The costs and policies associated with the provision of health services in a society are probably better judged by HALE than by child mortality. Award 1 mark for a valid reason with an additional 1 mark for further development, such as quantification or exemplification.

Depending on the disease(s) chosen, many different geographic factors may be relevant, including climate, relief, transport lines and connections, incidence of hazards such as flooding, availability and access to methods of prevention (for example, vaccination) or cure, population density, mobility, religion, politics, poverty.

Award 1 mark for each valid factor, with an additional 1 mark for further development, clearly linked to the spatial diffusion/spread of the disease. Award a maximum of 2 marks if no diseases are named.

There are few simple relationships between poverty/affluence and the incidence of disease. At a global level, a distinction is recognized between the so-called “diseases of affluence” (type 2 diabetes, heart disease, cardiovascular disease, some forms of cancer, asthma, allergies, depression, some psychiatric illnesses) and the “diseases of poverty” (AIDS, malaria, tuberculosis, pneumonia, measles, cholera, typhoid, malnutritional diseases, dysentery, diarrhoeal diseases). In practice, both groups of disease often co-exist in any one society, with their incidence depending on income levels and other socio-economic characteristics.

Higher life expectancies in affluent societies may explain the higher incidence of diseases of affluence, most of which are degenerative, chronic and non-communicable. Diseases of poverty tend to be linked to infections, inadequate environmental health regulations or poor hygiene; they are often communicable. Rapidly developing countries may have relatively high levels of both groups.

Candidates should discuss the statement not only in terms of the distribution or incidence of disease, but should also look at other effects. These include the financial costs associated with disease prevention, treatment options and public health facilities, the possible economic consequences of disease in terms of reduced workforce productivity, and the social costs of any disease linked especially to a particular age group, such as women of childbearing age.

Answers with developed examples or case studies are likely to be credited at bands E/F.

Marks should be allocated according to the markbands.

This posed little difficulty for most candidates.

This posed little difficulty for most candidates.

It was sometimes difficult to distinguish three factors in rambling accounts where ideas often overlapped or that explained the occurrence of the disease rather than its spread. Weaker responses were superficial and revealed a very limited understanding, even of diseases they had selected as examples.

There were some outstanding responses that looked at all the possible nuances of the question, including the occurrence of diseases of poverty in poorer areas of economically developed countries and offered lots of evidence in support. At the other extreme, the weakest discussions were very, very superficial and often were just a list of diseases found in poor and affluent societies.