Health Psychology. Michael Murray

      Figure 4.2 Associations of sales of tobacco, alcohol, soft drink and processed food markets, 80 countries, 2010

      Source: Stuckler et al. (2012)

      Population Growth

      The US Census Bureau (2017) publishes online a continuous, second-by-second update of the world’s population on its website (https://www.census.gov/popclock/). According to the Bureau, the total world population, at 05:07 GMT on 28 October 2017, was 7,430, 555, 770. That figure was increasing at a rate of 2.4 extra people every second. By 2025 there will be 8 billion people on Earth.

      Dividing the globe into regions, the most populous region is China. With 1.379 billion people in 2017, China contains 19% of all people on Earth. The second most populous country is India, with 1.282 billion in 2017. It is expected that India’s population will surpass China’s, with around 1.5 billion by 2040. Fertility is falling in most of the developing world but there is a huge variation between countries.

      One intervention for population growth, birth control, is practised in many countries. However, religious edicts influence sexual and reproductive practices, leading to population growth. This issue is difficult to ignore. Consider the position of the Roman Catholic Church as one example. The human failure to practise abstinence as the only acceptable method for birth control in South America and Africa is adding to population growth, poverty and the spread of HIV infection. Fertility is highest in sub-Saharan Africa, the poorest region in the world where the prevalence of AIDS is maximal. Birth control is also cheaper than other methods of reducing carbon emissions (Wire, 2009). Failing to prevent unwanted births increases the population and causes poverty and malnutrition, and the physical climate becomes more unstable.

      Increasing Life Expectancy

      Life expectancy has been increasing almost everywhere due to dramatic decreases in infant and adult mortality from infectious diseases. In Britain, life expectancy is currently around 75 years for men and 80 years for women. Life expectancy is increasing by three months every year in developed countries. If life expectancy increases to 85, 90 or even 100, social, health and pension systems will be difficult to maintain in their present form.

      The age profile of any population is displayed as a ‘population pyramid’, in which numbers in each age group are plotted on a vertical axis. In the UK, the number of people older than 85 is increasing dramatically. Inflows and outflows suggest that by 2050 the UK will be the largest country in Europe. In 2050, like many other places, the country will be both crowded and warm.

      China has the fastest-changing demographic profile in the world, with the largest population of senior citizens. Currently, China has more than 130 million senior citizens aged above 60, more than 10% of the total population. By the middle of this century senior citizens in China will exceed 400 million, one-quarter of the total population. There will be a significant shift in the demographic profile of the Chinese population between 2010 and a projection for 2050. The population pyramids show the ageing process is changing China’s pyramid, with much larger segments in the higher age brackets.

      Poverty

      Of 7.2 billion people alive in 2014, approximately 5 billion (70%) live in so-called ‘developing’ countries, i.e., low- and middle-income countries, the word ‘developing’ being a polite euphemism for ‘poor’. Poverty, by whatever name, exists on a massive scale: 1 billion to 1.5 billion people live on less than US$1.25 per day – i.e., more than one person in every five. For them, clean drinking water, flushing toilets, health services and modern medicines are completely out of reach. Initiatives that have attempted to improve the health of people in extreme poverty mostly have failed.

      The UN Development Programme defined poverty as ‘a level of income below that people cannot afford a minimum, nutritionally adequate diet and essential non-food requirements’ (United Nations Development Programme, 1995). Half of the world’s population lacks regular access to medical care and most essential drugs. International organizations such as the UN state with some justification that poverty is the greatest cause of ill health and early mortality. The health effects of poverty are tangible and the biological and economic mechanisms are the same everywhere. The major impacts of poverty on health are caused by the absence of:

      These are familiar themes. The most common health outcomes of poverty are infectious diseases, malnutrition and reproductive hazards (Anand and Sen, 2000). Poverty implies a lack of access to necessary medicines. HIV infection and AIDS provide a good example. A major killer disease is AIDS (acquired immune deficiency syndrome). In 2004, 6 million people living with HIV infection and AIDS in developing countries urgently needed access to highly active antiretroviral therapy (HAART). The World Health Organization (WHO) began the ‘3 by 5 Initiative’ in 2004 when less than 10% of sufferers had access to HAART. The WHO set a target of providing HAART to 3 million people living with HIV infection or AIDS by the end of 2005. The data show that this figure was half met. However, the number of people accessing antiretroviral therapy in low- and middle-income countries has risen, and reached an estimated 6.6 million at the end of 2010. The major barrier to increasing access to HAART is cost. The pharmaceutical industry holds the patents and loses profits if patent rights are relinquished to enable the generic production of HAART medication. Further discussion of HAART can be found in Chapters 8 and 22.

      Economic growth refers to the rate of increase in the total production of goods and services within an economy. Such growth increases the capacity of an economy to produce new goods and services, allowing more needs and wants to be satisfied. A growing economy increases employment, and stimulates business enterprise and innovation. Sustained growth is fundamental to the raising of living standards and to providing greater quality of life (QoL). A key concept is gross national income (GNI), which is the monetary value of all goods and services produced in a country over a year. GNI is therefore a useful indicator for measuring growth.

      BOX 4.1 INTERNATIONAL EXAMPLE: Reducing poverty in Brazil

      The Brazilian economy came under the media spotlight in June 2014 when it hosted the FIFA World Cup. In spite of its anti-hunger programme, protests and strikes in Brazil’s cities were a prominent feature of the 2014 World Cup. Life in the favelas was shown in TV documentaries as exotic, entrepreneurial and exciting, in spite of the child prostitution, drug trafficking and extremely impoverished communities. Graffiti art was used to draw attention to the contradiction between the lavish expenditure on 12 new stadia and the chronic levels of extreme poverty among a large proportion of the Brazilian