I have called this section 'patterns of disease' rather than 'patterns of health' deliberately, or, rather, I have little choice. 'Complete physical, mental and social well-being' is impossible to measure but disease is not. So, despite the problems that we discussed in the last section, we have to use something we can measure if we are to get anywhere.

In this section we are going to use measures that are related to the ultimate impact of disease - death. We are going to use measures that tell us how long people can expect to live and what the rates of child deaths are in different parts of the world, and even within the same parts. Do not be put off by the numbers involved.

Learning to 'read' them comes with practice and you will be surprised by how quickly you can make sense of them and how they can be used to help you find out what is happening and why it is happening. Don't, therefore, be tempted to skip or gloss over the activities involving numbers, because they are important in building up our understanding. First, however, a few words of caution.

The numbers (or 'data') that we are interested in can be notoriously difficult to collect and for this reason they may not be reliable, but, even if they are, you have to be careful when interpreting them. Look back at Figure 3.1. You probably said, like me, that the baby is unhealthy because it looks malnourished. But when the clinical measure of malnourishment (the actual measure need not concern us here) was applied to this baby, it was diagnosed as not being officially malnourished. Someone, somewhere, has made an assumption about what number represents the dividing line between being and not being malnourished. In other words, be careful of treating numbers as objective facts as they carry with them other people's assumptions.

We do not want to give the impression that numbers are no good. We have to work with what we have. But I repeat, be careful with your interpretations as you work through the activities below.

The main measure we are going to use in this section is the under-five mortality rate (U5MR). This is a measure often used by the United Nations, for example, and it represents the number of children, per 1000 live births, who die before the age of five. Child mortality is important because it is closely linked to the general health of a country or community. Many health interventions, such as immunization campaigns, are directed at children.

Abbreviations: Note that I have put the abbreviation for the World Health Organization, WHO, in brackets immediately after it. This is to show that I intend to use the shorter form whenever I refer to the organization later. You should always write out abbreviations in full the first time you use them, unless they are very common in everyday language (e.g. TV for television). In other words, you must always assume that an abbreviation that may be common to you may not be known to your reader. Also, be careful not to have too many abbreviations in your text when you write, as it can become very difficult to read.

Disease variations depending on where you live

Table: Child mortality rates

Region	Country	U5MR (1998)	North or South?
Africa	Mozambique	213	South
	Sierra Leone	283
	Malawi	229
	Uganda	170
	Ghana	96
	Egypt	59
America	Peru	47
	Brazil	40
	Jamaica	24
	Cuba	8*
	Canada	7
Asia	Pakistan	120
	Bangladesh	96
	India	83
	Indonesia	52
	China	36
	Sri Lanka	18
	Japan	5
Europe	Poland	11
	Greece	8
	UK	7
	Sweden	5	North

* UNICEF, 2000
Source: World Bank, 2000

Activity Two
(a) Consider the first table. For each country decide whether you think it belongs to the rich North or to the poorer South. Put your answers in the end column.
Download a blank table for your answers.

(b) Examine the under-five mortality rates (U5MRs) in the first table. In general, which countries have the higher under-five mortality rates - countries in the North or the South? Explain briefly whether or not your answer surprises you.

(c) Examine those countries that you identified as belonging to the South. What is the highest under-five mortality rate and what is the lowest? Does the difference surprise you? Again, briefly explain your answer.

I'll give you my suggested answers on the next page.

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