가난한 어린이 설사로 죽는다


5살 미만 어린이 사망 원인 2위,
기후변화가 설사 발병을 부추겨

한겨레 등록 : 2013.04.11 15:45
http://www.hani.co.kr/arti/international/international_general/582365.html

Diarrhoeal disease

Key facts

• Diarrhoeal disease is the second leading cause of death in children under five years old. It is both preventable and treatable.
  
• Each year diarrhoea kills around 700 000 children.
  
• A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene.
  
• Globally, there are nearly 1.7 billion cases of diarrhoeal disease every year.
  
• Diarrhoea is a leading cause of malnutrition in children under five years old.

Diarrhoeal disease is the second leading cause of death in children under five years old, and is responsible for killing around 700 000 children every year. Diarrhoea can last several days, and can leave the body without the water and salts that are necessary for survival. Most people who die from diarrhoea actually die from severe dehydration and fluid loss. Children who are malnourished or have impaired immunity as well as people living with HIV are most at risk of life-threatening diarrhoea.

Diarrhoea is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual). Frequent passing of formed stools is not diarrhoea, nor is the passing of loose, “pasty” stools by breastfed babies.

Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral and parasitic organisms. Infection is spread through contaminated food or drinking-water, or from person-to-person as a result of poor hygiene.

Interventions to prevent diarrhoea, including safe drinking-water, use of improved sanitation and hand washing with soap can reduce disease risk. Diarrhoea can be treated with a solution of clean water, sugar and salt, and with zinc tablets.

There are three clinical types of diarrhoea:

• acute watery diarrhoea – lasts several hours or days, and includes cholera;
  
• acute bloody diarrhoea – also called dysentery; and
  
• persistent diarrhoea – lasts 14 days or longer.

Scope of diarrhoeal disease

Diarrhoeal disease is a leading cause of child mortality and morbidity in the world, and mostly results from contaminated food and water sources. Worldwide, 780 million individuals lack access to improved drinking-water and 2.5 billion lack improved sanitation. Diarrhoea due to infection is widespread throughout developing countries.

In developing countries, children under three years old experience on average three episodes of diarrhoea every year. Each episode deprives the child of the nutrition necessary for growth. As a result, diarrhoea is a major cause of malnutrition, and malnourished children are more likely to fall ill from diarrhoea.

Dehydration

The most severe threat posed by diarrhoea is dehydration. During a diarrhoeal episode, water and electrolytes (sodium, chloride, potassium and bicarbonate) are lost through liquid stools, vomit, sweat, urine and breathing. Dehydration occurs when these losses are not replaced.

The degree of dehydration is rated on a scale of three.

• Early dehydration – no signs or symptoms.
  
• Moderate dehydration:
  
  
  
  • thirst
    
  • restless or irritable behaviour
    
  • decreased skin elasticity
    
  • sunken eyes
  
  
• Severe dehydration:
  
  
  
  • symptoms become more severe
    
  • shock, with diminished consciousness, lack of urine output, cool, moist extremities, a rapid and feeble pulse, low or undetectable blood pressure, and pale skin.

Death can follow severe dehydration if body fluids and electrolytes are not replenished, either through the use of oral rehydration salts (ORS) solution, or through an intravenous drip.

Causes

Infection: Diarrhoea is a symptom of infections caused by a host of bacterial, viral and parasitic organisms, most of which are spread by faeces-contaminated water. Infection is more common when there is a shortage of adequate sanitation and hygiene and safe water for drinking, cooking and cleaning. Rotavirus and Escherichia coli are the two most common etiological agents of diarrhoea in developing countries.

Malnutrition: Children who die from diarrhoea often suffer from underlying malnutrition, which makes them more vulnerable to diarrhoea. Each diarrhoeal episode, in turn, makes their malnutrition even worse. Diarrhoea is a leading cause of malnutrition in children under five years old.

Source: Water contaminated with human faeces, for example, from sewage, septic tanks and latrines, is of particular concern. Animal faeces also contain microorganisms that can cause diarrhoea.

Other causes: Diarrhoeal disease can also spread from person-to-person, aggravated by poor personal hygiene. Food is another major cause of diarrhoea when it is prepared or stored in unhygienic conditions. Water can contaminate food during irrigation. Fish and seafood from polluted water may also contribute to the disease.

Prevention and treatment

Key measures to prevent diarrhoea include:

• access to safe drinking-water;
  
• use of improved sanitation;
  
• hand washing with soap;
  
• exclusive breastfeeding for the first six months of life;
  
• good personal and food hygiene;
  
• health education about how infections spread; and
  
• rotavirus vaccination.

Key measures to treat diarrhoea include the following:

• Rehydration: with oral rehydration salts (ORS) solution. ORS is a mixture of clean water, salt and sugar. It costs a few cents per treatment. ORS is absorbed in the small intestine and replaces the water and electrolytes lost in the faeces.
  
• Zinc supplements: zinc supplements reduce the duration of a diarrhoea episode by 25% and are associated with a 30% reduction in stool volume.
  
• Rehydration: with intravenous fluids in case of severe dehydration or shock.
  
• Nutrient-rich foods: the vicious circle of malnutrition and diarrhoea can be broken by continuing to give nutrient-rich foods – including breast milk – during an episode, and by giving a nutritious diet – including exclusive breastfeeding for the first six months of life – to children when they are well.
  
• Consulting a health professional , in particular for management of persistent diarrhoea or when there is blood in stool or if there are signs of dehydration.

WHO response

WHO works with Member States and other partners to:

• promote national policies and investments that support case management of diarrhoea and its complications as well as increasing access to safe drinking-water and sanitation in developing countries;
  
• conduct research to develop and test new diarrhoea prevention and control strategies in this area;
  
• build capacity in implementing preventive interventions, including sanitation, source water improvements, and household water treatment and safe storage;
  
• develop new health interventions, such as the rotavirus immunization; and
  
• help to train health workers, especially at community level.

For more information contact:

WHO Media centre
Telephone: +41 22 791 2222
E-mail: mediainquiries@who.int

U.S. Poverty on Track to Post Record Gain Under Obama’s Watch

출처 : Fox News Published September 11, 2010 | Associated Press

http://www.foxnews.com/politics/2010/09/11/poverty-track-post-record-gain-obamas-watch/

The number of people in the U.S. who are in poverty is on track for a record increase on President Obama’s watch, with the ranks of working-age poor approaching 1960s levels that led to the national war on poverty.

Census figures for 2009 — the recession-ravaged first year of the Democrat’s presidency — are to be released in the coming week, and demographers expect grim findings.

It’s unfortunate timing for Obama and his party just seven weeks before important elections when control of Congress is at stake. The anticipated poverty rate increase — from 13.2 percent to about 15 percent — would be another blow to Democrats struggling to persuade voters to keep them in power.

“The most important anti-poverty effort is growing the economy and making sure there are enough jobs out there,” Obama said Friday at a White House news conference. He stressed his commitment to helping the poor achieve middle-class status and said, “If we can grow the economy faster and create more jobs, then everybody is swept up into that virtuous cycle.”

Interviews with six demographers who closely track poverty trends found wide consensus that 2009 figures are likely to show a significant rate increase to the range of 14.7 percent to 15 percent.

Should those estimates hold true, some 45 million people in this country, or more than 1 in 7, were poor last year. It would be the highest single-year increase since the government began calculating poverty figures in 1959. The previous high was in 1980 when the rate jumped 1.3 percentage points to 13 percent during the energy crisis.

Among the 18-64 working-age population, the demographers expect a rise beyond 12.4 percent, up from 11.7 percent. That would make it the highest since at least 1965, when another Democratic president, Lyndon B. Johnson, launched the war on poverty that expanded the federal government’s role in social welfare programs from education to health care.

Demographers also are confident the report will show:

_Child poverty increased from 19 percent to more than 20 percent.

_Blacks and Latinos were disproportionately hit, based on their higher rates of unemployment.

_Metropolitan areas that posted the largest gains in poverty included Modesto, Calif.; Detroit; Cape Coral-Fort Myers, Fla.; Los Angeles and Las Vegas.

“My guess is that politically these figures will be greeted with alarm and dismay but they won’t constitute a clarion call to action,” said William Galston, a domestic policy aide for President Bill Clinton. “I hope the parties don’t blame each other for the desperate circumstances of desperate people. That would be wrong in my opinion. But that’s not to say it won’t happen.”

Lawrence M. Mead, a New York University political science professor who is a conservative and wrote “The New Politics of Poverty: The Nonworking Poor in America,” argued that the figures will have a minimal impact in November.

“Poverty is not as big an issue right now as middle-class unemployment. That’s a lot more salient politically right now,” he said.

But if Thursday’s report is as troubling as expected, Republicans in the midst of an increasingly strong drive to win control of the House, if not the Senate, would get one more argument to make against Democrats in the campaign homestretch.

The GOP says voters should fire Democrats because Obama’s economic fixes are hindering the sluggish economic recovery. Rightly or wrongly, Republicans could cite a higher poverty rate as evidence.

Democrats almost certainly will argue that they shouldn’t be blamed. They’re likely to counter that the economic woes — and the poverty increase — began under President George W. Bush with the near-collapse of the financial industry in late 2008.

Although that’s true, it’s far from certain that the Democratic explanation will sway voters who already are trending heavily toward the GOP in polls as worrisome economic news piles up.

Hispanics and blacks — traditionally solid Democratic constituencies — could be inclined to stay home in November if, as expected, the Census Bureau reports that many more of them were poor last year.

Beyond this fall, the findings could put pressure on Obama to expand government safety net programs ahead of his likely 2012 re-election bid even as Republicans criticize him about federal spending and annual deficits. Those are areas of concern for independent voters whose support is critical in elections.

Experts say a jump in the poverty rate could mean that the liberal viewpoint — social constraints prevent the poor from working — will gain steam over the conservative position that the poor have opportunities to work but choose not to because they get too much help.

“The Great Recession will surely push the poverty rate for working-age people to a nearly 50-year peak,” said Elise Gould, an economist with the Economic Policy Institute. She said that means “it’s time for a renewed attack on poverty.”

To Douglas Besharov, a University of Maryland public policy professor, the big question is whether there’s anything more to do to help these families.

The 2009 forecasts are largely based on historical data and the unemployment rate, which climbed to 10.1 percent last October to post a record one-year gain.

The projections partly rely on a methodology by Rebecca Blank, a former poverty expert who now oversees the census. She estimated last year that poverty would hit about 14.8 percent if unemployment reached 10 percent. “As long as unemployment is higher, poverty will be higher,” she said in an interview then.

A formula by Richard Bavier, a former analyst with the White House Office of Management and Budget who has had high rates of accuracy over the last decade, predicts poverty will reach 15 percent.

That would put the rate at the highest level since 1993. The all-time high was 22.4 percent in 1959, the first year the government began tracking poverty. It dropped to a low of 11.1 percent in 1973 after Johnson’s war on poverty but has since fluctuated in the 12-14 percent range.

In 2008, the poverty level stood at $22,025 for a family of four, based on an official government calculation that includes only cash income before tax deductions. It excludes capital gains or accumulated wealth. It does not factor in noncash government aid such as tax credits or food stamps, which have surged to record levels in recent years under the federal stimulus program.

Beginning next year, the government plans to publish new, supplemental poverty figures that are expected to show even higher numbers of people in poverty than previously known. The figures will take into account rising costs of medical care, transportation and child care, a change analysts believe will add to the ranks of both seniors and working-age people in poverty.

가난 및 낮은 수준의 교육은 흡연이나 비만만큼 건강을 해치므로 대중들의 건강을 증진시키기 위해서는 비의료적 분야에 더 관심을 기울여야 한다는 내용의 “미국공중보건학회지” 2009년 12월호 연구결과입니다.

미국 컬럼비아대학 피터 뮤닝(Peter Muennig) 교수가 이끈 연구팀은 1997~2000년에 실시된 국립보건면접조사(National Health Interview Surveys) , 1996~2002년 이뤄진 의료비지출패널조사(Medical Expenditure Panel Surveys) 자료를 토대로 가난, 낮은 수준의 교육, 흡연, 비만 등과 건강한 생활 사이의 관계를 분석했습니다.

연구 결과 항상 소득이 낮은 가난한 사람은 그렇지 않은 사람보다 건강을 유지하는 기간이 평균 8.2년 감소하였습니다. 지속적인 흡연자는 6.6년, 고등학교도 졸업하지 못한 사람은 5.1년, 만성 비만자는 그렇지 않은 사람보다 4.2년이 줄었습니다. 연구진은 가난함의 기준을 최저생계비의 200% 이하가 소득인 가구로 정했습니다. 참고로  2010년 한국의 최저생계비는 4인 가족 기준 136만 3천원입니다.


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RESEARCH AND PRACTICE:
Peter Muennig, Kevin Fiscella, Daniel Tancredi, and Peter Franks

The Relative Health Burden of Selected Social and Behavioral Risk Factors in the United States: Implications for Policy

출처 : Am J Public Health(American Journal of Public Health), Dec 2009; doi:10.2105/AJPH.2009.165019
http://ajph.aphapublications.org/cgi/content/abstract/AJPH.2009.165019v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Muennig&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&fdate=1/1/2009&resourcetype=HWCIT

Abstract

Objectives. We sought to quantify the potential health impact of selected medical and nonmedical policy changes within the United States.

Methods. Using data from the 1997–2000 National Health Interview Surveys (linked to mortality data through 2002) and the 1996–2002 Medical Expenditure Panel Surveys, we calculated age-specific health-related quality-of-life scores and mortality probabilities for 8 social and behavioral risk factors. We then used Markov models to estimate the quality-adjusted life years lost.

Results. Ranked quality-adjusted life years lost were income less than 200% of the poverty line versus 200% or greater (464 million; 95% confidence interval [CI]=368, 564); current-smoker versus never-smoker (329 million; 95% CI=226, 382); body mass index 30 or higher versus 20 to less than 25 (205 million; 95% CI=159, 269); non-Hispanic Black versus non-Hispanic White (120 million; 95% CI=83, 163); and less than 12 years of school relative to 12 or more (74 million; 95% CI=52, 101). Binge drinking, overweight, and health insurance have relatively less influence on population health.

Conclusions. Poverty, smoking, and high-school dropouts impose the greatest burden of disease in the United States.

Key Words: Epidemiology, Health Financing, Health Policy, Obesity, Overweight, Underweight, African Americans/Blacks, Socioeconomic Factors

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Poor Face Greater Health Burden Than Smokers or the Obese