status. Indeed, stigma is a major barrier to both mental-health treatment and recovery (Pinto-Foltz and Logsdon, 2009). Lewis (2019) points out that nearly one in three British young people had been exposed to trauma by the age of eighteen, which increases their risk of mental-health disorders; however, stigma and shame affected their ability to access services. Roberts et al. (2018) discuss the fact that failure to seek treatment for common mental-health disorders is a global problem, associated with people experiencing less disabling symptoms, as well as holding perceptions that they do not need health care. They argue that that there are different views about the ‘treatment gap’ between professionals and patients, because some statistics over-estimate unmet need for care when compared to perceptions within the target population. So, while mental-health problems are evident as a contemporary threat to health, they do not always require medical treatment.
Mental-health problems are increasingly understood to be linked to the social determinants of health, such as the environments in which we live. The mental-health impacts of climate change have already been discussed; but what, too, of our usual living conditions? Elliot (2016) reports that poverty increases the likelihood that people will experience mental-health problems, so it can be a consequence of inequality, but it can also be causal and so lead to poverty because of the complex relationships at play. Exposure to trauma is associated with mental-health problems, with conditions such as post-traumatic stress disorder, anxiety and depression following experiences of violence noted in the literature (Ophius et al., 2018). Increasing levels of chronic disease and sedentary lifestyles have also been discussed as detrimental to mental health. Kondo et al. (2020) report that the average American child spends almost eight hours daily on screen-time, creating health conditions as they move to adulthood; therefore they suggest prescribing nature as a tool for physical and mental health promotion to combat lifestyle problems including depression. Concerns about declining mental health among young people are all too frequently discussed in the UK media. Windsor-Shellard (2019) report growing suicide rates among young people in the UK; 2018 statistics showed that among 10 to 24-year-old females suicide rates had increased by 83% when compared to 2012. Young men in the same age bracket also saw a 25% increase in their rate compared to the previous year. Rates of self-harm have also increased among young people (particularly young women), arguably as a way for them to release emotional distress. The role of exposure to early childhood trauma, and the increased use of social media among younger people have been cited as causal factors but more research is needed (Windsor-Shellard, 2019).
Infectious diseases The media are forever drawing our attention to the problem of infectious diseases. In 2009 there were concerns about the possibility of a swine-flu pandemic, with many countries stock-piling vaccinations, implementing vaccination programmes, offering health advice and developing emergency plans. Here a political economy perspective would critically examine the role of the pharmaceutical industry as part of the construction of this health threat (see chapter 4 for further discussion of Marxist understandings of health and illness). This is interesting, given that it is the case that at least once a year an epidemic occurs somewhere in the world. There are many infectious diseases that threaten the health of humans, such as rotavirus, ebola, HIV and the more recently discovered SARS, H5N1 – bird flu (Kaufmann, 2009) and coronavirus, COVID-19 (Boni, 2020). The emergence of COVID-19 across the globe, starting in 2019 and continuing during 2020, led to a huge increase in excess deaths, particularly among older and more vulnerable groups with pre-existing health conditions, as well as unprecedented government action (lockdowns and social distancing rules) in an attempt to control the spread of the virus. At the time of writing more than ten million people have been infected, and over half a million people have died as a result of this new disease (WHO, 2020d), with infections continuing to spread and localized outbreaks occurring. The lack of effective treatment has been a challenge for all health systems, with many hospitals struggling to meet demand. The need to develop a vaccination is now high on the global agenda, resulting in world leaders pledging money towards this (WHO, 2020e). Furthermore, the implications of this disease in relation to inequality require consideration, for example there have been much higher death rates reported among BAME community members, in care homes in the UK and across economically poorer regions. Aside from the urgent threat of loss of life and potential disability resulting from COVID-19, there are many issues for future consideration in relation to the broader social determinants of health. For example, children have missed out on education, ‘non-essential’ health-care appointments have been delayed (WHO, 2020e), and many industries have been negatively affected, leading to increased unemployment; all of which are likely to impact more negatively upon health outcomes. Epidemics such as COVID-19 are transnational, have no boundaries and are hard to control. As a consequence, they instil fear in many people, and the associated social policy measures of lockdown and social distancing are likely to lead to adverse mental-health outcomes for some people. Our experience of infectious diseases varies according to where we live in the world, our own personal characteristics (social determinants), as well as the ways in which such threats are framed by the media and politicians.
In higher-income countries, we all experience coughs, colds and sore throats, generally for a few days and then we feel restored back to normal health. These minor illnesses are often the result of contact with viruses and are experienced as inconveniences rather than as a major threat to health. Almost 2.38 million deaths were caused by lower respiratory infections in 2016, making lower respiratory infections the sixth leading cause of mortality for all ages and the leading cause of death among children younger than five years (Naghavi et al., 2016). This is also true of diarrhoeal diseases. In high-income countries bouts of diarrhoea are unpleasant but generally do not cause a major health impact or result in death (this can happen in rare cases of cholera or e-coli infection when prompt medical attention is not sought), whereas in lower-income countries death is not an uncommon result (Kaufmann, 2009), especially in the under-fives (WHO, 2017b). This issue of the disproportionate burden is the same story for lower-income countries for most infectious diseases, including measles, HIV and AIDS, dysentery, cholera, typhoid and polio, to name but a few. Rossman and Badham (2019) point out that the media pay attention to ebola, with widespread coverage of this disease. In the Democratic Republic of the Congo, however, measles has proved much more fatal, killing three times as many people, yet this is under-reported.
HIV as an infectious disease is often seen as being a major contemporary threat to health and, as highlighted earlier, has received much media attention. WHO (2020c) reports that 770,000 people died of HIV-related illnesses worldwide in 2018, with 61% of these deaths occurring in the Africa region. The major problem with the prevention of HIV lies in the relationship between prevention and behaviour change (see chapter 6 for an in-depth discussion of behaviour change). Currently an effective vaccination has yet to be developed, therefore prevention via condom use and behaviour change (such as abstinence from sexual encounters) is advocated. However, some individuals find themselves powerless to negotiate safe sex and strong cultural traditions also serve to influence individual perceptions of risk.
The re-emergence of old infectious diseases On some occasions, a number of infectious diseases has been declared to have been ‘defeated’ and eradicated, only later to reappear and pose a threat to the health of humans. Tuberculosis is one such example within contemporary society (Kaufmann, 2009). This is because of TB’s close relationship with those infected with the HIV virus, so people often develop TB as a result of their weakened immune systems. In addition, the situation has been made worse by the bacterium that causes TB becoming increasingly resistant to drugs and treatment. Borgdorff and van Soolingen (2013) argue that drug-resistant TB is a major threat worldwide. WHO (2019d) report that TB was one of the top ten causes of death worldwide in 2018, yet only one in three people who need treatment are receiving it. The WHO has clear guidelines for the treatment of TB, and there is a vaccination available, but this only protects against a specific strain of the disease more common among children. Hence the disease remains a problem in that outbreaks continue to occur within specific populations, once again especially among those living in poverty because this is an ideal breeding ground for such an infectious disease. The principal reasons for the re-emergence of the disease are overcrowded housing, increasing homelessness, rising immigration rates, poor urban living conditions and rising levels of HIV infection (Kaufmann, 2009). Vaccination uptake can
