the UK lost its WHO measles-free status in 2019 because of rising case numbers, and associated loss of herd immunity, attributed to fewer people being vaccinated.
Lifestyle diseases Whereas the social determinants of health approach emphasize the larger structural influences that affect our health (chapter 4 discusses both structure and agency in relation to health), in recent years threats to our health are also seen to be related to our own illness behaviour and the lifestyle choices that we make. The way in which we all live our lives is argued to have a huge impact upon our health. Lupton (1993) argues that risk discourse is used to blame the victim and to displace the real reasons for ill-health. Risks are located at the level of the individual, which serves to avoid people from examining broader, structural determinants. Perceptions of health risks are indeed changing (Giddens, 1999) and are numerous, as this chapter tells us; populations are generally ageing and patterns of physical activity, alcohol and tobacco consumption are also shifting, leaving many countries facing a burden of increasing chronic and non-communicable diseases (WHO, 2017), often labelled as lifestyle diseases.
The types of food we choose to consume, levels of inactivity, our sexual behaviour, attitudes to alcohol and recreational drug use, as well as attitudes to risk, are all having a huge impact on our health, and this is borne out in evidence of changing social trends. Hamilton and Sumnall (2019) point out that alcohol deaths in the UK remain high, with 7,551 people dying in the UK in 2018. Patterns of UK alcohol consumption are changing, with young people drinking less but older groups of people are continuing to drink alcohol heavily (Nicholls, 2019). UK obesity rates are also reflective of unhealthy lifestyles, with the Health Survey for England (2017) estimating that 28.7% of adults in England are obese and that another 35.6% are overweight. Changing lifestyles are cited as a significant causal factor in relation to obesity, as well as in relation to a number of different health problems. Hamilton and Stevens (2019) also report that every year since 2013, the UK’s Office for National Statistics reports increases in drug-related deaths, with the highest burden in deprived areas. These lifestyle theories are used to explain the social variations and gradients that exist between the different social classes. Thus, the lower social classes arguably smoke more, consume more alcohol and dietary fat, and exercise less and, as a consequence, these factors are used to explain their higher rates of cancers and heart disease by some commentators. However, the evidence between lifestyle choices and disease is incredibly complex and much research has been criticized for lacking scientific rigour (Skrabenek and McCormick, 1989). There is also the issue of moral judgements being made here in relation to lifestyle choices, about people who make ‘wrong’ and unhealthy choices, with personal volition increasingly used as a mechanism to label the deserving and undeserving sick. Therefore, the idea of lifestyle choices as a threat to our health has been associated with victim blaming and in some instances the treatment of individuals with lifestyle diseases has become highly politicized in the media. For example, there have been debates about the refusal of treatment for smokers, those who are obese and individuals who are seen to ‘refuse’ to change their behaviour without broader recognition of the structural factors underpinning the causation of lifestyle diseases.
In conclusion, the population of the world faces some large health risks and lower-income countries face even more of a risk because populations living there are exposed to multiple risk factors and face the increased risks associated with poverty. Indeed, there are some commentators who argue that we are living in a ‘risk society’ (Beck, 1992), where the main risks that we produce are the result of our own activity, for example, pollution and terrorism. However, the measurement of risk, now possible as a result of increased technology, the availability of large data sets, and improved computer capacity allows perhaps too many risks to be highlighted. Wainwright (2009a) argues that although many identified risks are genuine, the evidence for others is ‘weak’ and based upon spurious relationships such as the links between some lifestyle choices and specific conditions. Thus, risk ratios often used to demonstrate specific threats to health can be misleading and misreported in the media, affecting our perception of the actual risks that we face, which, according to research, is often skewed and incorrect (Duffy, 2019). On a more positive note, we do have the capability to measure these threats and to try to control them within modern society (Giddens, 1999).
Why and how is all this important?
In order fully to understand health within contemporary society, it is essential to be able to identify what the key health issues and challenges are. As this chapter shows, the conceptualization of key threats to health is a complex process, and health threats also evolve over time. What are considered as key health threats are influenced by the context in which we live and our social position, which also determine our levels of risk. Indeed, key health threats can also be contested (e.g. climate change is still being debated, so for those who hold the view that it is not happening, then it will not be conceptualized as a health threat). As this chapter shows, there are many threats to public health and therefore it is essential that these are identified in order to prioritize strategies for action in relation to managing and dealing with them. Interventions intended to improve health can be designed, communicated and implemented in relation to many of these key health threats – for example, vaccination programmes can very effectively tackle infectious diseases.
Case study 2
Global antibiotic resistance
The WHO (2019a) lists antimicrobial resistance as one of the top ten global health threats. This is the ability of bacteria, bugs and parasites to resist antibiotic medicines, commonly used to treat infections such as pneumonia and tuberculosis. Furthermore, surgical procedures will be compromised without the availability of effective antibiotics. Since 1930 these drugs have transformed how medicine treats diseases, protected the sick (e.g. cancer patients with weakened immune systems from chemotherapy) and supported global food production (Kirchhelle and Roberts, 2019). However, economic interests (profit-making) have meant that the development of new antibiotics has failed because investment has focused upon more lucrative options (medication that needs to be taken for longer). However, bacteria have become more resistant to existing drugs, compounded by the overuse of antimicrobials in people, but also in animals, especially those used for food production, as well as in the environment (WHO, 2019f).
Some governments have created action plans which include public-health awareness campaigns, attempting to educate communities about correct usage. Haenssgen (2019) suggests that such approaches assume that knowledge will lead to behaviour change but that the effectiveness of health education needs evaluation. Mohammed and Millard (2019) highlight an alternative approach where scientists are trying to use viruses as an alternative to antibiotics in the treatment of bacterial infections. WHO has also called upon Big Pharma to invest more money in the development of new antibiotics. There has been one positive development of a drug called pretomanid, now approved for use with patients who have drug resistant TB, developed by a not-for-profit organization called TB Alliance (Boseley, 2020a). Kirchhelle and Roberts (2019) point out that the market is broken, as even the injection of £520 million of public money since 2016 has not stopped industry departments responsible for antibiotic development from shrinking. Instead they call for a publicly owned approach, which will be better able to respond to need rather than prioritizing commercial interests.
Summary
Identifying substantive health threats is constructed by definitions of health, considerations of determinants of health, magnitude, seriousness as well as media and moral panics about health threats.
Epidemiological transition has changed global patterns from infectious diseases at the start of the twentieth century to chronic diseases in the twenty-first century and this pattern is predicted to continue.
Health threats in the twenty-first century will require global action around the major
