Despite the enormous improvements, poverty, malnutrition and bad housing are still major causes of ill health in Western society where the death rate for tuberculosis is 10 times higher
in social class V than in social class 1.10 Studies in the Scottish city of Glasgow have shown that a child’s social class is three times more important than vaccination in influencing whooping cough outbreaks.11 Such differences have long been appreciated. During the 19th century infant mortality stood at several hundred per 1000 births except among royal families where the rate was only 12 per 1000 births, much the same as in many developed nations today.2 Clearly, poverty is highly detrimental to the chances of survival.
Nowhere is this more obvious than in lesser developed nations where infectious diseases are still rife. Poverty leads to malnutrition and a lowered resistance to infection: the death rates for whooping cough and diphtheria are 300 times and 100 times higher in poorer countries.12 Fewer than one in five people in these nations have clean water, so diseases transmitted by contaminated food and water are widespread. The World Health Organization estimates that 25 million die every year because they do not have clean water and sanitation. Although modem drugs can treat many of these infections, they are powerless to break the cycle of disease if the environment remains unhealthy. The prescription for better health in these poorer countries is therefore the same as that which worked so effectively in Britain and the United States: improved nutrition, hygiene and sanitation, and living and working conditions. Tropical diseases like malaria can also be effectively controlled through public health measures.13
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