Contemporary Health Studies. Louise Warwick-Booth

is now evidenced.

      Sources: Raleigh and Polato (2004); Warwick-Booth (2019)

      Health inequity refers to those differences that are perceived to be unfair and unjust (Graham and Kelly 2004). For example, it can be argued that everyone has the right to health care; however, despite the presence of health care in many countries, not everyone is able access it, which results in health inequity.

Mental health Mental-health issues are often neglected in a world that tends to prioritize physical health. However, separating mental, social and physical health contradicts our understanding of the holistic nature of health. As a whole person, the domains of health are inextricably linked and influence each other. Achieving good mental health is fundamentally important in daily functioning, quality of life and integral to the health of individuals and communities (Brundtland, 2001). Rehm and Shield (2019) point out that mental health and addictive disorders affected more than one billion people globally, causing 7% of all global burden of disease and 19% of all years lived with disability; therefore mental health is a significant contemporary challenge. Statistics are likely to be a significant underestimation, as they only capture data about people who are classified and diagnosed as ‘disordered’. Many people experience anxiety and poor mental health without ever receiving a diagnosis of illness or disorder. A major issue for mental-health sufferers is the serious stigma and discrimination associated with poor psychological and psychiatric 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