Students can provide many answers and reasons for the first two questions. The point of the questions is that people's perceptions of health and disease are different. Prompt students to explain why they do not feel at risk from some afflictions, yet are concerned about others. Ask them to consider not only infectious diseases, but also chronic disease, such as heart disease. Students should also consider nutritional deficiencies as causes of disease; psychosocial stress, bioclimatology, and environmental contamination as risks or stresses that may can affect their health; genetic susceptibility as a factor in disease development; and access to health services as a factor in health status. Examples of each of these are provided in the module text.

This activity also provides an opportunity for you to bring geography into the discussion. Many students will likely feel that they are not at risk to some health problems due to their location. Students in the United States may not feel at risk from dengue fever, but may mention heart attacks or cancer. You can broaden their concept of risk by suggesting its changing nature in light of global environmental changes (i.e., the shrinking space-time continuum, with airline travel speeding up the diffusion of disease and changing the areas in which a disease could be introduced). Dengue has occurred in the US -- on wagon trains heading west it was called "breakbone fever" -- and there is now an increased likelihood of dengue epidemics because it is again spreading in the Caribbean and because the Asian mosquito, Aedes albopictus, has been introduced and is spreading in the US (it survives cold better than other species and bites animals as well as people, so it can spread infection between them).

Concerning health responsibility, when students begin this exercise they are likely to think that they alone are responsible for their health. The discussion and the questions should help students begin to see the complexity of health and to realize that everyone cannot be responsible for her or his own health. Students should get a sense of community responsibility for health.

 

Activity 1.2  It Could Happen to You -- Bringing Health Home

 
A variety of responses are possible for the questions posed after each narrative in this activity. The following answers should be used only as a guide to assessing students’ responses.

Narrative 1:

1. Yes, they are, in relative terms.
2. There are many stereotypes of victims of hunger, including that of a homeless person, an unemployed person, or a starving child from a lesser developed country. John and Margaret do not fit any of these stereotypes. They have a home and some form of income.
3. Any number of problems could arise from John and Margaret’s nutritional circumstances. They could be susceptible to diseases like osteoporosis resulting from vitamin or mineral deficiencies, or they could be at risk of contracting influenza or pneumonia due to weakened immune systems.
4. John and Margaret live in an area that requires them to own an automobile and therefore they must spend some of their income for maintenance and insurance for the car. The fact that their daughter is unable to assist them because she lives in Tulsa illustrates the impact of increased mobility on the family unit and the health of family members.
5. Blame is a difficult and complex notion to assess, and in this case there are many factors that have produced John and Margaret’s circumstances. They did not have savings adequate to support themselves during retirement. They do not have private medical insurance, most likely because John was self-employed and did not have the benefit of employer-assisted insurance programs. Social Security has proven to be inadequate to cover their costs of living, and in fact, the entire program may face bankruptcy early in the next century without some reforms. John and Margaret also do not have the "safety net" that has traditionally been provided by one’s children and extended family. Their daughter lives several hundred miles away and is unaware of their situation.
6. One aspect of global change is the increasing mobility that has allowed John and Margaret to be separated from their family by several hundred miles. Another (which may not be global) is the growth of suburbs in the US where public transportation and other public support facilities may not be easily accessible.

1. Ann could have contracted TB from a number of locations, including her office in New York City, her Connecticut suburban community, on an airplane to vacation locations, in London, in Miami, on her Caribbean Cruise, at her company health club, or any other place in which she often comes in contact with people, like the New York subway.
2. Ann’s last statement makes it clear that she assumes TB to be a disease of the poor. She appears to believe that her wealth can keep her immune to the disease. Her surprise may also be explained by the fact that she makes an effort to keep herself healthy and fit by working out at the health club and by taking stress-relieving vacations around the world.
3. This question will depend entirely upon the student and may include some of the same stereotypes that Ann has (see above).
4. The key geographic factor is Ann’s global travel, which exposes her to many different individuals, in many different locations. She also works and lives in a very densely populated urban location, where she comes in contact with many people on a daily basis.
5. This narrative illustrates the role of increasing mobility in the (re)emergence of infectious diseases, like tuberculosis.

1. Yes there is a hidden threat at Emilio’s workplace. It could be any number of things, but the narrative suggests that it may be carpal tunnel syndrome, a condition often affects the wrists of individuals who use computer terminals or who perform data entry for much of their workday.
2. Emilio may be in decent physical shape, but his mental health is deteriorating. He has become depressed from his job and his father’s death and has turned to alcohol.
3. Yes. Emilio’s last comment illustrates this notion of immunity. He believes that since he isn’t doing hard physical labor or anything "dangerous" that his health may not be at risk.
4. Emilio lives in the Midwest, and from the description, we can assume that he lives in a small town or rural area. Urbanization has resulted in many job opportunities being relocated to urban areas; therefore, those in rural areas may find their career options somewhat limited, as Emilio did. Also, those living in rural areas or small towns may not have access to the bigger universities often found in larger cities.
5. As mentioned above, urbanization has resulted in the loss of job opportunities in rural areas. To make a living, people often find it necessary to migrate to the city. Those who do not move may find that the local economy is stagnant and their career and educational options limited. Emilio and his friends appear to be experiencing these effects, as they all are described as depressed, discouraged, living for the day, and abusing alcohol.
6. Because he is a part-time or temporary employee, Emilio most likely does not receive any employer-provided benefits like health insurance.

1.  Students should create a table similar to the one shown below. Note that the ranges they choose for their data classes may vary from this example.
 

3.  Based on the four categories used in #1 and #2, and the color scheme below, the map would look like the following:
 

KEY:  1 - 2.99 = white;  3 - 4.99 = light gray;  5 - 6.99 = dark gray;  7 - 8.99 = black

4. The area with the highest incidence rates is area G on the eastern part of the town, bordered by Route 13 to the north and Big Run Creek to the south. In general terms, Yukilosis is found in all parts of the town, but the highest rates appear mainly on the eastern part of the town. If different categories were used, we would see a somewhat different picture. For example, the one area of highest incidence may have been subsumed under a different category, thus making the eastern portion more uniform. More detail could be shown if more categories with smaller ranges were used.