1. Read the Text and the definition of life expectancy at birth and answer the following questions:

1. What does life expectancy at birth mean? [The number of years a newborn infant would live if prevailing patterns of mortality at the time of birth were to stay the same.]
2. What does it tell you about a country? [High life expectancy at birth suggests that people have access to the things that contribute to a long, healthy life such as nutritious food, safe water, sanitation, health care and education.]
3. On the basis of your experience, what do people need to maintain health? [immunizations, clean drinking water, adequate and nutritious food, hygienic living conditions and health care]
4. On the basis of your experience, what do people need when they are ill? [medicine, doctors, nurses, hospitals, pharmacies, nutritious food, clean water]
5. Based on the above answers, what can you infer about conditions in a country with a low rate of life expectancy at birth? [The things identified in c and d are lacking.]

2. Read the Text and the glossary definitions of infant mortality and under-five mortality, and answer the following questions:

1. What do infant mortality rates measure? What do under-five mortality rates measure? [The infant mortality rate measures the number of infants who die before reaching the age of one, per 1000 births in one year. The under-five mortality rate is the probability that a newborn baby will die before it reaches the age of five.]
2. Why do low-income countries have lower rates of infant and under-five mortality? [They are unable to prevent malnutrition in mothers and children, and to prevent or treat infectious diseases.]
3. Why is infancy and childhood such an important period in determining a country's life expectancy at birth? [Children who survive their fifth year have a much better chance of living to adulthood and old age. Much of the increase in life expectancy is due to improvement in health care and nutrition for children and infants.]

3. Life expectancy statistics do not tell how long a person will actually live, but rather, how long a person, on average is likely to live. Changes in income, health conditions, and education are constantly occurring and will affect life in a country. Read the list below and decide whether each situation is likely to increase or reduce life expectancy at birth, or have little or no effect in either direction. Explain your decision.

1. A severe drought causes a famine. [Reduce: A prolonged food shortage would lead to an increase in deaths, especially among children.]
2. A new health clinic opens and more children are inoculated against childhood diseases. [Increase: Vaccines for childhood diseases such as diphtheria, pertussis (whooping cough), tetanus, measles, poliomyelitis can prevent illnesses that cause death or weaken children resistance to other illnesses.]
3. The government declares a new national holiday for all workers. [No effect: This would not directly affect mortality rates.]
4. Village women attend classes to learn more about good nutrition and hygiene. [Increase: Mothers' knowledge of nutritious food, health, hygene, safe water and sanitation is important especially for the survival of children.]
5. Traveling nurses monitor the growth of infants and provide extra food to those who are not thriving. [Increase: Having sufficient nutritious food would strengthen children's resistance to diseases and illnesses.]
6. Men from a low-income neighborhood lose their jobs when the factory in which they work closes. [Reduce: Loss of income can affect peoples' ability to buy nutritious food or pay for medical care and medicine. Also, people who face long-term unemployment often are subject to health problems such as stress-related illnesses, drug and alcohol abuse, or suicide. On a large scale these problems may contribute to a higher adult mortality rate, and therefore lower life expectancy.]

4. Which of the following government actions would best respond to the problems listed below: (building pit toilets, using posters and handouts to transmit information, testing women for iron deficiency, requiring immunizations for all male and female children).

1. Doctors note an alarming increase in HIV (the virus that causes AIDS) in pregnant women. [using posters and handouts to transmit information]
2. Problem: An increase in measles and polio occurs among children. [requiring immunizations for all children]
3. Problem: Many women give birth to underweight babies. [testing women for iron deficiency]
4. Problem: A village suffers from an epidemic of Cholera, a disease transmitted by contaminated water. [building pit toilets]
5. Problem: Alcoholism increases following a severe economic depression. [using posters and handouts to transmit information]

5. Study the table and answer and discuss at least three of the following questions:

	Level of GNP per Capita (low, middle, high)	Low birthweight babies as a percent of all births, 1992-1998	Percent of adult males who smoke, 1985-1998	Percent of adults infected with HIV, 1997	Percent of children under 12 months with immunization for measles, 1995-1998
Argentina	Middle	7	40	.69	98
Togo	Low	20	65	8.52	38
United States	High	8	28	.76	89
Portugal	High	5	38	.69	99
Bangladesh	Low	50	60	.03	97
Vietnam	Low	17	73	.22	96
Moracco	Middle	4	40	.03	92

1. According to the Text, surviving the first five years is the most important factor in determining life expectancy at birth in a country. Based on that statement, which of the countries in the chart is most likely to have low life expectancy at birth? [Togo, Bangladesh, Vietnam] Why? [Low birthweight is a significant factor in causing high child mortality rates. Children who are underweight at birth may not be strong enough to fight off common childhood illnesses.]
2. In what country might life expectancy at birth actually decline? [Togo] Why? [Togo has a high rate of HIV infection and a high percent of adults who smoke, both factors in adult mortality. Its high percent of low birthweight babies also contributes to its child mortality rate. Togo's life expectancy at birth was 49 in 1998, the same as in 1980.]
3. Which countries might experience an increase in its adult mortality rate in two or three decades? [All the countries shown in the table could experience higher adult mortality if the percent of adults who smoke remain the same. Togo, Bangladesh, and Vietnam face a much high rate of adult mortality than the others.] Why? [Smoking-related diseases such as lung cancer usually take 20 to 30 years to develop. Furthermore, the percent of adults who smoke in high-income countries has been declining, while the percent that smoke in middle- and low-income countries has been on the rise since the 1970s.]
4. What evidence in the table would suggest that education could bring improvement in these public health problems? [The lower figures for Portugal and the United States suggest that high-income countries with widespread literacy, schools, and media can more effectively encourage people not to start smoking or to stop smoking. In countries in which AIDS is a serious threat such as in Argentina, the United States, and Portugal, literacy, schools, and the media have played a major role in prevention campaigns] What other factors might also be required for further improvement in these statistics? [Having sufficient money to provide immunization, literacy, educational campaigns, and nutritious food, and having a government that is responsive to its people's need for better living conditions are essential ingredients.]
5. Why might it be more difficult for a low-income country like Togo to educate its people about the dangers of AIDS and smoking than for high-income countries like Portugal or the United States? [Togo's illiteracy rate is high: for young people aged 15 to 24 in 1998, it was 14 percent for males and 44 percent for females; Portugal's illiteracy rate was 0 percent for both boys and girls, aged 15 to 24 in 1998. Furthermore, more investment in education is difficult because Togo does not produce enough. Togo's GNP per capita was $330 in 1998; the GNP per capita for the United States was $29,240.]
6. What is your hypothesis for why it appears to be easier for countries to achieve high levels of measles immunizations than to reduce the percentage of low birthweight babies? [The problem of low birthweight babies is more complex, involving the supply of nutritious food, the health and care of pregnant mothers, knowledge and availability of family planning, and the education of women and girls. Those problems in turn are often influenced by the availability of money and by the attitudes and values within communities. Immunization may also be influenced by money and values, but otherwise, are relatively easy to obtain and carryout. Immunization does not require long-term commitment to individual families. Little preparation or follow-up is needed.]
7. How might some high-income countries contribute to the high levels of smoking in low- and middle-income countries? [Stockholders in high-income countries own shares of many tobacco companies. Because of free trade policies adopted by most countries, they can sell their products in low- and middle-income countries.]
8. How might some high-income countries contribute to the high levels of immunization for measles in many low- and middle-income countries? [Stockholders in high-income countries own shares of many drug companies. Because of the free trade policies that most countries have adopted, they can sell their products in low- and middle-income countries.]
9. Countries usually base their decisions and policies on the priorities of their governments and people. To what extent does the evidence in the chart, suggest the top public health priority of each country? [Answers will vary. Students should recognize that in Togo, all of these problems may be top priorities. Because Togo is a poor country, the money to invest in starting or expanding programs is lacking. Positive figures also may not reveal priorities. Low HIV infection rates, for example, may reflect the influence of culture, religion or location, rather than specific public health or educational programs.] Hypothesize about other reasons for the variation in the statistics. [Answers will vary. Although having sufficient money to invest in programs is always important, political or cultural factors may be as significant. In the United States, a high-income country where individual responsibility is an important belief, the percent of low birthweight babies is higher than in middle-income countries and the percent of children immunized against measles is lower. The history of individual countries also plays a role. Because of long experience with cigarette smoking, Portugal and the United States faced an epidemic of smoking related diseases much earlier-- by the middle of the twentieth century. They have had much more time to plan educational programs. Togo and Bangladesh gained political independence and control of their futures much more recently than the other countries shown here. Since educational and health care facilities and programs take many years to develop, new nations may take longer to implement programs.]

6. Based on the Text and your own knowledge, argue for or against the following statement: Life expectancy at birth is a useful indicator for measuring Sustainable Development. [Answers will vary.]