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
Morocco	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.]

Life Expectancy at Birth, 1990-98

1. Study the world map and answer the following questions:

1. What color on the map represents countries with higher life expectancies? [Green (or black if using black and white print out)] Where do these countries tend to be located? [North and Central America, Western Europe, and parts of East Asia and the Pacific, South America, and Middle East and North Africa]
2. What color represents countries with lowest life expectancies? [Red (or dark gray if using black and white print out)] Where do these countries tend to be located? [Sub-Saharan Africa]
3. What assumptions might you make about living conditions in the region with the lowest life expectancies? [The people may not have enough nutritious food to eat; they may lack access to safe water; they probably have limited access to primary health care and education; they probably have relatively low incomes.]

2. Look at the map and list five countries in which life expectancy at birth is less than 50 years, five in which it is between 50 and 59 years, five in which it is 60 to 69 years, and five in which it is 70 years or more.

1. Now look at the Basic Data Tables, and find the economic group of each country on your list: low-income, middle-income, and high-income. [Answers will vary.]
2. Use this information to make a general statement describing the relationship between life expectancy at birth and income level. [Answers will vary. Most high-income countries tend to have high life expectancy at birth. Low-income countries tend to have low life expectancy at birth. Life expectancy in middle-income countries tends to range in between. There are exceptions. For example, low-income countries such as Armenia, and middle-income countries such as Sri Lanka, and Cuba have life expectancy at birth of more than 70 years.]
3. What assumptions can you make about living conditions in the countries in each category of life expectancy at birth? [High-income: Living conditions, including nutritious food, health care, clean water, sanitation, and education, are available for most people. Middle-income: Living conditions improved rapidly in recent decades. More people have access to nutritious food, health care, clean water, sanitation, and education. Low-income: People may not have access to adequate nutritious food, safe water, sanitation, health care, and education.]
4. How might living conditions differ in low- or middle-income countries such as Armenia, Sri Lanka, or Cuba whose life expectancy at birth is 70 years or more? [Access to nutritious food, safe water, sanitation, health care, and education may be adequate, and possibly similar to high-income countries. Other conditions such a jobs, incomes, or housing, and the availability of other goods and services, however, may still be far below the level of high-income countries.]

1. Using the data in Chart 1 on life expectancy at birth in 1965 and 1998, complete the table below as accurately as you can.

Changes in Life Expectancy at Birth, 1965 and 1998
	1965	1998	Years Added
Low- and middle-income countries	[50]	[65]	[15]
Low-income countries	[47]	[63]	[16]
Middle-income countries	[54]	[69]	[15]
High-income countries	[71]	[78]	[7]
United States	[70]	[77]	[7]

1. What was the overall trend in life expectancy between 1965 and 1998? [It increased.]
2. Which group of countries-low income, middle income, or high income-- had the greatest percentage increase in life expectancy? (Subtract the 1965 number from the 1998 number, divide the result by the 1965 number, and multiply by 100 to get the percentage.) [low income: 34%; middle income: 28%; high income: 9%. Low-income countries had the greatest percentage increase.]
3. What do the numbers suggest about living conditions in low-income countries and middle-income countries? [The living conditions are not as high as in high-income countries, but they are improving, especially in low-income countries.]
4. Looking at the chart, what are some assumptions you can make about living conditions in the United States in 1900? [Living conditions were probably very similar to those in low-income countries in 1965: people lacked adequate health care, clean water, and sanitary facilities, and levels of education and income were much lower than in the United States today.]

2. Refer to chart 1, the text, and the Social Data Table.

1. How did life expectancy change in your country between 1980 and 1998? [Answers will vary.]
2. What do you think caused this change? Use the text and your own knowledge to support your answer. [Answers will vary.]
3. Was this change typical of your country's income group? [Answers will vary.]
4. What does this suggest to you about living conditions in your country relative to others in its income group? [Answers will vary.]

1. Look at Chart 2 and answer the following questions:

1. What was the infant mortality rate for low-income countries in 1998? [68 deaths per 1,000 live births]
2. What was the infant mortality rate for high-income countries in 1998? [6 deaths per 1,000 live births]
3. How much more likely is it for a newborn baby to die within its first year in a low-income country versus a high-income country? [Approximately 11 times (divide 68 by 6)] Why do you think this is the case? [Answers will vary. People in high-income countries have much better access to nutritious food, quality pre- and post-natal health care, and sanitary living conditions. In addition, most women in high-income countries are educated and better prepared to provide the best care for their families.]

2. Look at the table below and then answer the questions.

	Population (1998)	Infant mortality rate per 1000 live births (1998)	Number of infant deaths (1998)
Country A	1,160,000,000	31	575,360
Country B	6,000,000	6	792
Country C	16,900,000	134	92,840

1. What country had the lowest infant mortality rate in 1998? [Country B]
2. Which country had the most infant deaths in 1998? [Country A]
3. What country can you assume has high life expectancy at birth? [Country B] Why? [It has the lowest infant mortality rate.]
4. What is the difference between "infant mortality rate per 1000 live births" and "number of infant deaths"? [The first is a rate per 1000, while the second is a straight number.]
5. Why is "infant mortality rate per 1000 live births" a better statistic to use than "number of infant deaths" for comparing countries than "number of infant deaths"? [Using "per 1000 live births" provides the same standard (1000 live births) for comparing infant deaths for all countries regardless of the total populations or total number of infant deaths.]
6. Based on the table, what country faces the greatest challenge in increasing its life expectancy rate at birth? [Although Country A has the most infant deaths, Country C has more than four times as many deaths per 1000 live births as Country A. Therefore, Country C probably faces the greatest challenges in increasing its life expectancy rate at birth since infant mortality rates strongly influence overall life expectancy.]

3. If more newborn babies lived, what might be the effect on each of the following? Give reasons for your responses. [Answers will vary.]

1. The number of productive adults in 15 or 20 years
2. The attitudes of parents about having children
3. School enrollment in five or six years
4. The need for jobs in 15 or 20 years
5. Attitudes toward family planning
6. A family's educational costs
7. A family's need for food
8. A country's need for food

1. Study Chart 3 and answer the following questions:

1. In which region do boys and girls have the greatest chance of living beyond their fifth birthday? [East Asia & the Pacific]
2. In which region do they have the greatest chance of dying before their fifth birthday? [Sub-Saharan Africa]
3. Go to the Map Gallery and compare these two regions on the Life Expectancy, Population Growth Rate, GNP per Capita, and Access to Safe Water maps. In what ways are they similar or different? [In Sub-Saharan Africa, nearly all the countries have a Life Expectancy under 64 years, but most of the East Asia & Pacific has a Life Expectancy over 65 years; in Sub-Saharan Africa, nearly all of the countries have a Population Growth Rate of 2% or higher, but most of East Asia & Pacific, the Population Growth Rate is under 2%; both Sub-Saharan Africa and East Asia & the Pacific most countries are low income; in most Sub-Saharan African countries, less than 50% of the population has Access to Safe Water, while in a substantial portion of East Asia & the Pacific, more than 70% of the population has Access to Safe Water.]
4. What do these comparisons suggest about the links between child mortality and these other indicators? [While GNP per capita can have a strong influence on mortality and life expectancy, child mortality is also closely related to whether families have safe water to drink and how many children families have.]
5. Based on your reading of the text and your own knowledge, what might be other reasons for the differences in child mortality in these two regions? [Sub-Saharan Africa has a much higher prevalence of HIV/AIDS than East Asia & the Pacific; not only are young children being orphaned, but many are also infected with the virus. In addition, one would want to look at other indicators such as literacy rates, girls education rates, access to health care, and immunization rates.]

2. Look at the table below and then answer the questions.

Countries and GNP per Capita (high, middle, low)	Life expectancy at birth (1998)	Child mortality rate per 1000 live births (1988-1998)		Adult mortality rate per 1000 live births (1998)
		Males	Females	Males	Females
Côte d'Ivoire (L)	46	71	58	526	513
Jordan (M)	71	4	7	158	119
Mexico (M)	72	15	17	165	84
Pakistan (L)	62	22	37	172	152
Philippines (M)	69	21	19	197	149
Romania (M)	69	7	5	256	122
Trinidad and Tobago (M)	73	4	3	161	101

1. In which country(s) do female children (age 1 to 5) survive at a higher rate than males? [Côte d'Ivoire, Philippines, Romania, Trinidad and Tobago]
2. In which country(s) do adult (defined as age 15 to 60) females survive at a higher rate than adult males? [All countries in the table]
3. What does the text suggest may be a reason for why female children do not survive at a higher rate in some countries? [In cultures that have preference for male children, girls may not receive as much food or health care-including immunizations--as their brothers.]

* Data unavailable for Middle East and North Africa region.

1. Make a copy of the blank Comparative Data Table and label the first column Countries, the second column Infant Mortality Rate (per 1,000 live births), 1998, and the third Life Expectancy at Birth, 1998. Then using the Social Data Tables, fill in the table according to the following instructions.
(Note. The Work On Line version tables are already labeled.)

1. Read the definition of infant mortality rate. Then find the countries in each region that have the highest and the lowest infant mortality rates for 1998. Write the names of these countries and their regions in the left hand column. If two or more countries have the same rate, please choose one. [[Asia (South and East) and the Pacific: Afghanistan (highest rate), Hong Kong (lowest rate). Europe and Central Asia: Turkey (highest rate), Finland, Norway, Sweden, or Switzerland (lowest rate). Middle East and North Africa: Iraq (highest rate), Israel (lowest rate). North and Central America and the Caribbean: Haiti (highest rate), Canada (lowest rate). South America: Bolivia (highest rate), Chile (lowest rate). Sub-Saharan Africa: Sierra Leone (highest rate), Senegal (lowest rate).]
2. In the second column, fill in the infant mortality rates for each of your chosen countries. [Afghanistan: 149; Hong Kong: 3; Turkey: 38; Finland, Norway, Sweden, or Switzerland: 4; Iraq: 103; Israel: 6; Haiti: 71; Canada: 5; Bolivia: 60; Chile: 10; Sierra Leone: 169; Senegal: 5.]
3. Read the definition of life expectancy at birth. Then fill in the third column with 1998 life expectancy at birth data for each of your selected countries. [Afghanistan: 46; Hong Kong: 79; Turkey: 69; Finland: 77, Norway:78, Sweden: 79 or Switzerland: 79; Iraq: 59; Israel: 78; Haiti: 54; Canada: 79; Bolivia: 62; Chile: 75; Sierra Leone: 37; Senegal: 75.] See an example of a completed data table.
4. Compare the data and make a statement about the relationship between infant mortality and life expectancy at birth. Is your statement true for all regions? [Typically, the countries that have higher infant mortality rates, have lower life expectancy at birth and vice versa. The relationship is general and tends to be true across countries and regions.]

2. Make a copy of the blank Comparative Data Table and label the first column Countries, the second column Life expectancy at birth, 1998, the third column Population growth rate, 1980-98, the fourth column GNP per capita, 1998 and the fifth Access to safe water, 1990-96. Then using the text and the Basic Data Tables, fill in the chart according to the following instructions.
(Note. The Work On Line version tables are already labeled.)

1. Choose a low-income country in Sub-Saharan Africa and one in Asia (South and East) and the Pacific and write their names in the first column.
2. Choose a middle-income country in each of the following regions and add them to the first column: South America, Europe and Central Asia, and Middle East and North Africa.
3. Choose a high-income country in North and Central America and the Caribbean, one in Europe and Central Asia, and one in Asia (South and East) and the Pacific and add them to the first column.
4. Label each country in your data table with an L, M, or H to show which income group it belongs to: low, middle, or high.
5. Read the definitions of life expectancy at birth, population growth rate, GNP per capita, and access to safe water. Go to the Basic Data Tables, and for each of your countries find the 1998 life expectancy at birth, 1980-98 population growth rate, 1998 GNP per capita, and 1990-96 percentage of population with access to safe water, and write this information in the appropriate columns. If data for one of the indicators are not available, select another country from the same income group and region.
6. Rank the countries, with "1" equaling the highest life expectancy at birth and "8" the lowest. Write the appropriate ranking number in parentheses after the data in column 2.
7. Study your chart and answer the following questions:
   • In the countries with a life expectancy of less than 55 years, are the other indicators high or low?
   • In the countries with a life expectancy of 55-64 years, are the other indicators higher or lower than in the countries with a life expectancy of less than 55 years?
   • In the countries with a life expectancy of 65-69 years, are the other indicators higher or lower than in the countries with less than 65 years?
   • In the countries with a life expectancy of 70 or more years, are the other indicators higher or lower than in the other countries?
   • Does life expectancy at birth follow the same trend as the other development indicators in your chart? Explain.

1. Look at the photograph. Describe what you see. [A mother holds a child while a nurse administers an immunization.]

2. Would this be a common scene in your country? Why or Why not? [Answers will vary.]

3. In which country was this photograph taken? [India]

4. Find the country in the World and Regional Map Gallery. What region is it in? [South Asia]

5. Find the country in the Basic Data Tables and determine if it is a low-, middle-, or high-income economy. [low-income]

6. According to the Basic Data Tables, what is the country's projected population growth rate for 1998–2015? [1.3%] It's GNP per capita for 1998? [$440] The percentage of its 1990–1996 population with access to safe water? [81%]

7. What do you think life is like for the average person in this country? Support your answer. [Answers will vary, but should take into account India's life expectancy, projected population growth rate, its GNP per capita, and the percent of its people with access to safe water.]

8. What, if any, of the activity shown in the photograph might help improve living standards in industrial countries? In developing countries? [Immunizations improve living standards in both industrial and developing countries. Healthy people are more productive than sick people. Parents who believe their children will survive often have fewer children freeing more resources for better living standards.]

9. Which sector of development (i.e., social, economic or environmental) is best represented by the photograph? Explain your answer. Is it possible for this photograph to represent other sectors as well? In what way? [Answers will vary.]

10. In what ways might the activity in the photograph encourage sustainable development? In what ways might it discourage sustainable development? Explain your answers. [Immunizations for children will encourage sustainable development by supporting health and normal growth, which are key factors for effective childhood education and later adult productivity. If immunizations use resources that are needed to increase current production, then sustainable development could be endangered. Long-term increase in production, however, requires improvement in people's health through immunizations and other programs.]

1. Look at the photograph. Describe what you see. [A young child is smoking a cigarette.]

2. Would this be a common scene in your country? Why or Why not? [Answers will vary.]

3. In which country was this photograph taken? [Mexico]

4. Find the country in the World and Regional Map Gallery. What region is it in? [North and Central America and the Caribbean]

5. Find the country in the Basic Data Tables and determine if it is a low-, middle-, or high-income economy. [It is a middle-income economy.]

6. According to the Basic Data Tables, what is the country's life expectancy at birth for 1998? Its population growth rate for 1980–1998? Its GNP per capita for 1998? The percentage of its 1990–1996 population with access to safe water? [72 years; 1.9%; $3,840; 83%]

7. What do you think life is like for the average person in this country? Support your answer. [Answers will vary, but should take into account the possible effects of the life expectancy, population growth rate, GNP per capita, and the percentage of the population with access to safe water on the quality of life.]

8. What, if any, of the activity shown in the photograph might help improve living standards in industrial countries? In developing countries? [Answers will vary. This activity might improve living standards in industrial or developing countries that grow tobacco or manufacture cigarettes. It will have a negative effect on living standards in countries where people—especially children—take up the smoking habit.]

9. Which sector of development (i.e., social, economic or environmental) is best represented by the photograph? [social] Explain your answer. [Answers will vary.] Is it possible for this photograph to represent other sectors as well? [economic] In what way? [Answers will vary.]

10. In what ways might the activity in the photograph encourage sustainable development? In what ways might it discourage sustainable development? Explain your answers. [Answers will vary. Smoking does not encourage sustainable development. It discourages sustainable development because in the long run smoking causes cancer and lung and heart disease. If many young people become addicted to tobacco, there will be an increase in the need for costly medical care and a loss of productivity.]

1. Though the story is about a nutrition center, what other activities does the center sponsor or promote? [Immunizing children, conducting pre-school classes, giving check-ups for pregnant mothers, referring sick children to hospitals, teaching about health, gardening, and nutrition.]

2. At least three women in the story were reluctant to go to the Nutrition Center. Explain why. [It was time-consuming to go to the center every day; some did not trust the center; one was embarrassed about her pregnancy.]

3. Abhirami says, "We have to gain their trust." Why would people be suspicious about receiving nutritious food for their children? [They may not understand about vitamins and other food supplements. They have to leave their homes where they normally prepare food to receive food from strangers. Laddoos are new. They did not exist when the mothers were young.]

4. Why do you think the workers at the center weigh the children every day? [The mothers can see that the food supplements are working and that their children were growing normally. It shows if a child is experiencing other problems that interfere with growth.]

5. Why do you think that Abhirami believes that if the laddoos were prepared at home, "the children would not always get them"? [The family might decide to share the laddoos with all the children in the family, even if they are not underweight. Or they might give them to adults who are doing the heaviest work.]

6. Why do you think the two women in the story were surprised that ordinary people went to the hospital? [Few people from poor villages go to hospitals due to the distance and the cost.]

7. Why might a woman be embarrassed about her pregnancy and not want to talk about it because "she had a fourteen–year–old daughter"? [She may have considered herself too old to have another child, especially since her daughter was now old enough to have a child herself.]

8. In how many different ways did the center educate children and adults about nutrition? [Daily weighing of children, explanations of the purpose of the laddoos, pre-school lessons about food and gardening, using popular musicians to sing songs about nutrition and health.] Why would the center choose to do all of these different time consuming activities instead of simply feeding the children? [Answers will vary. By educating people instead of just feeding them, there is a greater chance that people will change their behaviors and learn to feed themselves in a healthy way. Using many different methods to teach mothers and children helps to ensure that the lessons go beyond the nutrition center walls.]

9. Find India on the Social Data Table. What is the 1998 Infant Mortality Rate? [70 deaths per 1,000 live births.] What is the 1998 average Life Expectancy at Birth? [63 years.] If India were to extend the Tamil Nadu nutrition project throughout the entire country, what changes would you expect to see in these data over time? [The Infant Mortality Rate would probably decrease and the Life Expectancy would probably increase.] Find your own country on the Social Data Table. How do the data for your country compare with those of India? How would you explain these differences? [Answers will vary.]

10. Do you think malnutrition is a problem for low– and middle-income countries only? Explain your answer. [Answers will vary. Malnutrition may occur in any country–low, middle, or high income—where segments of the population cannot afford enough nutritious food, but it is more common in low– and middle-income countries. Even where there is sufficient food people may be malnourished because they do not know how to eat a balanced diet or understand the role that vitamins and minerals play in nutrition. Also, malnutrition may occur as a result of unhealthy and extreme attempts to lose weight, a trend that appears to be growing especially among adolescent girls in some high-income countries.]

11. Is malnutrition a problem in your country? What programs do you know about that try to change eating habits or provide more nutritious food for those who need it in your country? [Answers will vary.]

1. Assume that you and members of your class work on the planning staff of the Ministry of Health in a country where life expectancy at birth is 47 years. Listed below are some activities that could help your country increase life expectancy. Because of budget limitations, the Ministry of Health cannot undertake all the activities at once.

1. The Minister has asked each of you to choose the activities that you would undertake first, rank them in the order in which you would implement them, and explain why you chose this ranking.
   • Train health workers to immunize children in urban slums against common childhood diseases.
   • Provide classes in nutrition for pregnant and nursing mothers in villages.
   • Start research on the control of the AIDS virus, which is a major threat in your country.
   • Build a new wing on an existing hospital to house modern medical instruments and equipment.
   • Train village women as midwives to assist women with childbirth and to advise them on pre- and post-natal care.
   • Provide free literacy classes for women in rural and urban areas.
   • To combat malaria, provide mosquito netting treated with insecticide for beds for all children
   • Install a sewage system in the largest city of the country
   • Develop a print and radio campaign on the danger of risky sexual behavior and the dangers of smoking.
2. Are there any listed activities that you would not use?
3. What are three additional activities that you would add to your list? Describe each one and how it would fit into your ranking.
4. Now, you should present your report to the rest of the class. After each report, class members should ask critical questions, and you should defend your choices.

2. Immunizations are widely used to prevent infectious diseases, an important way to improve life expectancy at birth. In this activity you will investigate your own immunization and what further actions you may need to take to protect yourself against infectious diseases.

1. Find out what immunizations you have received. Ask you parents, your local doctor or your local clinic for the names of the diseases for which you are immunized. Ask for the dates of your immunizations too.
2. Interview the staff of the local clinic to discover if immunizations are required by laws, if they are required for entrance into school, and if immunizations are good for the rest of your life or whether you must have them again. Be sure to ask if immunizations are required for traveling to other countries or to return from other countries.
3. Interview your parents and community leaders to learn what other actions they have taken to prevent or reduce the likelihood of your exposure to infectious diseases. Ask especially about access to safe water, sanitation, and education.
4. Using your own knowledge, discuss with members of your class what actions you must take personally to prevent or reduce the likelihood of exposure to infectious diseases.

3. Because life expectancy is an average, a major change in the living conditions in a country is needed to bring about a change-for better or worse-in overall life expectancy at birth. As shown in the text and charts, life expectancy around the world has generally been increasing over the past thirty years. Yet in some countries life expectancy has either stayed the same or decreased between 1980 and 1998. Complete the following exercises to explore this phenomenon.

1. Make a table with five columns.
2. Label the first column Countries, the second column Region, the third column Life Expectancy at Birth 1980, the fourth column, Life Expectancy at Birth 1998, and the fifth column Difference.
3. Go to the Social Data Tables, and for each region find any countries in which life expectancy has either stayed the same or decreased between the years 1980 and 1998. Write these countries' names and life expectancy data in the appropriate columns.
4. For each country, subtract the 1980 data from the 1998 data and write the result in the column labeled Difference (this number should be 0 or negative). Check your answer.
   After creating your table complete the following exercises:
   • Choose one country from your list and research living conditions in this country find out why life expectancy has stayed the same or decreased in the last twenty years. (If a whole class is doing this exercise, each student or pairs of students can choose a different country to research.)
   • Based on what you have learned about life expectancy at birth and the specific issues affecting your country, outline a strategy to help increase life expectancy. Include the following information:
     • Difference between 1980 and 1998 life expectancy data
     • Probable causes for this change (use supporting evidence)
     • Three actions that you would advise the government to take and reasons for these actions. Be specific and make sure you identify which portion(s) of the population you would target. For example, if the main cause for the decrease in life expectancy is poor childhood nutrition, you might want to start a feeding program for children under 5 and an educational program for mothers.
   • * If the problems you define are common to your country's region, determine whether it would help to work with your neighboring countries to establish some regional policies. If so, what would you advise and why?

4. Infectious diseases and chronic, non-communicable diseases are major cause s of child and adult mortality. These two types of diseases, however, affect different parts of the world in different ways, and have quite different causes and results. To investigate these two types of diseases, divide the class into two groups.

1. Individuals or pairs will each research and report to the class on one of the following infectious diseases (diseases that can be passed on from person to another):
   • AIDS
   • Cholera
   • Dengue
   • Dysentery
   • Ebola
   • Influenza
   • Malaria
   • Poliomyelitis
   • Tuberculosis
   • Typhoid Fever
   • Yellow Fever
   • Riverblindness
2. Individuals or pairs will research and report the following chronic/non-communicable diseases (diseases that cannot be passed to another person and usually progress slowly and last a long time):
   • Alzheimer's disease
   • Arthritis
   • Asthma
   • Cancer
   • Diabetes
   • Heart disease
   • Hypertension and stroke
   • Kidney and liver failure
3. Look for information about the disease. Interview your local doctor or nurse, or officials in your town clinic or hospital. Consult libraries or these Internet sites: This United Nations web site on which this activity is based: http://www.un.org/Pubs/CyberSchoolBus/special/health/disease/index.html and a web page from the Centers for Disease Control: http://www.cdc.gov/health/diseases.htm
   Look for the following information:
   • Causes of the disease and how it is spread
   • Effects of the disease
   • Conditions that encourage transmission and/or growth of the disease
   • Extent or incidence of the disease
   • Treatment/Success
   • Prevention/Success
4. Following the class reports, discuss the implications of the information you have heard. Consider some of the following questions:
   • In what parts of the world are infections diseases serious threats to public health? To what extent are all infectious diseases preventable? To what extent are they treatable?
   • Are children or adults most likely to be victims of infectious diseases?
   • Is it possible to eliminate infectious diseases through prevention and treatment?
   • How long have we known about AIDS and ebola? Are other new infectious diseases likely to emerge in the future?
   • To what extent is sustainable development a factor in successfully controlling infectious diseases? To what extent is controlling infectious diseases a factor in promoting sustainable development?
   • In what parts of the world are chronic/non-communicable disease serious threats to public health?
   • To what extent are chronic/non-communicable diseases treatable? To what extent are they preventable?
   • Are children or adults most likely to be victims of chronic/non-communicable diseases?
   • To what extent is it possible to eliminate chronic/non-communicable diseases through treatment or prevention?
5. To what extent do chronic/non-communicable diseases restrict economic development?

* For highly motivated students and those with greater knowledge of developing countries.