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?
2. What does it tell you about a country?
3. On the basis of your experience, what do people need to maintain health?
4. On the basis of your experience, what do people need when they are ill?
5. Based on the above answers, what can you infer about conditions in a country with a low rate of life expectancy at birth?

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?
2. Why do low-income countries have lower rates of infant and under-five mortality?
3. Why is infancy and childhood such an important period in determining a country's life expectancy at birth?

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.
2. A new health clinic opens and more children are inoculated against childhood diseases.
3. The government declares a new national holiday for all workers.
4. Village women attend classes to learn more about good nutrition and hygiene.
5. Traveling nurses monitor the growth of infants and provide extra food to those who are not thriving.
6. Men from a low-income neighborhood lose their jobs when the factory in which they work closes.

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.
2. Problem: An increase in measles and polio occurs among children.
3. Problem: Many women give birth to underweight babies.
4. Problem: A village suffers from an epidemic of Cholera, a disease transmitted by contaminated water.
5. Problem: Alcoholism increases following a severe economic depression.

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? Why?
2. In what country might life expectancy at birth actually decline? Why?
3. Which countries might experience an increase in its adult mortality rate in two or three decades?
4. What evidence in the table would suggest that education could bring improvement in these public health problems? What other factors might also be required for further improvement in these statistics?
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?
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?
7. How might some high-income countries contribute to the high levels of smoking 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?
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? Hypothesize about other reasons for the variation in the statistics.

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.

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? Where do these countries tend to be located?
2. What color represents countries with lowest life expectancies? Where do these countries tend to be located?
3. What assumptions might you make about living conditions in the region with the lowest life expectancies?

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.
2. Use this information to make a general statement describing the relationship between life expectancy at birth and income level.
3. What assumptions can you make about living conditions in the countries in each category of life expectancy at birth?
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?

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
Low-income countries
Middle-income countries
High-income countries
United States

1. What was the overall trend in life expectancy between 1965 and 1998?
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.)
3. What do the numbers suggest about living conditions in low-income countries and middle-income countries?
4. Looking at the chart, what are some assumptions you can make about living conditions in the United States in 1900?

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?
2. What do you think caused this change? Use the text and your own knowledge to support your answer.
3. Was this change typical of your country's income group?
4. What does this suggest to you about living conditions in your country relative to others in its income group?

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

1. What was the infant mortality rate for low-income countries in 1998?
2. What was the infant mortality rate for high-income countries in 1998?
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? Why do you think this is the case?

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?
2. Which country had the most infant deaths in 1998?
3. What country can you assume has high life expectancy at birth? Why?
4. What is the difference between "infant mortality rate per 1000 live births" and "number of infant deaths"?
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"?
6. Based on the table, what country faces the greatest challenge in increasing its life expectancy rate at birth?

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

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?
2. In which region do they have the greatest chance of dying before their fifth birthday?
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?
4. What do these comparisons suggest about the links between child mortality and these other indicators?
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?

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?
2. In which country(s) do adult (defined as age 15 to 60) females survive at a higher rate than adult males?
3. What does the text suggest may be a reason for why female children do not survive at a higher rate in some countries?

* 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.
2. In the second column, fill in the infant mortality rates for each of your chosen countries.
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. 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?

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.

2. Would this be a common scene in your country? Why or Why not?

3. In which country was this photograph taken?

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

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

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

7. What do you think life is like for the average person in this country? Support your answer.

8. What, if any, of the activity shown in the photograph might help improve living standards in industrial countries? In developing countries?

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?

10. In what ways might the activity in the photograph encourage sustainable development? In what ways might it discourage sustainable development? Explain your answers.

1. Look at the photograph. Describe what you see.

2. Would this be a common scene in your country? Why or Why not?

3. In which country was this photograph taken?

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

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

7. What do you think life is like for the average person in this country? Support your answer.

8. What, if any, of the activity shown in the photograph might help improve living standards in industrial countries? In developing countries?

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?

10. In what ways might the activity in the photograph encourage sustainable development? In what ways might it discourage sustainable development? Explain your answers.

1. Though the story is about a nutrition center, what other activities does the center sponsor or promote?

2. At least three women in the story were reluctant to go to the Nutrition Center. Explain why.

3. Abhirami says, "We have to gain their trust." Why would people be suspicious about receiving nutritious food for their children?

4. Why do you think the workers at the center weigh the children every day?

5. Why do you think that Abhirami believes that if the laddoos were prepared at home, "the children would not always get them"?

6. Why do you think the two women in the story were surprised that ordinary people went to the hospital?

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"?

8. In how many different ways did the center educate children and adults about nutrition? Why would the center choose to do all of these different time consuming activities instead of simply feeding the children?

9. Find India on the Social Data Table. What is the 1998 Infant Mortality Rate? What is the 1998 average Life Expectancy at Birth? 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? 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?

10. Do you think malnutrition is a problem for low– and middle-income countries only? Explain your answer.

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?

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.