AQA A-level Geography · 3.2.4

Environment, health and well-being

Exam-style questions with answers for 3.2.4 Environment, health and well-being in AQA A-level Geography (spec 7037). Practise with flashcards, a topic quiz, a random quiz across the course, 5 crosswords, or read every question and answer below.

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Question 1 · Spec 3.2.4.3 · Patterns of health
Define mortality, morbidity, life expectancy and infant mortality rate. [4 marks]
Answer:
Mortality is the death rate in a population (1); morbidity is the rate of illness or disease (1); life expectancy is the average number of years a person is expected to live at birth (1); infant mortality rate is the number of deaths of children under one year per 1,000 live births (1).
Question 2 · Spec 3.2.4.3 · Patterns of health
Describe the global pattern of life expectancy. [3 marks]
Answer:
Life expectancy is highest, over 80 years, in Japan, Western Europe, Australia and Canada (1); it is lowest, in the low 50s to 60s, in many countries in sub-Saharan Africa such as Chad and Nigeria (1); it has increased in almost all countries since 1950, although the gap between rich and poor countries remains large (1).
Question 3 · Spec 3.2.4.3 · Patterns of health
Describe the global pattern of infant and child mortality. [3 marks]
Answer:
Rates are lowest in high-income countries, with infant mortality of fewer than 5 per 1,000 (1); they are highest in sub-Saharan Africa and parts of South Asia, with rates of over 50 per 1,000 in some countries (1); rates have fallen sharply since 1990, but the greatest numbers of child deaths are still in Africa (1).
Question 4 · Spec 3.2.4.3 · Patterns of health
In a region there were 3,000 live births and 12 infant deaths in a year. Calculate the infant mortality rate per 1,000. [2 marks]
Answer:
12 ÷ 3,000 × 1,000 (1); 4 per 1,000 (1).
Question 5 · Spec 3.2.4.3 · Patterns of health
Explain what is meant by a disability-adjusted life year (DALY). [2 marks]
Answer:
One DALY is one year of healthy life lost, through early death or living with illness or disability (1); it is used to measure the burden of disease and compare health problems between countries (1).
Question 6 · Spec 3.2.4.3 · Patterns of health
Describe the pattern of causes of death in high-income and low-income countries. [3 marks]
Answer:
In high-income countries most deaths are from non-communicable diseases such as heart disease, cancer and dementia (1); in low-income countries infectious diseases, such as malaria, HIV, tuberculosis and diarrhoea, and complications of birth are much more important (1); non-communicable diseases are rising rapidly in low- and middle-income countries (1).
Question 7 · Spec 3.2.4.3 · Patterns of health
Explain why health outcomes differ between countries. [4 marks]
Answer:
Income affects access to food, clean water, sanitation and healthcare (1); education, especially of women, influences health behaviour and child survival (1); government spending and the availability of doctors, vaccines and hospitals vary (1); the physical environment, conflict and pollution also influence disease (1).
Question 8 · Spec 3.2.4.3 · Patterns of health
Explain how economic and social development is linked to improvements in health. [3 marks]
Answer:
Rising incomes allow better diet, housing, water supply and sanitation (1); governments can invest in health services, vaccination and education (1); development also brings risks, such as pollution, road accidents and lifestyle diseases (1).
Question 9 · Spec 3.2.4.3 · Patterns of health
Explain the causes of high maternal mortality in some countries. [3 marks]
Answer:
Women often have little access to trained midwives, antenatal care or emergency treatment (1); long distances to hospitals and poor roads delay care (1); early pregnancy, anaemia, poverty and low status of women add to the risk (1).
Question 10 · Spec 3.2.4.3 · Epidemiological transition
Describe the stages of the epidemiological transition. [4 marks]
Answer:
Stage 1: the age of pestilence and famine, with high death rates from infectious disease (1); stage 2: receding pandemics, with falling death rates as sanitation and medicine improve (1); stage 3: degenerative and man-made diseases such as heart disease and cancer become the main causes (1); later stages include delayed degenerative disease with greater life expectancy, and the return of infectious diseases and lifestyle conditions (1).
Question 11 · Spec 3.2.4.3 · Epidemiological transition
Explain how the epidemiological transition is linked to the demographic transition. [3 marks]
Answer:
Death rates fall as infectious disease declines, which is the start of the demographic transition (1); as life expectancy rises, populations age and chronic diseases become dominant (1); countries move through both transitions as they develop economically, with differences in speed (1).
Question 12 · Spec 3.2.4.3 · Epidemiological transition
Explain what is meant by the double burden of disease. [3 marks]
Answer:
Low- and middle-income countries have to deal with infectious diseases and also with rising non-communicable diseases (1); urbanisation, changing diets and inactivity increase obesity, diabetes and heart disease while malaria, HIV and TB persist (1); health systems with limited resources struggle to meet both challenges (1).
Question 13 · Spec 3.2.4.3 · Epidemiological transition
Explain the causes of the shift from communicable to non-communicable diseases. [3 marks]
Answer:
Clean water, sanitation, vaccines and antibiotics reduce infectious disease (1); people live longer, so more develop diseases of old age such as cancer and dementia (1); changing lifestyles, with more processed food, smoking, alcohol and inactivity, increase heart disease and diabetes (1).
Question 14 · Spec 3.2.4.3 · Epidemiological transition
Explain why some infectious diseases are re-emerging. [3 marks]
Answer:
Antibiotic and drug resistance make diseases such as tuberculosis harder to treat (1); global travel and urbanisation spread new diseases rapidly, as COVID-19 showed (1); climate change and disruption of ecosystems can bring people into contact with new pathogens and vectors (1).
Question 15 · Spec 3.2.4.3 · Epidemiological transition
Explain why the UK and Japan are at a later stage of the epidemiological transition. [3 marks]
Answer:
Deaths from infectious disease are low because of vaccines, clean water and healthcare (1); most deaths are from heart disease, cancer and dementia in older people (1); obesity and mental health problems are growing concerns, while Japan has one of the oldest populations (1).
Question 16 · Spec 3.2.4.3 · Environment and disease
Explain how climate affects the incidence of disease. [3 marks]
Answer:
Warm, wet conditions allow insects that carry diseases to breed and survive (1); temperature affects how fast parasites and viruses develop inside vectors (1); rainfall and floods spread waterborne diseases such as cholera, while cold weather increases flu and heart attacks (1).
Question 17 · Spec 3.2.4.3 · Environment and disease
Explain how topography and drainage affect the incidence of disease. [3 marks]
Answer:
Flat, poorly drained land and floodplains form standing water, which is a breeding site for mosquitoes (1); steep, well-drained land has fewer breeding sites, so less malaria (1); valley bottoms may trap polluted air, and altitude limits the range of some vectors (1).
Question 18 · Spec 3.2.4.3 · Environment and disease
Explain how seasonal changes affect the incidence of disease. [3 marks]
Answer:
Malaria and dengue peak in or after the rainy season, when mosquito numbers rise (1); influenza and respiratory infections peak in the cold season, when people are indoors together (1); cholera often follows floods and droughts, when water supplies are contaminated (1).
Question 19 · Spec 3.2.4.3 · Environment and disease
Explain how outdoor air quality affects health. [4 marks]
Answer:
Fine particles (PM2.5) penetrate the lungs and bloodstream, causing asthma, heart disease, stroke and lung cancer (1); nitrogen dioxide and ozone cause breathing problems (1); the WHO estimates that outdoor air pollution causes over four million premature deaths a year (1); children, older people and those with existing conditions are most at risk (1).
Question 20 · Spec 3.2.4.3 · Environment and disease
Explain the health effects of household air pollution. [3 marks]
Answer:
Over two billion people cook using wood, charcoal, dung or coal on open fires (1); smoke causes respiratory infections in children and lung disease in adults, and over three million deaths a year (1); women and children, who spend most time near the fire, are most affected (1).
Question 21 · Spec 3.2.4.3 · Environment and disease
Explain how water quality and sanitation affect health. [4 marks]
Answer:
Around two billion people lack safely managed drinking water, and more lack safe sanitation (1); contaminated water spreads diarrhoea, cholera, typhoid and parasites (1); children are most at risk and illness reduces school attendance and work (1); chemical contamination, such as arsenic in Bangladesh, causes long-term illness (1).
Question 22 · Spec 3.2.4.3 · Environment and disease
Explain the causes and effects of the cholera outbreak in Haiti in 2010. [3 marks]
Answer:
The outbreak began after the earthquake, which destroyed sanitation and left people in camps (1); it spread through contaminated rivers and water, and the disease was introduced from outside (1); hundreds of thousands became ill and thousands died, showing the link between water, sanitation and health (1).
Question 23 · Spec 3.2.4.3 · Environment and disease
Explain how the Flint water crisis showed that water quality can be a problem in a high-income country. [3 marks]
Answer:
In 2014 Flint, Michigan, switched its water source to save money and failed to treat the water, so lead pipes corroded (1); lead entered the drinking water and children were exposed to high levels (1); poor communities were most affected and trust in authorities was damaged (1).
Question 24 · Spec 3.2.4.3 · Malaria
Describe the cause of malaria and how it is transmitted. [3 marks]
Answer:
Malaria is caused by Plasmodium parasites (1); it is transmitted by the bites of infected female Anopheles mosquitoes, which feed at night (1); the parasites multiply in the liver and red blood cells, causing fever, chills and in severe cases death (1).
Question 25 · Spec 3.2.4.3 · Malaria
Describe the global prevalence and distribution of malaria. [3 marks]
Answer:
There are about 250 million cases and 600,000 deaths a year (1); about 95% of cases and deaths are in sub-Saharan Africa, with the remainder in South Asia, South East Asia and Latin America (1); children under five account for about three quarters of deaths in Africa (1).
Question 26 · Spec 3.2.4.3 · Malaria
Explain the environmental conditions that favour malaria transmission. [4 marks]
Answer:
Temperatures of 20–30°C allow rapid development of the parasite inside the mosquito (1); below about 16°C the parasite cannot complete its development, so highlands and cooler regions have less malaria (1); rainfall and humidity create standing water for breeding and help mosquitoes to survive (1); flat, poorly drained land, irrigation channels and swamps provide breeding sites (1).
Question 27 · Spec 3.2.4.3 · Malaria
Explain the seasonal incidence of malaria. [3 marks]
Answer:
In the tropics cases rise during and after the rainy season, when pools form (1); in the Sahel, transmission is concentrated in a short period from July to October (1); seasonal malaria chemoprevention gives children drugs during this period (1).
Question 28 · Spec 3.2.4.3 · Malaria
Explain how socio-economic factors affect malaria. [4 marks]
Answer:
Poverty means people cannot afford bed nets, drugs or screened homes (1); poor housing with open eaves and no screens lets mosquitoes in (1); weak health systems, conflict and long distances to clinics delay treatment (1); drug resistance and a lack of education and awareness also increase risk (1).
Question 29 · Spec 3.2.4.3 · Malaria
Explain the impacts of malaria on health and well-being. [4 marks]
Answer:
Illness causes fever, anaemia and death, especially among children and pregnant women (1); families spend money on treatment and lose income from days off work or school (1); the disease slows economic growth, and Africa loses billions of dollars a year (1); this contributes to a cycle of poverty (1).
Question 30 · Spec 3.2.4.3 · Malaria
Describe the strategies used to prevent malaria. [4 marks]
Answer:
Insecticide-treated bed nets protect people while they sleep (1); indoor residual spraying kills mosquitoes on walls (1); draining or treating standing water reduces breeding sites (1); preventive medicine for pregnant women and children, and rapid testing, help to reduce spread (1).
Question 31 · Spec 3.2.4.3 · Malaria
Describe the treatment of malaria. [3 marks]
Answer:
Artemisinin-based combination therapies are the main treatment (1); rapid diagnostic tests allow quick diagnosis in remote areas (1); drug resistance is a growing problem, so treatments need to be changed and combined (1).
Question 32 · Spec 3.2.4.3 · Malaria
Describe the development of malaria vaccines. [3 marks]
Answer:
The RTS,S vaccine was recommended by the WHO in 2021 for children in areas of high transmission (1); the R21 vaccine was recommended in 2023, and is cheaper and can be made in larger amounts (1); rollout in African countries began in 2024, but supply, cost and the need for several doses are challenges (1).
Question 33 · Spec 3.2.4.3 · Malaria
Describe the role of Roll Back Malaria and the Global Fund in tackling malaria. [3 marks]
Answer:
Roll Back Malaria, launched in 1998, coordinates the global fight against the disease (1); the Global Fund, set up in 2002, funds bed nets, drugs and tests in poor countries (1); deaths have fallen from around 900,000 in 2000 to around 600,000 in recent years (1).
Question 34 · Spec 3.2.4.3 · Malaria
Explain how climate change may affect malaria. [3 marks]
Answer:
Warmer temperatures may allow mosquitoes and the parasite to survive in highland areas and at higher latitudes (1); changing rainfall may increase breeding sites in some places, while droughts reduce them in others (1); the effects depend on the quality of health systems and control measures (1).
Question 35 · Spec 3.2.4.3 · Malaria
Evaluate the effectiveness of malaria control strategies. [4 marks]
Answer:
Bed nets and spraying have saved millions of lives and reduced cases (1); some countries, such as Sri Lanka and China, have eliminated malaria (1); however, drug and insecticide resistance, funding gaps and conflict threaten progress (1); vaccines will help, but the best results come from a combination of methods with strong health systems (1).
Question 36 · Spec 3.2.4.3 · Coronary heart disease
Describe the global distribution and prevalence of coronary heart disease. [3 marks]
Answer:
Cardiovascular disease is the world's leading cause of death, with heart disease responsible for about nine million deaths a year (1); death rates are highest in Eastern Europe and Central Asia and are rising in South Asia and low-income countries (1); rates have fallen in many high-income countries such as the UK, USA and Australia since the 1970s (1).
Question 37 · Spec 3.2.4.3 · Coronary heart disease
Explain the risk factors for coronary heart disease. [4 marks]
Answer:
Smoking damages blood vessels and raises blood pressure (1); diets high in saturated fat, salt and sugar raise cholesterol and blood pressure (1); lack of exercise, obesity and diabetes increase risk (1); age, genetics, stress and heavy drinking also contribute (1).
Question 38 · Spec 3.2.4.3 · Coronary heart disease
Explain how the physical and socio-economic environment influences coronary heart disease. [3 marks]
Answer:
Lower-income groups in high-income countries have higher rates because of smoking, poorer diet and less access to healthcare and exercise facilities (1); cold weather and air pollution increase the risk of heart attacks (1); urban environments with fast food outlets and limited green space may encourage unhealthy lifestyles (1).
Question 39 · Spec 3.2.4.3 · Coronary heart disease
Explain the impacts of coronary heart disease on health and well-being. [3 marks]
Answer:
It leads to premature death, disability and reduced quality of life (1); families lose income, and carers' time is needed (1); it places a large cost on health services and reduces productivity (1).
Question 40 · Spec 3.2.4.3 · Coronary heart disease
Explain why heart disease is increasing in low- and middle-income countries. [3 marks]
Answer:
Urbanisation and rising incomes lead to more processed food, tobacco use and inactivity (1); populations are ageing as life expectancy rises (1); healthcare systems are less able to prevent and treat the disease, so death rates are higher (1).
Question 41 · Spec 3.2.4.3 · Coronary heart disease
Describe public health measures to reduce heart disease. [4 marks]
Answer:
The smoking ban in public places in England in 2007 reduced exposure to tobacco smoke (1); the Soft Drinks Industry Levy of 2018 encouraged reductions in sugar (1); targets for reducing salt and trans fats in food, and health education campaigns, change diets (1); NHS health checks and medicines, such as statins, identify and treat people at risk (1).
Question 42 · Spec 3.2.4.3 · Coronary heart disease
Describe the North Karelia Project in Finland. [3 marks]
Answer:
Begun in 1972, it was a community programme in a region with the world's highest rates of heart disease (1); it encouraged lower-fat diets, vegetable growing, reduced smoking and blood pressure checks (1); heart disease deaths among working-age men fell by more than 80%, and the approach was extended across Finland (1).
Question 43 · Spec 3.2.4.3 · Coronary heart disease
Describe how coronary heart disease is treated. [2 marks]
Answer:
Drugs such as statins and blood pressure medicines lower the risk, and aspirin reduces clots (1); surgery such as bypass operations and stents opens or replaces blocked arteries (1).
Question 44 · Spec 3.2.4.3 · Coronary heart disease
Compare the patterns and management of malaria and coronary heart disease. [4 marks]
Answer:
Malaria is concentrated in the tropics, especially Africa, while heart disease is global with high rates in Eastern Europe and rising in developing countries (1); malaria is biologically transmitted and linked to climate and vectors, whereas heart disease is linked to lifestyle (1); malaria is managed through nets, drugs and vaccines, and heart disease through prevention policies, diet and treatment (1); both are more severe where poverty limits access to healthcare (1).
Question 45 · Spec 3.2.4.3 · Agencies and NGOs
Describe the role of the World Health Organization in global health. [3 marks]
Answer:
Set up in 1948, it sets health standards and gives guidance to governments (1); it coordinates responses to disease outbreaks and led the campaign to eradicate smallpox by 1980 (1); it promotes primary healthcare and universal health coverage, and the Framework Convention on Tobacco Control (2003) (1).
Question 46 · Spec 3.2.4.3 · Agencies and NGOs
Describe the roles of UNICEF and Gavi in improving health. [3 marks]
Answer:
UNICEF provides vaccines, nutrition and clean water for children (1); Gavi, the Vaccine Alliance, set up in 2000, funds vaccines for the poorest countries and has helped to immunise hundreds of millions of children (1); both depend on donations and partnerships with governments (1).
Question 47 · Spec 3.2.4.3 · Agencies and NGOs
Explain the role of NGOs in improving health, using examples. [3 marks]
Answer:
Médecins Sans Frontières provides emergency medical care in conflict and disaster zones (1); WaterAid helps communities to install safe water, toilets and hygiene education (1); NGOs can reach remote areas and work with local people, but their projects can be short-term and uncoordinated (1).
Question 48 · Spec 3.2.4.3 · Agencies and NGOs
Evaluate the role of international agencies and NGOs in combating disease. [4 marks]
Answer:
Agencies can coordinate action, set standards and fund vaccines on a global scale (1); NGOs work directly with communities and respond quickly (1); both depend on donor funding and politics, and cannot solve problems of poverty and weak health systems on their own (1); the greatest successes, such as smallpox eradication, came from cooperation between governments, agencies and local people (1).
Question 49 · Spec 3.2.4.3 · Evaluation
Assess the extent to which the physical environment determines health and well-being. [6 marks]
Answer:
Climate and topography control where diseases such as malaria occur (1); water quality, air pollution and natural hazards affect health directly (1); however, poverty, education and healthcare often decide who becomes ill and who survives (1); disease has been reduced in unfavourable environments by technology such as bed nets and vaccines (1); lifestyle diseases such as heart disease are linked more to human behaviour (1); environment and socio-economic factors interact, so health depends on both, and the balance changes over time (1).
Question 50 · Spec 3.2.4.3 · Patterns of health
Explain why life expectancy differs between men and women and between rich and poor areas within the same country. [3 marks]
Answer:
Women generally live longer than men because of biological factors and because men have higher rates of smoking, drinking, risk-taking and dangerous jobs (1); people in wealthy areas have better diet, housing, education and access to healthcare (1); in the UK there is a gap of around ten years or more in life expectancy between the richest and poorest areas, with deprived areas having higher rates of smoking, obesity and heart disease (1).

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