L6 Demographic Epidemiological Transitions PDF

**[L6: Demographic, epidemiological and other related transitions *(part 2)*]** - Mortality is the principle driving force of demographic transitions - Deaths rates initially most marked in infants - Reduction in adult mortality later on - Context, environment and humans vary between cou...

**[L6: Demographic, epidemiological and other related transitions *(part 2)*]** - Mortality is the principle driving force of demographic transitions - Deaths rates initially most marked in infants - Reduction in adult mortality later on - Context, environment and humans vary between countries - Improvements in survival are highly influential - Nutritional status, living standards, clean water, sanitation, knowledge of disease transmission, access to medicine - Demographic transition *(SEE RED GRAPH)* - Theory of Epidemiological Transition - Abdel Omran (1971) - Describes the decline in mortality and changes in the burden of disease (shift from young to old) - Based on European countries - Stage 1: Age of pestilence and famine - Pre-modern era - Young populations - Life expectancy at birth e\^0 \~ 20-40 years (mortality crises) - Stage 2: Age of receding pandemics - 19^th^ Century - Mortality declines e\^0 \~ 50 years - Biological and behavioural adaptions - Stage 3: Age of degenerative diseases - From 1930s - Ageing populations e\^0 \~ 70 years - Survival to ages where degenerative diseases are important - Olshansky & Ault (1986) - Expanded the theory to reflect recent mortality experiences, mainly in high income countries - They suggested a 4^th^ stage - Stage 4: Age of delayed degenerative diseases - 1970s-1980s - Middle and old-age mortality improvements - e\^0 \~ 80 years - Proposed 5^th^ stage (*see L2)* - Health transition and epidemiological transition sometimes used in combination - Pat and Jack Caldwell (1991): health transitions defined as cultural, social, and behavioural determinants of health - Reduction in mortality due to effective medical care and clinical interventions - Some high mortality levels remain due to availability and access of healthcare - Health transitions in aging populations with increasing burden of chronic diseases - Nutrition transition focuses on aspects of food production and diet and the relationship between health and disease - In Stage 4, lower mortality but increased nutrition-related, non-communicable diseases - Barry M. Popkin's Five Propositions Underpinning Nutritional Transition (1993): - Major shift in pop. growth and age structure associated with nutritional trends and dietary changes - Roles of food industry and the state determining structure of diet - Changes in socioeconomic structure (e.g. role of women) leads to changes in dietary patterns - Dietary changes associated with change in public knowledge concerning diet, health and disease prevention - Interaction between epidemiological, socioeconomic and demographic changes determines nature and pace of nutrition transition - Changes in burden of disease: shifts in the types and causes of disease that affect population - Rise in infectious (aids, malaria) and non-communicable diseases as well as deaths in newborns and infants - Double burden of disease: coexistence of non-communicable diseases with dietary related diseases (e.g. underweight/obesity) - Diversity of disease burden often associated with rapid development - Different types of disease burdens need different prevention interventions, treatment strategies and healthcare infrastructure Major challenge for LMIC health services which are already overstretched