Unit 2 The Epidemiological Transition Explained How it works with The DTM

Background: Medical Services Health services vary widely around the world, primarily, because countries possess different resources to care for people who are sick.

Hospital in Sierra Leone, West Africa

Recovery room in Hartford Hospital

HEALTH CARE Gov’t Expenditures on Healthcare: Health services also vary because governments spend different amounts on healthcare. Gov’t Expenditures on Healthcare: More than 15 percent of total government expenditures in Europe and North America. Less than 5 percent in sub-Saharan Africa and South Asia.

FIGURE 2-43 GOVERNMENT EXPENDITURES ON HEALTH CARE The lowest levels of government expenditures are in Africa and Asia.

HEALTH CARE in MOST DEVELOPED COUNTRIES Public service available at little or no cost. Government pays more than 70 percent of individuals’ health-care costs in most European countries.

HEALTH CARE in DEVELOPING COUNTRIES Private individuals must pay more than half of the cost of health care, in many places more than 70%. All on wages significantly lower than developed world!

FIGURE 2-46 PUBLIC EXPENDITURES ON HEALTH CARE AS A SHARE OF TOTAL HEALTH CARE EXPENDITURES The highest percentages are in Europe.

HEALTH CARE in the UNITED STATES Private individuals are required to pay about 55 percent of health care costs- more closely resembling a developing country. $$$$$$$$$$$$$$$$$$$$$

In Key Issue 2, we examined the DEMOGRAPHIC TRANSITION model, which describes the variance in natural growth rates between countries.

Today, we will look at another model that works in PARALLEL with the DTM.

This second model focus on DEATH RATES, and what drives them as a country matures.

EPIDEMIOLOGICAL TRANSITION MODEL Identifies distinct health threats in each stage of the Demographic Transition model.

Stage 1 – Pestilence and Famine (High CDR, High CBR) During stage 1 most deaths occur due to PANDEMICS (infectious/parasitic diseases) or from ENVIRONMENTAL FACTORS (floods, earthquakes, drought…)

A PANDEMIC is a disease or other ailment which spreads across a wide area of the Earth’s surface, deeply impacting multiple countries or even continents.

A EPIDEMIC is an ailment which deeply impacts a community or region (smaller scale than pandemic)

1347-50 The BLACK PLAGUE was the deadliest of the Stage 1 pandemics; more than HALF of Europe died- IN THREE YEARS.

It was spread from Central Asia to Europe on fleas carried by rats on ships, so port cities were the first to fall victim.

They also carried a stick to keep any infected person at distance. Men known as PLAGUE DOCTORS traveled to help the sick. Because plague was believed to be spread by ‘foul-smelling air,’ they wore a mask filled with scented herbs. They also carried a stick to keep any infected person at distance.

Stage 2 – Receding Pandemics (High CBR, falling CDR) Improved sanitation, nutrition, and medicine lead to a reduction in epidemics; overall death rates plummet.

EPIDEMIOLOGY makes its rise in Stage 2; doctors work to understand the actual causes and cures for diseases.

DEVELOPMENT has much to do with movement into Stage 2. As countries mature, they build life-saving INFRASTRUCTURE, like hospitals and sewers.

John Snow’s famous 1854 Cholera Study is an example of Stage 2 epidemiology.

Stage 3 – Degenerative Diseases (Dropping CBR, Low CDR) During Stage 3, people are living longer than ever before, and chronic diseases associated with age become society’s greatest health challenge.

Chief among these are CANCER and CARDIOVASCULAR DISEASE. With people living longer lives, new health conditions become prevalent in Stage 3. Chief among these are CANCER and CARDIOVASCULAR DISEASE.

Infant mortality drops dramatically in Stage 2, so by Stage 3 women are starting to have less babies (more will survive until adulthood).

Stage 4 – Delayed Degenerative Diseases (Low CBR, Low CDR) Deaths caused by cardiovascular diseases, cancer, and other progressive diseases delayed by modern medical technology and treatments.

People are surviving longer even with deadly conditions, leading to a GREYING population.

Today, Italy’s population is rapidly aging Today, Italy’s population is rapidly aging. What will happen when its ‘bulge’ – currently 40-50 – ages into their 70, 80s, and 90s?

GLOBAL ISSUE: GREYING POPULATIONS https://www.youtube.com/watch?v=0ukNFMeZvcc

Because of the epidemiologic transition, health patterns are very different in the developed and developing world.

Stage 1-2 problems- MALARIA RATES

STARVATION & MALNUTRITION Stage 1-2 Problems- STARVATION & MALNUTRITION

Stage 3-4 problems-CANCER RATES FIGURE2-33 MALE CANCER Cancer is an example of a cause of death for men that is higher in developed countries than in developing ones.

Stage 3-4 problems- OBESITY RATES FIGURE 2-34 OBESITY Obesity is a health problem in the United States and in Southwest Asia.

STAGE 5 – Low CBR, rising CDR During stage 5 of the Demographic Transition, death rates begin to rise, sometimes even above the CBR (leading to negative NIR). The Epidemiologic Transition model offers three possible explanations for this. Some medical analysts argue that the world is moving into stage five of the epidemiologic transition, brought about by a reemergence of infectious and parasitic diseases.

1.) DISEASE EVOLUTION Infectious disease microbes evolve and establish RESISTANCE to drugs and other treatments. Antibiotics and genetic engineering contributes to the emergence of stronger strains of viruses and bacteria.

Spread of drug-resistant H1N1 Flu (2009)

2.) POVERTY Though development in Stage 5 countries is high, it is still uneven. Even the most modern societies still harbor pockets of poverty. Infectious diseases are more prevalent in poor areas due to presence of unsanitary conditions, and inability to afford drugs needed for treatment.

3.) INCREASED CONNECTIONS Advancements in modes of transportation, especially air travel, makes it easier for an individual infected in one place to rapidly transmit disease elsewhere.

Imagine the impact of ONE INFECTED PERSON in Atlanta…

AIDS is most prevalent in cities with massive international airports (numbers are millions of int’l arrivals) FIGURE 2-38 INTERNATIONAL PASSENGER ARRIVALS AT U.S. AIRPORTS 2011 Because AIDS arrived in the United States primarily through air travelers, the pattern of diffusion of AIDS in Figure 2-37 closely matches the distribution of international air passenger arrivals.

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