1. DEMOGRAPHIC TRANSITION!!!!!
Why does Denmark, one of the world’s wealthiest countries, have a higher CDR than Mongolia, one of the poorest?
Why does the United States, with its extensive system of hospitals and physicians, have a higher CDR than Mexico and every country in Central America?
DEMOGRAPHIC TRANSITION!!!!!

2. Demographic Transition Model:

3. Stage One = “High stationary” What is happening with CBR and CDR?

4. Stage One
Birth Rate and Death rate are both high. Population growth is slow and fluctuating.
Birth Rate is high because of:
Lack of family planning
High Infant Mortality Rate:
Need for workers in agriculture
Religious beliefs
Children as economic assets
Death Rate is high because of:
High levels of disease
Famine
Lack of clean water and sanitation
Lack of health care
War
Competition for food from predators such as rats
Lack of education
Typical of Britain in the 18th century and the some Least Economically Developed Countries (LDC's) today.

5. Stage Two = “Early Expansion”

6. Stage Two
Birth Rate remains high. Death Rate is falling. Population begins to rise steadily.
Death Rate is falling as a result of:
Improved health care (e.g. Smallpox Vaccine)
Improved Hygiene (Water for drinking boiled)
Improved sanitation
Improved food production and storage
Improved transport for food
Increased female literacy
Decreased Infant Mortality Rates due to 2nd Agricultural Revolution (more food available)
Medical revolution in LDCS (1950)
Typical of Britain and the United States in 19th century (Industrial Revolution); Bangladesh and Nigeria

7. Stage Three = “Late Expanding”

8. Stage Three Reasons behind birth and death rate falling:
Birth Rate starts to fall. Death Rate continues to fall. Population rising.
Reasons behind birth and death rate falling:
Family planning available (contraceptives were not widely available in the 1st half of 20the century)
Lower Infant Mortality Rate
Increased mechanization reduces need for workers
Increased standard of living
Changing status of women – increase in literacy rate, more access to education, postponing marriage
Typical of Britain in late 19th and early 20th century;
China; Brazil (within the last 20 years)

9. Stage Four = Low Stationary

10. Typical of USA; Sweden; Britain; Denmark
Stage Four
Birth Rate is low, Death Rate is low, Population steady.
CBR = CDR
ZPG – zero population growth
Typical of USA; Sweden; Britain; Denmark
Reasons for low CBR and CDR
Careers for women postpones marriage/childbirth
Rise of daycare more expensive
Wide access to birth control methods
DINKs MUCH more common lifestyle choice (duel income no kids)
Travel not conducive to raising a family
More freedom for people to enjoy life

11. Stage Five = Decline

12. Typical of Eastern Europe
Stage Five
Typical of Eastern Europe
Low CBR
Increasing CDR due to aging population
Decrease in NIR
Bleak future due to pollution, political instability, low economic growth rates, etc.
Reasons for changes in birth rate:
Family planning
Better health
Later marriages
Improved status of women
Reasons for changes in death rate:
Good health care
Reliable food supply
People are generally living longer

13. What are the limitations?
What limitations do you think there could be with the DTM?
It does not include the influences of migration
It assumes that all countries will go through the same pattern
There is no time scale
Reasons for birth rates and death rates are very different in different countries

14. The Demographic Divide: Niger and Netherlands
Population (2013)
16.9 million
16.8 million
Projected Population (2050)
65.8 million
17.9 million
2050 Projected Population as a Multiple of 2013
3.9
1.1
Lifetime Births per Woman
7.6
1.7
Annual Births
845,000
176,000
Annual Deaths
195,000
141,000
% of Population Below Age 15
50%
17%
% of Population Ages 65+ (2013) 3%
16%
% of Population Ages 65+ (projected 2050)
27%
Life Expectancy at Birth (all)
57 years
81 years
Infant Mortality Rate (per 1,000 live births) 51
3.7
Annual Number of Infant Deaths
43,000
650

16. Cape Verde - Stage 2
How can you use these two images to analyze population issues in Cape Verde?

17. Chile - Stage 3
What do these two images tell us about population issues in Chile?

18. Denmark - Stage 4
How does Denmark compare to Cape Verde and Chile?

19. Among the most important influences on population dynamics are geographical differences in sanitation, prevalence of diseases, and availability of health care.

20. Measures of Mortality
Two useful measures of mortality in addition to the CDR are:
IMR - Infant Mortality Rate
Annual number of deaths of infants under 1 year of age, compared with total live births (expressed as number of deaths per 1,000 births)
Life Expectancy

21. Infant Mortality (IMR)
Baby’s death during 1st year following birth
# of cases per thousand
Reflects overall health of society

22. What does IMR reveal about a nation or region?

23. Causes of High IMR
Physical health of mom (inadequately nourished, exhausted from overwork, suffering from disease, poorly educated)
Many kids die from diarrhea (& malnutrition = leading killer of kids around world)
Poor sanitation – more than 20% of world population lacks access to clean drinking water or hygienic human waste disposal facilities

24. Variations in IMR
Varies within countries by region, ethnicity, social class, etc.

25. IMR United States 2004 Among African-Americans 13.6 Non-whites 5.7
Country average 6.8
CDC says 88.9% non-Hispanic whites and 76.5% African Americans received prenatal care in 1st trimester
Lower education levels for African American women
13.8% non-Hispanic whites smoke cigarettes during pregnancy in 2004
8.4% African Americans
Varies by region – highest IMR in South and lowest in Northeast

26. What factors impact life expectancy?

27. Life Expectancy # of years on average someone may expect to live
Does not take gender differences into account
Women outlive men by 4 years in Europe & East Asia
‘’ ‘’ by 3 years in Sub-Saharan Africa
“ “ by 6 years in North America
“ “ by 7 years in South America
“ “ by 14 years in Russia

28. Life Expectancy Huge regional contrasts World average in 2000
68 women -64 men
Japan’s should be 106 by 2300
Tropical Sub-Saharan Africa – lowest life expectancy (+ AIDS) – some below 40

29. Please answer the questions as you walk in.
What are the CBRs and CDRs like in Stage 1 of the DTM?
How does the CBRs and CDRs compare to countries in Stage 2 of the DTM to countries in Stage 4 of the DTM?
What are the reasons for the differences between these 2 stages?
How are the dependency ratio and possible Stage 5 of the DTM connected?
In the epidemiological transition, what is the principle cause of death in Stage 1?
In the epidemiological transition, what are the reasons for Stage 4 – delayed degenerative diseases?
How has increased connections led to the introduction of infectious diseases in Stage 5 of the epidemiological transition?

30. Why Do Some Regions Face Health Threats?
Epidemiologic Transition
Medical researches have identified an epidemiologic transition that focuses on distinct health threats in each stage of the demographic transition.
Stage 1: Pestilence and Famine (High CDR)
Principal cause of death: infectious and parasitic diseases
Ex. black plague (bubonic plague)
Epidemiology is the branch of medical science concerned with the incidents, distribution, and control of diseases that are prevalent among the population at a special time and are produced by some special causes not generally present in the affected locality.

31. Why Do Some Regions Face Health Threats?
Epidemiologic Transition
Stage 2: Receding Pandemic (Rapidly Declining CDR)
Pandemic is a disease that occurs over a wide geographic area and affects a very high proportion of the population.
Factors that reduced spread of disease, during the industrial revolution
Improved sanitation
Improved nutrition
Improved medicine
Famous cholera pandemic in London in mid nineteenth century.

32. FIGURE 2-32 SIR JOHN SNOW’S CHOLERA MAP In 1854, Dr
FIGURE 2-32 SIR JOHN SNOW’S CHOLERA MAP In 1854, Dr. John Snow mapped the distribution of cholera victims and water pumps to prove that the cause of the infection was contamination of the pump near the corner of Broad and Lexington streets.

33. Why Do Some Regions Face Health Threats?
Epidemiologic Transition
Stage 3: Degenerative Diseases (Moderately Declining CDR)
Characterized by…
Decrease in deaths from infectious diseases.
Increase in chronic disorders associated with aging.
Cardiovascular diseases
Cancer
Stage 4: Delayed Degenerative Diseases (Low but Increasing CDR)
Deaths caused by cardiovascular diseases and cancer delayed because of modern medicine treatments.

34. 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.

35. FIGURE 2-34 OBESITY Obesity is a health problem in the United States and in Southwest Asia.

36. Why Do Some Regions Face Health Threats?
Infectious Diseases
Reasons for Possible Stage 5
Evolution
Infectious disease microbes evolve and establish a resistance to drugs and insecticides.
Antibiotics and genetic engineering contributes to the emergence of new strains of viruses and bacteria.
Poverty
Infectious diseases are more prevalent in poor areas because of presence of unsanitary conditions and inability to afford drugs needed for treatment.
Increased Connections
Advancements in modes of transportation, especially air travel, makes it easier for an individual infected in one country to be in another country before exhibiting symptoms.
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.

37. Types of Diseases Infectious diseases Chronic or degenerative diseases
Genetic or inherited diseases
65% of diseases
Result from invasion of parasites & their multiplication in body
Ex. Malaria
Maladies of longevity & old age
Ex. Heart disease
Trace to our ancestry
Ex. Sickle-cell anemia, hemophilia, lactose intolerance
Can indicate need for specialized, local treatment

38. Infectious Diseases
Malaria – kills 1 million yearly; infects 300 million today
HIV/AIDS – has killed about 25 million in 30 years
2 types of infectious diseases
1. vectored disease
2. nonvectored disease

39. Vectored Disease Transmitted by intermediary vector like mosquito
Stings already infected person or animal (host), sucks up some blood with parasite, reproduces and multiplies in mosquito’s body, reaches its saliva, and then is injected into next person’s bloodstream

40. Vectored Disease Mosquitoes can spread yellow or dengue fever
Other vectors include fleas, flies, worms, snails, etc.
Transmit sleeping sickness, river blindness, guinea worm, elephantiasis, etc.
Tropical areas are worse

41. Malaria No disease has taken more lives than malaria
3000 people will die, most in Africa and children
3-5 million lives shortened and weakened by malaria

42. NonVectored Disease Ex. Influenza
Transmitted by direct contact between host and victim
Ex. AIDS – sex and needle-sharing

43. Chronic & Genetic Diseases
Heart disease, cancer stroke, pneumonia, diabetes, liver disease
Early 1900s – tuberculosis (TB) and pneumonia caused 20% of deaths; today fewer than 5%
Battles against cancer & heart disease – far from won
What has caused changes in what is killing us?

44. AIDS Identified in Africa in 1980s
Est ,000 people infected – all Africans
2007 – over 33.2 million (68% of cases in Sub-Saharan Africa)
New surge in Eastern Europe and central Asia

46. What effect of AIDS does this reveal?

47. What are the other implications for children in AIDS-ravaged areas?

48. HIV/AIDS Weakens body and reduces ability to combat infection
Spread through bodily contact – involves exchange of bodily fluids like blood/semen
Official statistics lag far behind real numbers

49. HIV/AIDS Africa 22+ million Southeast Asia 6 million China 650,000 +
India 5 million
USA 1 million
Middle/South America 2 million

50. HIV/AIDS
East and Southern Africa is the region that is hardest hit by HIV. It is home to 6.2% of the world’s population but has 19.4 million people living with HIV, over 50% of the total number of people living with HIV in the world. In 2016, there were 790,000 new HIV infections, 43% of the global total

51. HIV/AIDS Peter Gould’s The Slow Plague (1993)
Called Africa “a continent in catastrophe”
AIDS reshaping population pyramids for countries hardest hit
Look like chimneys – higher death rates among young women than men – who then take younger brides
Increase in number of orphans
Increase in # of girls taken out of school to be caregivers to relatives with AIDS

52. Figure 1: Stages of Health, Nutritional, and Demographic Change
Demographic Transition
Epidemiologic Transition
Nutrition Transition
High
fertility/mortality
High prevalence
infectious disease
High prevalence
undernutrition
Reduced mortality,
changing age structure
Receding pestilence, poor
environmental conditions
Receding famine
Focus on family planning,
infectious disease control
Focus on famine
alleviation/prevention
Reduced fertility,
aging
Chronic diseases
predominate
Diet-related
noncommmucable
diseases predominate
Focus on healthy aging
spatial redistribution
Focus on medical intervention, policy
initiatives, behavioral change
Source: Popkin, Barry M. ( 2002) Public Health Nutrition 5: