1. Epidemiologic Transition: Changes of fertility and mortality with modernization Abdel Omran Abdel Omran The Epidemiologic Transition: A Theory of the epidemiology of population change. Milbank Quarterly. 1971;49:509-538 The Epidemiologic Transition: A Theory of the epidemiology of population change. Milbank Quarterly. 1971;49:509-538

2. Charles Darwin Evolution of Species Abdel Omran Evolution of Disease

3. The New NCD Epidemiology and Prevention  Systems approach  Disease Monitoring  Telecommunications Backbone  Deming approaches to Prevention

5. Epidemiology  Psychiatric Epidemiologists  Diabetes Epidemiology  Cardiovascular Epidemiology  Cancer Epidemiology  Infectious Disease Epidemiology

6. Instead at looking at individual diseases, we need to look at the patterns of diseases

7. Mortality is the fundamental factor in the dynamics of population growth and causes of death. Mortality has no fixed upper limits. Thus if fertility approached its upper maximum, depopulation would still occur.

8. During the epidemiologic transition, a long-term shift occurs in mortality and disease patterns whereby pandemics of infection are replaced by degenerative and man-made diseases...

9. Age of Pestilence and Famine Characterized by high mortality rates, wide swings in the mortality rate, little population growth and very low life expectancy

10. Age of Receding Pandemics Epidemics become less frequent, infectious diseases in general become less frequent, a slow rise in degenerative diseases begin to appear

11. The shifts in disease patterns in the 19th century were primarily related to changing SES. With the 20th Century more related with disease control activities independent of SES: e.g. Mexico, China

12. Stages of the Epidemiologic Transition  Pestilence and Famine  Receding Pandemics  Degenerative and man-made diseases

19. Epidemiologic Transition in Developing and Developed Countries

21. 35 years 14 years

26. 40444852566064687276 Population Life Expectancy 0 20 40 60 80 100 Infection CA CHD Other Violence Increasing Life Expectancy and Causes of Death

34. Epidemiologic Transition Mortality Rates Infectious Diseases NCD

35. Death Rates for TB in England and Wales

36. TB Bacillus Identified Chemotherapy BCG Vaccination

37. Death Rates for Measles in Children in England and Wales

38. Immunization begun

39. Epidemiologic Transition Mortality Rates CA CHD NIDDM Trauma

46. CHD Death Rates Males, aged 45-54

47. Incidence of Stomach CA Males

48. Breast Cancer Incidence Females

49. Cirrhosis Death Rates, Males, aged 45-54

50. Death Rates for Stroke Males, aged 45-54

51. High Incidence of NCDs in Developed Countries ] Cardiovascular CHD CHD Deep Vein Thrombosis Deep Vein Thrombosis ] Respiratory Emphysems Emphysems Lung CA Lung CA ] Female Genital Endometriosis Endometriosis Endometrial CA Endometrial CA

52. High Incidence of NCDs in Developed Countries ] Breast Breast CA Breast CA Fibrocystic Disease Fibrocystic Disease ] Male Genital Prostrate CA Prostrate CA ] Metabolic NIDDM NIDDM

53. High Incidence of NCDs in Developing Countries ] Possible Infectious Etiology Macronodular Cirrhosis Macronodular Cirrhosis Hepatocellular Carcinoma Hepatocellular Carcinoma Rheumatic Heart Disease Rheumatic Heart Disease Iron deficiency anemia Iron deficiency anemia ] Related to Nutrition Deficiency Endemic Goiter Endemic Goiter Malnutrition Related Diabetes. Malnutrition Related Diabetes.

54. Back to Nature  Improved Physical activity  A Healthier Diet, less saturated fats, more fiber  Less Stress

55. Transition  Nomads  Farmers  Urban 45 yrs 60 yrs 70 yrs

56. 1960 Urban Rural USA Developing Countries ruralurban

57. 2003 Urban Rural USA Developing Countries rural urban

58. Life Expectancy in Developing Countries

59. Changing Life Expectancies

60. Causes of Death n Age 15-44 Accidents Accidents CA CA CHD CHD n Age 45-54 CHD CHD CA CA Accidents Accidents Age 15-44 Accidents CHD CA Age 45-54 CHD CA Accidents DevelopedDeveloping

61. Other Transitions  Agriculture  Forestry  Toxicity  Urbanization  Fossil Fuel  Nutrition

62. Systems Analysis Attempts to build a replica of the real world and experiment with it in order to obtain a better understanding of what is observed Systems approach The Need for the Development of a systems approach to Epidemiology EPI systems Interplay of factors that cause one disease to increase while another falls.

63. Questions for readers of Epidemiologic Transition lecture by Ron LaPorte (developed by Supercourse Team) What might the epidemiologic transition tell us about the evolution of chronic diseases? What might the epidemiologic transition tell us about the evolution of chronic diseases? Over the past 100 years, life expectancy and causes of death have become homogenous world wide. Why is this important? Over the past 100 years, life expectancy and causes of death have become homogenous world wide. Why is this important?