1. Health transition and emerging cardiovascular disease in developing countries: situation and strategies for prevention
Pascal Bovet, MD, MPH, Senior Lecturer
Institute of Social and Preventive Medicine
Group for Epidemiologic Transition and Cardiovascular Disease
University of Lausanne, Switzerland
WHO collaborating center for population-based cardiovascular research and prevention in populations in health transition
IUMSP-GCT

2. Definition of the ‘health transition’
Trends of disease patterns in populations
The 4 stages of the epidemiological transition
The cardiovascular disease transition
Engines of the health transition
Urbanization, demographic, epidemiologic, socioeconomic and health care
Other determinants of NCDs
Predicted trends in disease patterns, ‘Global Burden of Disease’
The double burden of disease
Impact of NCDs on public health
Evidence for the preventability of CVD
Strategies for the primary prevention of CVD
Public health response to emerging CVD
IUMSP-GCT

3. The health transition
Originally described in the 1970s (Omran, later Olshansky, Ault)
As socioeconomic development proceeds, mortality and fertility rates shift from high to low rates, populations get larger and older, and disease pattern shifts from one dominated by infectious diseases, perinatal diseases and nutritional disorders to one dominated by NCDs
conventional classification of 4 stages relating socioeconomic development and disease patterns
Key to understanding current and future health patterns
useful tool to anticipate health needs in developing countries experiencing early stages of health transition
particularly in countries where data on mortality and risk factors are scarce
Omran AR. The epidemiologic transition. Milbank Mem Fund Q 1971;49:
Olshansky & Ault. The fourth stage of epidemiologic transition. Milbank Mem Fund Q 1986;64:355-91
IUMSP-GCT

4. Definition of the ‘health transition’
Trends of disease patterns in populations
The 4 stages of the epidemiological transition
The cardiovascular disease transition
Engines of the health transition
Urbanization, demographic, epidemiologic, socioeconomic and health care
Other determinants of NCDs
Predicted trends in disease patterns, ‘Global Burden of Disease’
The double burden of disease
Impact of NCDs on public health
Evidence for the preventability of CVD
Strategies for the primary prevention of CVD
Public health response to emerging CVD
IUMSP-GCT

5. Health transition: proportionate mortality over time (US, 1900-1970, Omran)
100%
Other causes
Violence
80%
Diabetes
Stroke
60%
Heart disease
Percent of all deaths
Cancer
40%
Dis. of early infancy
Omran, Millbank Mem Fund Quart, 1971;49,215
Diarrhea enteritis
Pneumonia
20%
Other infectious d.
Tuberculosis 0%
1900
1910
1920
1930
1940
1950
1960
1970
IUMSP-GCT

6. Health transition: proportionate mortality by broad cause of death (US, 1900-1970)
100%
80%
Other
Violence
60%
Percent of all deaths
Cancer
40%
CVD
Omran, Millbank Mem Fund Quart, 1971;49,215
20%
Infectious 0%
1900
1910
1920
1930
1940
1950
1960
1970
IUMSP-GCT

7. Health transition: mortality rates (US, 1910-1970)
(up to >1000 earlier)
Omran. Epidemiologic transition in the US. Pop Bull, 1977;32, No 2:1-39
IUMSP-GCT

8. The health transition favors the young over the old (Age-specific mortality rates, US, 1890-1970)
Omran. Epidemiologic transition in the US. Pop Bull, 1977;32, No 2:1-39
IUMSP-GCT

9. Definition of the ‘health transition’
Trends of disease patterns in populations
The 4 stages of the epidemiological transition
The cardiovascular disease transition
Engines of the health transition
Urbanization, demographic, epidemiologic, socioeconomic and health care
Other determinants of NCDs
Predicted trends in disease patterns, ‘Global Burden of Disease’
The double burden of disease
Impact of NCDs on public health
Evidence for the preventability of CVD
Strategies for the primary prevention of CVD
Public health response to emerging CVD
IUMSP-GCT

10. The 4 stages of the health transition
Omran. The epidemiologic transition. Millbank Mem Fund Q 1971 ;49 :509-38
Olshansky & Ault. The 4th stage of the epidemiological transition. Millbank Mem Fund Q 1986 ;64 :355-91
IUMSP-GCT

11. Definition of the ‘health transition’
Trends of disease patterns in populations
The 4 stages of the epidemiological transition
The cardiovascular disease transition
Engines of the health transition
Urbanization, demographic, epidemiologic, socioeconomic and health care
Other determinants of NCDs
Predicted trends in disease patterns, ‘Global Burden of Disease’
The double burden of disease
Impact of NCDs on public health
Evidence for the preventability of CVD
Strategies for the primary prevention of CVD
Public health response to emerging CVD
IUMSP-GCT

12. Transition in cardiovascular disease patterns along the health transition
Late stage of health transition
High income economies
IHD > stroke
Stroke of ischemic origin
Older age
Lower case fatality
Early stage of health transition
Low & middle income economies
Stroke > IHD
Stroke of hemorrhagic origin
Younger age (stroke, IHD)
Higher case fatality
IUMSP-GCT

13. Differences in proportionate CVD mortality across regions at different stages of development, 1990
100%
IHD
80%
CVA
60%
Cardio myopathies
40%
Murray & Lopez. Global comparative assessments in health sector. WHO, 1994
Rheumatic
20% 0%
West
India
China
East
Europe
Middle
East
Latin
America
Sub-
Saharan
IUMSP-GCT

14. The high burden of stroke in developing countries:
stroke mortality rates in selected countries, age 40-69
Seychelles: cohort study; Dar es Salaam: AMMP verbal autopsy (Lancet 2000); others: WHO.
IUMSP-GCT

15. High toll of NCD/CVD in middle age in developing countries:
mortality by broad cause, Seychelles,
Bovet P et al. CVD Prevention 1999;2:
High CVD mortality
High (preventable) CVD mortality in middle-aged persons (particularly in men)

16. Stages of the health transition: focus on the type and regional distribution of cardiovascular disease

17. A model of the health transition accounting for mortality rates of diseases and types of CVD
IUMSP-GCT

18. How to interpret the health transition across populations at different stages of development: emergence and decline of CVD
IUMSP-GCT