health transitions – and the impact on regional and …
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HEALTH TRANSITIONS – AND THE IMPACT ON REGIONAL AND GLOBAL HEALTH POLICYDr HL Harvey Fall 2020
HEALTH TRANSITION
A term refers to the change in the disease 'mix' of a population as it undergoes “ westernization” which, in general, is marked by an:
increased lifespan (lifetime)
reduction in death due to infection
changes and transitions in the world's health needs
an increase in NCD morality rates (cancer, diabetes and cardiovascular)
Health transition relates to the role that the cultural, social and behavioral determinants of health play in:
Rising life expectancy at birth
Decreasing proportion of all deaths caused by infectious diseases
The institutional changes associated with the cultural aspects of the health transition include the : • systematic promotion of the techniques of
disease control and • health care associated with modern
medicine instead of traditional /folk medicine
"DISEASES OF POVERTY" VERSUS "DISEASES OF AFFLUENCE"
Diseases and health conditions prioritized by global health initiatives are sometimes grouped under these terms
https://knowledgepolicy.wordpress.com/2012/06/23/health-healthcare-diseases-of-affluence-vs-poverty/
IT WAS PREVIOUSLY THOUGHT
As countries develop, noncommunicable disease replaced communicable disease as the main source of ill-health.
However, there is now evidence that the poorest in developing countries face a triple burden of:
1. communicable disease,
2. noncommunicable disease and
3. socio-behavioural illness.
TRENDS IN HEALTH ISSUES
CURRENTLY lifestyle and behavior are linked to 20-25% of the global burden of disease. This proportion is rapidly increasing in poorer countries.In the developing regions, NCDs such as depression and heart disease, as well as road traffic deaths, cancer and diabetes mellitus are replacing the IDs and malnutrition, as the leading causes of disability and premature death.
Injuries, both unintentional and intentional, are also growing in importance and by 2020 could compete with infectious diseases as a source of ill-health.
3 EXAMPLES OF HEALTH TRANSITIONS The burden of mental illnesses, such as
depression, alcohol dependence and schizophrenia, has been seriously underestimated in the developing countries and take account only of deaths and not of disability.
Adults under 70 years of age in Africa today face a higher probability of death from a NCD, same as for adults of the same age in the developed countries.
By 2020 tobacco is expected to kill more people than any single disease, even HIV/AIDS.
Figure 1. Global Mortality and Burden of Disease Attributable to Cardiovascular Diseases and Their Major Risk Factors for People 30 y of Age and Older
Ezzati M, Vander Hoorn S, Lawes CMM, Leach R, James WPT, et al. (2005) Rethinking the “Diseases of Affluence” Paradigm: Global Patterns of Nutritional Risks in Relation to Economic Development. PLOS Medicine 2(5): e133. https://doi.org/10.1371/journal.pmed.0020133 https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020133
MODELDEMOGRAPHIC TRANSITION
Is used to explain the process of transition from high birth rates and high death rates to low birth rates and low death rates as part of the economic development of a country from a pre-industrial to an industrialized economy.
The model consists of 4 -5 stages.
Most developed countries are already in stage four of the model, the majority of developing countries are in stage 2 or stage 3, and no country is currently still in stage 1.
The model has explained human population evolution (development) relatively well in Europe and other highly developed countries.
Many developing countries have moved into stage 3. …the major exceptions are poor countries, mainly in sub-Saharan Africa and some Middle Eastern countries.
BENEFITS OF USING A DT MODEL
it is easy to understand and countries can be
compared
it can be applied
globally to all countries
it provides a starter for all demographic
studies
The model provides a
useful generalization of population change over
time.
It can be used to compare rates
of growth between different
countries at a given point in
time.
Can be a useful predictive tool, so that future
changes can be forecasted
(determined).
PROBLEMS WITH THE DTM
The model is Eurocentric (European countries) , and assumes that all countries will pass through the same stages. Some developing countries appear to skip stages, e.g. China’s one child policy implemented in 1980 resulted in a rapidly declining birth rate.
It does not take migration into account as a component of population growth/decline.
Some developing countries appear to be stuck in stage 2. Their death rates have fallen, but their birth rates remain high, due to cultural or religious reasons.
Associate Professor Dr Eman A Al-Kamil 8/13/2016
What the previous model is showing
examples of countries & what is happening to birth rates & death rates, etc…
WITH THE DTM
TRENDS FOR DEVELOPING COUNTRIES
have a higher birth rate in the first two stages
have a much stepper fall in the death rate
start with a larger population
see a steep fall in fertility in stage 3
governments playing a more significant role in population management.
OTHER TRENDS THAT MAY OCCUR
At Stage Two of the demographic transition there will be a change in the age structure of the population.
In Stage One, the majority of deaths are concentrated in the
first 5–10 years of life.
Therefore, the decline in death rates in Stage Two entails the increasing survival of children
and a growing population.
Hence, the age structure of the population becomes
increasingly youthful and more of these children enter the reproductive cycle of their
lives while maintaining the high fertility rates of their parents.
WHAT STAGE IS JORDAN ?us i ng the data be low . . can you te l l now? what abou t i n 2025?
JORDAN Social Progress IndexGDP per Capita PPP
71.5/100 73/163$9,906 96/163
Score/Value
Score/Value
Score/Value
Score/Value
Rank
Rank RankRank
Strength/Weakness
Strength/Weakness
Strength/Weakness
Strength/WeaknessBASIC HUMAN NEEDS OPPORTUNITYFOUNDATIONS OF WELLBEING
Nutrition & Basic Medical Care
Access to Basic Knowledge Personal Rights
Personal Freedom & Choice
Inclusiveness
Access to Information & Communications
Health and Wellness
Enviromental Quality
Water & Sanitation
Shelter
Personal Safety
Comparing Countries
Notes
Key
Undernourishment (% of pop.)Women with no schooling Political rights
(0=no rights; 40=full rights)
Vulnerable employment (% of employees)
Satisfied demand for contraception (% of women)
Corruption (0=high; 100=low)
Freedom of religion(0=no freedom; 4=full freedom)
Discrimination and violence against minorities (0=low; 10=high)
Quality weighted universities (points)
Citable documents
Equality of political power by socioeconomic position (0=unequal power; 4=equal power)
Equality of political power by social group (0=unequal power; 4=equal power)
Access to justice (0=non-existent; 1=observed)
Property rights for women (0=no right; 5=full rights)
Freedom of expression (0=no freedom; 1=full freedom)
Early marriage (% of women)
Acceptance of gays and lesbians (0=low; 100=high)
Expected years of tertiary education
Women with advanced education (%)
Equality of political power by gender (0=unequal power; 4=equal power)
Life expectancy at 60 (years)
Access to online governance(0=low; 1=high)
Internet users (% of pop)
Premature deaths from non-communicable diseases (deaths/100,000)
Outdoor air pollution attributable deaths (deaths/100,000)
Greenhouse gas emissions (total CO2 equivalents)
Particulate matter
Biome protection
Access to essential services (0=none; 100=full coverage)
Access to quality healthcare (0=unequal; 4=equal)
Media censorship (0=frequent; 4=rare)
Mobile telephone subscriptions (subscriptions/100 people)
Primary school enrollment (% of children)
Secondary school attainment (% of population)
Gender parity in secondary attainment (distance from parity)
Access to quality education (0=unequal; 4=equal)
Deaths attributable to unsafe water, sanitation and hygiene (per 100,000 pop.)
Maternal mortality rate (deaths/100,000 live births)
Populations using unsafe or unimproved water sources (%)
Household air pollution attributable deaths (deaths/100,000)
Usage of clean fuels and technology for cooking (% of pop.)
Access to electricity (% of pop.)
Homicide rate (deaths/100,000)Perceived criminality (1=low; 5=high)
Political killings and torture (0=low freedom; 1=high freedom)
Tra!c deaths (deaths/100,000)
Populations using unsafe or unimproved sanitation (%)
Child stunting (% of children)
Deaths from infectious diseases (deaths/100,000)
92.9681.63 62.84
69.77
27.14
57.67
75.02
64.13
95.43
94.08
74.95
8.500.07
12.00
9.20
55.70
48.00
2.72
8.90
21.00
0.52
2.24
1.42
0.76
3.85
0.56
7.52
n/a
1.76
0.77
0.91
23.06
0.33
66.79
250.31
37.75
27.90
33.01
2.28
78.36
2.75
1.02
87.62
80.98
84.00
0.05
2.38
0.96
16.15
8.92
31.47
95.00
99.90
1.363.00
0.69
11.30
5.11
9.29
22.33
89.35 55.5469.61
7386 114
67
149
120
38
150
51
52
51
99114
147
28
121
59
122
157
54
64
81
134
74
110
125
91
n/a
81
56
161
43
147
78
42
132
87
135
173
56
63
139
142
146
54
66
84
61
93
57
62
1
105
5237
104
72
52
63
45
46 9293
Over-and underperfomance is relative to 15 counties of similar GDP per capita Overperforming by 1 or more pts.Underperforming by 1 or more pts.No data available.Performing within the expected range
Overperforming by less than 1 pt.Underperforming by less than 1 pt.
Namibia, Jamaica, Guyana, Tunisia, Iraq, El Salvador, Bolivia, Eswatini, Philippines, Guatemala, Bhutan, Indonesia, Egypt, Algeria, Ecuador
1. On some components and indicators, there are more ranked countries than the number of countries for which a full index score could be calculated. 2. Overall index, component and dimension scores are on a 0-100 scale; indicators scores are raw values.
Access toAdvanced Education 62.40 60
Child mortality rate (deaths/1,000 live births)
21.16 59
JORDAN RATES VS IT’S NEIGHBORS
WHAT DOES THE REPRODUCTION RATE SAY ABOUT JORDAN
Fertility rate, total (births per woman) - Jordan( 1 ) United Nations Population Division. World Population Prospects: 2019 Revision. ( 2 ) Census reports and other statistical publications from national statistical offices, ( 3 ) Eurostat: Demographic Statistics, ( 4 ) United Nations Statistical Division. Population and Vital Statistics Reprot ( various years ), ( 5 ) U.S. Census Bureau: International Database, and ( 6 ) Secretariat of the Pacific Community: Statistics and Demography Programme.