hss4331a – international health theory feb 1, 2010

HSS4331A – International Health

Theory

Feb 1, 2010

More Seminars

• There are several new and interesting upcoming seminars on the class website

Current Events Quiz #2• Feb 8, 2010• This time, you have only one news source: BBC

radio:– Bbc.co.uk/radio – the World News report– Or download the podcasts:

www.bbc.co.uk/podcasts/series/globalnews/ – (each day, there are about 2 30-min podcasts)– Podcasts are archived only 3 days, so don’t waste till the

last minute!

• Quiz will cover the days Feb 1-6 inclusive

Today….

• OVERPOPULATION

What is overpopulation

• For an area to be considered overpopulated; its population reaches a point where it can't be maintained without rapidly depleting nonrenewable resources

• In short, if its current human occupants are clearly degrading the long-term carrying capacity of an area, then that area is overpopulated– Overpopulation by Ehrlich (1990)

Why Is Overpopulation Bad?

• Ecological degradation– Food supply– Water supply– Land overuse

• Diminished food supply• Greater economic demands• Increased population density means easier spread of

communicable disease• Potential for mass migration -> refugees• Potential for border insecurity

Population Density• number of people per unit of area

Population Density

• Of the Earth:– pop density is 13/km2

• If you use the entire surface area of the Earth

– Pop density is 48/km2

• If you use the entire land area of the Earth

Other Measures of Population Density

• Arithmetic density: The total number of people / area of land measured in km² or mi².

• Physiological density: The total population / the amount of arable land.

• Agricultural density: The total rural population / amount of agricultural land.

• Residential density : The number of people living in an urban area / the area of residential land.

• Urban density: The number of people inhabiting an urban area / the total area of urban land

• Ecological optimum: The density of population which can be supported by the area's natural resources.

Most Populous Nations

100%

19.81%

17.52%7.39%

4.55%3.47%

2.81%

Source: UN, 2005

Nations With Highest Pop. Density

Source: UN, 2005

Where Do Some Of The Poorer Countries Rank?

Source: UN, 2005

Demographic Transition

• Idea developed by Warren Thompson in 1929• A nation transitions from high birth rate and

high death rate to low birth rate and low death rate, as it “evolves” from a pre-industrial to post-industrial economy

• Defined in four stages– 1) pre-industrial society, death rates and birth

rates are high and roughly in balance– 2) death rates drop rapidly due to improvements

in food supply and sanitation, which increase life spans and reduce disease

– 3) birth rates fall due to a variety of social factors– 4) both low birth rates and low death rates



CBR = crude birth rateCDR = crude death rate

• Stage 1– In pre-industrial society, death and birth rates are

high and fluctuate according to natural phenomena (drought, disaster, disease)

– Population is relatively young– Cost of a child is the cost of feeding him (low)– Economic contribution of child is high (working on

farm, etc)– Net economic value of child is therefore high– Majority of deaths concentrated in 5-10 year olds


• Stage 2– Decline in death rate, but birth rate remains high

• Increased survival of children, so age distribution shifts younger

– In Europe, initiated by Agricultural Revolution in 18th century

– Today: Yemen, Afghanistan, “Palestine”, – Today: sub-Saharan Africa, before AIDS epidemic– Agricultural improvements

• Crop rotation, selective breeding

– Public health improvements• Vaccination, clean water, sewerage, maternal care


• Stage 3– Decline in birth rate– Fewer children suffice to maintain family economic

unit– Increased urbanization– Increased female literacy and education– Improved contraception practices– Some countries that have experienced fertility decline

of 40% since pre-industrial levels:• India, Jamaica, Mexico, Sri Lanka, Egypt, Panama


• Stage 4– “post transition” stage– Birth rates more-or-less equal death rates– Some countries with total fertility rates <2.5:

• Canada, USA, Argentina, New Zealand, Australia, China


Total fertility rate = total number of children a woman will squeeze out in her lifetime

• Stage 5?– Some people think a stage 5 is needed to describe

countries that have transitioned from manufacture-based economies to information-based

– Also called “de-industrialization”– Fertility rates are below replacement rate– Examples:

• Japan, Greece, Germany, Italy, Spain… pretty much all the wealthy nations of the world


Replacement rate = national birth rate needed to maintain the total population

• “Demographic Trap”– During stage 3 –high birth rates, low death rates– Failure to progress to stage 4

• Birth rates remain high, resulting in rapidly growing population

– Country’s economic growth is used up to support the exploding population, and not on promoting economic and social development

• E.g. Yemen


Related concept…

• Age of Pestilence and Famine• Age of Receding Pandemics• Age of Degenerative and Manmade Diseases

In very very very broad terms, historians consider the history of human disease to have occurred in 3 phases:

Abdel Omran, 1971….

http://www.who.int/bulletin/archives/79%282%29159.pdf

Omran defined: The Epidemiologic Transition

• a human phase of development witnessed by a sudden and stark increase in population growth rates brought about by medical innovation in disease or sickness therapy and treatment, followed by a re-leveling of population growth from subsequent declines in procreation rates– Wikipedia

Demographic Trap

– Concept first discussed by WHO in 1988– Fear that exploding population will lead to

ecological collapse– Fear that this will lead to mass migration of

people• Border insecurity• Food depletion• Population density leads to easier epidemics

http://www.enotes.com/public-health-encyclopedia/demographic-trap

Demographic Trap• Dissenting voice:

– Demographic Trap mostly seen as a path to famine– Nobel Prize-winning economist Amartya Sen argues

that most large famines are a result of lack of access to food, rather than a lack of actual food

• therefore it’s a political issue, not necessarily a scientific one


– Does not apply to current South, since model is based and validated on the experiences of Europe and North America, where data has been available longest

– Does not account for unforeseen huge developments, like AIDS, which disproportionately affects the South

– The model paints an overly optimistic view of the future of developing nations

Criticisms of the model/theory


– Peruvian economist Hernando de Soto: subsistence farmers cannot transition into industrial economies because of political barriers, i.e. they do not own their land

– With globalization, the extreme gap between rich nations and poor nations creates external pressure to keep birth rates high to maintain economic output

– Not enough consideration of social changes on reproduction practices (religion, social roles of women, etc)

Criticisms of the model/theory

For More Info

• Here’s a nice article on a socio-political take on the Demographic Transition:

• http://www.globalchange.umich.edu/globalchange2/current/lectures/pop_socio/pop_socio.html

Malthus

• Thomas Robert Malthus (1766-1834)• Author of Essay on the Principle of Population• Yet another economist

Malthus

• Food production accelerates in “arithmetic progression”– Farm twice as much land, create twice as much food

• Population accelerates in “geometric progression”– Exponential growth

• Populations must always outgrow their food supply, resulting in inevitable famine– leads to “Malthusian collapse” of society

Malthus

• Criticisms of Malthus

Malthus

• Criticisms of Malthus– William Godwin (1820):

• There’s plenty of land to farm• Reproductive rates will not necessarily be constant• Due to attrition, population growth is not geometric

(Not an economist, but a journalist and philosopher)

Malthus

• Criticisms of Malthus– Marx (1867): rising population is actually a

measure of wealth

Malthus

• In general, supporters of Malthus believe in the land’s limited ability to sustain large numbers of people

• In general, critics of Malthus believe in the potential of the free market to create wealth for everyone, and therefore the ability to purchase resources

Strategies for Reducing Population Growth

The Nation of Deonandia…

100men

100women

9 months later: 100 babies

Residents are in perfect reproductive health, in their early 20s and horny as heck


99men

100women



98men

100women



1Lucky man

100women



100men

99women



100men

98women



100men

1Very

popular woman

9 months later: 1 baby

The Lesson?

• Population fertility is determined mostly by female fertility

• To address population fertility, one must address female fertility

(Problems With That Analysis)

• Not everyone has 100% fertility• Does not consider contraception• Does not consider abortion/miscarriage• Does not consider abstinence or other non-

reproductive behaviours• Does not consider twins, triplets, etc• Does not consider social factors (monogamy,

religion, etc) that dictate reproduction

Female Reproductive Rights

• The right to reproduce• The right to contraception

– Including abortion

• The right to education about reproductive health– STIs, contraception, etc

• Protection from reproductive alteration– Genital mutilation– Forced sterilization

Focus on Women

• “The World Bank has recognized that there is no investment more effective for achieving development goals than educating girls.”

• Relates to MDG #3 and #5:– #3: promote gender equality and empower

women– #5: improve maternal health

Why Is Female Education Important?

• Reducing women’s fertility rates. Women with formal education are much more likely to use reliable family planning methods, delay marriage and childbearing, and have fewer and healthier babies than women with no formal education– one year of female schooling reduces fertility by 10 percent. (

www.worldbank.org)

• Lowering infant and child mortality rates. Women with some formal education are more likely to seek medical care, ensure their children are immunized, be better informed about their children's nutritional requirements, and adopt improved sanitation practices

http://www.worldbank.org/

Why Is Female Education Important?• Lowering maternal mortality rates. Women with formal

education tend to have better knowledge about health care practices, are less likely to become pregnant at a very young age, tend to have fewer, better-spaced pregnancies, and seek pre- and post-natal care.

– one year of schooling for 1000 women prevents 2 maternal deaths. (www.worldbank.org)

• Protecting against HIV/AIDS infection. Girls’ education ranks among the most powerful tools for reducing girls’ vulnerability. It slows and reduces the spread of HIV/AIDS by contributing to female economic independence, delayed marriage, family planning, and work outside the home, as well as conveying greater information about the disease and how to prevent it.

http://www.worldbank.org/

hss4331a – international health theory feb 1, 2010

Documents

density of population

urban area

urban density

high birth rate

high death rate

low birth rates

entire land area

area of residential