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The Impact of the Demographic Transition on Global Disease Patterns
"Global Health in the 21st Century ‐ celebrating 50 years of Heidelberg's contribution”
14th September 2012
Alex C Ezeh & Catherine KyobutungiAfrican Population & Health Research Center
2
Outline
• The Demographic Transition • Key Features of the Transition • Implications
– On Regions of the World – Global Disease Patterns– Inequity
• Summary and Conclusion
Demographic Transition
Demographic Transition
Demographic Transition • Historical accuracy esp. in developed world (as a group)• Transition in developing world shaped by:
– Faster decline in death rates (death control imported and applied)
– Fast economic growth & social change (China, Brazil…)– Persistently high fertility despite decline in child mortality (access to FP, SES factors, high % rural …..)
– Higher growth rates (younger populations, momentum)– Emergence of infectious diseases (esp. HIV/AIDS) affecting reproductive age groups
• Many developing countries stuck in Stage 2
Key Features of the Transition
•Overall Global Population Growth•Differences by Region and Wealth
–Population Ageing–Youthful Populations
•Urbanization /Slum growth (also driver)
Global Population Trends
Global Population Trends – 2010 ‐ 2050
Source: United Nations 2011
Population growth rate by country
Population Growth Rate(% per year) 2005-2010
Source: United Nations 2011
<0.00
0.00 - 0.99
1.00 - 1.99
>=2.00
Total fertility rate (TFR) by country
Source: United Nations 2011
Total fertility rate (TFR)
<2.00
2.00 - 2.99
3.00 - 3.99
4.00 - 4.99
5.00+
Contraceptive prevalence rate (CPR) - Any modern method
Source: United Nations 2011
CPR (%)<20.0
20.0 - 33.3
33.4 - 49.9
50.0 - 66.7
66.8+
Where will the next 2.41 Billion be added?
2,41000
,07500
2,33400
1,10400
2,694002,52400
0
0,5
1
1,5
2
2,5
3
World MDC LDC SSA Urban Urban LDC
2010‐2050 Growth
Population Ageing
Population Ageing
5 5.58.3
13.3
19.2
0
5
10
15
20
25
30
35
40
2010 2025 2050 2075 2100
Sub-Saharan Africa
Asia
LA & Carib.
North America
Europe
Rise in population share (%) of older persons (60+), 2010‐2100
Source: United Nations 2011 World Population Prospects
2010 2050 2100 Increasefactor (x)
Sub‐Saharan Africa 43 163 644 14.9Latin America & Caribbean 59 188 236 4.0Asia 414 1,253 1473 3.6North America 64 121 166 2.6Europe 161 242 219 1.4
Increase in absolute number (in millions) of older persons (60 +) 2010‐2100
Population Ageing
By 2050, SSA will have more older people than N. America
Source: United Nations 2011 World Population Prospects
Youthful Populations Distribution of people aged 10–24 years as a % of the population
Source: United Nations, 2010 World Population Prospects (2008 revision)
Young people constitute about 25% of current world population17% of 13‐15yr olds use tobacco90% of Adult smokers start before the age of 20 years
Urbanization
Urbanization
Population Growth Rate by Region and Residence, 2005‐2010
Source: UNPD 2009; UNHabitat 2006
0,35
-0,52
0,46
1,66
1,98
0,54
2,53
3,65
2,22
0,72
2,37
4,53
-1 0 1 2 3 4 5
Slum Urban Rural
World
MD
LDC
SSA
769,348
266,194191,394
1081,029
521,109
371,999
,0
200,0
400,0
600,0
800,0
1000,0
1200,0
Total Pop Urban Slum
2005 2020
Projected Growth of Total, Urban and Slum Populations in SSA (In Millions)
The Many Faces of Nairobi
Health Challenges in Nairobi • Communicable diseases
– Overcrowding– Poor WASH infrastructure– Limited access to health services – High risk behaviour
• Injuries (both intentional and unintentional ) – Road safety (lack thereof) with increasing traffic volumes– Limited access to emergency services – Lack of social cohesion – high interpersonal violence– Crime and insecurity – Limited access to law enforcement and judicial services
• Non‐communicable Diseases– High risk behaviour– Environmental pollution– Limited access to health services
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Current risk and future CVD burden
Has diabetes (a)
Aware (b)
Treated (c)
On treatment (d)
Controlled Well Controlled
n=298 n=101 n=72 n=52 n=23 n=3
As a % of N (5190) 4.3% 0.9% NA NA NA NA
As a % of (a) NA 19.9% 13.4% 10.3% 4.5% 0.7%
As a % of (b) NA NA 67.5% 51.8% 22.5% 3.5%
As a % of (c) NA NA NA 70.4% 26.9% 5.2%
As a % of (d) NA NA NA NA 43.3% 6.7%
Diabetes prevalence, awareness, treatment and control – Adults 18+
Findings on High Blood Pressure not any differentUndetected , untreated and uncontrolled risk factors point to a future huge burden of CVD
Implications on Global Disease Patterns
Implications of Key Demographic Trends
AgeingYouthful
PopulationsUrbanization
Degenerative processes
Reproductive Health needs
Environmental pollution
Non‐Communicable
Diseases
Communicable Diseases
Injuries
Lifetime acquired risk
Initiation of high risk behavior Obesogenicity
Health System Responsiveness
Health System Responsiveness
High Population density
Implications of Key Demographic Trends
Inequity• Existing inter‐country inequalities by wealth, in mortality burden maintained
• Intra‐country inequities • Intra‐urban inequities
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Conclusion
A combination of key demographic trends will ensure that non‐communicable disease maintain their dominant place as the main contributor to the global burden of disease….. and obtain this place in all regions of the world
2828
Happy 50Th Anniversary, IPH
Thank You for Your Attention
Contacts:Alex C. Ezeh
Catherine [email protected]