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Development, Health & Poverty. Anth 597.01. Epidemiological Transitions. H-G origins low fertility + high infant mortality = low avg. life expectancy Low pop. Density High mobility Chronic helminth infections 1st Epi Transition – Agr high density sedentary pop. High Fertility

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epidemiological transitions
Epidemiological Transitions
  • H-G origins
    • low fertility + high infant mortality
      • = low avg. life expectancy
    • Low pop. Density
    • High mobility
    • Chronic helminth infections
  • 1st Epi Transition – Agr
    • high density sedentary pop.
    • High Fertility
    • Avg. age at death increases
    • Animal domestication
      • Endemic infectious zoonosis
      • Acute & Communicable diseases
      • Influenza, smallpox, measles, tuberculosis, etc
2nd epidemiological transition
2nd Epidemiological Transition
  • Increased life expectancy
    • Sanitation & healthcare
  • Chronic non-Infectious diseases
    • High energy & fat diet
    • Low PAL’s
    • Ex: CVD/CHD, cancers, diabetes
  • Used to be
    • “diseases of affluence”
    • Western disease on the rise in developing nations
what do transitions illustrate
What do transitions illustrate?
  • Dominant disease patterns are result of interactions between factors:
    • Cultural
    • Social
    • Political
    • Economic
    • Biological
  • Why the early success in combating infectious diseases?
u n millennium development goals
U.N. Millennium Development Goals
  • 8 Goals to achieve in the new millenium:
    • Eradicate extreme poverty & hunger
    • achieve universal primary education
    • Promote gender equality & empowerment
    • Reduce child mortality
    • improve maternal health
    • Combat HIV/AIDS, malaria & other diseases
    • Ensure environmental sustainability
    • develop a global partnership for development
epidemiology developed vs developing nations
Epidemiology: developed vs. developing nations
  • The Good:
    • global life expectancy 50 yrs ago = 46 yrs
    • now = 64 yrs
  • The Bad (inequalities in health):
    • global life expectancy is an aggregate average
    • Disability Adjusted Life Years (DALY)
      • premature mortality + yrs of productive life lost owing to mortality & disease.
      • 1 DALY = 1 yr of healthy life lost
    • Comm. diseases account for 7% DALY in developed nations
    • 57% in developing nations
what is causing the disparity in daly
What is causing the disparity in DALY?
  • Health care infrastructure
    • Europe 3.9 per 1,000
    • U.S. 2.7 per 1,000
    • Sub-Saharan Africa 0.1 per 1,000
  • Basic Research on diseases of Poor
    • small fraction of research papers dedicated to diseases of importance for developing nations
  • Drug Development
    • Of 1,233 drugs licensed (‘95-97), 13 (1%) tropical diseases
    • only 4 of 13, developed specifically for Tropical diseases of humans

4. Pharmaceutical Sales

    • N. America, Europe & Japan = 82% of sales
    • Africa = 1%
cultural vectors
Cultural Vectors
  • Set of cultural characteristics that allow transmission (often from immobilized hosts to susceptibles)
    • care giving
    • irrigation, sewage & wells
    • boats, ships, trains & cargo
  • Forces of modernization can have important consequences for disease transmission
    • virulence
    • emerging diseases & susceptibility
technological change
Technological Change
  • increased Transportation
    • economic centers
    • population centers
  • Mixing & movement of peoples over short time
    • faster travel over larger areas
    • globalization fosters cheap air travel
  • Spreads new diseases or variants
    • Ex: SARS, Avian Flu, West File
    • large monoculture raising operations
      • Confined Animal Feeding Operations
      • animal feed, hormones, & antibiotics
culture change virulence
Culture Change & Virulence
  • Virulence
    • Magnitude of neg. effect of a parasite on host
    • measured by mortality & morbidity
  • Insufficient time hypothesis
    • Not benefit of parasite to kill host
      • Evolve to be benign
    • High virulence = insufficient time to evolve
  • evolutionary epidemiology model of virulence:
    • virulence the product of host-parasite interactions
    • niche
    • transmission vectors
    • behavioral practices
virulence host parasite relationship
Virulence: host-parasite relationship
  • Coevolution
    • Btw host-parasite/prey-predators
    • Resistance vs. Virulence
  • Why are vectorborne diseases more virulent?
    • Malaria, Chagas, Schistosomiasis, sleeping sickness
  • Case Study: Malaria
    • +ed breeding grounds (cultural)
    • +ed host density (social)
hiv aids epidemic in africa
HIV/AIDS Epidemic in Africa
  • Found in OWM & Apes
    • Genetic evidence for 100 - 1000+ yrs of human infection
  • Sexual reproduction = mode of transmission
    • increased promiscuity = more virulent
    • Less partners = less virulent
  • Globalization = breakdown of traditional African culture
    • High Mobility in male wage workers
    • High levels of prostitution
    • Low levels of condom use
hiv aids epidemic in africa1
HIV/AIDS Epidemic in Africa
  • High levels & Virulence of HIV
  • Sub Saharan Africa
    • 25 mil living w/ HIV
    • 3 mil newly infected
    • 2.2 mil died in 2003
  • Anti-viral Drugs
    • AZT
    • virus mutates rapidly
the downward spiral infectious disease poverty
The Downward Spiral:Infectious Disease & Poverty
  • Unhealthy living conditions + likelihood of contracting diseases
    • Poor sanitation
    • Overcrowding & population growth
    • Poor infrastructure for prevention
    • malnutrition & hunger
  • Infection/Malnutrition Cycle

Infection/parasite Load

Malnutrition/Hunger

Low Production

medicalization of disease
“Medicalization of Disease”
  • Cultural beliefs that many of today’s diseases can be “cured” by medicine
    • 20th Cent. Positivist ideals
  • Hunger/Malnutrition
    • Nervos
  • Antibiotics
    • Resistant strains - incomplete regiment
    • “cure alls” - viral infections
rebirth of tuberculosis
Rebirth of Tuberculosis
  • 20th Cent. antibiotics nearly eliminate TB
    • Few cases in Developed nations & controllable
  • Social & Economic chaos of Soviet Collapse
    • Overcrowding & few antibiotics
    • Improper healthcare in Russian prisons
  • Antibiotic resistant “Super Strain”
    • Slowly spreading from Russian Jails across world
    • May 2007, TB super strain patient travels from Atlanta to Paris after being warned by U.S. Govnt
infectious disease environmental changes
Infectious Disease & Environmental Changes
  • Destruction of Environment
    • Logging, pasture, Dams, irrigation, etc
    • Bush meat trade & emerging infectious diseases
  • Destruction of local ecosystems
    • Balance of prey/predator interactions
    • +eszoonoses
  • Climate Change
    • Spread to new habitats
    • South moves North
    • West Nile, Malaria
next generation of healthcare
Next Generation of Healthcare
  • Greater emphasis on prevention
    • Save more lives
    • Long-term = cheaper
    • Healthy people
  • “Evolutionary Epidemiology”
    • Prevention over treatment
    • Stress more control of disease transmission
    • Active role in selective forces of pathogens
  • Proposed Example: Influenza
    • Now: vaccine = most prevalent strain
    • Future: vaccine = only most virulent strains
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