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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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Development, Health & Poverty

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Development health poverty

Development, Health & Poverty

Anth 597.01


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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