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Definition of the ‘health transition’ Trends of disease patterns in populations The 4 stages of the epidemiological transition The cardiovascular disease transition Engines of the health transition Urbanization , demographic, epidemiologic, socioeconomic and health care

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slide1

Definition of the ‘health transition’

  • Trends of disease patterns in populations
  • The 4 stages of the epidemiological transition
  • The cardiovascular disease transition
  • Engines of the health transition
    • Urbanization, demographic, epidemiologic, socioeconomic and health care
  • Other determinants of NCDs
  • Predicted trends in disease patterns, ‘Global Burden of Disease’
  • The double burden of disease
  • Impact of NCDs on public health
  • Evidence for the preventability of CVD
  • Strategies for the primary prevention of CVD
  • Public health response to emerging CVD

IUMSP-GCT

health transition demographic transition and epidemiologic transition
Health transition: demographic transition and epidemiologic transition

Economic, social & environ mental changes

 mortality

( infant mortality)

 life expectancy

  fertility

 nutrition

 technology for health care

Industrialization & urbanization

 public sanitation, housing, health care

 per cap. income,

 wealth

 NCD

 infectious diseases

persons at at risk of developing NCDs

Increasing and aging population

 levels of RF:

fat, calories, tobacco,

sedentary habits

IUMSP-GCT

slide4

Definition of the ‘health transition’

  • Trends of disease patterns in populations
  • The 4 stages of the epidemiological transition
  • The cardiovascular disease transition
  • Engines of the health transition
    • Urbanization, demographic, epidemiologic, socioeconomic and health care
  • Other determinants of NCDs
  • Predicted trends in disease patterns, ‘Global Burden of Disease’
  • The double burden of disease
  • Impact of NCDs on public health
  • Evidence for the preventability of CVD
  • Strategies for the primary prevention of CVD
  • Public health response to emerging CVD

IUMSP-GCT

slide5

Demographic transition: indicators over time(UK as an example of the ‘Western’ model)

  •  Mortality rate
  •  Fertility rate
  • ( birth rate)
  •  Size population
  •  Age population

IUMSP-GCT

slide6

Models of demographic transition

  • Heterogeneity of social and economic development among countries and over different periods of time leads to distinguish:
  • Classical (or Western) model
    • mostly economical and social factors, started in 18th-19th century
  • Accelerated model (Japan, Eastern Europe)
    • started later but evolved quicker
  • Delayed (or contemporary) model (most developing countries)
    • rapid decrease in overall mortality (mainly  child deaths) but less (delayed) decrease in birth rates, hence explosive population growth
    • important role of public health and medical interventions (treatment, contraception, abortion)

IUMSP-GCT

slide7

Models of demographic transition

Mortality and birth rates driven to various extents by socio-economic development, public health & medical interventions

IUMSP-GCT

determinants of fertility rates
High fertility

Economic needs of self-sufficient agrarian communities

Little striving for advancement

High child mortality

Religious doctrines and community sanctions

\'Individual\' not important

Childbearing is major source of prestige and economic support for women

Low fertility

Cost of children, earning power down

Reduced child mortality

Family and community less important for mobile city dwellers

Factory employment makes individual responsible for his/her own accomplishment

Education and rational point of view become important

Later marriage, migration, abortion, contraception

Determinants of fertility rates

IUMSP-GCT

slide10

Demographic transition in Seychelles: 3-fold increase of the number of people 50-70 by 2020-30 (hence expected large increase in NCDs)

IUMSP-GCT

slide12

Impact of growing and aging populations in industrialized and developing countriesWorld population structure by region, 1950-1990

IUMSP-GCT

slide13

Definition of the ‘health transition’

  • Trends of disease patterns in populations
  • The 4 stages of the epidemiological transition
  • The cardiovascular disease transition
  • Engines of the health transition
    • Urbanization, demographic, lifestyle, socioeconomic and health care
  • Other determinants of NCDs
  • Predicted trends in disease patterns, ‘Global Burden of Disease’
  • The double burden of disease
  • Impact of NCDs on public health
  • Evidence for the preventability of CVD
  • Strategies for the primary prevention of CVD
  • Public health response to emerging CVD

IUMSP-GCT

lifestyle transition
Lifestyle transition
  • Behaviors (e.g. smoking, sedentary habits)
  • Nutritional transition (e.g.  fats,  complex carbohydrates)
    • industrialization
    • urbanization
    • globalization of world markets and mass media

IUMSP-GCT

slide15

Changes in cigarettes consumption (sales) in developing and developed countries, 1974-1992

IUMSP-GCT

slide17

Higher levels of several risk factors in Seychelles than in Switzerland (age 35-64, 1989-1991)

Females

Males

(>160/95 or tt)

35

30

Hypertension

15

14

53

13

Smoking

(>1 cig/day)

34

24

Blood total cholesterol

11

20

(>6.5)

39

46

Seychelles

Blood HDL-cholesterol

11

8

<0.9 mmol/l

12

2

Switzerland

Blood lipoprotein(a)

33

35

>300 mg/l

10

13

5

28

(BMI>30)

Obesity

11

12

7

7

Diabetes

5

5

(diff. criteria)

0

20

40

60

0

20

40

60

IUMSP-GCT

Prevalence (%)

Prevalence (%)

slide18

Increasing levels of several risk factors in a rapidly developing country, Seychelles, 1989-1994

Males

Females

21

32

High cholesterol

(>6.5)

11

20

42

27

Hypertension

(>160/95)

31

24

41

8

Smoking

54

12

1994

8

5

Diabetes

(diff. criteria)

1989

7

7

Obesity

(BMI>30)

10

34

5

29

Heavy exercise at work

14

2

36

18

Leisure exercise weekly

20

13

3

2

0

20

40

60

0

20

40

60

IUMSP-GCT

Prevalence (%)

Prevalence (%)

slide19

Prevalence of overweight and obesity in children, age 5-17, in developed and developing countries (using same criteria)

Overweight

Obesity

20

Girls

Boys

16

12

Proportion (%)

8

4

0

UK

UK

USA

USA

Brazil

Brazil

Singapore

Singapore

Hong Kong

Seychelles

Hong Kong

Seychelles

Netherlands

Netherlands

IUMSP-GCT

slide20
Prevalence of high systolic blood pressure in children, age 5-17, Seychelles and USA (using same criteria)

20

\'High normal\'

\'Hypertension\'

15.3

14.0

15

US

Seychelles

10

10

Prevalence (%)

9.5

10

8.3

5

5

5

0

IUMSP-GCT

Boys

Girls

Boys

Girls

slide21

Definition of the ‘health transition’

  • Trends of disease patterns in populations
  • The 4 stages of the epidemiological transition
  • The cardiovascular disease transition
  • Engines of the health transition
    • Urbanization, demographic, lifestyle, socioeconomic and health care
  • Other determinants of NCDs
  • Predicted trends in disease patterns, ‘Global Burden of Disease’
  • The double burden of disease
  • Impact of NCDs on public health
  • Evidence for the preventability of CVD
  • Strategies for the primary prevention of CVD
  • Public health response to emerging CVD

IUMSP-GCT

slide22

Socioeconomic transition in disease patterns: early- vs. late-adopter communities

Time

IUMSP-GCT

slide24
Socio-economic differential in risk factor levels (random sample of 9254 adults of Dar es Salaam, 1999)

Prevalence

Body mass

Systolic BP

OR for

in index

SES

index (kg/m2)

(mmHg)

smoking

category

indicators

(adusted for age

(adjusted for

(adjusted for

(%)

& sex)

age, sex & BMI)

sex & age)

Education

Secondary or more

+1.48

-5.3

0.72

22

vs non manual unskilled

Occupation

Non manual skilled

+0.66

-2.7

0.40

7

vs. manual unskileed

Wealth

Refrigerator at home

+1.44

-1.5

0.52

18

vs. not

Flush toilet at home

+1.21

-2.1

0.63

15

vs. latrine

some issues related to socioeconomic transition
Some issues related to socioeconomic transition

Equity

  • access to information & health care related to RF and NCDs
  • costs related to adopting healthy behaviors/lifestyles
  • costs of treatment for chronic NCDs

Socioeconomic differences within populations

  • pockets of underdevelopment within western countries
  • large variations in development within developing countries

Forward and backward dynamic of development

  • underdevelopment can follow phases of development (e.g. FSE)

IUMSP-GCT

slide26

Definition of the ‘health transition’

  • Trends of disease patterns in populations
  • The 4 stages of the epidemiological transition
  • The cardiovascular disease transition
  • Engines of the health transition
    • Urbanization, demographic, lifestyle, socioeconomic and health care
  • Other determinants of NCDs
  • Predicted trends in disease patterns, ‘Global Burden of Disease’
  • The double burden of disease
  • Impact of NCDs on public health
  • Evidence for the preventability of CVD
  • Strategies for the primary prevention of CVD
  • Public health response to emerging CVD

IUMSP-GCT

health care transition
Health care transition
  • Availability of preventive and curative services
    • immunization, contraception, maternal/child care, antibiotics
  • Large influence on the dynamics of demographic transition
    • e.g. ‘delayed transition model’ in many developing countries (decrease in infant mortality not followed by proportionate decrease in birth/fertility rates: population increase ++)
  • Large heterogeneity between populations due to costs and efficiency in allocation of health services

IUMSP-GCT

slide28

Burden of disease and health expenditures in industrialized and developing countries: the \'90/10 desequilibrium\'

100%

7

80%

Health expenditure

60%

93

Percent

87

DALYs

40%

20%

13

0%

All other

EME

IUMSP-GCT

slide29

Aid disbursements for health by type of disease burden: current low priority given to NCDs

IUMSP-GCT

slide30

Allocation of resources for NCD control concentrates on equipment, not on prevention(Growth in medical equipment imports in one state of India)

IUMSP-GCT

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