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  1. Principles of Epidemiology for Public Health (EPID600) The population perspective Victor J. Schoenbach,PhD home page Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel Hill www.unc.edu/epid600/ Population perspective

  2. 50% x 90% + ? "Half this game is ninety percent mental." – Philadelphia Phillies manager, Danny Ozark

  3. I California "I love California. I practically grew up in Phoenix." – Dan Quayle

  4. An honest politician "That lowdown scoundrel deserves to be kicked to death by a jackass, and I'm just the one to do it," – A congressional candidate in Texas.

  5. Population perspective - outline 1. Epidemiology emphasizes the population perspective 2. Populations are dynamic, diverse, heterogenous - demographic characteristics have major impact on health a. Fertility and mortality, population pyramids b. Sex ratio, place, education, gender, ethnicity Population perspective

  6. 1. Epidemiology emphasizes the population perspective 1. Epidemiology emphasizes the population perspective • We see the world through our perspectives. • Individual perspective - focus on health, risk factors, exposures, causal mechanisms in people as individuals • Population perspective - focus on disorders (“mass disease”), exposures, causal mechanisms in people as a group Population perspective

  7. Age-adjusted cancer death rates - US males, 1930-2005 Source: American Cancer Society: www.cancer.org Population perspective

  8. (Continuation of notes) (continuation) Population perspective

  9. Age-adjusted cancer death rates - US females, 1930-2005 Source: American Cancer Society: www.cancer.org Population perspective

  10. (Continuation of notes) (continuation) Population perspective

  11. Population perspective vs. the individual perspective on the lung cancer epidemic • Individual perspective concerned with what individual exposures cause lung cancer, lead people to smoke, help people quit, smoking cessation clinics • Population perspective concerned with the environmental factors (including social, economic, technological, political) that promote smoking Population perspective

  12. (Continuation of notes) (continuation) Population perspective

  13. HIV pandemic • Individual perspective - counseling and testing, know about HIV, know serostatus, attitudes, safe sex, clean syringes with bleach • Migrant labor patterns, long distance truck driving, subordination of women, globalization, societal response to sex, homosexuality, and drug use Population perspective

  14. Individual vs. population perspectives’ approach to health problems • Individual perspective - diagnosis (presenting complaint, history, physical exam, lab tests), treatment derived from biomedical understanding of etiology • Population perspective - “community diagnosis” (surveillance, descriptive data, surveys and analytic studies), intervention via health care system, policy, … Population perspective

  15. Population perspective and individual perspective complement each other • Really a continuum - every health condition results from a combination of individual-level factors and population-level factors • Thus, both perspectives are important for public health and clinical medicine, but emphases are different • Political and institutional factors often favor the individual-level perspective Population perspective

  16. 2. Populations are dynamic, diverse, heterogeneous - demographic factors • Key characteristics: • Size/density, age, sex, place, ethnicity, education, economic resources • Key events and processes: • Birth, marriage, migration, aging, death Population perspective

  17. Population Reference Bureau www.prb.org Population perspective

  18. My mother works at PRB “Just wanted to let you know that I'm glad you use PRB reference materials - my mother works there and was actually an editor of the bulletin we used in one of the first lectures. She was thrilled when I told her that you highlighted their work in the lecture. Because they provide many of their publications for a reduced or no cost, it is very important for them to get feedback on which publications are most useful. Please continue to let them know what a good job they do! thanks!” From Julia, a student in the Certificate Program in Core Public Health Concepts who took the EPID160 Internet course in fall 2005. Population perspective Population perspective 18

  19. You are here From: Joseph A. McFalls, Jr. Population: A lively introduction, 5th ed, Population Reference Bureau Population Bulletin; 62(1), March 2007. Population perspective

  20. Mortality • Life expectancy • Health status • Fertility Population perspective

  21. 1/27/2002 Population perspective 21

  22. From: Joseph A. McFalls, Jr. Population: A lively introduction, 5th ed, Population Reference Bureau Population Bulletin; 62(1), March 2007. 8/27/2008 Population perspective 22

  23. Population perspective

  24. Population perspective

  25. From: Joseph A. McFalls, Jr. Population: A lively introduction, 5th ed, Population Reference Bureau Population Bulletin; 62(1), March 2007. 6/15/2008 Population perspective 25

  26. Birth rate calculation Notes: 1. “Births” means live births 2. For “crude” birth rate, denominator is men and women, all ages. Can also have subgroup birth rates. 3. Often expressed per 1,000 (per year). 1/9/2007 Population perspective 26

  27. Fertility rate calculation Notes: 1. Denominator is women of reproductive age (15-44 or 49 years) (per unit time). 2. Often expressed per 1,000 (per year) 9/30/2008 Population perspective 27

  28. Death rate calculation Notes: 1. Denominator is total population (men and women, all ages) (or can have subgroup death rates) [/ time] 2. Often expressed per 1,000 people (/year) 9/30/2008 Population perspective 28

  29. Average annual death rate calculation Notes: 1. Denominator is total population (men and women, all ages) [/ time] 2. Often expressed per 1,000 people (/year) 9/30/2008 Population perspective 29

  30. Age structure • Population growth • Fertility, momentum • Demographic transition • Population aging Population perspective

  31. Population pyramids From: Joseph A. McFalls, Jr. Population: A lively introduction, 5th ed, Population Reference Bureau Population Bulletin; 62(1), March 2007. Population perspective

  32. A record of a population’s history From: Joseph A. McFalls, Jr. Population: A lively introduction, 5th ed, Population Reference Bureau Population Bulletin; 62(1), March 2007. Population perspective

  33. Population perspective

  34. From: Carl Haub and O.P. Sharma. India’s Population Reality: Reconciling Change and Tradition, Population Reference Bureau Population Bulletin; 61(3), Sept 2006. Population perspective

  35. Population perspective

  36. From: Joseph A. McFalls, Jr. Population: A lively introduction, 5th ed, Population Reference Bureau Population Bulletin; 62(1), March 2007. Population perspective

  37. Population perspective

  38. Population perspective

  39. Total fertility rate Summarizes current fertility rates by imagining a cohort of women moving through their reproductive age years 15 20 25 30 35 40 45 Population perspective

  40. Total fertility rate calculation Population perspective

  41. Total fertility rate calculation Population perspective

  42. Total fertility rate calculation Population perspective

  43. China’s Age Distribution by age and sex, 1964, 1982, and 2000 From Figure 6. China’s Population by Age and Sex, 1964, 1982, and 2000 from Nancy E. Riley, China’s Population: New trends and challenges. Population Bulletin 2004: 59(2);21. Original sources: Census Bureau, International Data Base (www.census.gov/ipc/www/idbnew.html, accessed April 7, 2004); and tabulations from the China 2000 Census. 6/19/2009

  44. From: Nancy E. Riley.. China’s population: new trends and challenges. Population Reference Bureau Population Bulletin; 59(2), June 2004. Population perspective

  45. Population perspective

  46. Population perspective

  47. Chronic conditions among older Americans Population perspective

  48. Sex ratio Population perspective

  49. From: Joseph A. McFalls, Jr. Population: A lively introduction, 5th ed, Population Reference Bureau Population Bulletin; 62(1), March 2007. Population perspective

  50. Population perspective