Epidemiologic Transition Theory Research Articles

Industrialization and health.

Throughout history and prehistory trade and economic growth have always entailed serious population health challenges. The post-war orthodoxies of demographic and epidemiological transition theory and the Washington consensus have each encouraged the view that industrialization necessarily changes all this and that modern forms of rapid economic growth will reliably deliver enhanced population health. A more careful review of the historical demographic and anthropometric evidence demonstrates that this is empirically false, and a fallacious oversimplification. All documented developed nations endured the 'four Ds' of disruption, deprivation, disease and death during their historic industrializations. The well-documented British historical case is reviewed in detail to examine the principal factors involved. This shows that political and ideological divisions and conflict-and their subsequent resolution in favour of the health interests of the working-class majorities-were key factors in determining whether industrialization exerted a positive or negative net effect on population health.

James C Riley, Rising life expectancy: a global history, Cambridge University Press, 2001, pp. xii, 243, £30.00, US$49.95 (0-521-80245-8), £11.95, US$16.95 (paperback 0-521-00281-8).

James C Riley, Rising life expectancy: a global history, Cambridge University Press, 2001, pp. xii, 243, £30.00, US$49.95 (0-521-80245-8), £11.95, US$16.95 (paperback 0-521-00281-8).

Severe Acute Respiratory Syndrome (SARS) in Asia: A Medical Geographic Perspective

The Severe Acute Respiratory Syndrome (SARS) represents the first major and readily transmissible disease to emerge in the 21st Century. This paper illustrates the medical geography of SARS, which is believed to be caused by a new member of the coronavirus family. The origin of SARS as well as the vast majority of cases occurred in Asia, most notably China. Theories pertaining to the biological and geographical origin of the etiologic agent are examined and local, national, and international spatial diffusion patterns in Asia are illustrated. The SARS epidemic provides additional evidence that developed as well developing countries face major new health threats from emerging infectious and contagious diseases in an era of globalization, bringing into further question the epidemiological transition theory. Journal of Economic Literature, Classification Numbers: F22, I10, I18. 7 figures, 79 references.

Convergences and divergences in mortality

Abdel Omran's 1971 theory of Epidemiologic Transition was the first attempt to account for the extraordinary advances in health care made in industrialized countries since the 18th century. In the framework of the Demographic Transition, it implied a general convergence of life expectancies toward a limit imposed by the new epidemiological features of modern societies. However, important failures, occurred in the past decades (mainly the health crisis in Eastern Europe and AIDS in Africa), seem to have stopped that process of convergence. In fact such failures do not really contradict the theory. The latter is much more ruined by the unexpected dramatic improvement in the field of cardiovascular disease experienced since the seventies, which results in a new step of a more general process. On the basis of the broader concept of “Health Transition” initiated by Julio Frenk et al., the present paper tries to rethink the full process in term of divergence/convergence sequences inferred by successive major changes in health technologies and strategies. 1 Institut national d'etudes demographiques, 133, bd Davout 75980 Paris Cedex 20, France. Email: vallin@ined.fr 2 Institut national d'etudes demographiques, 133, bd Davout 75980 Paris Cedex 20, France. Email: mesle@ined.fr Demographic Research – Special Collection 2: Article 2 -Determinants of Diverging Trends in Mortality -12 http://www.demographic-research.org

Relationship between economic development and suicide mortality: a global cross-sectional analysis in an epidemiological transition perspective

Aim. The aim of this study was to analyse the relationship between suicide rates and economic development within the theoretical framework of epidemiological transition. Result. A weak positive correlation was found between suicide rates and GNP per capita in both sexes for all ages. Discussion. According to previous studies, there is a clear decline in deaths due to unintentional injuries with improved economic conditions. This example of a man-made disease that declines during the fourth stage is in agreement with the theory of epidemiological transition. However, our results found the opposite pattern for deaths due to intentional self-inflicted injury. Conclusion. Mortality rates due to unintentional and intentional self-inflicted injury show deviating patterns from an epidemiological transition perspective.

Economic distress and cause‐of‐death patterns for black and non‐black men in Chicago: Reconsidering the relevance of classic epidemiological transition theory

The mortality disadvantage of African Americans is well documented, but previous studies have not considered its implications for population theory in the general case of industrialized nation states with high levels of income inequality. This paper examines the relevance of classic epidemiological theory to the extremes of income and mortality observed in Chicago, one of America's most racially divided cities. We analyze cause-specific death rates for black and non-black male populations residing in Chicago's community areas by using linked data from the 1990 Census and from 1989-1991 individual death certificates. The same cause-of-death patterns explain much of the mortality of black and non-black men. These two major structures include one, degenerative diseases, the other, "tough-living" causes (accidents, homicides, and liver disease). Community socioeconomic status is strongly related to tough-living deaths within each racial group, and to degenerative deaths for African Americans. Black men's tough-living mortality is much greater than non-blacks', but their younger age structure suppresses their degenerative death rates. Aggregate unemployment and social disorganization account for the most salient disparities in mortality across racial groups. This patterning of mortality along a socioeconomic continuum supports epidemiological theory and extends its applicability to highly unequal populations within industrialized countries.

La transición epidemiológica en México : un caso de políticas de salud mal diseñadas y desprovistas de evidencia

¿A qué se debe que, al paso de los años, tantos expertos hayan llegado a adoptar la teoría de la transición epidemiológica como base para descifrar el curso del perfil epidemiológico, independientemente de sus evidentes debilidades teóricas? A partir de una relectura de la versión elaborada por Omran hace 30 años y de sus cuestionamientos más conocidos, en este artículo se postulan algunas hipótesis para responder a esa pregunta; se subraya la necesidad de considerar las consecuencias de seguir recurriendo a esa teoría para el diseño y evaluación de la política pública de salud, y se señala la importancia de construir modalidades alternativas de interpretación, si es que ha de lograrse un mejor entendimiento de los cambios en el perfil de daños que oriente hacia la búsqueda de respuestas más ajustadas a los retos que imponen el cuidado de la salud y la atención de la enfermedad en las sociedades actuales.

The uneven tides of the health transition

As spectacular mortality reductions have occurred in all developing nations at all national income levels, the epidemiologic transition theory suggests that cause-of-mortality patterns should shift from communicable diseases especially prevalent among infants and children to problems resulting from non-communicable conditions at older ages. Global estimates confirm this expectation, and mortality from these latter conditions has become predominant worldwide, leading some observers to argue for a corresponding shift in the public health agenda. In this paper, we nuance this finding by studying the important poverty-gradient concealed in the global estimates. Our results demonstrate the remaining cause-of-death disparities between the world's poorest and richest populations. We find that the poorest population (1st quintile) experiences higher mortality than the richest population (5th quintile) in each of the three main groups of mortality causes but that the excess mortality of the poorest population is mostly due to the higher incidence of communicable diseases (77% of excess deaths). Overall, those diseases only account for 34.2% of deaths in the world but still dominate mortality causes among the poorest 20% of the world population (58.6% of all deaths). Moreover, these results appear robust to alternative estimates of the international distribution of the world's poorest people. While recognizing the emerging agenda of the non-communicable conditions, we thus underscore the “unfinished agenda” of communicable diseases in many countries. As populations affected by these diseases are predominantly among the poorer, equity considerations should caution against a premature shift away from these diseases.

The Epidemiologic Transition Revisited: Compositional Models for Causes of Death by Age and Sex

For decades, researchers have noted systematic shifts in cause‐of‐death patterns as mortality levels change. The notion of the “epidemiologic transition” has influenced thinking about the evolution of health in different societies and the response of the health system to these changes. This article re‐examines the epidemiologic transition in terms of empirical regularities in the cause composition of mortality by age and sex since 1950, and considers whether the theory of epidemiologic transition presents a durable framework for understanding more recent patterns. Age‐sex‐specific mortality rates from three broad cause groups are analyzed: Group 1 (communicable diseases, maternal and perinatal causes, and nutritional deficiencies); Group 2 (noncommunicable diseases); and Group 3 (injuries), using the most extensive international database on mortality by cause, including 1,576 country‐years of observation, and new statistical models for compositional data. The analyses relate changes in cause‐of‐death patterns to changing levels of all‐cause mortality and income per capita. The results confirm that declines in overall mortality are accompanied by systematic changes in the composition of causes in many age groups. These changes are most pronounced among children, for whom Group 1 causes decline as overall mortality falls, and in younger adults, where strikingly different patterns are found for men (shift from Group 3 to Group 2) compared to women (shift toward Group 2 then Group 3). The underlying patterns that emerge from this analysis offer insights into the epidemiologic transition from high‐mortality to low‐mortality settings.

Inequalities in the transition of cerebrovascular disease mortality in New South Wales, Australia 1969–1996

With reference to epidemiological transition theory, this paper examines change in cerebrovascular disease mortality in Australia's most populous state in the 28 year period, 1969–1996. The hypotheses were that in the context of overall stroke mortality decline over the period, marital status, occupational status and spatial differences decreased. However, while overall mortality declined, differentials increased. The reasons for this are considered, with particular implications for epidemiological transition theory and for the targeting of populations at risk in policy terms.

Microbes and Us

This article provides an overview of microbes (viruses and pathogenic bacteria) in human history, with special focus on their emerging threat in societies that had appeared to have conquered them as significant takers of life. The relationship between microbes and mortality level is discussed, with reference to both developed and developing societies, which display different historical patterns regarding the timing and tempo of reductions in mortality due to microbes. An overview of the epidemiological transition theory - which has until recently guided current thinking about the mortality-microbe relationship - is presented in the light of current trends that counter its view of the diminishing role of microbes over time. Four factors leading to a re-examination of epidemiological theory’s optimism about the eventual control of microbes are identified. Consequences of microbe resurgence in the West, particularly in Canada, are discussed. Concerns about the Canadian reaction to microbes - which focuses upon individualist responses - and to threats to the health care system - which ignore public health - are raised.

Epidemiology as discourse: the politics of development institutions in the Epidemiological Profile of El Salvador

STUDY OBJECTIVETo determine the ways in which institutions devoted to international development influence epidemiological studies.DESIGNThis article takes a descriptive epidemiological study of El Salvador,Epidemiological Profile, conducted in 1994 by the...

Demographic, social, and economic effects on Mexican causes of death in 1990.

This study examined spatial geographic patterns of cause of death and 28 demographic and socioeconomic influences on causes of death for 31 Mexican states plus the Federal District for 1990. Mortality data were obtained from the state death registration system and are age standardized. The 28 socioeconomic variables were obtained from Census records. Analysis included 2 submodels: one with all 28 socioeconomic variables in a stepwise regression, and one with each of the 4 groups of factors. The conceptual model is based on epidemiological transition theory and empirical findings. There are 4 stages in mortality decline. Effects are grouped as demographic, sociocultural, economic prosperity, and housing, health, and crime factors. Findings indicate that cancer and cardiovascular disease were strongly correlated and consistently high in border areas as well as the Federal District and Jalisco. Respiratory mortality had higher values in the Federal District, Puebla, and surrounding states, as well as Jalisco. The standardized total mortality rate was only in simple correlations associated inversely with underemployment. All cause specific mortality was associated with individual factors. Respiratory mortality was linked with manufacturing work force. Cardiovascular and cancer mortality were associated with socioeconomic factors. In submodel I, cause specific mortality was predicted by crowding, housing characteristics, marriage and divorce, and manufacturing work force. In submodel II, economic group factors had the strongest model fits explaining 33-60% of the "r" square. Hypothesized effects were only partially validated.

Refocusing the lens: Epidemiologic transition theory, mortality differentials, and the AIDS pandemic

The epidemiologic transition theory presented first by Omran [Omram, A. R. (1971) The epidemiologic transition: a theory of the epidemiology of population change, Mildbank Quarterly 49(4), 509–538] was designed to explain global trends in the dynamic relationship between epidemiological phenomena and demographic change. This paper argues that universalizing this theory only partially serves to explain mortality declines over the last century and eclipses key epidemiologic differences between population subgroups based on socioeconomic status, race, and sex. This paper examines morbidity and mortality differentials between population subgroups and demonstrates important inconsistencies with the optimistic trends implied by the epidemiologic transition theory, an argument further developed using the HIV/AIDS pandemic as a case study. The paper argues that these differences should be brought from margins to center to present a more complex and comprehensive picture of how population subgroups experience epidemiologic transitions differently.

EXISTENCE OF MAJOR DISEASES AND MODELING OF EPIDEMIOLOGIC TRANSITION: A GENERAL SYSTEMS THEORETIC APPROACH

Multiretation general systems theory is used to study the theory of epidemiologic transition. An existence theorem is shown by virtue of the concept of centralized systems. This result guarantees the existence of major health and disease patterns at each fixed moment in history. A discussion of the feasibility of introducing the so-called theory of epidemiologic transition is given. Conditions are derived under which a health and disease pattern becomes important or attracts major public attention. A consequence of this discussion is the discovery of a new understanding of how to design an education program about disease prevention. Concepts, such as time systems, linked time systems, and periodic linked time systems, are used to model the conceived epidemiologic transition. One of the main results of this paper is that general systems theory is definitely the right tool for qualitative research in epidemiology. Many open-ended questions for further research are pointed out.

Aboriginal and Non-Aborigiml Mortality in Rural Australia

This article evaluates how Aboriginal and non-Aboriginal mortality patterns differ at a community level. Relying on data from two communities in western New South Wales the author examines differences in Aboriginal and non-Aboriginal mortality regimes over a recent 10-year period. Results from this analysis clearly show that Aborigines have appallingly high rates of death and that this pattern of Aboriginal mortality is an anomaly that does not adhere closely with classical epidemiologic transition theory. Potential reasons for existence of such a unique pattern of mortality are discussed. (EXCERPT)

Epidemiological transition and geographical discontinuities: The case of cardiovascular mortality in French Polynesia

The need to maintain the unity of geography justifies the use of every possible approach to the study of spatial discontinuities. The geography of health can be enriched by studying and applying routine methods of regional geography. To achieve this aim, the use of epidemiological transition theory, involving its tranposition from the domain of time to space, is proposed. This requires careful analysis of sources of data not commonly used in geography and emphasizes links between health, environment and development. French Polynesia constitutes a prime study area for such an approach, especially because of its multiple contrasts in geographic scale and levels of development between the different archipelagoes and even within individual islands. To demonstrate the utility of this approach, cardiovascular mortality is studied at different geographic scales. Results are displayed as health spatiograms which show the discontinuities of human geography in French Polynesia at different scales. The results appear to constitute synthetic indicators of socio-spatial disparities and permit the geography of health to contribute not only to the measurement of regional health conditions but also to the matters of global human geography.

Has Canadian Mortality Entered the Fourth Stage of the Epidemiologic Transition?

According to the epidemiologic transition theory the third and final stage of the evolution of mortality and morbidity patterns consists of degenerative and man-made diseases. It has been proposed that there is yet another stage of the epidemiologic transition the fourth stage which is remarkably different from the third. This paper brings together the different perspectives of this new stage and examines whether or not Canadian mortality has entered the fourth stage. The implications for public health planning are discussed. (SUMMARY IN FRE) (EXCERPT)

The epidemiologic transition and morbidity.

In essays about the theory of epidemiologic transition, Abdel Omran has argued that demographic change in the last century occurred in stages that can be characterized by their leading causes of death. The transition consists of a change in leading causes from infectious to degenerative and man-made diseases. In that version of the theory, the death rate is held to approximate the sickness rate. This essay identifies an epidemiologic transition in morbidity, using insurance records and health surveys to assess the morbidity trend. Two morbidity rates -incidence and prevalence- are distinguished. Each describes a trend independent from the mortality trend. While the risk of death declined sharply after 1870 in Britain, the age-specific incidence of disease and injury remained approximately level and the age-specific of duration increased. These independent trends are explained in part by ways the mortality decline affected the composition of the population. And they in turn affect interprétation of the mortality decline and the epidemiologic transition by suggesting that a key change occurred in the outeome of maladies. Sicknesses were more prolonged, but more people recovered.

Are subarctic Indians undergoing the epidemiologic transition

The applicability of A. R. Omran's ‘epidemiologic transition’ theory to subarctic Indians in Canada is examined in a historical review of health and demographic data. The major trends since the time of European contact include the rise-and-fall of infectious diseases, the emergence of chronic, degenerative diseases, and the preeminence of the social pathologies in the post-World War II era. The divergences of the Amerindian experience from the 3 models in the epidemiologic transition theory and their implications for health care delivery are discussed.