EH2 Lecture 1 - Changing Patterns of Health and Disease

The scientific study of human populations with reference to:

- size

- composition

- distribution across places

- processes through which they change

Define "demography"

by birth, by in-migration

How can an individual enter a population?

by death, by out-migration

How can an individual leave a population?

number of births per 1000 population (per year)

Crude birth rate

Because it is not age-standardised,

because it includes all individuals rather than women who can have children

Why is crude birth rate an inaccurate representation of fertility?

15-44

What age range is cosidered child-bearing age?

"The number of children per woman"

Total fertility rate (TFR)

Women need to have on average 2.1 babies to maintain population size based on births

What is the replacement rate?

Yes, as this is an age-standardised measure

Can TFR be used to compare population growth betweeen countries? why/why not?

Age-specific fertility rates are the number of children per woman in a specified age bracket. The TFR is the sum of all ASFRs.

What is ASFR

from the 1930s there was a large spike in TFRs until the late 50s where there was a large drop,

the mid to late 60s were stable,

there was a sharp drop between 1970 and 1980 and TFRs have since sat below the replacement rate, though increasing since the low of 2001

What have been the general trends in TFRs since the 1930s

Crude death rate (CDR),

Infant mortality rate (IMR),

child mortality rate

What are the 3 commonly reported categories of mortality rates?

Infant mortality rates are the deaths per 1000 live births in a given year before said individuals reach 1 year of age

Define IMR

Child mortality rates are the deaths per 1000 live births in a given year for children between 1 and 5 years of age. This is often reported together with IMR as deaths per 1000 live births for children aged 5 or below

Define child mortality rate

82%

What proportion of deaths under 5 years of age occur during infancy?

A country's level of health development

What are infant and child mortality rates good indicators of?

socioeconomic factors (housing, hygiene, sewage & waste disposal, nutrition, etc.)

Health care factors (poor access to primary health care and hospital services surrounding pregnancy and birth, immunisation, etc.)

Name two factors influencing infant and child mortality rates

62% occur during the neonatal period

Within infant mortality rates, during what stage do most deaths occur?

within 28 days from birth

During what ages is an infant considered a neonate?

It allows for healthcare initiatives to target high risk areas/ages.

Why is knowing all these statistics surrounding child deaths important?

perinatal conditions,

congential abnormalitites,

signs, symptoms, abnormalities,

other causes

List 4 causes of infant death in descending percentage

Because they are not age-standardised. Age-specific death rates (ASDR) are a better representation of mortality trends in a population

Why are CDRs not a good reflection of the death rates of a population? What might be a better measurement?

Ischaemic heart disease (heart attacks),

Dementia and Alzheimer's,

Cerebrovascular Diseases (strokes),

trachea, bronchus, and lung cancer,

chronic lower respiratory diseases (eg emphysema)

What are the current 5 leading causes of death (current as of 2013)

fertility,

mortality,

migration

Which big 3 factors produce population stability and change?

Population pyramid

What is this data representation called?

immigration

What is the current largest contributor to Australia's population growth?

stable

What is this pattern called?

expanding

What is this pattern called?

contracting

What is this pattern called?

This term describes a shift from the 18th century from

pandemic and infectious diseases causing the majority of deaths to non-communicable diseases (ncd). This was more due to the conquest of infectious diseases, rather than the rise of degenerative disease.

This shifted the majority of deaths from the young to the old

Describe the epidemiological transition

tuberculosis,

organic heart disease,

diarrhoea,

senility,

bronchitis,

pneumonia

Name some of the main causes of death before the epidemiological transition

ischaemic heart disease,

dementia,

stroke,

lung cancer,

chronic obstructive pulmonary disease (COPD),

diabetes,

bowel cancer

Name some of the main causes of death since the epidemiological (aka health) transition

better living standards,

improvements in hygiene,

antibiotics,

mass immunisation,

progress of medical knowledge and skills

What are some of the contributing factors to the epidemiological shift?

1. age of pestilence and famine

2. age of receding pandemics

3. age of degenerative and man-made diseases

4. age of delayed degenerative diseases

5. age of emergent and re-emergent infections

What are stages 1 to 5 of the epidemiological transition model?

tuberculosis,

rubella (measles),

pertussis (whooping cough)

Name 3 re-emerging diseases

ebola,

legionaires diseases,

AIDS,

gastric ulcers (due to helicobacter pylori)

Name 4 "emerging" diseases

- doesn't account for emerging and re-emerging diseases

- doesn't account for co-existence of chronic and infectious diseases ("double-burden") and the relationship between them (eg. chronic diseases increases risk of infection)

-fails to recognise that degenerative diseases have always been present, but simply were noticed less

What are some of the flaws of the epidemiological transition theory?

This describes how births and deaths affect population growth over time. These are affected by social and economic factors. The model describes how developing populations move from high fertility and mortality patterns to stabilisation of both rates as they become more modern

Describe the demographic transition model

1. pre-industrial stage/pre-modern (high birth, high death, slow growth)

2. urbanising/industrialising (sharp population increase due to high births but falling death rates)

3. mature industrial (birth rates drop, death rates stabilise, some population growth)

4. post industrial (population stabilises with steadying death and birth rates at low levels)

Describe the graph and the 4 stages of the demographic transition model

2 - industrialising

Which stage of the demographic transition model is represented here?

1 - pre-industrial

Which stage of the demographic transition model is represented here?

4 - post-industrial

Which stage of the demographic transition model is represented here?

3 - mature industrial

Which stage of the demographic transition model is represented here?

high birth rates, high death rates, high infant mortality, high out-migration

Comment on fertility, deaths, migration, and infant mortality trends for developing countries

low fertility, low death rates, in-migration from less developed countries, low infant mortality

Comment on fertility, deaths, migration, and infant mortality trends for developed countries

lowering fertility rates

Which demographic trend is hardest to explain?