C

Chapter 7

Determinants of Population Health

  • Population health perspective: recognizes complex interactions of individual and societal factors in determining health
  • Determinants are interconnected and operate in interaction with each other
  • Socioeconomic status: is a major determinant of conditions that impact the well-being
    • Link with the risk of vascular and chronic diseases
  • Emphasis on the reduction of socioeconomic inequalities and poverty
  • Better health = more productive workforce
  • Societal affluence = good health
  • Gender: encompasses biological and sociological dimensions linked to variations in health, morbidity, and mortality risks
  • Culture can also be an important influence

Demographic and Sociological Dimensions of Mortality

  • Mortality: the number of deaths taking place in a given interval in a specific population
  • Long-term decline of the death rate

Basic Measures of Mortality

Crude Death Rate

  • CDR: number of deaths in a given interval (year) divided by the midpoint population
  • Three-year average CDR
  • Highest CDR: Sierra Leone + Zambia + Afghanistan
  • Some developing countries have lower CDR because their age compositions are younger than those in developed countries

Age-Specific Death Rate

  • ASDR: number of deaths in a given interval to persons of a given age divided by the mid-interval population at risk in that same age category

Age Pattern of Mortality

  • J-shaped pattern of mortality: common in more developed countries
  • Mortality probabilities are higher for men than women
  • Age pattern of mortality: the shape of the pattern of death rates over age
  • Level of mortality: the overall death rate of a population
    • Lower for advanced countries than poorer nations

Infant Mortality Rate and Its Components

  • Early neonatal mortality: includes deaths that occur between birth and the end of the first week of life
  • Late neonatal mortality: includes deaths that occur from 8th day after birth to the end of the 27th day after birth
  • Post-neonatal mortality: includes deaths from the 28th day after birth to the end of the 1st year
  • Fetal deaths: death of a fetus prior to its complete removal or expulsion from the mother
  • Miscarriage: spontaneous or accidental termination of fetal life early in pregnancy
  • Abortion: any termination of pregnancy
  • Infant mortality rate (IMR): number of infant deaths in a given year divided by the number of live births in the same year
    • IMR in Central African Republic: 116
    • IMR in Japan and Sweden: 2
  • Developing countries have higher rates of infant mortality

Causes of Death in Infancy

  • Endogenous infant deaths: related to genetic makeup or internal physiological processes in the fetus - stem from complication
  • Exogenous infant deaths: associated with external factors
  • Improvements to public health decrease the causes of post-neonatal and early childhood mortality
  • Low birth weight: prematurity

Cause-Specific Death Rate

  • Heart disease + cancer = important causes of mortality in industrialized countries
  • Underlying cause of death: initial cause of the morbid process leading to death
  • Cause-specific death rate: number of deaths due to a disease divided by the mid-interval population
  • Cause-specific death ratio: the percentage of all deaths in the population that are attributable to causes of diseases

The Life Table

Basic Description of the Life Table

  • Life table: describes the survival experience of a fictional cohort subjected to the current age-specific death rates of a population

Mortality Change through History

  • Recent increase in life expectancy
    • Decrease in infectious and pathogenic diseases

Epidemiological Transition

  • Abdel Omran
    • Before modernity: infectious/parasitic diseases + famine + war = premature deaths
    • Chronic + degenerative diseases now became the leading killers

The Age of Famine and Pestilence

  • Mortality + fertility = very high
  • Rural population
  • Traditional society
  • Economy = agrarian system
  • Low standards of living
  • Life expectancy at birth for women: 20-35 years
  • Mortality = higher in urban areas

The Age of Receding Pandemics

  • Early phase
    • Improvements in health, agriculture, transportation, communication, standards of living and industrialization
    • Slow decline in mortality
    • Mortality = higher in urban areas
    • Epidemics
    • No health care system
  • Late phase
    • Explosive population growth
    • High fertility + mortality decline
    • Improvement in agriculture, sanitation, hygiene
    • Rise of the expectancy at birth
    • Vaccination
    • Increase in non-infectious diseases (heart disease + cancer)

The Age of Human-Made and Degenerative Causes of Death

  • Increases in life expectancy
  • Mortality decline
  • Non-infectious diseases
  • Urban population
  • Technology + science
  • Organized society
  • Nuclear family
  • Morbidity: rates of disease
  • Health systems
  • Causes
    • Smallpox vaccine
    • Standards of living thesis: recession of virulent epidemic diseases

Extensions to Epidemiological Transition Theory

The Age of Delayed Degenerative Diseases

  • Decline in cardiovascular diseases

The Hybristic Stage

  • Features linked to lifestyle and health behaviour: smoking, overeating, unhealthy diet, avoiding exercise
  • Infection diseases (HIV)
  • Chronic and communicable disease mortality
  • In some poor countries, major health improvements are possible without large-scale economic growth
  • Agent of health transition can be the Church

Health Transition

  • Health transition: improvements in life expectancy and overall health of populations over the historical spectrum
  • Systemic factors: related to the environment and social organization
  • Societal factors: cultural and structural determinants (stratification/inequality)
  • Institutional/household-level factors: working/living conditions, health care systems, lifestyles
  • Individual factors: health status, behavioural risk factors

Inequalities in Health and Mortality

The Sex Differential in Mortality

  • Increase in the sex gap: women are living longer than men
  • Maleness has some intrinsic risks that are genetic/biological kin origin
  • Immunocompetence: an organism’s all-around ability to avoid the harmful effects of parasites
    • Low for males
    • Testosterone
  • Men have higher death rates from vascular diseases
  • Behavioural components: stress, safety, diet, substance abuse
    • Greater risk taking + aggressiveness
  • Manhood trials: dangerous rites of passage
  • Declining sex difference in life expectancy is largely due to the faster declines for men in death rates
  • More female deaths are concentrated in older ages

The Aboriginal Disadvantage in Health and Survival

  • Deplorable socioeconomic and epidemiological conditions
  • Life expectancy is lower than other Canadians
  • Canada’s Aboriginal populations are undergoing the epidemiological transition
  • More chronic and degenerative diseases
  • More incidence of high birth weight babies
  • Higher mortality risk

Socioeconomic Disparities in Health and Mortality

  • As socioeconomic status increases, mortality declines
    • More money = access to health care
  • Factors of socioeconomic inequality
    • Low social status
    • Poor social affiliations
    • Poor quality or early childhood experiences
  • Psychosocial dimensions

Canadian Mortality in Comparative Perspective

  • US: low infant mortality, high life expectancy, high rates of adolescent birth rates
  • Japan + Sweden: low infant mortality, high life expectancy - top
  • United Kingdom: high rates of adolescent birth rates

Future Prospects

  • Future increase in the incidence of cancer
  • Respiratory conditions
  • Congenital anomalies
  • Public efforts to reduce inequalities
  • Greater public health interventions