IDSB04H3 Lecture Notes - Lecture 5: Tuberculosis

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IDSB04- Lecture 5 Chp. 6 October 5/2010
Epidemiologic Terms
See Table 6-1, p.243-244
Endemic disease: the occurrence in a community or region of cases of an illness,
specific health related behaviour, or other health –related events clearly in excess
of normal expectancy. (ex. chicken pox in Canada)
Demographic Transition
See Box 2-2, p31-32
From high mortality, high fertility societies to low mortality, low fertility
Demographic Transition
oStage 1: high birth rate; high but fluctuating death rate
oStage 2: declining death rates and continuing high birth rates
oStage 3: Declining birth and death rates
oStage 4: lower death rates and low, but fluctuating birth rates
Demographic Transition??
Based on observation of certain European population patterns
oNot necessarily generalizable
No explaination of how or by what mechanism changes take place
Why did fertility rates decline in the past?
Possible reasons for fertility rate declines
Shift from subsistence agriculture to factory
Higher cost of children
Increase in women’s education and paid work
Social security systems
Longer workday – less ‘leisure time
Epidemiologic Transition
See Box 2-4, p40-41
Long term shifts in overall mortality rates and patterns of disease
As infectious diseases recede (and life expectancy increases), they are replaced by
degenerative and so called human made diseases
Process accompanies development
3 Transition Stages
1. Pestilence and famine
Low life expectancy
High Mortality rates
High swings in mortality
Little population growth
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IDSB04- Lecture 5 Chp. 6 October 5/2010
Should also emphasize role of warefare and violence
Interaction of food insecurity,
2. Receding pandemics
Theory says:
Epidemic less frequent
Infectious disease diminishes
Degenerative diseases slowly rise (CHD, cancer, obesity)
Living standards improvement
3. Degenerative and human made diseases
Industrial ‘accidents and exposures
Environmental toxins/food production
Congenital problems
Work stress and social inequality
Cardiovascular diseases
Epidemiologic Transition too flawed??
Eras may overlap
Changes in morbidity and mortality reversible (Former Soviet Union)
Partial transitions abound
Despite stereotypes, people all over the world die of both communicable and non-
communicable diseases.
What about the differences in causes of death within populations??
McKeown Thesis
See box 2-3 p. 37-38
How to explain modern decline in mortality?
Spontaneous change in virulence of microorganisms?
Medical technologies?
Public health measures (through state policies)?
Improvements in standard of living?
Leading causes of death in the world?
Still, significant variation among and within countries
oCompare Denmark, Egypt, and Nigeria
Also, mortality inequalities between rich and poor countries exist for both
communicable and non-communicable diseases
Little attention paid to the coming ‘plague of non communicable disease in low-
income countries
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Document Summary

Possible reasons for fertility rate declines: shift from subsistence agriculture to factory, higher cost of children, social security systems, longer workday less leisure time". should also emphasize role of warefare and violence. Infectious disease diminishes: epidemic less frequent, degenerative diseases slowly rise (chd, cancer, obesity, living standards improvement, degenerative and human made diseases. environmental toxins/food production: cancer, congenital problems. work stress and social inequality: cardiovascular diseases. October 5/2010: prevention and control efforts (primary, secondary, and tertiary), although important, tend to neglect these issues. Health of infants and children: mortality dramatically reduced by half but . 10 million children still die very year from preventable diseases, decline in mortality not evenly distributed around the world. distance, cost, women"s lack of decision: poorly performed abortions, unhygienic conditions during delivery, but, women"s health not only about reproduction. overall well being of girls and women is important.

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