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Lecture 8

Lecture 8 Nov 15.rtf

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University of Toronto St. George
Matthias Koenig

SOC256H1F – MORTALITY – LECTURE 8 NOVEMBER 15 What do people die of? Causes of Death? - In the past dominant cause of death was death from infectious diseases. - Pre-modern societies high death rates with leading cause of death - infection – 80% Kung - Farming societies have greater exposure to infection than hunting and gathering societies, contact with domestic animals and other humans… shift to the more efficient farming method of producing food meant larger communities. – lots more people who could communicate the disease to each other - It is in farming communities and those after that you can have epidemics- o Kung and scattered groups do not give infection ability to transfer as easily in farming societies [Note: below, M+P refers to the reading by McCracken and Phillips in your reprotext. Statistics for Canada come from Wayne W. McVey Jr. and Warren E. Kalbach, Canadian Population.] Comparing types of societies: Hunters and gathers versus contemporary industrial: -infectious disease much more important for foragers -roughly 80% of deaths among the !Kung (Howell) -1% of deaths in Canada in 1991 -major causes now cancer and heart disease, about 2/3 of all deaths -Foragers varied For the Ache, ~25% infectious disease, ~50% human violence due to extreme circumstances - M+P point out that big variations in death rates were typical of pre-modern societies in general - Reasons included variations in epidemics, war, starvation, and cleanliness Foragers versus farmers - the shift to farming increased human exposure to diseases we can catch from domestic animals (e.g. tuberculosis) -the shift to larger settled communities increased role of infections that die out quickly in small groups (e.g. upper respiratory) - infectious disease grew overall -even today, neighbouring foragers and agrarians have different disease patterns and different folk medicines, with the foragers having fewer remedies for infection As societal level of technology rose, so did sizes of settlements, increasing the opportunities for communicable diseases 1 -M+P illustrate some differences in mortality between cities and rural areas, in the recent premodern period The rise of levels of technology also brought increasing inequality -inequality of health grew with inequalities of wealth and power -archeology shows that the poorer and less powerful were less well nourished and more diseased, from the earliest farming societies onward From the beginning of farming to the beginning of industrial societies, remarkably little about mortality changed. The low level of death from infectious disease is recent even for the most technologically developed societies: -still accounted for 14% of deaths in Canada as recently as 1921 - but only 1.3% in 1991 -the reasons for the decline include technology, but not very high-tech medical technology -sewers, clean water, good food, antibiotics 1991- Infectious disease responsible for only 1.3% of deaths in Canada Why the dramatic decline in infectious disease of killer of humans – - Simple sanitation was a huge improvement in medical practice - Decrease due to discovery of antibiotics but most historians of medicine argue that the big difference was due to cleanliness - Modern sewers, hot and cold running water to allow for showers- fundamental changes made a huge difference in transmission - Rise in wealth so that people can afford to be well nourished = all works best for those in developed societies who can take advantage of all of the above - So if you have people who are poor with poor access, these people may well have hybrids of infectious disease even though overall level is pretty low in particular society - Inequality grows as level of technology rises - Infectious diseases actually becoming more important now! – According to Statistics Canada- 2008 major killers are cancer (29.6) and heart disease (21.3)(in the modern world) followed by stroke (5.8%), chronic lower respiratory (4.6%), accidents (4.3%), diabetes (3.2), Alzheimer’s (2.8) , flu and pneumonia (2.3%), kidney disease (1.6%) o Why are cancer and heart disease highest? Carcinogens in environment, not enough exercise, increasing life expectancy – if you live long enough your heart will go bad or you will get cancer o Hunting and gathering society if life expectancy is 30 or so, only a certain amount live long enough to get cancer… o Hill and Hurtado trying to get description of how people died o Infections down because of sanitation, living longer life - Why resurgence of infectious disease? Viruses resistant to antibiotics which evolve in a global world, people travel more, so in the past it was harder for flus to be transported… o Drug resistant applies to pneumonia o No telling what will happen next o It depends on whether there is a new bug or not – these thing mutate constantly o Ex. H1N1, HIV/AIDS o Africa- high rate of infection of AIDS o Accidents- important cause of death o Because we do not die from a lot of other stuff, there is room for car accident deaths As our control over infectious diseases grew, causes of death shifted to “degenerative” diseases, primarily cancer and heart disease (M+P). More recently in post-industrial societies, there have been further changes in what we die of (M+P): - rates of heart disease have fallen somewhat - rates of death from infection may be rising again -new disease, e.g. HIV/AIDS -re-emergence of old diseases, e.g. tuberculosis -growth in strains resistant to antibiotics - infection’s possible rise is related to technology itself: - over-use of antibiotics -globalization of trade and travel, hence of disease - infection’s rise is also related to maintenance of huge pools of poverty -with associated high rates of infectious disease - there has also been a rise in the proportion of deaths due to “social pathology” (homicide, suicide, accidents), largely because other causes of death have fallen so much A NOTE ON INEQUALITY: - When income inequality is greater, mortality rates tend to be higher and life expectancy shorter. - Shown in comparisons of countries and comparisons of US cities - Inequality vs. mortality picture- more unequal the society, the worse the mortality, younger people die - But NOT true in comparisons of the 53 largest Canadian cities: - Nancy Ross. Et al, 2000. British Journal of Medicine v. 320 pp. 898-902 - FOUND no effect on death rates in Canada being correlated to level of income – why does this differ from worldview that inequality goes with greater levels of mortality - If you protect the people at the bottom of the inequality structure, and have good public 3 health care system, the people who are the poorest are buffered in an unequal community, this is true in Canada but not in the US where there is no buffer! - A lot of credit given to Canadian Health Care System - Interesting that in general, aside from countries with progressive health care systems like Canada, the worse inequality means worse mortality picture Comparing societies today: (M+P) The poorer the country, the higher are death rates and shorter on average people live - Data from 2009 – Life Expectancy GDP per capita – average amount of value of goods and service product in the society pre person- how wealthy is the society pretty much – we live in a world where societies are dramatically unequal in GDP – à life expectancy at birth in 2009 – there are societies that have life expectancy below 40 years vs. some that have low 80 life expectancy = people in rich countries living twice as long - Big difference is between moderately to quite rich to the poor ones - LDC’s less developed countries – just a bit more wealth bumps life expectancy way up - Only need to be moderately rich to maintain necessities of wealth- additional wealth will increase the life span a little more… from the care side – but another possibility – it looks like there is a ceiling effect in terms of only going so high according to the “Life Expectancy GDP per capita” – could be there is a natural kind of limit to the human life span… - There is one very rich country but does not mean it is the healthiest – same as countries half as rich… USA – due to their horrific healthcare system - Poorer countries have less surplus and less sophisticated technology - Health related consequences include: -less access to safe drinking water -less to eat -less health care - In poorer countries, preventable deaths from infectious disease are still an important part of mortality Comparisons within societies (especially Canada today) -Men die at higher rates – in Canada today – women still out live men by 5 years- latest Stats Can figures this is actually progress because a few years ago it was 6 years… à Why do men die sooner than women: - Marriage provides men with more care and assistance – when people in US asked “is there anyone who gives you health advice?” men said yes when married and no when not married - Women are raised to take responsibility for health – do a lot of the unseen work - Men do a lot of things that expose them to physical hazard- accidents, wars, suicide, crazy stupid stuff… - Obesity makes more of a difference for men than women – due to the fact that when people are fat – the fat for women is around the hips and what not but does not do any harm but storing fat on the abdominal cavity or tummy is very bad for you and thus where men put it! – some biological causes - Evolutionary causes - And more often for lifestyle reasons: accidents, suicides, and illnesses related to smoking and drinking -e.g. suicides per 100,000, 1993-98 Men 21.5 Women 5.4  Will this change, e.g. because smoking has grown more common among girls? - Poorer people die at higher rates - Native Canadians die at higher rates (as do aboriginal people in other societies, see M+P) *Diabetes is a big problem for poor people… As industrial societies developed, inequality first rose still further and then declined (Lenski et al.). This is one reason why inequality in health, including death rates, also declined compared to the early industrial era. But mortality is STILL not equal, even in the most developed countries in the world today. WHEN do people die? -“age-specific mortality rates” this is the term for when people die… this is directly connected to the life course. A sad form of age specific mortality is the infant mortality rate. INFANT MORTALITY IN THE OECD COUNTRIES. 2006 - Infant mortality- number of deaths before age 1, for every 1000 live births - Best: Japan: 2.6 - Next Best: Finland, Norway, Sweden - Ties for se
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