chp 14 notes
DepartmentInternational Development Studies
ProfessorAnne- Emanuelle Birn
Oct 12 (Week 5, lecture 5)
Incidence- rate if new cases if disease per year
Prevalence- overall rate of disease per year
Duration- length of time illness/disease lasts
Case-fatality- percent of deaths among all people with a particular disease
Disability- physical/mental impairment that substantially limits one or more major life activity
(movement, work, study, personal/household tasks)
Risk factor- individualized activity or condition that may increase chance of developing the disease.
The demographic transition (box 2-2 in chapter 2)
Virtually all societies have gone through a transition from; High mortality, high fertility To Low mortality,
-stage 1: high birth rate and high, but fluctuating death rate
-stage 2: declining death rates, and continuing high birth rates
-stage 3: declining birth and death rates
-stage 4: low death rates, and low, but fluctuating birth rates
Malthus and Marx
-thomas R Malthus, an essay on the principle of population (1798): Population incrases geometrically,
subsistence, arithmetically (much slower). Poverty is the result unless there is moral restraint (less
sex/procreation). His theory was contested because of new agricultural technologies that can increase
production of crops.
-Karl Marx, Das Kapital (1867): each mode of production has its corresponding mode of reproduction.
Feudalism, where people were tied to the land, and the more offspring the family hand enabled more
harvesting of that land. In industrial society, cost of raising each additional child was really high, and
prohibitions of child labour leads to lower corresponding fertility rate.
Possible explanations for lower fertility (box 2-2)
-shift from subsistence agriculture to factory means smaller family size needed. Did not need more
people for manual labour on farms.
-higher marginal cost of extra children in urban setting/decline of multi-family households (extended
family live together is not as much as before).
-more women educated and in paid labour force
-development of social security systems: parents no longer dependent on children to take care of them
in old age.
-long workdays/shift work means less leisure time.
-contraceptive technologies/birth spacing. Condoms invented in 1840 with mass balkanization or
-preference, economic conditions.
Abdel Omran & the Epidemiologic transition (Box 2-4)
-long term shifts in overall mortality rates and patters of disease
-as infectious diseases recede (and life expectancy increases), they are replaced by degenerative and so-
called manmade diseases.
-Stages of transition
-Pestilence and famine: pre-modern period, if crops eating by insects, flooding, etc. it would
lead to famine. Women tend to survive famine more than men in pre-modern period because
they were the last to eat after men in many societies.
-low life expectancy, high mortality rates, high swings in mortality, little population
-he fails to emphasize the role of warfare and violence (infections). Fatalities were more
a result of infections following battle wounds than because of the weapons.
-fails to emphasize the interaction of food insecurity with contagious respiratory
-receding pandemics: a range of factors lead to pandemic mortality. Quarantine measures,
improvement in social conditions, etc.
- epidemics less frequent, infectious disease diminishes, degenerative diseases slowly
rise, living start improvements
-fails to realise that 19th century industrialization/urbanization also generated increased
industrial deaths and increased urban/trade linked infections such as respiratory
(crowding, malnutrition) and gastrointestinal (poor sanitation, less breast feeding).
-degenerative and human-made disease:
-environmental toxins/food production patterns: cancer, diabetes, congenital problems
-work, stress, and social inequality: cardiovascular diseases
-capitalism and globalization?: all of the above + resurgence of infectious diseases.
McKeown Thesis: how to explain the modern decline of mortality (Box 2-3)
-spontaneous change in the virulence of micro-organisms
-medical measures: suggested that yes, many medical measures are effective, but for the most part they
took place after mortality declines were initiated.
-public health measures (state policies around sanitation, etc.): says they were effective, but in the case
of England and Wales, majority of mortality decline, was due to respiratory ailments, but they did not
take that into account (figure 2-2). His argument is flawed, as today there is a rise in TB, his thesis is
-Improvements in standards of living made all the difference: improved living conditions and nutrition,
food distribution, inspections of food brought to market, etc.
P.245 key questions
-approximately 47 million deaths per year: leading cause of death coronary heart disease, followed by
cancer (figure 6-1)
-approximately 10 million child deaths per year: important demographically. Societies with high infant
child mortality means lower life expectancy. Children are most vulnerable to infectious diseases because
they have underdeveloped immune systems. It can take up to five to ten years to have a fully developed
-over half of child deaths in developing countries is associated with malnutrition (54%).
Health of Adults (255-259)
-aging (CVD, diabetes, cancer, COPD, mental health conditions, musculoskeletal, visual impairment)
-Injecting drug use
-Dental health: one of leading causes of morbidity illness. Accounts for huge proportion of absenteeism
at work and infection
-longer life expectancy but higher morbidity: women tend to go to doctors for check-up more than men.
-unequal power in home and workplace, with negative health consequences
-reproductive health issue: if abortions were regulated and safe it would reduce maternal mortality
significantly around the world.
-sub-Saharan Africa has highest maternal mortality rate across the world.
-higher CVD rates: more stress at work, less coping mechanisms relating to stress
-higher violent death and injury rates (including due to armed conflict)
-higher tobacco, alcohol, and other stress related mortality. Ex. Former soviet union
LGBT Health issues (262)
-discrimination and abuse/violence: deaths either by suicide or murder.
-mental health issues: societal or family marginalization /mistreatment in institutional settings
-unrecognized needs (beyond STIs).
Indigenous Health issues (262-265)
-in virtually all societies, indigenous people have poorer health and higher mortality than any other
-Colonial legacy of oppression
-discrimination and economic marginalization
-mental health/substance abuse issues
-consistently higher mortality than non-indigenous populations
Diseases (ailments) of marginalization and deprivation
-substandard living conditions
-geographic isolation: rural population, no adequate infrastructure or transport
-political oppression: (whether its forced child labour, human trafficking of women forced into
-leading disease morbidity is diarrhea:
-4 billion cases per year (table 6-5).
-2.2 million deaths (4%, leading cause of death among children.
-Yet it is preventable and treatable
-1990s: eighth cholera pandemic: result of decline in infrastructure in areas.
-many ailments caused by bacterial or viral infections have to do with interaction of humans with
ecological conditions, (ex. the growth and movement of people to new areas)
-Malaria: kills more than 1 million a year, with 90% of these deaths in Africa, mostly children under 5
-approximately 500 million cases annually; >40% global population is at risk
-can be controlled through transmission interruption (bed nets, screens, repellents) and drug
-1955 Malaria Eradication campaign: used DDT pesticide to kill off mosquitos therefore reducing
transmission (campaign a failure).
-mosquitos can breed in water, yet providing adequate infrastructure is ignored.