DR SHAHZAD AKHTAR AZIZ

MBBS, MPH, CHPE,PGD

ASSOCIATE PROFESSOR OF COMMUNITY MEDICINE

ISLAMIC INTERNATIONAL MEDICAL COLLEGE
3
ARE WE TOO MANY?
4
BY 2050 THE WORLD’S POPULATION WILL HAVE GROWN BY ANOTHER
3.5 BILLION, THE SAME NUMBER AS LIVED ON THE ENTIRE PLANET IN
1950. CAN A DEPLETED PLANET SUPPORT POPULATION GROWTH? WE
LOOK AT BOTH SIDES OF THE DEBATE.
5 OBJECTIVES OF LECTURE
6
DEMOGRAPHY

WORLD POPULATION TRENDS

7 YEAR POPULATION & TIME

1800 1 billion

1930 2 billion (130 years)

1960 3 billion (30 years)

1974 4 billion (15 years)

1987 5 billion (12 years)

1999 6 billion (12 years)

 How Many People Have Ever Lived On Earth?
8 Year
Population Births per 1,000
Births Between
Benchmarks
50,000 B.C. 2 - -
8000 B.C. 5,000,000 80 1,137,789,769
1 A.D. 300,000,000 80 46,025,332,354
1200 450,000,000 60 26,591,343,000
1650 500,000,000 60 12,782,002,453
1750 795,000,000 50 3,171,931,513
1850 1,265,000,000 40 4,046,240,009
1900 1,656,000,000 40 2,900,237,856
1950 2,516,000,000 31-38 3,390,198,215
1995 5,760,000,000 31 5,427,305,000
2002 6,215,000,000 23 983,987,500

Number who have ever been

born 106,456,367,669
World population in mid-
7,714576923
2019
Percent of those ever born who are
5.8
living
 WORLD POPULATION CLOCK
2015
9

Less
More Less Developed
Natural Developed Developed Countries
Increase per World Countries Countries (less China)
Year 80,794,218 1,234,907 79,559,311 71,906,587
Day 221,354 3,383 217,971 197,004
Minute 154 2 151 137

Source: Population Reference Bureau, 2015 World Population Data Sheet.

 WORLD POPULATION GROWTH THROUGH HISTORY
Billions
10
12

11
2100
10
9 Modern
Old Age
8 Iron Middle
Stone Bronze
New Stone Age Age Age Ages
7 Age

6 2000 Future

4 1975

3
1950
2
1900
1 Black Death — The Plague 1800

1+ million 7000 6000 5000 4000 3000 2000 1000 A.D. A.D. A.D. A.D. A.D. A.D.
years B.C. B.C. B.C. B.C. B.C. B.C. B.C. 1 1000 2000 3000 4000 5000

Source: Population Reference Bureau; and United Nations, World Population Projections to 2100 (1998).
 • Terms
• Birth rate (or crude birth rate): The number of live births per
12 1,000 population in a given year. Not to be confused with the
growth rate.
• Death rate (or crude death rate): The number of deaths per 1,000
population in a given year.
• Demographic transition: The historical shift of birth and death
rates from high to low levels in a population. The decline of
mortality usually precedes the decline in fertility, thus producing
rapid population growth during the transition period.
• Emigration: The process of leaving one country to take up
permanent or semipermanent residence in another.
• Growth rate: The number of persons added to (or subtracted from)
a population in a year due to natural increase and net migration;
expressed as a percentage of the population at the beginning of the
time period.
• Immigration: The process of entering one country from another to
take up permanent or semipermanent residence
 Less developed countries: Less developed countries include all
countries in Africa, Asia (excluding Japan), and Latin America and the
13 Caribbean, and the regions of Melanesia, Micronesia, and Polynesia.
More developed countries: More developed countries include all
countries in Europe, North America, Australia, New Zealand, and
Japan.
Mortality: Deaths as a component of population change.
Rate of natural increase: The rate at which a population is increasing
(or decreasing) in a given year due to a surplus (or deficit) of births
over deaths, expressed as a percentage of the base population.
Total fertility rate (TFR): The number of children women are having
today. The average number of children that would be born alive to a
women during her childbearing years if she conformed to the age-
specific fertility rates of a given year.
14
15
 DEMOGRAPHY

16

Thomas Malthus (1766-1834), British economist, born near Guildford, Surrey, England, and
educated at Jesus College, the University of Cambridge.
From 1805 until his death, he was professor of political economy and modern history at the
college of the East India Company at Haileybury.

theory of population,
Malthus's main contribution to economics was his

published in An Essay on the Principle of Population (1798).

According to Malthus, population tends to increase faster than the supply of food available
for its needs. Whenever a relative gain occurs in food production over population growth, a
higher rate of population increase is stimulated; on the other hand, if population grows too
much faster than food production, the growth is checked by famine, disease, and war.
Malthus's theory contradicted the optimistic belief prevailing in the early 19th century, that a
society's fertility would lead to economic progress. Malthus's theory won supporters and was
often used as an argument against efforts to better the condition of the poor.
• It focuses its attention on three readily observable human phenomena

• Changes in population size

1 (Growth or decline).

• The composition of
2 population.

• The distribution of population

3 in space.
 DEMOGRAPHY
IT DEALS WITH FIVE DEMOGRAPHIC PROCESSES
18

Fertility Mortality

Marriage Migration

Social Mobility
 DEMOGRAPHY

19

• SIZE: Refers to the number of persons in the population

• STRUCTURE: is the distribution of the population among its sex and age groups.

• CHANGE: is the growth or decline of the total population or of one of its structural units.

The components of change in the total population are Births, Deaths and migrations.

• POPULATION CHANGE: Refers to the increase or decrease in the population size and its

composition, and the determinants and consequences thereof.

• Distribution: Refers to the arrangement of the population in space at a given time.
 DEMOGRAPHY

20 • Population: A group of objects or organisms of the same kind.

• Mean Age: The mathematical average age of all the members of a population.

• Median Age: The age that divides a population into two numerically equal groups; that is,
half the people are younger than this age and half are older.

• Population Control: A broad concept that addresses the relationship between fertility,
mortality, and migration, but is most commonly used to refer to efforts to slow population

growth through action to lower fertility. It should not be confused with family planning.

• Population Density: Population per unit of land area; for example, people per square mile

or people per square kilometer of arable land.

 DEMOGRAPHY
• POPULATION GROWTH RATE:
21 Refers to the rate, at which a given population is increasing at a given period of time, it is given in
percentage per year.

• POPULATION DOUBLING TIME:

Refers to the time that would take for a population to double. Formula is 70 divided by the
population % increase per year
• NET MIGRATION:

Refers to the total number of persons added or subtracted from a population as a result of the
combined effect of immigration and emigration.
NET MIGRATION = (In migration – out migration).
• URBANIZATION:

Refers to the mass movement of rural population into urban centers resulting in increasing the
urban population and growth of cities.
 Demography

DEMOGRAPHIC TRANSITION
22
The historical shift of birth and death rates from high to low levels in a population.
The decline of mortality usually precedes the decline in fertility, thus producing rapid
population growth during the transition period.

• OLD BALANCE (High Fertility and High Mortality)

• NEW BALANCE (Low Fertility and Low Mortality)

• IMBALANCE (High Fertility and Low Mortality)

 Demography
THEORY OF DEMOGRAPHIC TRANSITION
DEMOGRAPHIC CYCLE COMPRISES OF FIVE STAGES THROUGH WHICH
A23
NATION PASSES.
FIRST STAGE Population remains stationary
(High stationary)
High birth rate high death rate

SECOND STAGE Population increases

(Early expanding)
death rate begins to decline while birth
rate remains unchanged

THIRD STAGE The population continues to increase

(Late expanding) (PAKISTAN, INDIA)
The death rate declines still and the
birth rate tends to fall

FOURTH STAGE (Low stationary) Population becomes stationary (Zero

Low birth and low death rate population growth) Austria, Denmark,
(Demographic transition) Sweden, U.K, and BELGIUM.

FIFTH STAGE Population begins to decline e.g. Germany,

(Declining) Birth rate is lower than Hungary.
death rate
 Demography

DOUBLING TIME
24

Population Growth DOUBLING TIME

Rate

1 percent per year 70 years

2 percent per year year 35 years

3 percent per year 23 years

 Demography
POPULATION DYNAMICS:
25

• Basic Demographic Equation

• Pt1 = Pt0 + (B – D) + I M-O M)
• P = population
• to , t1 = two time periods
• B = births
• D = deaths
• IM = immigration
• OM = out migration
• B-D =Natural Increase
• IM-OM = Net migration
• POPULATION GROWTH = NATURAL INCREASE + NET MIGRATION.
 26 NATURAL INCREASE NET MIGRATION

• The Demographic Balancing Equation • Population in 2001

• + Births
• Populations grow or decline as the result of three
processes: • – Deaths
• + Immigrants
• birth, death, and migration. These three variables are the
• – Emigrants
• components of population change
• = Population in 2002

• Births • Immigrants
• – Deaths • – Emigrants
• = Natural increase • = Net migration
BY ORDINARY METHOD THE POPULATION CAN BE
Demography
CALCULATED AS FOLLOWS
IF27
THE POPULATION OF A TOWN IS 20000 IN 2002 AND IT IS
INCREASING (GROWTH RATE) AT A RATE OF 3% PER YEAR IS

2002 (Present 20000

population)
2003 (in one year) 20000+600
=20600
2004 (in two years) 20600+618
=21218
2005 (in three years) 21218
+637=21855
2006 (in four years) 21855
+656=22510
2007 (in five years) 22510
+675=23185
Demography

CALCULATION OF POPULATION
28
IF ONE WANTS TO ESTIMATE POPULATION OF A COMMUNITY FIVE YEARS LATER I.E. IN THE
YEAR 2007(PT1), GIVEN THE 2002 POPULATION (PT0) AS 20000 AND ANNUAL GROWTH RATE OF 3%
THE FOLLOWING FORMULA MAY BE USED

PT1 = PT0 (1+ R) T

PT0= PRESENT POPULATION

PT1 = FUTURE POPULATION

R = GROWTH RATE PER PERSON

T = NUMBER OF YEARS BETWEEN T0 AND T1

THUS
P 2007 = P2002 (1 + .03)*5
= 20000 * 1.159
= 23185
Demography

29
THE POPULATION PYRAMID
•THE AGE AND SEX STRUCTURE OF A POPULATION IS REPRESENTED
BY THE POPULATION PYRAMID.
•ON THE RIGHT SIDE OF POPULATION PYRAMID ARE FEMALES AND ON LEFT
ARE MALES.
•THE YOUNGER ARE ALWAYS AT THE BOTTOM AND THE OLDER AT THE TOP.
•PYRAMIDS ARE PRESENTED IN FIVE-YEAR AGE GROUPS.
•PERCENTAGE DISTRIBUTION BY AGE AND SEX IS USED.
•POPULATION PYRAMID IS A PICTORIAL PRESENTATION OF THE AGE AND SEX
COMPOSITION BY VISUALIZING ONE CAN KNOW THAT. WHETHER THE
POPULATION IS OLD OR YOUNG.
•WHAT IS THE DEPENDENCY RATIO?
•AT WHAT RATE THE POPULATION IS INCREASING.
•WHAT ARE THE SEX RATIOS AT DIFFERENT AGE GROUPS?
•IS THERE A RECENT CHANGE IN FERTILITY OR MORTALITY IN THE POPULATION
 Demography

POPULATION PYRAMID
30
POPULATION PYRAMID –PAKISTAN 2018
 •Demography

32
 Demography

33 DEPENDENCY RATIO.
• Is an index summarizing an age • JAPAN 1995
distribution.
• This is the ratio of population who is
economically not active to those who
are economically active. = 20,240,000 + 17,52,000 * 100
87,073,000
• PAKISTAN 1995
• DEPENDENCY RATIO =
Children + Elderly * 100
Working age
43.6
= Pop below 15 + 65 and above * 100
• Pop 15 to 64 years
• = 58,192, 000 + 4,179,000 * 100=
• 73,86,000
• 84.4
 DEMOGRAPHY

34

• SEX RATIO:
• Is simply the ratio of males to females in the population, It is usually expressed
as the number of males per 100 females.
• SEX RATIO =Number of Males *
Number of Females
 Demography

35 FERTILITY

• FERTILITY

• Refers to the actual; reproductive performance of a women or a couple.

Fertility deals with the human child bearing or reproduction and is
generally confined to the women during their reproductive age’s 15-49
years.

• FECUNDITY:

• Refers to the physiological capability of a woman to reproduce.

36
37
38
39
40
 Demography

41 FERTILITY

• Factors Influencing Fertility:

• Age at marriage

• Duration of married Life

• Spacing of children (Family Planning)

• Education

• Economic status

• Caste and Religion

• Other Physical Biological, Social and cultural Factors

e.g. Place of women in society, widow marriage, breast feeding, customs & beliefs,
urbanization, health conditions, housing.
 Demography Fertility

42 CAUSES OF HIGH FERTILITY:

• PSYCHOLOGICAL: Natural urge of being parents and

seeking pleasure from bearing many children.

• SOCIAL: Lack of education, early marriage and family

pressure.
• ECONOMIC: Children are potential earners and provide old

age security to parents.

• DEMOGRAPHIC: Past experience of high infant and child

mortality also results in high fertility.

 Demography

HOW INFANT MORTALITY EFFECTS FERTILITY:

43

• BIOLOGICAL Curtailment of breast feeding

• REPLACEMENT EFFECTS Replacement of child’s who

die at an early age

• INSURRANCE EFFECTS Precautionary if some of them

die.
 Demography

44 BASIC FERTILITY MEASURES

& FERTILITY RELATED STATISTICS
• CRUDE BIRTH RATE (CBR)
•= Number of live births in a year * 1000
Population at mid-year

• GENERAL FERTILITY RATE (GFR)

•= Number of live births in a year * 1000
Number of women age 15-49

• AGE SPECIFIC FERTILITY RATE (ASFR)

ASFR = Live births in a year to women age X
Number of women of age X
 DEMOGRAPHY

FERTILITY
45

• GROSS REPRODUCTION RATE:

Average number of girls that would be born to a women if she experiences the
current fertility pattern throughout her reproductive span (15-44 years).

• NET REPRODUCTION RATE:

Number of daughters a newborn girl will bear during her lifetime assuming
fixed age specific fertility and mortality rates.

• REPLACEMENT LEVEL FERTILITY: (ZERO POPULATION GROWTH)

Is achieved when a couple has two births during their reproductive life. At the
community level the replacement level is considered when there are 2.1 births
per women to compensate for the child hood deaths.
 Demography

46 FERTILITY

BIRTH RATE:

• “Number of live births per 1000 estimated mid year population, in a given year”

Birth Rate = Number of live births during the year * 1000 Estimated mid
year pop

Death rate (or crude death rate): The number of deaths per 1,000
population in a given year.

Number of Deaths during the year * 1000

Estimated mid year pop

 Demography

AGE SPECIFIC FERTILITY RATE PAKISTAN

47 FERTILITY
1996-97
How to Calculate?
AGE NUMBER OF NUMBER OFLIVE ASF
GROUP WOMEN BIRTS IN 1 year R
(a) (b) = b/a
15-19 3100 255 .082
20-24 2350 577 .245
25-29 2000 550 .275
30-34 1580 335 .212
35-39 1230 178 .145
40-44 900 64 .071
45-49 640 15 .023
TOTAL 11800 1974 1.053

TOTAL FERTILITY RATE

= Sum of ASFRs X 5
= 1.053 * 5 = 5.26
Source: Pakistan fertility and family planning survey 1996-97
 Demography

48 FERTILITY
 Demography

49 FERTILITY

• FERTILITY CONTROL:
• Education
• Economic development
• Delayed marriage.
• Use of contraception. Family planning.
• Induced abortion.
• Postpartum infecundability induced by breastfeeding or abstinence.
 Demography

MORTALITY:
50 • Refers to the experience of a population in terms of deaths.

• MORTALITY MEASURES:

• CRUDE DEATH RATE; is simply the number of deaths in a year

divided by the total population at midyear and multiplied by 1000.

• CDR = Number of deaths in a year * 1000

Population at midyear
 Demography
MORTALITY:
• AGE SPECIFIC DEATH RATE
51
• = # of deaths of persons age X in year * 1000
Number of persons age X

• INFANT MORTALITY RATE

• IMR = Number of deaths of infants * 1000
• (Below one year) in a year)
Number of live births in one year
DEMOGRAPHY

MORTALITY:

52 ►NEONATAL MORTALITY RATES:

THE SOCIAL AND BIOLOGICAL FACTORS INFLUENCING
INFANT MORTALITY VARY DURING THE FIRST YEAR OF LIFE.
DEATHS DURING THE FIRST MONTH OF LIFE (KNOWN AS
NEONATAL MORTALITY) IS GENERALLY DUE TO EVENTS
OCCURRING DURING PREGNANCY WHILE THOSE OCCUR
DURING 1 MONTH TO 11 MONTH OF LIFE (KNOWN AS POST
NEONATAL MORTALITY) IS GENERALLY DUE TO
ENVIRONMENTAL CONDITIONS.
 Demography
MORTALITY:
NEONATAL MORTALITY RATE IS FURTHER
53 DIVIDED INTO EARLY NEONATAL MORTALITY
AND LATE NEONATAL MORTALITY RATES.
• EARLY NEONATAL MORTALITY RATE
= Deaths under 1 week * 1000 Live births in one year

• LATE NEONATAL M.R

= Deaths during 1-4 weeks * 1000
Live births in a year

• POST NEONATAL M.R

•
= Deaths during 4-52 weeks * 1000 Live births in a year
 MORTALITY:
• PERINATAL M.R

54 = Stillbirths + Death under 1 week * 1000

Stillbirths + live births in a year.

• MATERNAL MORTALITY RATIO:

= Death of women due to pregnancy Complications or

after child birth
(Within 42 days after delivery) * 1000
Live births in a year
 MORTALITY:

55 REASONS FOR HIGH MORTALITY IN THE PAST:

1. Acute and chronic food shortages causing famine and
malnutrition.
• Food shortage leads to deaths or malnutrition. Malnutrition weakens the resistance and
mild infections can kill the people.
• In Western Europe 450 famines between years 1000 to 1855.
• During 1315- 1317 a severe famine in Europe.
• China experienced 1828 famines between 100 BC and 1911 AD.

2. Epidemic Disease
• Epidemics of Plague, cholera, smallpox, typhus and other contagious diseases.
• In the 6th century 40to 50 % population of Roman Empire died by plague.
• In 14th century 25 million people in Europe was eliminated by plague referred to as Black
Death.
 MORTALITY:

56

• Poor public health conditions:

• Absence of knowledge of medical value of cleanliness
• Low standards of living
• Inadequate personal hygiene
• Lack of water supply and sanitation. These all lead to epidemics (cholera, plague).
 MORTALITY:

CAUSES OF RAPID MORTALITY DECLINE:

• Most of decline in mortality occurred in Europe in 18th and 19th century and first
57 half of 20th century in the developing countries.
• During the past three centuries mankind has achieved partial mastery over many
of known killers such as famines and epidemics. Major reasons for decline in
mortality are
• Increased Agriculture Production
• Improvements in farming, better fertilizers, crops rotation.
• Industrialization
• Improved transportation
• Special reforms
• Control of temperature and humidity
• Public sanitation improved water supply and water purification and sewerage
disposal eliminated the spread of cholera and typhoid.
• Improved personal hygiene, cheap cotton clothing and soap became easily
available.
• Immunology. Vaccine against deadly diseases
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