MPH 702 – Population

Dynamics

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Populations and
Transitions

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Measuring Population Change :
Three Basic Demographic Processes

Births
 Births
 Deaths
 Migration
Immigration Population Emigration

Deaths
Sources of Data
 Registration systems
 Census
 Surveys
 Public/Private records
Registration System
 Is a recording of key life cycle or vital events. A
live birth, death, fetal death, marriage, divorce,
recognition of parenthood, annulment of
marriage, or legal separation.
 Vital statistics are collected on a continuous

basis and are important for the study of

population change.
Census
 The total process of collecting, analyzing and
publishing or otherwise disseminating
demographic, economic and social data pertaining
to all persons in a country at a specific time.

 http://www.pbs.gov.pk/content/population-census
Surveys
 Surveys are done to obtain information from a
sample representative of some population.
 They are with smaller sample sizes, than census;

surveys allow collection of more in depth

information that can then be generalized.
World Population Growth through
History
Population Change: Before 1800

- ExceedinglyPopulation
slowPopulation
Change:
population
Population Change:
Change:
1800 to 1900
growth
1900to to
1950 1950
2000
- High birth rates offset by high mortality from
- MDC:
Continuing mortality
Completion declinetoinlow
of declines
transition European populations
- famines
wars,withMortality and
in MDCepidemics furthermortality and lowby
accompanied
early industrialization
fertility
declines
- World
- European in population
populationfertility
size reached 1 billion around
growth contributed to a surge of
1800international migrationinPopulation
LDC: Rapid reductions
- Most of the Asia, Africa
death rates followingBeyond
Prospects:
and Latin
World War
2000II
America still facing
- Developing country
with birth rates populations
remaining growing
high for about very slowly
two decades leading
high
- Worldfertility and
population mortality,
reaches though mortality begins to
to dramatic population
Nearly all1.7
growth billion
in most
future by 1900
countries
growth will take place
decline in some countries.
in less developed countries –mostly
LDCs population share increases
India from two-thirds
and sub-Saharan to four-fifths
Africa.
- of
Population
total worldreaches 2.5 billion by the middle of the
population.
century More 6.2
dramatic
World population reaches billionredistribution
by 2000. of
population among the more developed
and less developed countries
Population Growth in real time

https://ourworldindata.org/grapher/number-o
f-births-per-year

https://ourworldindata.org/grapher/number-o
f-births-per-year?country=~PAK
Demographic Transition

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Population transition models
 Demographic  Epidemiological
Transition Model: Transition Model:
Warren Thompson Abdel Omran 1971
1929

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The Demographic Transition Theory

 The transition from a combination of high birth rate

and high death rate to a combination of low birth rate
and low death rate, with the decline in birth rate
lagging behind the decline in death rate so that during
the middle phase of the transition there is population
explosion

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Stage I

 Both birth and death rates are high with the two rates being
approximately equal
 Population growth is slow, although the potential for more rapid
growth exists
 The death rate fluctuates in response to war and disease
 This stage involves a low-income agricultural economy

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Stage II

 Dramatic reduction in death rate as a result of industrialization

and related medical and health advances
 This reduction in death rate is not accompanied by a parallel
reduction in birth rate
 Hence, the rate of natural increase (r) is high
 Population growth is rapid

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Stage III
 Declining birth rate, the result of voluntary decisions to reduce family size
facilitated by advances in contraceptive techniques

 This is related to increased standards of living

 r falls as birth rate approaches the already low death rate

 Population growth is once again slow

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Stage IV

 Birth and death rates are again, as in the first stage

approximately equal

 A low r reappears

 The transition involves a change in high birth rate and death

rates to a much more socially acceptable state of affairs
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Stage V

 Birth rates are lower than death rates (theoretically)

 A low r continues

 The transition involves a change in high birth rate and death

rates to a birth rate lower than death rate

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The Demographic Transition Theory …
Developed vs. Developing Nations

 All industrialized nations have gone through these stages of

demographic transition
 The developing nations have completed Stage I and are
currently in stage II - a phase of explosive rates of natural
increase
 While these countries will eventually complete their
demographic transitions, what is uncertain is how long this
process will take
 Countries in western Europe took roughly 200 years to complete
their transitions
 But the less developed regions of the world can not wait to so
long if social upheaval and environmental disaster on a global
scale are to be avoided
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Epidemiologic Transition

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The Epidemiologic Transition
 It comprises three stages characterized by
categories in which fertility levels and causes of
death are grouped

1. The age of pestilence and famine

2. The age of receding pandemics
3. The age of chronic diseases

◦ Epidemiologic transition comprises of the first three

stages of the health transition

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The age of pestilence and famine
 This first stage of the health transition stage (the age
of pestilence and famine) is characterized by the kind
of mortality that has prevailed throughout most of
human history.
 Epidemic, famines and wars cause huge numbers of
deaths.
 The provision of basic ecological resources, i.e. food
and fresh water, is inadequate.
 The lack of sufficient infrastructure for most services
 high levels of mortality and fertility.
 Infectious diseases are dominant, causing high
mortality rates, especially among children.

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The age of pestilence and famine …
 In this stage, women of childbearing age also face
considerable risks due to the complications associated
with pregnancy and childbirth

 Life expectancy between 20-40years

 Population growth, improvements in health, and

advances in socio‑economic development are all
limited by the local carrying capacity of the
environment.

 Some developing countries are still in this stage.

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The age of receding pandemics

 This stage began in the mid‑19th century in many of

what are now developed countries.

 It involved a reduction in the prevalence of

infectious diseases, and a fall in mortality rates.

 As a consequence, life expectancy at birth climbed

rapidly from about 35 to 50.

 Increased economic growth leads to a sharp fall in

deaths from infectious diseases, and from
malnutrition
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The age of receding pandemics …
 In tandem with these improvements in population
health, social factors become increasingly important.

 Finally, the introduction of modem healthcare and

health technologies, e.g. immunization programmes
and the introduction of antibiotics enable the control
and elimination of group of infectious diseases such as
acute bronchitis, influenza and syphilis.

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The age of receding pandemics …
 As fertility rates are high, a population grows
rapidly at this stage of the health transition. Without
moving to the next stage, the carrying capacity of the
local ecosystem may be exceeded.

 As population and ecological pressures increase, food

and water become scarcer, and the lack of ecological
and social resources may cause economic
development to stagnate.

 If there is a surplus of available resources, the

transition may be accelerated, but if they are lacking,
the transition may slow, or even stagnate in this phase.
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The age of chronic diseases
 In the third stage the elimination of infectious
diseases makes way for chronic diseases among the
elderly.

 While improved healthcare means that these are

less lethal than infectious diseases, they nonetheless
cause relatively high levels of morbidity.

 Increasingly, health patterns depend on social and

cultural behaviour, such as patterns of food
consumption and drinking behaviour.

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The age of chronic diseases …

 Due to low levels of mortality and fertility, there

is little population growth.

 When the health transition is at an advanced stage,

life expectancy may exceed 80 years.

 However, the prevalence of one or more diseases

means that such a long life also includes, on
average, a relatively long period of morbidity.

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The age of chronic diseases …
 This stage occurs at different rates in different
nations:
◦ in both developed and developing countries, mortality rates
are driven by socially determined factors;
◦ in developed nations they are also driven by medical
technology.
 It becomes necessary to ensure sufficient social and
health‑care investment for all age groups.
 At the same time, there is increased demand for
healthcare related to the diseases of older people.

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Health Transition

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The Health Transition
 Health transition: the shifts that have taken place in
the patterns and causes of death in many countries

 Previously, the health transition has been covered

by two separate terms:

◦ demographic transition
◦ epidemiological transition

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 The Health Transition …
 Demographic transition - describing the change
from high fertility and mortality rates in less
developed societies to low fertility and low mortality
rates in 'modem' societies
 Epidemiological transition - which was introduced
to describe the changes in mortality and morbidity
patterns (from infectious to chronic diseases) as
societies' demographic, economic and social
structures changes
 The health transition covers the full range of social,
economic and ecological changes driving the
epidemiological and demographic transition
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 Future stages of the health transition

 Martens (2002) described the developments in the

health status of populations according to three
potential future 'ages‘:

4. the age of emerging infectious diseases

5. the age of medical technology
6. the age of sustained health.

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 Future stages of the health transition…

 These stages are imaginary (although some features

are already recognizable in some countries) and are
not sharply delineated‑ there is always a
continuum.

 Of course, each country follows its own route to

the 'ages' in question.

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 The age of emerging infectious diseases
 In this stage, the emergence of new infectious
diseases or the reemergence of 'old' ones will
have a significant impact on health.
 A number of factors will influence this
development:
◦ travel and trade
◦ microbiological resistance
◦ human behaviour
◦ breakdowns in health systems
◦ increased pressure on the environment

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 The age of emerging infectious diseases …
 Social, political and economic factors that cause the
movement of people will increase contact between
people and microbes.

 Environmental changes caused by human activity

(for example, dam and road building, deforestation,
irrigation, and, at the global level, climate change)
will all contribute to the further spread of disease.

 The overuse of antibiotics and insecticides,

combined with inadequate or deteriorating
public health infrastructures will hamper or delay
responses to increasing disease threats.
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 The age of emerging infectious diseases …
 As a result, infectious diseases will increase
drastically, and life expectancy will fall (as is
currently the case in many developing countries due
to the AIDS pandemic).

 Ill health will lead to lower levels of economic

activity, and poor countries will be caught in a
downward spiral of environmental degradation,
depressed incomes and bad health.

 Control of infectious diseases will be hampered by

political and financial obstacles, and by an inability
to use existing technologies.
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 The age of medical technology
 To a large extent, increased health risks caused by
changes in life‑style and environmental changes
will be offset by increased economic growth and
technology improvements in the age of medical
technology.

 If there is no long‑term, sustainable economic

development, increased environmental pressure and
social imbalance may propel poor societies into the
age of emerging infectious diseases.
 On the other hand, if environmental and social
resources are balanced with economic growth,
sustained health may be achieved.
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 The age of sustained health

 In the age of sustained health, investments in

social services will lead to a sharp reduction in
life‑style related diseases, and most
environmentally related infectious diseases are will
be eradicated.

 Health policies will be designed to improve the

health status of a population in such a way that the
health of future generations is not compromised by,
for example, the depletion of resources needed by
future generations.

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 The age of sustained health…

 Although there is only a minimal chance that

infections will emerge, improved worldwide
surveillance and monitoring systems will mean that
any outbreak is properly dealt with.

 Despite the ageing of the world population, health

systems will be well adjusted to an older
population.

 Furthermore, disparities in health between rich and

poor countries will eventually disappear.

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Health Transition – Developed Countries

 Currently, most developed countries are in the

third stage of the health transition:

◦ fertility rates are low

◦ causes of diseases and deaths have shifted from infectious

to chronic diseases.

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Health Transition – Developed Countries …

 All developed countries in Europe, North America

and Asia are seen as having arrived in the latter
stage of the health transition in the 1970s,
although there were large differences with
regard to timing, particularly in the onset the
decline in fertility.

In these countries, declining fertility rates and
increased life expectancy have led to the ageing,
or so‑called 'greying', of the population.

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Health Transition – Developing Countries
 The health situation in developing countries varies
greatly from one country to another.

 In most, there is still very low life expectancy; this

is due largely to malnutrition and the lack of
safe drinking water, which are compounded by
poor healthcare facilities.

 In other countries, however, particularly in Asia and

Latin America, chronic diseases have now become
more important than infectious diseases.

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Health Transition – Developing Countries …
 The same large variation is reflected in the
demographic situation.

 In countries such as China and Thailand fertility

rates are very low; in others they are very high.

 Due to sub‑national differences of an economic,

social or ecological nature, there may also be large
differences within a single country.

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 Health Transition – Developing Countries …
 It is widely believed that, with increasing economic
growth, developing countries will follow the same
pattern of health transition as Europe and North
America.

 Many countries, especially the poorest, will not

'trade' infectious diseases for chronic diseases;
instead, they may even suffer a 'double burden'
of disease.

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 Health Transition …
 Future developments will not be the same for all
countries, and developing countries are unlikely to
follow the same transition path as the developed
world.
 Although improvements in health may take place
worldwide, differences in health status between the
developing and developed world will to some extent
remain, regardless of the future development path.
 The processes of globalization in today's world that
include socio‑economic change, demographic change
and global environmental change, oblige us to
broaden our conception of the determinants of
population health.
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Country classification
 Assignment

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