Demography and Health

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Demography and Health

  1. 1. Demography and Health Dr.Rajkumar Patil Asstt. Prof., Community Medicine AVMCH, Pondicherry
  2. 2. Demos + graphein Demography is scientific study of human population
  3. 3. Community Medicine and Demography <ul><li>Community medicine is vitally concerned with population as the health of the people depends upon: </li></ul><ul><li>the number of people </li></ul><ul><li>the space they occupy </li></ul><ul><li>the skill that they have acquired </li></ul>
  4. 4. Major sources of demographic data <ul><li>Census </li></ul><ul><li>Registration of vital events </li></ul><ul><li>NFHS </li></ul>
  5. 5. <ul><li>Three phenomena in Demography </li></ul><ul><li>Changes in population size </li></ul><ul><li>Composition of population </li></ul><ul><li>Population distribution in space </li></ul><ul><li>Five demographic processes </li></ul><ul><li>Fertility </li></ul><ul><li>Mortality </li></ul><ul><li>Marriage </li></ul><ul><li>Migration </li></ul><ul><li>Social mobility </li></ul>
  6. 6. <ul><li>There are four ways in which the number of people </li></ul><ul><li>in an area can change during two time periods </li></ul><ul><li>Population Growth </li></ul><ul><li>Natural Increase (Births-Deaths) </li></ul><ul><li>+ </li></ul><ul><li>Net Migration (Immigration-emigration) </li></ul>Population Dynamics
  7. 7. Demographic cycle
  8. 8. Demographic cycle Phase/ Stage BR DR Natural Increase Examples High Stationary 0-very slow India was in this stage till 1920 Early Expanding + Slow South Asia & Africa Late Expanding Rapid India, China, Singapore Low Stationary Slow UK, Denmark, Sweden, Belgium Declining Declining Germany & Hungary
  9. 9. Distribution of world population
  10. 10. World Population Trend Year Population 1800 978 million 1900 1650 million 1950 2.5 billion 1970 3.6 billion 1980 4.4 billion 1985 4.8 billion 2000 6 billion
  11. 11. Trend-Population of world
  12. 13. (2001 estimates) 1. China – 20.43% 2. India – 17.01% 3. U.S.A. – 4.61% 4. Indonesia – 3.42% 5. Brazil – 2.81% 6. Pakistan – 2.39% 7. Russia – 2.25% 8. Bangladesh – 2.21% 9. Nigeria – 2.20% 10. Japan – 2.01% 10 most populous countries of the world
  13. 14. <ul><li>On 2.4% of world’s land area,17% of the world’s </li></ul><ul><li>population ( 2004-1080 million) </li></ul><ul><li>1921-Year of “big divide”, India’s population has </li></ul><ul><li>been steadily increasing since 1921 </li></ul><ul><li>India will become the most populous country by the </li></ul><ul><li>year 2050 (1.53 billion) </li></ul>Population trend in India
  14. 15. 1901-2001 Population trend in India Year Total popu. (millions) Average annual Growth rate (%) Decadal Growth rate (%) 1901 238.4 - - 1911 252.1 0.56 0.75 1921 251.3 -0.03 -0.31 1931 279.0 1.04 11.00 1941 318.7 1.33 14.22 1951 361.1 1.25 13.31 1961 439.2 1.96 21.64 1971 548.2 2.20 24.80 1981 683.3 2.22 24.66 1991 843.9 2.14 23.86 2001 1027.0 1.93 21.34
  15. 16. Population trend in India
  16. 17. Most populous states of India Rank State Population (million) Percentage (%) 1 Uttar Pradesh 166.1 16.2 2 Maharashtra 96.8 9.4 3 Bihar 82.9 8.1 4 West Bengal 80.2 7.8 5 Andhra Pradesh 75.7 7.4 6 Tamil Nadu 62.1 6.6 7 Madhya Pradesh 60.4 5.9 8 Rajasthan 56.5 5.5 9 Karnataka 52.7 5.1 10 Gujarat 50.6 4.9
  17. 19. <ul><li>Proportion of males & females in different age-groups </li></ul><ul><li>Direct bearing on social, economic, health needs of communities </li></ul><ul><li>In an “old” population, for example, the society has to arrange for </li></ul><ul><li>the care of the elderly, & the country’s health system must be </li></ul><ul><li>organized accordingly. </li></ul>Age & Sex composition
  18. 20. Table-Distribution of population by age & sex (SRS–2003) Age group (yr) Male (%) Female (%) Total (%) 0-4 11.3 10.8 11.0 5-9 10.6 10.3 10.5 10-14 11.0 10.7 10.9 15-19 11.0 10.4 10.7 20-24 9.5 9.7 9.6 25-29 8.4 8.3 8.3 30-34 7.4 7.5 7.5 35-39 6.6 7.0 6.8 40-44 5.8 5.7 5.7 45-49 4.9 5.0 4.9 50-54 3.9 3.7 3.8 55-59 3.1 3.2 3.2 60-64 2.3 2.5 2.4 65-69 1.9 2.2 2.0 70+ 2.5 3.1 2.8 Total 100 100 100
  19. 21. <ul><li>It is a pictorial presentation (double histogram) of the age-sex </li></ul><ul><li>composition of a population </li></ul><ul><li>Male & Female are compared for age </li></ul><ul><li>Under-developed/developing country: Broad base & tapering top </li></ul><ul><li>(pyramid shape) </li></ul><ul><li>Developed countries: Bulge in the middle and has a narrow base </li></ul><ul><li>(spindle shape) </li></ul>Age pyramid
  20. 23. Population/age pyramid of India, SRS estimates1996 Spindle shape
  21. 24. <ul><li>Age pyramid, World Population Prospects 1998 (UN)          </li></ul>
  22. 26. <ul><li>Dependency Ratio is the ratio of economically dependant </li></ul><ul><li>population to economically independent population </li></ul><ul><li>Total Dependency Ratio </li></ul><ul><ul><ul><li>= Children (<15 yr) + Elderly (>65 yr) X 100 </li></ul></ul></ul><ul><ul><ul><li>Working Age(15-64) </li></ul></ul></ul><ul><li>Young age dependency ratio </li></ul><ul><li>Old age dependency ratio </li></ul>Dependency Ratio
  23. 27. Trends in Dependency ratio in India (per 100 persons) Year Total (Societal) Dependency Young age dependency Old age dependency 1990 68 61 7 2000 62 54 8 2004 64 56 8 2010 54 45 9
  24. 28. <ul><ul><ul><li>Ratio of males to females in the population </li></ul></ul></ul><ul><ul><ul><li>Sex Ratio = Number of Males X 1000 </li></ul></ul></ul><ul><ul><ul><li> Number of Females </li></ul></ul></ul><ul><ul><ul><li>Sex ratio of: </li></ul></ul></ul><ul><li>India : 933 females/1000 males </li></ul><ul><li>Kerala : 1058 females/1000 males </li></ul><ul><li>Punjab : 874 females/1000 males </li></ul><ul><ul><ul><li>Factors affecting sex ratio: </li></ul></ul></ul><ul><ul><ul><ul><li>1. Difference in mortality conditions of males & females </li></ul></ul></ul></ul><ul><ul><ul><ul><li>2. Female foeticide and infanticide </li></ul></ul></ul></ul>Sex Ratio
  25. 30. Sex ratio trend in India
  26. 31. CBR & CDR of selected countries (2004) World’s average birth rate is 21/1000 population Country CBR (per1000 mid yr pop.) CDR ( per1000 mid yr pop.) India 24.1 7.5 Bangladesh 27 8 Pakistan 31 8 Sri Lanka 16 6 Thailand 16 7 Nepal 30 8 China 13 7 Japan 9 8 Singapore 9 5 UK 11 10 USA 14 8
  27. 33. Source: SRS 1998 CBR
  28. 34. <ul><li>Rate at which a given population is expected to increase </li></ul><ul><li>in a given period of time </li></ul><ul><li>CBR-CDR = GR (in %, excluding migration) </li></ul><ul><li>10 </li></ul><ul><li>Approximately 95% of population growth occurs in </li></ul><ul><li>developing countries </li></ul>Growth Rate
  29. 35. Relation between growth rate & population Rating Annual rate of growth % Population doubling time in years Stationary Population No growth - Slow growth Less than 0.5 More than 139 Moderate growth 0.5 to 1.0 139-70 Rapid growth 1.0 to 1.5 70-47 Very rapid growth 1.5 to 2.0 47-35 Explosive growth 2.0 to 2.5 35-28 Explosive growth 2.5 to 3.0 28-23 Explosive growth 3.0 to 3.5 23-20
  30. 36. <ul><li>Total number of children borne by a women during </li></ul><ul><li>her child bearing age (15 to 45 years) </li></ul><ul><li>Total fertility rate (TFR) gives an idea of total family size </li></ul><ul><li>TFR in India: 2.68 (NFHS-3) </li></ul><ul><li>Family size depends upon – </li></ul><ul><li>Duration of marriage </li></ul><ul><li>Education of couple </li></ul><ul><li>No. of live births </li></ul><ul><li>No. of living children </li></ul><ul><li>Preference of male child </li></ul>Family Size
  31. 37. <ul><li>Mass migration of rural population into urban centers resulting in increasing the urban population & growth of cities </li></ul><ul><li>Cause of urbanization: </li></ul><ul><li>Better employment and social services </li></ul><ul><li>MEGA CITY: </li></ul><ul><li>City with population of 10 million or more </li></ul>Urbanization
  32. 38. <ul><li>Number of persons living per square kilometer </li></ul><ul><li>Density in India: </li></ul><ul><li>Year 1901 – 77 persons/km 2 </li></ul><ul><li>Year 2001 – 324 persons/km 2 </li></ul><ul><li>Year 2004 – 363 persons/km 2 </li></ul>Density of population
  33. 40. A person (7 yr or more) is considered as literate if he or she can read & write with understanding in any language. Literacy & education Literacy rates State Male lit.(%) Female lit.(%) Total lit.(%) Tamil Nadu 82 65 73 Kerala 94 88 91 India 76 54 65.38
  34. 41. Female literacy
  35. 43. <ul><li>Expectation of life at a given age is the average number of years which a person of that age may expect to live, according to the mortality pattern prevalent at that age </li></ul><ul><li>Indicator of country development & overall health </li></ul><ul><li>Expectation of life at birth – World </li></ul><ul><li>1950 : 46.5 years </li></ul><ul><li>2002 : 63 years </li></ul><ul><li>Expectation of life at birth – India </li></ul>Life expectancy Year Males Females Total 1901 23.63 23.96 23.8 2001 63.90 66.90 65.4
  36. 45. <ul><li>Approximately 95% of population growth is in </li></ul><ul><li>developing countries </li></ul><ul><li>Currently,1/3 of the world population is under 15yr, </li></ul><ul><li>& will soon enter the reproductive bracket, giving </li></ul><ul><li>more potential for population growth </li></ul><ul><li>The expected number of births per woman, at </li></ul><ul><li>current fertility rate is: </li></ul><ul><ul><ul><ul><li>Africa 6.1 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Asia 3.2 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Latin America 3.4 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>North America 2.0 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Europe 1.6 </li></ul></ul></ul></ul>Population Explosion
  37. 46. <ul><li>Economic implications </li></ul><ul><li>Demographic Implications </li></ul><ul><li>In population with low birth and death rate, </li></ul><ul><li>9-13% is 65yr or more. </li></ul><ul><li>There is increased demand for senior citizen </li></ul><ul><li>Environmental / Ecological Implications </li></ul><ul><li>Social / Political Implications </li></ul>Implications of Population Explosion
  38. 47. <ul><li>Fertility </li></ul><ul><li>Actual bearing of child </li></ul><ul><li>Factors affecting fertility </li></ul><ul><li>Age at marriage </li></ul><ul><li>Duration of married life </li></ul><ul><li>Spacing of children </li></ul><ul><li>Education </li></ul><ul><li>Economic status </li></ul><ul><li>Caste & religion </li></ul><ul><li>Nutrition </li></ul><ul><li>Family planning </li></ul><ul><li>Others – biological, physical, social, cultural, housing, breast feeding, industrialization, urbanization, health conditions etc. </li></ul>
  39. 48. <ul><li>Great impact on fertility </li></ul><ul><li>Early marriages- increased births </li></ul><ul><li>Age of marriage: </li></ul><ul><li>In 1930’s:13 years </li></ul><ul><li>In 2001: 21years </li></ul>AGE AT 'MARRIAGE'
  40. 49. Duration of married life YEARS AFTER MARRIAGE % OF BIRTHS 1-5 10-25 % 5-15 50-55 % 25 very few
  41. 50. <ul><li>Well fed society- </li></ul><ul><li>low fertility </li></ul><ul><li>Poorly fed society- </li></ul><ul><li>high fertility </li></ul>Nutrition
  42. 51. Family Planning
  43. 52. <ul><li>Education is inversely proportional to fertility </li></ul>Education
  44. 53. <ul><li>“ economic status is inversely proportional to fertility” </li></ul><ul><li>Economic development is the best contraceptive </li></ul>Economic status
  45. 54. <ul><li>Total fertility rate </li></ul><ul><li>Muslims ---3.59 </li></ul><ul><li>Hindus ---2.78 </li></ul><ul><li>Christians ---2.44 </li></ul><ul><li>MBC/SC/ST-higher fertility rate </li></ul>Caste and Religion
  46. 55. <ul><li>Physical, social, and cultural factors </li></ul><ul><li>Place of women in society </li></ul><ul><li>Opportunities for women and local community involvement </li></ul><ul><li>Value of children in society </li></ul><ul><li>Widow remarriage </li></ul>Other factors
  47. 56. <ul><li>Breast feeding </li></ul><ul><li>Customs and beliefs </li></ul><ul><li>Industrialization and urbanization </li></ul><ul><li>Better health conditions </li></ul>Other factors
  48. 57. <ul><li>Replacement Level Fertility </li></ul><ul><li>When a couple has two births during their reproductive </li></ul><ul><li>life, just enough to replace themselves. </li></ul><ul><li>Replacement level is considered when there are, on the </li></ul><ul><li>average, 2.1 births per woman (TFR), to compensate for </li></ul><ul><li>child deaths </li></ul>
  49. 58. <ul><li>Fertility Indicators </li></ul><ul><li>a. Original rates </li></ul><ul><li>1.Crude Birth rate (CBR) </li></ul><ul><li>CBR=Live Births x 1000/mid year population </li></ul><ul><li>2.General fertility rate (GFR) </li></ul><ul><li>GFR = Live Births x 1000/mid year female pop. (15-49yr) </li></ul><ul><li>General marital fertility rate (GMFR) </li></ul><ul><li>GMFR= Live Births x 1000 </li></ul><ul><li>mid year married female pop.(15-49yr) </li></ul>
  50. 59. <ul><li>4. Age specific fertility rates (ASFR) </li></ul><ul><ul><ul><li>Indicator of Fertility pattern & family planning </li></ul></ul></ul><ul><li> Live births in specific age group x 1000 </li></ul><ul><li>Midyear population of women in that age group </li></ul><ul><li>5. Age specific marital fertility rate (ASMFR) </li></ul><ul><li> Live births in specific age group x 1000 </li></ul><ul><li>Midyear population of married women in that age group </li></ul>
  51. 60. b. Derived rates 6. Total fertility rate (TFR) Average number of live births a woman is expected to undergo during her reproductive life. TFR = 5 x ƩASFR 1000 7. Total marital fertility rate (TMFR) TFR = 5 x ƩASMFR 1000
  52. 61. <ul><li>8. Gross reproduction rate (GRR) </li></ul><ul><li>Average number of girls born to a woman during her reproductive life, if she experiences the current fertility pattern throughout the reproductive life (15-49) assuming no mortality </li></ul><ul><li>GRR = 5 x ƩASFR for female Live Births </li></ul><ul><li>1000 </li></ul><ul><li>GRR = TFR x newborn sex ratio </li></ul>
  53. 62. <ul><li>9. Net reproduction rate (NRR) </li></ul><ul><li>Average number of girls born (and survived) to a woman during her reproductive life, if she experiences the current fertility pattern throughout the reproductive life (15-49) and assuming current mortality pattern </li></ul><ul><li>NRR = Number of girls born and survived </li></ul><ul><li>Number of the women survived </li></ul><ul><li>after the end of reproductive life </li></ul>
  54. 63. c. Related rates and ratios 10. Child-woman ratio Number of children < 4 yrs of age per 1000 women of child bearing age. 11. Pregnancy rate Ratio of no. of pregnancy in a year to married women in the ages (15 – 49)
  55. 64. 12. Abortion rate No. of abortions per 1000 women of child bearing age group. 13. Abortion ratio No. of abortions performed/ no. of live births 14. Marriage rate Crude MR = Number of marriages in a yr x 1000 Mid Year Population General MR = Number of marriages in a yr x 1000 Number of unmarried persons in 15–49 age gp.
  56. 65. Exercise-I <ul><li>In a PHC with a population of 28000,the age wise break up of women population in reproductive age group and the live births in these age groups are given below . </li></ul>Calculate: 1.Age specific fertility rates 2.General fertility rate 3.Crude birth rate Age (yr) Women population Live births 15-25 1850 140 25-35 3210 352 35-45 1400 72
  57. 66. Following are the age specific fertility rates among reproductive age group women in 1991 and 2001 in a country. a. Calculate Total Fertility Rate (TFR) for 1991and 2001yr. b. Whether this country has achieved replacement level fertility in the year 2001? Exercise-II Age group (years) ASFR (1991) ASFR (2001) 15-19 70.1 58.2 20-24 220.0 188.2 25-29 179.0 165.5 30-34 112.0 98.0 35-39 64.5 52.1 40-44 28.7 18.9 45-49 12.4 6.3
  58. 67. Fertility trends
  59. 70. TFR and CBR in Indian states(2003-04)
  60. 71. <ul><li>universality of marriage </li></ul><ul><li>early marriage </li></ul><ul><li>early puberty </li></ul><ul><li>low standard of living </li></ul><ul><li>low rate of literacy </li></ul><ul><li>additional customs and habits </li></ul><ul><li>absence of family planning habit </li></ul>Reasons for High Birth Rate in India
  61. 72. <ul><li>Absence of natural checks </li></ul><ul><li>Mass control of diseases </li></ul><ul><li>Advance in medical science </li></ul><ul><li>Better health facility </li></ul><ul><li>Impact of national programmes </li></ul><ul><li>6. Improvements in food supply </li></ul><ul><li>7. International aid </li></ul><ul><li>8. Development of social consciousness among masses </li></ul>Reasons for declining Death Rate
  62. 73. Thank you

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