This lecture discusses how population dynamics and cultural changes impact human health and disease. It covers topics like fertility rates, mortality rates, population growth rates, developmental transitions, and the epidemiologic transition from infectious to chronic diseases as countries develop. Social epidemiology is introduced as the study of social and behavioral determinants of health. Variables like socioeconomic status, behaviors, culture, and environment are described as having distal, intermediate, or proximate impacts on health outcomes.

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Week 2 Lecture
Instructor: Gina Crosley-Corcoran, MPH
PBH 715 – Introduction to Social &
Behavioral Sciences

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Historical Perspectives on
Population & Disease

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Introduction
 In this section we will focus on the impact of
population and cultural change on human health and
disease.
 We will discuss
 Population dynamics
 Developmental transitions
 Disease and cultural evolution
 Evolutionary medicine

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Population Dynamics
 Utilizes demographics to explore and identify
populations and their characteristics
 Demographics are particularly important for public
health as these statistics help to define populations
based upon selected characteristics
 Three primary indicators for public health
 Fertility
 Mortality
 Population growth rate

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Population Dynamics
 Fertility
 Rate of childbearing
 May be measured on a “per woman” basis or as a rate pe 1,000
women
 Mortality
 Death rate
 May be measured as a crude rate (deaths per year per 1,000
population) but typically examined based upon age groups or
life stages (like infant mortality)
 Population growth rate
 Speed at which a population increases or decreases in size
 Issues of rapid growth, rapid decline, and maldistribution can
result in significant public health consequences

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Current “Population” Challenges and
Solutions
 Population growth rate at the time of book publication was
roughly 1.3% (Coreil, 2010, p. 27).
 In 2021, US Census data reports the slowest population growth
since the founding of the United States
(https://www.census.gov/library/stories/2021/12/us-
population-grew-in-2021-slowest-rate-since-founding-of-the-
nation.html)
 Concerns raised over carrying capacity have led to discussions
surrounding population approaches
 Use genetic engineering technology and crop treatments to increase the
amount of food available
 Reduce the number of people and encourage changes in eating patterns
to limit resource utilization
 Change how groups interact politically and economically, improving the
distribution and utilization of available resources

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Population Dynamics
Developmental Transitions Pre-transition Transition Post-transition
Demographic Transition High rates of fertility and
mortality (esp.
infants/children); moderate
population growth
Decreasing death rates due
to improved living
conditions; high fertility;
rapid population growth
Fertility decreases as
mortality falls; low
population growth rates
Epidemiologic Transition High rates of infectious
disease and poor nutrition;
increased infant/child
mortality
Decreasing incidence of
infectious disease and
improving nutrition lead to
reduced infant/child
mortality; chronic disease
becomes more common
As life expectancy
increases, injury and
chronic disease become
major causes of death and
disability
Health Transition Few chronic health
conditions; hardships and
lack of medical care lead to
lower life expectancy
Settled populations led to
issues with sanitation and
infectious disease;
increased purchasing of
foods rather than growing
it themselves; increased
population growth
Improved sanitation,
disease prevention,
medical care reduced
mortality; increased life
expectancy; chronic
disease, injury,
environmental issues
prevalent

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Social Epidemiology

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Social Epidemiology
 In this section we discuss the importance and application
of social epidemiology in public health
 The fields of social, behavioral, and cultural epidemiology
are intended to
 Identify correlates
 Develop hypotheses
 Uncover causal mechanisms
 Design interventions
 All with an eye toward the social, behavioral, and ultural
aspects of human health rather than a more strictly
biological/physiological approach of traditional
epidemiology

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Social Epidemiology
 Study of the causes, distribution, and control of
diseases within and between populations
 Study of social and behavioral determinants of
disease incidence and prevalence
 Important terms
 Incidence: Number of new cases occurring in a given
population over a specified time period
 Prevalence: Number of cases present in a given population at
a specified point in time

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Behavioral & Cultural Epidemiology
 Behavioral Epidemiology
 Study of the behavioral or lifestyle factors affecting disease
causes, distribution, and control
 Realize that behaviors are not randomly distributed in the
population
 Cultural Epidemiology
 Study of cultural factors affecting disease causes,
distribution, and control
• Religion
• Cultural models of illness
• Cultural values regarding health and illness

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Variables
Dependent (Outcome)
• Mortality
• Morbidity
• Incidence
• Prevalence
• Life Expectancy
• Health status
Independent (Etiologic)
• Social Environmental
• Family structure
• neighborhood
• Racism
• Behavioral/Lifestyle
• Diet
• substance use/abuse
• exercise
• seat belt use
• Cultural
• Religion
• Ethnicity
• models of health and illness
• values and meanings of health and
illness

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Causal Continuum
 Focus on etiology
 How direct is the
effect on health
outcomes?
 Explores three
types of
determinants
Distal
(Upstream)
Intermediate
(Midstream)
Proximate
(Downstream)

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Proximate Determinants
 Have direct effect
 Biology
 Behavior
 Belief
 Attitudes
 Genetics
 Considered easiest to change
 Most common point for intervention
 Examples:
 High blood pressure (biology), Choices of diet, exercise, sleep
(behavior), “I am in control of my health.” (belief),
Optimism/Pessimism (attitudes), BRCA1 mutation (genetics)

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Intermediate Determinants
 Do not have direct influence
 Family organization
 Social support
 Social network ties
 Healthcare accessibility
 Family organization
 Occupation
 Neighborhood or community setting
 May serve as buffers for distal factors
 May operate as intervening variables

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Distal Determinants
Indirect impact on health
•Background or contextual factors
•Impact through other factors
•Considered fundamental or structural causes
•Often difficult to change
Ecological setting
•Urban/rural
Culture
•Ideology, social organization, technology
Demographic features
•Ethnicity
Political-economic organization
•Demographic features
•Political economy
•Social structure
•SES
•Culture

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Week 2 Assignments
Discussion Board
Read Ch 1-10 in Mud Creek
Medicine for Week 3 Live
Discussion