This document discusses the health transition and epidemiological transition experienced by populations. It begins by defining key terms like demography, epidemiology, and fertility. It then discusses population growth trends globally over history. The main topics covered include the demographic transition characterized by declining mortality and fertility rates, and the epidemiological transition where infectious diseases are replaced by non-communicable diseases as the major causes of death. The engines driving these transitions are described as urbanization, changing demographics, epidemiology, socioeconomics, and advances in healthcare.

1. HEALTH
TRANSITION
DR:RIAZ AHMED MANGI-(MPH)
ASSISTANT PROFESSOR
DEPARTMENT OF COMMUNITY MEDICINE & HEALTH SCIENCES PUMHSW
BY

2. Objectives
 Terms
 Introduction
 Definition of the ‘health transition’
 Population Explosion
 Demographic transition
 Epidemiological transition
 Engines of the health transition
 Urbanization, demographic, epidemiologic, socioeconomic and health care

3. Terms:
Demography: The scientific study of human population or statistics
such as births, deaths, Fertility Marriage, Migration Social mobility
which illustrate the changing structure of human populations OR The
composition of a particular human population.
Epidemiology: Epidemiology is the study of the distribution and
determinants of health-related states or events in specified
populations, and the application of this study to the control of health
problems.”
Fertility: Ability of an individual or couple to reproduce
OR able to conceive.

4. Demography

5. Mesopotamian concepts of disease and healing
•Spirits were blamed.
•Each spirit or god was held responsible for only one disease.
•Specific offerings were made to a particular god or ghost
when it was considered to be a causative factor.

7. Mesopotamian medical practitioners
Asu also accounted
as “physician“.
Specialist in herbal
remedies.
Dealt with empirical
applications of
medication
(washing, bandaging
and making
plasters).

8. Empirical methods of treatment
• Surgery.
• Treating fractures.
• Pharmaceuticals.
• Delivery.
• Empathy and
encouragement.
Medical instruments from
Mesopotamia

9. Pharmaceuticals
More than 250 medicinal
plants (extracts, resins, or
spices).
120 mineral substances
and 180 other drugs were
combined with alcoholic
beverages, fats, honey,
milk in various forms, oils,
wax and parts and
products of animals.

10. • Successful agriculture
provided spare food so
more people were
doctors, priests and
other professionals.
• More trade and
communications – new
herbs and plants were
imported.
• The Egyptians had
writing – ideas could
be recorded and
communicated better
than previously.

11. HIGH DEGREE OF SPECIALIZATION.
“The practice of
medicine is very
specialized among them.
Each physician treats just
one disease. The country
is full of physicians,
some treat the eye, some
the teeth, some of what
belongs to the abdomen,
and others internal
diseases.” Herodotus,
Histories 2,84

12. NATURAL BELIEFS AND
TREATMENT

13. Diagnosis
The Chinese methods of
diagnosis included :
•questioning,
•feeling the pulse,
• observing the voice and
body,
•and in some
circumstances touching
the affected parts.

14. Health transition
The period of mortality decline which
accompanies the demographic transition.
It is characterized by improved health, nutrition
and organization of health services and a
change in the causes of death, with mortality
from infectious diseases progressively being
replaced by mortality from chronic and
degenerative diseases and accidents.

15. Introduction
The general shift from acute infectious and deficiency diseases to
chronic NCD characteristic of modernization and advanced levels of
development is usually referred to as the "epidemiological transition".
The most evident indicators of this transition are changes in the pattern
of mortality, particularly in relation to the cause of death, as well as
changes in morbidity.

16. Introduction
By the beginning of the 21st century, world population reached 6 billion
and current has crossed 8 billion.
 The World Population in 2023 is 8,045,311,447 (at mid-year, according to U.N.
estimates), a 0.88% increase (70,206,291 people) from 2022, when the population was
7,975,105,156, a 0.83% increase (65,810,005 people) from 2021, when the world
population was 7,909,295,151.
Most of the growth has occurred in the past 200 years.


17. Year Population Difference
1804 1 Billion _____________
1930 2 Billion 126 years
1960 3 Billion 30 years
1974 4 Billion 14 years
1987 5 Billion 13 years
2000(Start) 6 Billion 113 years
2023(Current) >8 Billion < 23 years
2037 9 Billion (2037) 14 years
2058 10 Billion 21 years

18.  Median Age
The median age in the World is 30.5 years (2023).
A Total Fertility Rate (TFR) of 2.1 represents the Replacement-Level Fertility: the average
number of children per woman needed for each generation to exactly replace itself without needing
international immigration. A value below 2.1 will cause the native population to decline.
 PREGNANT WOMAN TOTAL FERTILIY RATE (TFR)
 2.3(Live Births per Woman, 2023)

19. Life Expectancy in the World
 BOTH SEXES
 73.4 years(life expectancy at birth, both sexes combined)
 FEMALES
 76.0 years(life expectancy at birth, females)
 MALES
 70.8 years(life expectancy at birth, males)

20. World Urban Population:
Currently, 57.4 % of the population of the World is urban (4,616,769,941 people
in 2023)Urban Population World Urban vs. Rural Population from 1955 to 2020.
Population Density:
The 2023 population density in the World is 54 people per Km2 .

21. World:
INFANT MORTALITY
26.7(infant deaths per 1,000 live births)
DEATHS UNDER AGE 5
36.2(per 1,000 live births)

22. Introduction
 The shifts that have taken place in the patterns and causes of death in many countries:
 Demographic transition
 Epidemiological transition
 Demographic transition: describing the change from high fertility and mortality
rates in less developed societies to low fertility and low mortality rates in 'modern'
societies.
 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

23. Epidemiological transition
Epidemiological transition: the changes in mortality
and morbidity patterns (from infectious to chronic
diseases) .
It was thought to be a unidirectional process,
beginning when infectious diseases were predominant
and ending when NCD dominated the causes of death.


24. Epidemiological transition
 This transition is more complex and dynamic.
The health and disease patterns of a society evolve in diverse ways as a result of
 demographic,
socioeconomic,
technological,
cultural,
 environmental and
biological changes.
It is rather a continuous transformation process, with some diseases disappearing and others appearing or re-
emerging.
This also indicates that such a process is not unidirectional. In fact, a reversal of the trend sometimes
occurs. There are some outstanding examples, such as the emergence of new infectious diseases like
AIDS, and the increase in infections that were previously controlled, such as tuberculosis and dengue
fever.

25. Mechanisms involved in the epidemiological transition
There are several factors involved in the epidemiological transition.
Demographic changes:
Demographic changes are a composite of changes in both mortality and
fertility.
As populations become healthier, a reduction in mortality, particularly of
infants and children, usually occurs, followed later by a fall in fertility rates.
Therefore, more people will survive to adulthood and will have the disease
patterns of adults, with noncommunicable diseases at the top of list.

26. Shows the pattern of the
crude death rate
for the Eastern Mediterranean Region over the
past 25 years. The crude death rate decreased
from 17.4 per 1000 in the early 1970s to 9.1 per
1000 in 1995.

27. Shows the pattern of the IMR
 The pattern of decrease was sharper in the
early part of this period, and the decrease is
now at a much lower rate.

28. Shows the pattern of the
crude Birth rate
 shows that the crude birth rate (as an
indicator of fertility);
 an observation that supports the notion that
the decrease in fertility follows the increase
in mortality, particularly in infants and young
children.

29. Risk factors Involved
1.Biological factors:
It is well known that microorganisms constantly undergo changes that enable
them to cope with an increasingly hostile environment.
Alteration in antigenic identity: The antigenic change of influenza viruses is
well known.
Emergence of drug-resistant strains
Dual infection

30. 2.Environmental factors
There is conclusive evidence that certain changes in the patterns of diseases, in particular a decrease in the
occurrence of communicable diseases such as cholera, are the result of the development of environmental
sanitation, like
Clean water supply,
Sanitary disposal of waste
Proper housing.
On the other hand, environmental factors may increase the incidence of infectious diseases if they offer
opportunities for transmission of etiological agents from the reservoirs of infection to susceptible hosts, for
example by promoting breeding of vectors of diseases or because of overcrowding.

31. 2.Environmental factors
Exposure to environmental pollutants:
The discharge of waste products from industry and many other sources of hazardous waste into the air WHICH
people breathe, the water people drink and the food people eat is behind the increase in some diseases such as
various types of cancer and chronic chest conditions, including asthma and chronic bronchitis.
One of the main growing environmental pollutants is ionizing radiation from medical and occupational contacts
and from commercial and military use of atomic energy.
Unforgettable examples are the atomic bomb explosions at Hiroshima and Nagasaki in Japan during the Second
World War and the explosion of the nuclear reactor at Chernobyl in the former Soviet Union. These have been
responsible for thousands of deaths and very large numbers of cases of cancer.
It is not only industry and wars that are responsible for pollution BUT excessive use of insecticides both in
agriculture and in public health for vector control is another source of significant environmental pollution.
Excessive use of cars, some of which are not well maintained, is well known as a source of air pollution and its
effect on developing lung cancer is well documented.

32. Environmental Pollutants

33. 2.Environmental factors
 Overcrowding:
 Migration from villages to towns due to industrialization and the development of high density urban areas
facilitate the spread of infections, especially of diseases spread by droplets and those related to
atmospheric pollution.
 Social, cultural and behavioral factors:
 The shift from an agricultural to an industrial society and its accompanying process of modernization
produce changes that affect people's health.
 Changes in community relationships:
 Modernization has adversely affected close community ties, which used to provide opportunities to share
sorrow and happiness and to alleviate stress. An evident example of maladjustment due to urbanization is
the traumatic encounter of rural youth with urban values. This frequently has a serious impact on mental
health.
 Changes in lifestyle:

34. Practices of modern medicine
Several changes have occurred in the quantity, distribution, organization and quality
of health services that have contributed to the epidemiological transition.
The discoveries and technological developments of the 20th century, such as the
development of antibiotics and antimicrobial agents, insecticides, vaccines and
diagnostic and therapeutic technologies, have resulted in remarkable progress in the
prevention and control of many diseases and in the effective management of many
others.

35. Mortality related statistics
CRUDE DEATH RATE
EXPECTATION OF LIFE (LIFE
EXPECTENCY)
INFANT MORTALITY RATE
CHILD MORTALITY RATE
UNDER 5 PROPORTIONAL
MORTALITY RATE
MATERNAL MORTALITY RATE
DISEASE SPECIFIC MORTALITY RATE
PROPOTIONAL MORTALITY RATE

36. Morbidity indicators
Incidence rate Prevalence
rate
Disability rate

38. Phase of Primary health care
In 1965 the term basic health services was used by UNICEF/WHO in their joint health
policy.
Primary health care (PHC) became a core policy for the World Health Organization with
the Alma-Ata Declaration in 1978 and the ‘Health-for-All by the Year 2000’ Program.

39. Primary Healthcare unit

40. Curative care Services
Curative care is the kind of health care traditionally oriented towards seeking a cure for an existent disease or a medical condition.
Communicable Diseases Control.
Examples of curative care include:
Antibiotics for bacterial infections
Chemotherapy or radiation therapy for cancer
Cast for a broken bone
Dialysis treatment for kidney failure
Surgery for appendicitis
Acupuncture for certain conditions
Dietary programs for certain conditions

41. Transition of Prevention
 Concepts of preventing infection, malnutrition, and sanitation have existed since
ancient times.
 Roman sanitary engineering and military medicine made pivotal contributions.
Hospital organization and university training for physicians developed during Islamic
and Christian periods.
 The rise of cities, the Renaissance, and rapid changes in agriculture, trade, and
industry all contributed to public health.

42. Era of Vaccination
1400s to 1700s
From at least the 15th century, people in
different parts of the world have attempted
to prevent illness by intentionally exposing
healthy people to smallpox– a practice
known as variolation (after a name for
smallpox, ‘la variole’). Some sources suggest
these practices were taking place as early as
200 BCE.
PREVENTIVE SERVICES

44. Agricultural communities
Agricultural communities developed approximately 10,000
years ago when humans began to domesticate plants and
animals.
 By establishing domesticity, families and larger groups were
able to build communities and transition from a nomadic
hunter-gatherer lifestyle dependent on foraging(searching for
wild food resources) and hunting for survival.

45. Civilization in Ancient
China began along Yellow
river near 5000 years ago.
These people harvested silk
and used it to weave fine
fabrics.
They used a potter’s wheel
to make beautiful pottery.
They baked strong bricks
and used them to build
their homes.
They worked together on
flood-control and irrigation
projects.

46. New social, political, and economic reforms in the eighteenth and
nineteenth centuries, contributing to sanitation, social reform, and
improved nutrition and medical care, led to improved longevity and
quality of life in the twentieth century.
Immunology, social security, health insurance, and health promotion
expanded the scope and effectiveness of global health.
Biomedical and social sciences, technology, and public health
organization are critical as public health faces old and new health
challenges.

47. Urbanization and Its Historical Stages
 By the early 1900s both Great Britain and the United States had become
predominantly urbanized nations; since that time, urbanization has been
occurring around the globe at a rapid rate.
 Today, as many as 50 percent of the world's population lives in urban areas,
compared to only a few percent just 200 years ago.
 Sociologists studying urbanization trends note three distinct historical stages in
the development of cities:
 Preindustrial,
 Industrial, and
 Metropolitan‐megalopolitan stages.