Review Health Transition

and Global Health

Humera wagan
BCON,SMBBMU.
 OBJECTIVES

• Discuss the international health problems including demographic, health, and

epidemiological transitions.
• Discuss the difference between developed and developing countries
population pyramid and double burden of diseases.
• Discuss the important health statistics of Pakistan.
• Compare the different phases of natural history of disease transmission.
• Integrate epidemiological designs in to community health nursing practice.
• Discuss the measures of diseases frequency and disease occurrence.
HEALTH

Health is a state of complete physical, mental, and social well-being and

not merely the absence of disease or infirmity.

(World Health Organization)

HEALTH TRANSITION

Health transition refers to change, alteration, evolution, progress and

modification in health.
(World Health Organization)
 GLOBAL HEALTH
• Worldwide the condition of health.

• Community health professionals (nurses, doctors, other allied health

personals) throughout the world base their practice on the concepts of
partnership, collaboration, and empowerment.

• To gather with others in their communities the commit themselves to the

attainment health for all.
 Demography
• The statistical study of population.
• Age
• Sex
• The study of populations, especially with reference to size and density,
fertility, mortality, growth, age distribution, migration, and VITAL
STATISTICS, and the interaction of all these with social and economic
conditions.
 DEMOGRAPHIC TRANSITION
“Demographic transition refers to a population that begins with a fall in
death rate, continues with a phase of rapid population growth and
concludes with a decline in birth rate”.

“Demographic transition is the transition from high birth and death

rates to lower birth and death rates as a country or region develops from
a pre-industrial to an industrialized economic system”.
 DEMOGRAPHIC TRANSITION

• The transition from high to low fertility and from high mortality to
low mortality( rates)
• The entire concept is more directly related to
• Female literacy and
• Status of women
• Socio-economic development.
 Stages of Demographic transition and trap

Birth rate
R
a
t
e Death rate
s

Stage 1 Stage 2 Stage 3 Stage 4

High mortality Towards low Low Low
High fertility mortality mortality mortality
High fertility towards Low fertility
low fertility 9
 Stages of Demographic Transition

Stage 1 Birth rate very high

Death rate very high
Population remain low and stable
Stage 2 Birth rate very high
Death rate falling rapidly
Population begins to grow rapidly
Stage 3 Birth rate falling rapidly
Death rate falling more slowly
Population growth is more rapid
 Stages of Demographic Transition

Stage 4 Birth rate –falling more slowly

Death rate slight fall
Population growth stabilizes
Stage 5 Birth rate slight fall
Death rate stable
Population there is negative increase
 DEMOGRAPHIC TRANSITION
Demographic transition refers to a change in birth and death rates.

As countries develop, they move through various stages of demographic

transition:
• almost slow moving rates (high birth and death rates);
• to rapid growth (high birth rates, low death rates) and then,
• to a stable low growth rate when both births and deaths are low.
 EPIDEMIOLOGICAL TRANSITION
The epidemiologic transition describes changing patterns of
population distribution in relation to changing patterns of mortality,
fertility, life expectancy, and leading causes of death.
HEALTH PROBLEMS OF THE TWO PHASES
OF EPIDEMIOLOGICAL TRANSITION
AGE PRE- POST-
CATEGORY TRANSITION TRANSITION

CHILDREN Diarrheoa Congenital defects

Acute Growth failure
respiratory Injury
Infections AIDS
Intestinal Environmental
Helminths risk
Micronutrient
Deficiency
Malnutrition
Malaria
HEALTH PROBLEMS OF THE TWO
PHASES OF EPIDEMIOLOGICAL
TRANSITION
AGE PRE- POST-
CATEGORY TRANSITION TRANSITION

ADULTS Tuberculosis Neurological/Psyc

Malaria hiatric illness
Sexually Cardiovascular
transmitted diseases
Diseases Cancer
Parasites Injury
Injury Eye/ear
Maternity- impairment
related problems Metabolic
disorders
Substance abuse
Environmental
risks
 HEALTH TRANSITION
• Demographic and epidemiologic changes that have occurred in the past
five decades in many developing countries provide new opportunities for
internists from developed countries to contribute to improvements in
international health.
• These changes, called the “health transition”, are characterized by major
growth in the number and proportion of middle-aged and elderly persons
and in the frequency of the chronic diseases that occur in these age
groups.
• The health transition is the result of concentrated national and
international efforts to improve maternal and child health by emphasizing
primary care and community-organized outreach services.
 HEALTH TRANSITION
In many developing countries, such efforts have been responsible for a:
• decrease in the birth rate;
• reduced maternal mortality;
• improved preventive services;
• and a vigorous therapeutic approach to infantile diarrhea and respiratory
infection, which, in turn, have resulted in the reduced infant mortality and
the increased life expectancy that defines the health transition.
 DEVELOPED AND DEVELOPING
COUNTRIES POPULATION PYRAMID
 DOUBLE BURDEN OF DISEASES
Worldwide, developed and developing countries are facing the double burden
of communicable
However, developing countries are more exposed and more vulnerable due to a
multitude of factors, including geographic, demographic and socio-economic
factors.
Beyond the high mortality and morbidity rates caused by communicable and/or
non-communicable diseases in developing countries, the global burden
includes economic losses due to care for diseases and disabilities but also as a
lack of productivity.
More generally, communicable and non-communicable diseases are impeding
human development in developing countries by their negative impact on
education, income and life expectancy and other health indicators.
This figure shows that developing countries are exposed to the double
burden of communicable and non-communicable diseases
 IMPORTANCE OF HEALTH STATISTICS
Health statistics are used to understand risk factors for communities,
track and monitor diseases, see the impact of policy changes, and
assess the quality and safety of health care.

Health statistics are a form of evidence, or facts that can support a

conclusion.
HEALTH SITUATION IN PAKISTAN
Pakistan ranks 154th among 195 countries in terms of quality and
accessibility of healthcare, according to a Lancet study

Pakistan's Infant Mortality Rate (IMR) has declined from 62.1

deaths per 1,000 live births in 2015 to 55.7 in 2019, while Neonatal
Mortality Rate declined from 45.2 deaths per 1,000 live births in 2015
to 41.2 in 2019.
 HEALTH SITUATION IN PAKISTAN
• About 39% of the population suffers from multi-dimensional poverty
• Maternal Mortality Rate Index (MMRI), in 2015, Pakistan ranked at
149 out of 179 countries
• Approximately 20% of children aged 6 to 16 years do not have access
to school
• Pakistan ranks at the top 9th position with the lowest access to safe
drinking water and only 20% of the whole population of Pakistan has
access to clean drinking water
• Most people in Pakistan use solid fuels such as wood, charcoal, crop
waste, and dung for cooking practices and only 22% of the population
has access to natural gas as a clean cooking fuel
(Ref:15,16,17,18,19,20,21)
Natural history of disease
• Knowledge of the natural history of disease ranks alongside causal
understanding in importance for disease prevention and control.
• Natural history of disease is one of the major elements of descriptive
epidemiology
 CLINICAL
DISEASE DEATH
____________

SEVERE DISEASE
_________________________

SUB-CLINICAL MILD ILLNESS

DISEASE _____________________________________

INFECTION WITHOUT CLINICAL ILLNESS

_________________________________________________

EXPOSURE WITHOUT INFECTION

AGENT HOST

ENVIRONMENT
 Epidemiological Tetrad
• Agent
Causative factors
• Host

• Environment
Time
• Time
Group or Environment
Population and their Behavior and culture
Characteristics Physiological factors
Ecological elements