First to distinguish between senescent and non-senescent mortality

Senescent mortality is the result of biological aging; reflects the types of death that generally increase with age; it can be postponed through medical interventions and lifestyle adjustments, but it cannot be avoided

Non-senescent mortality is unrelated to aging; involves things like accidents and many infections; also called background mortality

Introduces handwashing after seeing birth by med students coming from working on corpses leading to much higher maternal deaths than midwives.

40+ years to catch on.

Deccline in death due to communicable diseases

Decline in TB, Typhus, Scarlett Fever, Small pox (and small decline in cholera)

First to write about the Epidemilogical Transition

3 stages –

1. Age of pestilence and famine

2.       2. Age of receeding pandemics – most benefits to women and children

3.       3. Age of man-made disease.

aka.

 1. "age of pestilence and famine", during which mortality is high and fluctuating, with an average life expectancy under 30 years;

2. "age of receding pandemics",
during with life expectancy rises considerably, from under 30 to over 50;

3. "age of degenerative and man-made diseases", during which the pace of the mortality decrease
slackens, while the disappearance of infectious diseases increases the visibility of
degenerative diseases, while man-made diseases become more and more frequent.

Characteristics of epidemiological transition

1. high mortality

2. mortality declines associated with modernization

3. first benefits by women and children

4. infectious diseases gradually replaced by man made ones

5. three different trajectories of modernization

Adds "age of receding degenerative diseases" to Omran's 3 stages of epidemilogical transition as a result of "cardiovasular revolution"

estimates max average LE at 85.

 “Epidemiological transitions in human history.” In Health and Mortality Issues of Global Concern. Proceedings of the Symposium on Health and Mortality. Pp. 54-71.

- Epidemiological Transition: long-term change in the overall distribution of diseases, injuries, and their risk factors

5 epidemiological transitions

1. External injuries to infectious diseases

- External injuries were the most common cause of death in hunter-gatherer societies

- Infectious diseases common among agricultural societies

- Some characteristics of farming societies that made it easier for pathogens to infect more people include greater population size of communities, higher population density, longer periods of residence at the same location, storage of foods, domestication of animals, and extended contact with other communities

- Also important are the rise of urbanization and decreased dietary diversity

- Common infectious diseases included tuberculosis, smallpox, cholera, etc.

2. Infectious diseases to degenerative diseases

- 2 phases of this transition

- First, crisis mortality due to epidemics reduced

- Second, mortality declines even in normal mortality years

- Many reasons for the decline in infectious diseases, such as improved nutrition, public health, and personal hygiene

- Increased proportion of deaths due to degenerative diseases occurred in the mid-1900s

- Common degenerative diseases include heart disease, stroke, cancers, diabetes, chronic liver disease, and chronic kidney disease

3. Decline of cardiovascular disease mortality

- This shift primarily affected old-age mortality, whereas previous shift contributed to gains in life expectancy by primarily reducing mortality at young and middle ages

- In some countries the periods of the second and third transitions are very distinguishable and in other countries they’re not

4. Decline of cancer mortality

- Expected to occur in the future

- Deaths due to some types of cancer (ex: lung cancer) have been declining in recent years, but whether this is the beginning of a long-term decline remains to be seen

5. Slowing of senescence

- Expected to occur in the future

- Senescence refers to a state of non-specific vulnerability; essentially old-age frailty

- 3 factors that may lead to delays in senescence are

1. maintain a healthier life style,

2. increased use of medical technologies, and

3. gerontological research on the fundamental biological mechanisms of senescence

- Demographic patterns associated with epidemiological transitions

- Drastic increase in life expectancy occurred between the 2^nd and 3^rd transitions

- In the early stages of the 2^nd transition mortality reduction was large for infants and young children, in the later stages of the 2^nd transition mortality decreased at reproductive ages (due to decrease TB), and in the 3^rd transition mortality decline was mainly seen among the elderly

- Sex differentials in life expectancy are relatively recent, and seem to have occurred due to unhealthier lifestyles among men

 - 5 reverse transitions (periods of increased mortality)

          1. Early stages of the industrial revolution

             - Industrialization -> urban poor -> diseases such as TB

          2. Unhealthy lifestyles among wealthy

              - High-fat diets, smoking, drinking, sedentary

          3. Re-emergence of infectious diseases

              - Reasons for this include

1) the emergence of new drug-resistant strains of old diseases,

2) technological advances that have allowed for increased global contact à faster spread,

3) only rapidly diffusing diseases can be deadly and continue to evolve at the same time, and

4) ecological advancement à contact with new diseases

           4. Pollution

               - Likely to increase mortality in the future

           5. Social alienation

               - Likely to increase mortality in the future

- Alienation may lead to mortality due to

1) lack of self-control and long-term plans increasing homicides, suicides, and accidents,

2) low concerns about health care,

3) unhealthy life styles during pregnancy and inadequate care of young kids, and

4) reduction of positive health effects stemming from positive attitudes

“The uneven tides of the health transition.” Social Science and Medicine, 55, 313-322.

- Uses the Global Burden of disease data to compare mortality patterns of the 20% of the world population living in the poorest countries, provinces, and states and the 20% of the world’s population living in the richest countries

- Find that poorest populations experience higher mortality in each of the three main groups of mortality, but that the excess mortality of the poorest populations is mostly due to their higher incidence of communicable diseases (77% of excess deaths)

- These diseases only account for 34.2% of deaths in the world but still dominate mortality among the poorest 20% of the world’s population (58.6% of deaths)

- Although developing countries have, to a certain extent, undergone an epidemiological transition, poorest populations still suffer from Group I diseases (in a sense they have been left behind by the epidemiological transition)

- This is partially due to the young age structure of poorer populations, but finding persists even with age standardization

- Most likely this trend has only gotten worse with the increase of AIDS

“The hidden penalties of gender inequality: Fetal origins of ill-health.” Economics and Human Biology, (1), 105-121.

Missing Women

- Main argument is that gender inequality harms the health of the entire population

- Overlapping health transitions in the developing world describe a regime in which both communicable diseases and chronic diseases are prevalent simultaneously

- Communicable diseases tend to affect children in poorer segments of the population whereas chronic diseases tend to affect adults in relatively better-off segments of the population

- Authors argue that both of these patterns are exacerbated by the common factor of maternal deprivation operating via fetal deprivation

- In Southeast Asia, mortality rates of women much higher than men

- Estimate 37 million “missing women” in India alone (women that would be alive if it were not for gender inequality)

- 100 million missing women worldwide

- Systematic biases against women -> higher mortality rates among women and averting of women that would have been born

- Authors suggest that gender bias -> maternal undernutrition -> low birthweight -> both child malnutrition and adult poor health

Two types of pathways link low birthweight to adult ill health

- Low birth weight babies may suffer from malnutrition and growth retardation in childhood and typically grow up to be adults of short stature and low BMI

- Barker Hypothesis: Low birthweight infants have bodies and organs that expect to be in a nutrient-poor environment for the rest of their lives

- Babies born with a low birthweight may be better-off in a nutrient poor environment than babies born at normal birthweight because their bodies adapted in the womb

- Babies born with a low birthweight that grow up in a normal or nutrient-rich environment may have more health problems than if they had grown up in a nutrient poor environment because they are more likely to suffer from hypertension, type II diabetes, cardiovascular disease, lung disease, and renal damage

- This hypothesis is supported by the fact that Indian adults have the highest rates of diabetes in the world

- In sum, gender inequality essentially leads to a double jeopardy—simultaneously aggravating both regimes of communicable and chronic diseases and raising the economic cost of the overlapping health transition

- Policies aimed at reducing gender inequality might be the most effective means of preventing these health problems

  “Measuring the global burden of disease and epidemiological transitions: 2002-2030. Annals of Tropical Medicine and Parasitology, 100(5), 481-499.

- The aim of the Global Burden of Disease Study was to assess global patterns of disease burden and recommend interventions

- This articles utilizes a measure called the Disability Adjusted Life Year (DALY)

- Composed of years of life lost due to premature death and years of life lived with disability

Diseases classified into 3 groups

   - Group I: Communicable diseases

   - Group II: Non-communicable diseases

   - Group III: Injuries

- Find that globally ½ of deaths among 15-59 year olds in 2002 due to Group II and 1/3 due to Group I

- If HIV is removed, only 1/5 of death due to Group I

- Group I deaths predominate in low and middle income countries (esp. in Africa)

- Ten leading causes of disease differ in low/middle income countries versus high income countries

- 3 main causes of death globally are cardiac diseases, stroke, and respiratory diseases

- In high income countries, depression, heart disease, and cardiovascular disease are the three main causes of loss of productive life years

- In low/middle income countries, perinatal conditions, respiratory infections, and AIDS are the three main causes of loss of productive life years

- These diseases rank much higher in terms of years of life lost than the leading causes in high income countries

- People in developing countries not only have lower life expectancies, but they also live a larger proportion of their lives in poor health

Small number of risk factors account for a large percentage of mortality and disease burden

These include poor nutrition, unsafe sex, smoking, and alcohol use

- Policies and programs that target these risk factors could reduce multiple causes of poor health

- Over the next 30 years, authors predict decrease in overall Group I diseases, except for HIV/AIDS

Also predict increase number of deaths caused by Group II and III diseases

Smoking, BMI, and mortality

BMI

Increase mortality @ BMI 15 or less.

Mortality declines until BMI = 20

relatively stable until BMI = 35

then mortality increases againg (but never as high as the very underweight)

HR of death is higher at underweight and class 2/3 obese compared to normal weight, overweight, obese.

No difference in HR between normal weight, overweight and class 1 obese.

Smoking accounts for a many fold percent increase in death than obest cat 2/3

The greatest change in projected LE would be if everyone were non-smokers and had normal BMI.

However the smoking rates declining would lead to more LE than constant BMI.