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GEOG 3372 Exam #2 (CH4- CH)

Terms in this set (50)

Chapter 4
The Health and Mortality Transition
Health and Mortality Transition
- Health and death are the two sides of morbidity and mortality.

- Refers to the shift:
From prevailing poor health (high morbidity) and high death rates from infectious diseases occurring especially among the young

To prevailing good health and low death rates from infectious diseases, with most people dying at older ages from degenerative diseases.

- Knows as epidemiology transition in 1977.

- Drop-in mortality is associated with the change in the cause of death (from communicable to non-communicable)
Mortality
Refers to the pattern of death
Morbidity
Refers to the prevalence of disease
History of Health and Mortality Transition
- Early death was commonplace, beginning about 200 years ago, we have been pushing death to older ages.

- The world had an annual increment of 0.25 year during the second half of the 20th century.

- Life expectancies of U.S. of females and males upper 40s in 1900s and upper 70s in 2000s.
Results of Increased Life Expectancy
- The variability by age in mortality is compressed, leading to an increased rectangularization of mortality meaning most people now survive to advanced ages and die pretty quickly.
- The survival of more people to ever older ages is a key contribution to the demographic transition.
Health and Mortality Changes Over Time
- For most of human history: life expectancy fluctuated b/w 20-30 years due to poor nutrition/starvation.
- About 2.3 of babies survived to their first birthday and about 1/2 were still alive at age five. (now it's 99%).
- At the other end of age continuum, around 10% of peple made it to 65 in a premodern society (now it's 90%).
Premodern Mortality Levels- The Roman Era
- Life expectancy: 21 was low due to high mortality among the young, which brought down the life expectancy.
- People who reached adulthood were not too likely to reach a very advanced age, although some did like Tiberius (78)
Death in the Middle Ages
- The plague (Black Death) in the 14th century in Europe spread west to Asia.
- 1/3 of Europe's population perished b/w 1346 - 1350
- Reduced life expectancy and population size.
- Term Quarantine originated during this time.
- Disease still exists but was more fatal then due to poor health and few resources.
The Global Impact of the Columbian Exchange
- Refers to the fact that Columbus and other explorers took diseases, horses, and guns to the Americas and brought back new foods and a few new diseases.

- They had immunity to the diseases they brought, but indigenous populations were devasted due to their lack of their immunity. Explains the ease for Spain's domination in Latin America after arriving around 1500.
Industrial Revolution to the Early 20th Century
- Plague spread by flees.
- Early 19th century: Plague and Little Ice Age receded, and improved housing, income, nutrition, and life expectancy in Europe and U.S. was 40 years.
- Deaths of children under 5 = deaths of adults 65+
Infectious diseases were still dominant reasons for death but their ability to kill was diminishing.
- Initial improvements in mortality declines were slow. (Potato Famine)
- Nutrition, and good sanitation helped improve life expectancy.
Key Elements in Postponing Death in 19th century
- Improved nutrition (first in Western Europe).
- Clean water (John Snow in London)
- Sewerage in cities (sanitation studies in Liverpool)
- Smallpox vaccinations (Edward Jenner)
- Validation of germ theory (Semmelweis, Lister, and Pasteur, and The Bone Garden by Tess Gerristen)
- Importance of handwashing and clean water technology in cities
Key Elements in Postponing Death in 20th and 21st century
- Health as a social movement- leading to gov. organized universal health care systems in all rich countries except the U.S.
- Antibiotics (emerging around WWII) E.g. Penicillin by Alexander Fleming.
- More vaccinations
- Oral rehydration therapy for infants and adults (water, glucose, and salts). E.g. Gatorade
- Advanced diagnoses, drugs, and other treatments for degenerative diseases to keep older people healhier and alive longer.

(Economic development was no longer necessary for countries to get healthier if they incorporated these elements)
Postponing death by preventing and curing disease
1. Prevent diseases from occurring or from spreading when they do occur. No physicians are need. Good nutrition, and sanitation.

2. Curing people of disease when they are sick.
John Snow's Map of Cholera
- 1854
-Known as the Pioneer of Disease Mapping
- 1855: Dot Street Epidemic
- Cholera is spread by contaminated water with fecal matter
- Higher lying areas had lower fatality
- The fatality was different in different areas of London
- The Thames River.
-South and Valux experienced more illnesses.
World War II Was A Global Turning Point
- Large increases in life expectancy
The Nutrition Transition From Hunter-Gatherers to Farmers
- Most of human history: Foragers
- Agriculturalists (10,000 years ago)
- Spurred population growth
- Intro, to infectious diseases (measles from cattle, influenza from poultry)
- Agricultural intensification - higher yields on the same acreage.
Factory farms
The Nutrition Link to Obesity and a Reduction in Good Health
- Used to be poor = skinny and fat = rich but not anymore
- Nutrition transition is a worldwide shift toward a diet high in fat and processed foods and low in fiber and with less exercise, leading to increases in degenerative diseases (counteracts the other positive influences on our health)
- Concides with demographic, morbidity, and mortality transitons.
Nutrition Transition: Stage 1
- 95% of human history
- Hunter-gatherer populations
- Diet low in fat and high in fiber
- High levels o physical activity
- Likely undernourished.
Nutrition Transition: Stage 2
- Sedentary farmers: Limited variety, high in grains, high physical activity

- AKA famine stage
Nutrition Transition: Stage 3
- High in starch
- Low in fat
- Little variety
- Reduction in famine threat
- Urban populations moving into the next phase of the transition.
Nutrition Transition: Stage 4
- Greatest change in diet
- Increased intake of fats, sugar, and salt (processed food, meats, dairy products, caloric beverages)
- Decreased physical activity
- Health effects related to overnutrition (obesity, type II diabetes, heart disease, cancer, etc..)
- Urban populations transition into this stage before rural populations
-E.g. US
Nutrition Transition: Stage 5
- Behavioral change
- Increased consumption of fruits, vegetables, and whole grains
- Decreased consumption of salt, sugar, and fat
- Increased physical activity
- No country at this stage, but individuals within the country are.
Life Span and Longevity
- Biological aging is the gradual and progressive decline in physical capability accompanied by a rise in disease vulnerability.
- Aging is more complex than previously assumed but have not discovered the underlying mechanisms.
Life Span
Is the oldest age to which human beings can survive. 122 year old French woman set the limit. Is almost entirely a biological phenomenon (genetics)
Longevity
Is the age at which we actually die. Currently about 72 years for the average human on he planet. Has biological and social components (more important, like exercise and access to healthcare).
Healthspan
The years of life spent in good health without serious illness, disability or age-related chronic disease
Healthspan and LifeSpspan
Populations with high mortality are those with high morbidity. It's not a one-to-one relation, living to an older age does not mean you're healthy.
Age Differentials in Mortality
The very young and old are the most vulnerable than young adults.
After the first year of life, there's a period of time until middle age (reproductive ages) when risks of death are low.
After middle age, mortality increases but at a decreasing rate.
Infant Mortality Rate
- The number of deaths during the first year of life for every 1,000 live births.
- Causes: Dehydration due to a lack of access to safe water to drink, and sanitation.
- Closely correlated with life expectancy and important health care access indicator.
- Declined after WWII, which was key to population growth
- Low infant mortality rate is found in richer and more developed countries.
Oral Rehydration Therapy (ORT)
- A solution of salt and sugars taken orally that treats diarrhea - a major cause of death in young children.
- Developed in labs and tested in fields, especially in Bangladesh.
- Improving the health of mothers also improves the chances of her infant's survival.
Child Mortality Rate
- The number of deaths of children under age 5 per 1,000 live births per year.
- Causes: Diarrhea.
Mortality by Sex and Gender
- Women (based on biological sex) a lower probability of death at every age from the moment of conception.. unless society intervenes with a lower status for women (based on gender roles) that gives them less food, less access to health care etc.
WHO'S 3 Major Categories of Causes of Poor Health and Death
1. Communicable diseases (infectious or transmissible)
- Bacterial (TB), Viral (Influenza), Protozoan (Malaria), and
Maternal Conditions: Lack of prenatal care, Delivering somewhere besides a hospital, Seeking an unsafe abortion, Prenatal (just before/just after birth) conditions, and nutritional deficiencies.

2. Noncommunicable diseases (degenerative and congenital/present at birth). Esp. Lung cancer due to smoking.

3. Injuries
Top Causes of Death
1. Ischemic heart disease (noncommunicable)
2. Stroke (noncommunicable)
3. Chronic obstructive pulmonary disease (noncommunicable)
4. Lower respiratory infections (communicable)
5. Alzheimer's disease and other dementias (noncommunicable)
The "Real Causes" of Death in Low-Mortality Societies
- Tobacco
- Diet and activity patterns
- Alcohol misuse
- Infectious diseases
- Toxic agents
- Motor vehicles
- Guns
- Sex
- Drugs
Crude Death Rate (CDR)
The total number of deaths in a year divided by the average total population. In general form: d/p*1000
Ages/Sex- Specific Death Rate (nMx or ASDR)
ASDR = ndx/npx *100,000
Measuring Mortality
- Expectation of life at birth, or more generally life expectancy.
- Derived from the life table: description of the mortality and fertility experience of a group of people.
Health and Mortality Inequlaities
- Urban and rural differentials: Urban now better than rural
- Neighborhood inequalities: Slums are bad for your health
- Educational differentials: Better educated live longer
- Social status differentials: The rich live longer
- Race and ethnicity differentials: Being different will be used against you
- Martial status: Marriage is good for your health
Long Term Impact of the Mortality Transition
...
Two Theories of Social Stratification Have Strong Implications for Fertility Behavior
1. Cultural innovation takes place in higher social strata as a result of privilege, education, and resources; lower social strata adopt new preferences through imitation.

2. Rigid social stratification or closure of class or caste inhibits downward cultural mobility and thus inhibits the diffusion of low fertility ideas.
The Education of Women is An Important Part of the Fertility Transition.
As fertility goes down, women have more opportunities to pursue their interests. Yet, as the economy grows, the more expensive it is to raise a child.
The Demographic Link Between The Fertility Transition and Women's Reproductive Health
Increased longevity, less pressure to marry early, greater freedom before marriage, high levels of education, lower fertility, less time spent bearing and rearing children.
Proximate Determinants of Fertility
1. Intercourse variables
- Age starting sex **
- Celibacy
- Abstinence
- Divorce, widow
2. Conception variables
- Involuntary fecundity or infecundity **
- Use or nonuse of contraception **
- Vary in their cost and effectiveness.
3. Gestation variables
- Fetal mortality from voluntary causes (induced abortion). **
- Involuntary (miscarriage)

More Contraception Equals Lower Fertility Among All Countries in the World.
How Do We Measure Fertility
1. Crude Birth Rate: # of live births per year/ 1,000 people alive in the society.

2. Total Fertility Rate: Average # of children a woman will have throughout her childbearing years. In the U.S., it's 1.7. Influences: Waiting later to get a child lowers TFR.

3. Cohort measure - cumulative cohort fertility rate or # of children ever born

4. Fertility intentions: women decide what they want.
Replacement Fertility Rate
Two children per woman and it's the best indicator of women's empowerment in the society.
Migration Transition
IT's the permanent movement of people from one place to another.
Usually in response to resource scarcity, caused by population growth in the area of origin, relative to perceived resources in the destination area.
- Closely related to urban transition
- The migration transition involves: An increase in the proportion of humans who migrate and a shift in the places to which and from they are migrating.
Defining Migration
Permanent change of residence (residential mobility), moving a great enough distance that all activities are transferred from one place to another. Crossed an administrative boundary for 3-12 months (UN says 1 year).

- Internal migrants move within national boundaries (usually without constraint but can be displaced persons). Times 2 1/2 more ppl are internal migrants.
International migrants move between countries (either legally or without documentation). E.g. Refugees.
Migration Has Two Directions
People move into and out of places
Immigrants: Are defined by the area of destination (in-migrant)
Emigrants: Are defined by are of origin (out-migrant)
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