Epidemiologic Transition: Russian examples

1. Epidemiologic Transition:Russian examples Abdel Omran. The Epidemiologic Transition: A Theory of the epidemiology of population change. Milbank Quarterly. 1971;49:509-538 http://www.who.int/docstore/bulletin/pdf/2001/issue2/vol.79no.2.159-170.pdf Faina Linkov, PhD, University of Pittsburgh

2. Questions to be discussed at the end of the lecture • Can Omran’s theory be applied to changing mortality patterns in Russia? • Epidemiologic transition in Russia: did it take place? • Reversal of transition in Russia. How does it relate to Omran’s theory?

4. Epidemiologic transition: Definition The epidemiologic transition is that process by which the pattern of mortality and disease is transformed from one of high mortality among infants and children and episodic famine and epidemic affecting all age groups to one of degenerative and man-made diseases (such as those attributed to smoking) affecting principally the elderly. Encyclopedia Britanica

5. Stages of Epidemiological Transition • Age of Pestilence and Famine • Age of Receding Pandemics • Age of Degenerative and Man-made diseases

6. Age of Pestilence and Famine Characterized by high mortality rates, wide swings in the mortality rate, little population growth and very low life expectancy Traditional society, chronic shortage of food, poor sanitary conditions, high MCH morbidity and mortality, environmental problems, young population

7. Peter I, the first emperor of Russia

8. Age of Receding Pandemics Epidemics become less frequent, infectious diseases in general become less frequent, a slow rise in degenerative diseases begin to appear, improved life expectancy, organized health services, increased proportion of older people

9. Alexander III, the last Russian Emperor to die from natural causes

10. Age of Degenerative and Man-made diseases Chronic diseases, cheap calories, morbidity overshadows mortality, rise in living standards, dramatic decline in fertility, comprehensive healthcare

11. Mickhail Gorbachev, the first and the last President of the USSR

12. Infant Mortality Rate in Russia: 1940-1993

13. Theory criticisms

14. Applications of Omran’s Theory to Russia: Difficulties in Applying the General Rules • Increased morbidity associated with WWI and WWII, famines, and political repressions • Reverse transition in 1990’s • Excess mortality for Russian males

15. Russia’s transition in 1990’s

16. Net Migration and Natural Increase in Russia, 1980–2001

17. Russia: decreasing population

18. The health care principles upon which the Soviet health care system was to be based (Nikolai Semashko): • government responsibility for health • universal access to free services • a preventive approach to “social diseases” • quality professional care • a close relation between science and medical practice • continuity of care between health promotion, treatment and rehabilitation.

19. Next steps following the establishment of the “Semashko” model in 1918 • The health care system was under the centralized control of the state, which financed services by general government revenues as part of national social and economic development plans. • All health care personnel became employees of the centralized state, which paid salaries and provided supplies to all medical institutions. • The main policy orientation throughout this period was to increase numbers of hospital bedsand medical personnel*.

20. Next steps following the establishment of the “Semashko” model in 1918 (cont.) • Russia made massive strides in arresting the spread of infectious diseases. • Drastic epidemic control measures were implemented, particularly in the cases of tuberculosis, typhoid fever, typhus, malaria and cholera. • These involved community prevention approaches, routine check-ups, improvements in urban sanitation and hygiene, quarantines, etc.

21. The period until 1991Life expectancy (both sexes)

22. The period until 1991Life expectancy in 1965

23. A campaign against alcohol • By the 1980s, the gap between Russia and Western countries in life expectancy at birth came to about 10 years for men and 6 years for women, mostly due to high death rates among those of working age (6). In the mid-1980s, the government made an attempt to address this problem (9). It was by then generally understood that potentially avoidable human losses were mostly attributable to excess adult age mortality from particular causes such as injuries, accidental poisoning, suicide, homicide, sudden cardiac death, hypertension and other conditions closely related to alcohol abuse and its consequences.

24. Life expectancy related to Campaign

25. But…. Russia failed to maintain this record, however: by 1987 the USSR was no longer able to enforce the anti-alcohol campaign and death rates rapidly resumed their upward trend from 1988 onwards. The anti-alcohol campaign was largely prohibitive and did not affect the attitude of the majority of Russia’s population towards alcohol.

26. The period after 1991 • The health status of the Russian population declined precipitously following the collapse of the Soviet Union in late 1991. By all accounts, in the last decade Russia has been experiencing a shock unprecedented in peacetime to its health and demographic profiles.

27. Life expectancy in Russia, male

28. Life expectancy in Russia, female

29. The leading causes of death in the Russia Federation • Cardiovascular diseases with rates that are the highest in the European Region • External causes of injury and poisoning • Cancer

30. Causes of the mortality crisis • Major social and economic shock and income stratification in a population already vulnerable because of: • Poor diet, high levels of smoking, and weak systems of social support, in which alcohol and, increasingly, intravenous drugs, are easily available. • Health care system is poorly equipped to respond to challenges.

34. Questions to be discussed at the end of the lecture • Can Omran’s theory be applied to changing mortality patterns in Russia? • Epidemiologic transition in Russia: did it take place? • Reversal of transition in Russia. How does it relate to Omran’s theory?