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EPIDEMIOLOGICAL TRANSITION Shiv Chandra Mathur Director

EPIDEMIOLOGICAL TRANSITION Shiv Chandra Mathur Director State Institute of Health and Family Welfare, Rajasthan, Jaipur, India. 3.4.05 Shiv Chandra Mathur. Health Transition in Sweden. Year Life Expectancy IMR 1780 37 187

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EPIDEMIOLOGICAL TRANSITION Shiv Chandra Mathur Director

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  1. EPIDEMIOLOGICAL TRANSITION Shiv Chandra Mathur Director State Institute of Health and Family Welfare, Rajasthan, Jaipur, India 3.4.05 Shiv Chandra Mathur

  2. Health Transition in Sweden Year Life ExpectancyIMR 1780 37187 190053 100 19356536 199679 4 Shiv Chandra Mathur

  3. EPIDEMIOLOGIC TRANSITION HEALTH TRANSITION DEMOGRAPHIC TRANSITION LIFESTYLE TRANSITION HEALTH-CARE TRANSITION ECOLOGICAL TRANSITION 3.4.05 Shiv Chandra Mathur

  4. The epidemiological transition dynamics STAGE: 1 2. Overlap of stages 3. Overlap of stages 4. Merging with… 5. Future Stages… Pestilence and Receding Degenerative, stress, Declining CVD Aspired quality of famine pandemics and man-made mortality, ageing & life with persistent diseases emerging diseases inequalities Determinants of disease and mortality charge Health transition Changing patterns of : O Health Survival Disease, and Mortality Continued dynamic Change with chronicity plus Emerging diseases Accroding to transition model: Decline in CVDs: actual (West) Of potential in non-western models QUALITY OF LIFE FOR ALL Fertility High then declines Age structure, Young then older. DEMOGRAPHIC TRANSITION & AGENING Determinants of fertility decline Environmental factors Technical transition Lifestyle and education transition Health Care transition Flow of the Transition can be disrupted or reversed under crises or  The Transition may accelerate under strikingly favorable conditions

  5. DETERMINANTS OF MORTALITY DECLINE Improvement in Nutrition <infectious diseases/ advances in agriculture Improvement in Personal cleanliness Washing hands/ cloths Ecological Recession of Diseases Plague/ Scarlet Fever Better Housing Ventilation/ waster disposal Reduction in reproductive risks 3.4.05 Shiv Chandra Mathur

  6. Will Infectious Diseases EverBe Extinguished? REGRETS! New Viruses/ mutation of old viruses. Encroachment on Jungles – new wild viruses. Obstinate resistance to existing drugs. Continuous threat to immunity compromised. the aged; Chronically ill; Prematurely born; malnourished; hospitalized; disadvantaged; high risk group . 3.4.05 Shiv Chandra Mathur

  7. DISEASES CAUSING MICROBES 1973 Rotavirus Infantile Diarrhea 1977 EBOLA Haemorrhagic fever 1980 HTLV – 1 Leukemia 1983 HIV AIDS 1983 Helicobacter pylori Peptic Ulcer 3.4.05 Shiv Chandra Mathur

  8. DISEASE CAUSING MICROBES 1988 Hepatitis E epidemic hepatitis 1989 Hepatitis C chr liver infection 1993 SIN NOMBRE Virus ARDS 1995 HHV – 8 associated with kaposi’s Sarcoma in HIV/AIDS 3.4.05 Shiv Chandra Mathur

  9. PERCEIVED CHALLANGES TO HEALTHIndirect ISSUES 1950 2000 Trade/ Markets Colonial networks Liberalized/ Global Transport Ship, rail Air and Car Population Growth Ageing, Refugees Displaced Communications Radio TV-electronics Approach to UN- growth of civil international end of period Society Groups Cooperation of global conflict 3.4.05 3.4.05 Shiv Chandra Mathur

  10. PERCEIVED CHALLANGES TO HEALTH ISSUES IN 1950 2000 HEALTH CARE Predominant diseases pattern Communicable Non-communicable INTERVENTIONS DrugsPromising and inexpensive Resistance TechnologyLimited Sophisticated 3.4.05 Shiv Chandra Mathur

  11. GLOBAL HEALTH COOPERATION I TRADITIONALIST VIEW health development II ESSENTIALIST VIEW Trans-border disease control co-ordination of global system III SOCIAL JUSTICE VIEW reintegrate health policies with development strategies 3.4.05 Shiv Chandra Mathur

  12. 4 invisible PERILS in the Future of Mankind VIRUSES mutation change in virulence ATOMIC ENERGY GENOME RESEARCH POPULATION GROWTH 3.4.05 Shiv Chandra Mathur

  13. Transition Stages in the developing Countries < 20th/Early 20th Century 1940-1960/70 1960/70-2050+ TRIPLE HEALTH BURDEN Unfinished old set Communicable disease Reproductive morbidity Nutritional deficiency Rapid population growth Rapid change since mid 20th Century • Old set of morbidity • Communicable disease • * epidemics • * endemic • Reproductive morbidity and mortality • Nutritional deficiency • Poor sanitation and housing • Poor personal hygiene • High child mortality • High disability Adjusted Life years Lost (DALYS) due to early death • Poverty Rising new set Cardiovascular disease Malignancy and diabetes Stress (depression) Ageing and diseases of the elderly Accidents (graffic, work) Emerging and resurgent diseases Transition Lagging health care Health systems and medical training ill-suited for the rising chronic and continuing acute diseases plus long-term care for the aged, the disabled and the mentally ill. Recession of epidemics Preventable disease burden LE 30 30-45 45-70 + 3.4.05 Shiv Chandra Mathur

  14. WORLD HEALTH Core functions Positive Established market Economies Industrialized Countries in transition Advanced developing Countries Other developing Countries Countries in crisis Supportive functions Development continuum Negative Importance of care and supportive functions according to economic circumstances 3.4.05 Shiv Chandra Mathur

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