Academic journal article Bulletin of the World Health Organization

The Milbank Memorial Fund Quarterly

Academic journal article Bulletin of the World Health Organization

The Milbank Memorial Fund Quarterly

Article excerpt

1971, 49(4): 509-538.

THE EPIDEMIOLOGIC TRANSITION A Theory of the Epidemiology of Population Change

Although demography continues to be the most prominent discipline concerned with population dynamics, involvement of other disciplines is highly desirable. The case for a multi-disciplinary approach to population theory has been aptly stated by Kurt Mayer: "Any meaningful interpretation of the cause and effects of population changes must ... extend beyond formal statistical measurement of the components of change, i.e. fertility, mortality and migration, and draw on the theoretical framework of several other disciplines for assistance."[1] ...

A theory of epidemiologic transition, sensitive to the formulations of population theorists who have stressed the demographic, biologic, sociologic, economic and psychologic ramifications of transitional processes, was conceived by this author less than four years ago. Recognition of the limitations of demographic transition theory and of the need for comprehensive approaches to population dynamics stimulated the development of this theory.[2]

FOCUS OF THE THEORY OF EPIDEMIOLOGIC TRANSITION

Conceptually, the theory of epidemiologic transition focuses on the complex change in patterns of health and disease and on the interactions between these patterns and their demographic, economic and sociologic determinants and consequences. An epidemiologic transition has paralleled the demographic and technologic transitions in the now developed countries of the world and is still underway in less-developed societies. Ample evidence may be cited to document this transition in which degenerative and man-made diseases displace pandemics of infection as the primary causes of morbidity and mortality.

The major precepts of the theory of epidemiologic transition are presented below. Smoothed data from the United Nations Model Life Tables,(3) representing a "pooled" cross-cultural view of mortality patterns at various life expectancy levels, provides a useful introduction to the basic propositions.(*) The longitudinal view added by historical and contemporary data from several countries provides further documentation; data from individual countries also serve to illustrate some of the peculiar variations of the transition and to support three models that differentiate distinctive patterns of the epidemiologic transition. These models are the Classical or Western Model, as represented here by England and Wales and Sweden; the Accelerated Transition Model, as represented by Japan; and the Contemporary or Delayed Model as represented by Chile and Ceylon....

MORTALITY AND POPULATION DYNAMICS

Proposition One: The theory of epidemiologic transition begins with the major premise that mortality is a fundamental factor in population dynamics. The clearest indication of mortality's dominant role in population dynamics is implicit in theories of population cycles. The cyclic rises and falls in population size that have been observed in animal and pre-modern human populations reflect sequential phases of population growth and decline; disregarding the possible selective influences of migration, these cyclic movements must ultimately be accounted for in terms of the range of variation in fertility and mortality....

No secular downward trend in mortality is apparent in any country before the middle of the eighteenth century, about the same time that population growth began to demonstrate an exponential curve. The initial period of sustained population growth in nearly every country for which reliable data are available corresponds with at least two decisive changes in the death rate. First the fluctuations in mortality became less frequent and less drastic. Second, the initial, slow--sometimes imperceptible--decline in mortality gradually gained momentum and eventually stabilized at relatively low levels in the twentieth century. …

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