Does the Recent Evolution of Canadian Mortality Agree with the Epidemiologic Transition Theory?

By Lussier, Marie-Hélène; Bourbeau, Robert et al. | Demographic Research, January-June 2008 | Go to article overview

Does the Recent Evolution of Canadian Mortality Agree with the Epidemiologic Transition Theory?


Lussier, Marie-Hélène, Bourbeau, Robert, Choinière, Robert, Demographic Research


Abstract

After studying the epidemiologic transition's situation in Canada, it is determined that the delimitation of temporal stages within the epidemiologic transition as put forward by Omran (1971, 1998), Olshansky and Ault (1986), Rogers and Hackenberg (1987) and Olshansky et al. (1998) does not suit the Canadian evolution. Many of the researchers' postulates on the epidemiologic transition were not confirmed, which leads us to assert that, since 1958, the epidemiologic transition in Canada is best described as an evolution process rather than specific stages confined within time limits.

1. Introduction

The last century has been the witness to numerous changes in population evolution, including an important decline in fertility, paired with a regression of mortality due in part to the changing nature of causes of death. The study of the theory of the epidemiologic transition has allowed better insight of the processes behind the evolution of mortality and causes of death in developed countries. However, this theory of the epidemiologic transition has also been a controversial issue among researchers in the last few decades. The object of this analysis is to study the evolution of the late stages of the epidemiologic transition in Canada, and to determine where Canada stands among the theoretical stages of the epidemiologic transition suggested by various researchers.

1.1 Social context in Canada

Various socio-economic indicators like the Gross Domestic Product (GDP) and human development index rank Canada as one of the wealthiest and most developed nations in the world. Canada has also one of the highest life expectancies at 80.2 years old for combined sexes in 2004, which is 2.4 years higher than the United States'. Canada has a publicly funded health care system where the government contributes 70% of total health care costs. As a comparison, public funds cover 45% of health care expenses in the United States (OECD 2007). Moreover, immigrants make up a significant portion of the population as 19.8% of Canadian residents are foreign-born, which is over 7% higher than the official figure for the United States (Chui, Tran, and Maheux 2006). The large immigrant population bolsters Canada's health indicators because immigrants are admitted into Canada upon their health status. This is typically referred to as the "healthy immigrant effect".

1.2 The epidemiologic transition theory: Variants on the number of stages and their characteristics

In 1971, following the incomparable decline of mortality in developed countries, Omran put forward a theory describing for the first time the decrease of infectious diseases, gradually replaced by chronic diseases. It was labelled the "epidemiologic transition" and was initially comprised of three phases spread throughout the last few centuries describing this shift between the main causes of death. According to Omran, the first phase, called the "age of pestilence and famine" lasted until the middle of the 19th century and was characterized by high and fluctuating mortality due mostly to infectious diseases. The second phase (the "age of receding pandemics") ended in the middle of the 20th century for most developed countries and is distinguished by the onset of the shift from infectious to chronic diseases, and the increase of life expectancy. The third phase, identified as the "age of degenerative diseases", is characterized by the predominance of chronic diseases and the stabilization of mortality at a low level.

In the mid-1980s, a fourth stage of the epidemiologic transition was suggested when researchers found that, contrary to what Omran had predicted, the decline of mortality never stopped (Olshansky and Ault 1986; Rogers and Hackenberg 1987). Subsequently, other researchers put forward variants or additions to the third stage of Omran and to the fourth stage of Olshansky and Ault (Olshansky et al. 1998; Omran 1998; Robine 2001; Meslé and Vallin 2002). …

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