Demography/Global Health &

Health Transition
 Demography
The statistical study of population.(age and sex
distribution)
• Size, density, fertility, mortality, growth, age
distribution, migration, and VITAL STATISTICS,
and the interaction of all these with social and
economic conditions.
 Demographic transition
• Resulting from birth, death and migration in and
out. The transition from high to low fertility and
from high mortality to low mortality( rates)
• Population dynamics due to:
– B= Births
– D= Deaths
– IM= In Migration
– OM= Out Migration:(B – D) and (IM - OM)]
 Crude Birth Rate (CBR)
• Births in country in year.
• Divided Mid-year population
• Times 1000

Births in country x in a year

CBR =   1000
Midyear population

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 Crude Death Rate (CDR)
• Deaths in country in year.
• Divided by mid-year population
• Times 1000

Deaths in country x in a year

CDR =   1000
Midyear population

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 Demographic Transition Model (DTM)
• The seeks to explain the transformation of countries
from having high birth and death rates to low birth and
death rates as countries develops from a pre-industrial
to an industrialized

• In developed countries this transition began in the

eighteenth century and continues today. (Reasons??)

• Less developed countries began the transition later

and are still in the midst of earlier stages of the model.
(Reasons??)
• The model is based on the change in crude birth rate
(CBR) and crude death rate (CDR) over time.

• Expressed /1000 population.

• The CBR & CDR is determined by taking the number of

births and deaths in one year in a country, dividing it by
the country's population, and multiplying the number by
1000.
 Stages of Demographic transition and trap

Birth rate
R
a
t
e Death rate
s

Stage 1 Stage 2 Stage 3 Stage 4

High mortality Towards low Low Low
High fertility mortality mortality mortality
High fertility towards Low fertility
low fertility 8
 Stages of DTM
Stage I
• In stage one, pre-industrial society, death rates
and birth rates are high and roughly in balance.
• Western Europe had a high CBR (labor
force)and CDR (diseases and unhygienic
conditions) .
• The high CBR and CDR were somewhat stable
and meant slow growth of a population.
Occasional epidemics would dramatically
increase the CDR for a few years (represented
by the "waves" in Stage I of the model.
Stage II -In the mid-18th century
• Drop in death rate - improvement
• This dropping death rate but stable birth
contributed to skyrocketing population growth
rates. (economic burden)
• 20th century advances in birth control,
reduced/slowed down CBR.
• Many less developed countries are currently in
Stage II of the model. For example, Kenya's high
CBR of 32 per 1000 but low CDR of 14 per 1000
contribute to a high rate of growth (as in mid-
Stage II).
Stage III - late 20th century,
• CBR lowered because of contraception, literacy
improved economy etc
• CBR and CDR in developed countries leveled off
• In some cases the CBR is slightly higher than the
CDR (as in the U.S. 14 versus 9) while in other
countries the CBR is
• Issue: Immigration from less developed countries
now accounts for much of the population growth in
developed countries that are in Stage III of the
transition. Countries like China, South Korea,
Singapore, and Cuba are rapidly approaching
Stage III.
Stage IV - Low CBR and CDR (shrinking)
• Low CBR- below replacement level as has happened in
countries like Germany, Italy, and Japan, leading to a
shrinking population.
• Threat to economy because of less workforce and increased
dependent because of low CDR

Stage V - Sub-replacement fertility (Negative

Growth). European and many East Asian countries
– Low birth rate
– High death rate
– No/poor immigration
 DTM challenge
• Does not provide "guidelines" as to how long it
takes a country to get from Stage I to III.

• Western European countries took centuries

through some rapidly developing countries like
the Economic Tigers are transforming in mere
decades. (Hong Kong, Taiwan, Singapore and
South Korea)

• Also does not predict that all countries will reach

Stage III and have stable low birth and death
rates.
 Population pyramid(age & sex structure)
• Important characteristic of a population is its
age-sex structure.
• Graphically display this information to improve
understanding and ease comparison.
• Display the percentage/actual number of
population broken down by gender and age.
• The five-year age increments on the y-axis allow
the pyramid to vividly reflect long term trends in
the birth and death rates but also reflect shorter
term baby-booms, wars, and epidemics.
Three key types of population pyramids :

• Triangle-shaped pyramid -high growth

rate of about 2.1 percent annually.
(Philippines)

• Square-like structure of the pyramid.

Note the lump in the pyramid between
the ages of about 35 to 50. increased
demand on health care services

• Negative growth (-0.1%). As negative

growth in a country = population is
reduced. A population can shrink due to
a low birth rate and a stable death rate.
Increased emigration may also be a
contributor to a declining population.
• Source: U.S. Census Bureau,
International Data Base.

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 DEMOGRAPHIC TRAP

• Population exceeds the CARRYING CAPACITY of

its local or regional ecosystem and cannot afford
to import food or other essentials 1: people caught
in the demographic trap become dependent upon
external food aid, must emigrate as environmental
refugees, or both. Another common outcome is
conflict.

1 Population growth and ecological deterioration-the demographic trap, in From Alma Ata to the Year 2000, reflections at
the mid-point. Geneva: WHO, 1988.

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Zero Population Growth
A population in equilibrium, with a growth rate of zero,
achieved when births plus immigration equal deaths
plus emigration

Population Momentum
The tendency for population growth to continue
beyond the time that replacement level fertility
had been achieved because of a relatively high
concentration of people in the childbearing years.
 Global health
• It has been defined as 'the area of study,
research and practice that places a priority on
improving health and achieving equity in
health for all people worldwide. Thus, global
health is about worldwide improvement of
health, reduction of disparities, and protection
against global threats that disregard national
borders
Global health addresses problems cooperative
actions and solutions

• Solutions that involve more than one country.

• Because global health problems can move across
national borders, countries can learn from one
another’s experiences, both in how diseases spread
and in how they can be treated and controlled.
• Cooperation across countries is essential to addressing
those health problems that transcend borders.
• This includes helping other countries address their
particular health care crises.
 Why global health

• Humanitarian reason
• Equity reasons: fair resource allocation
• Direct impact reasons (facilitates identification and
eradiation of the diseases
• In-Direct impact reasons (political and economic
instability due to diseases
 Factors determines the mortality and
morbidity
· Poor Nutrition.
· Inadequate/inaccessible medical services
· Environmental Conditions
• Poor sanitation,
• Unhygienic water supply,
· Communications and Transport.