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The Demographic/
Epidemiologic/ Nutrition
Transitions
Learning Objectives

• By the end of the course the

student will be able:
 To define demographic transition
 To describe the stages in demographic transition
 To define epidemiologic transition and the
mechanisms involved
 To describe models of epidemiologic transition
 To define nutrition transition and the stages
involved.
 The Demographic Transition
Definition: the change of a population from
high birth and death rates to low birth and
death rates.
Four stages
• First stage: high death and birth rates
(slow and steady population growth).
• Second stage: death rates begin to decline
and birth rates remain high (faster
population growth).
 The Demographic…

• Third stage: death rates continue to

decline and birth rates begins to decline.

• Fourth and final stage: death and birth

rates balance and population growth
stabilize : In some cases, (e.g. Italy)
population may cease to grow altogether.
 [[

Focus this
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Demographic transition…
The Classical demographic transition:
• It occurred through Europe, North America in
the 18th, 19th and early 20th centuries.
• Was characterized by slow and steady change.
The death rate had a long and gradual decline.
• The decline was due to three main factors
(agricultural revolution, trade revolution and industrial
revolution). In addition there was public health
improvement.
• No major medical breakthroughs.
• Japan (an exception) in the classical model.
 The Present (Contemporary) demographic transition

• It has started in many developing

countries in the middle of the 20th
century
– Birth and death rates start at higher
levels
– Death rates declined much more
dramatically and the causes are new
medical and public health
technologies
The Present…

– Birth rates remain very high, therefore,

high levels of population growth reaching
3%;

– In countries where fertility decline has

started is mostly due to contraceptive
technology and very little or substantial
economic development.
 The Second Demographic Transition ?
(Lesthaeghe R, 2004,2006, 2007)

• Europe of today- sub-replacement fertility

Very important!
- The demographic transition has occurred in
different paces and paths in different
countries and sometimes within countries.
 2. Epidemiologic transition
Definition:
• Is the general shift from acute infections and
deficiency diseases characteristic of
underdevelopment to chronic non-
communicable diseases characteristic of
modernization and advanced levels of
development.

• The most evident indicators of this transition

are changes in the pattern of mortality,
particularly in cause of death, as well as
changes in morbidity.
 What are the mechanisms involved in the
epidemiologic transition?

1. Demographic changes:

• both in mortality and fertility- the so called

demographic transition described above.

• As more people will survive to adulthood-

disease pattern of adults as well as
diseases of the elderly (in summary more
non- communicable diseases)
What are…

2. Changes in risk factors:

• Biological (alteration in antigenic identity;

emergence of drug-resistant strains and
dual infection)

• Environmental factors (exposure to environmental

pollutants and overcrowding)
 Models of Epidemiologic Transition
1. The Classical Epidemiologic Transition
• Gradual and progressive transition as
modernization occurred.
• typical of Western societies (Europe, USA,
NZ, AUS)

2. The Accelerated Epidemiologic Transition

• Faster mortality decline (Japan)
• Faster pace to non-communicable diseases
Models of …
3. The delayed Epidemiological Transition
• Africa, Latin America and Asia
• Substantial decreases in mortality and
high fertility
• Transition triggered mostly by public
health measures and health technology
and not necessary great economic
development.
Models of …

4. The Third Epidemiologic Transition

• Emerging new diseases (e.g. AIDS,
SARS.....)
• Prevalence of pre-existing diseases (e.g.
TB...)
• Re-emerging diseases
• Antimicrobial resistance
Models of …

• Important!
– Several stages of the epidemiologic
transition can overlap in the same country
(for instance, different socioeconomic
groups may experience the transition
differently)
 The Nutrition Transition
Definition:
• Shift in dietary, physical activity and
inactivity patterns.

• During the nutrition transition:

– Changes in nutritional outcomes, such
average stature and body composition.
The Nutrition…

• Usually societies converge to a pattern of

diet high in saturated fat, sugar and refined
foods and low in fiber- associated foods.
– High levels of degenerative diseases!

• The Nutrition Transition is strictly linked to

the Demographic and Epidemiologic
Transitions.
Figure 1. Stages of Demographic, Epidemiologic and Nutrition
Transitions
 Conclusion

• While the age structure of the population and

the distribution of disease change, socially
disadvantaged people and those who are
socially isolated continue to be at increased
risk (this is true for all countries, developed
or under-developed).
Conclusion…

• And when the epidemiologic and

demographic transition collide:

– Increased demand on health and

health care for the elderly
– Middle aged adults in the work force
need flexible jobs because they may
be in need to provide care for their
elderly.
Conclusion…

• Older workers will also need more flexible

jobs to contribute fully in the Society
– Societies need to sort out their policies. For
instance benefits and practices related to
retirement, child care, sick leave, part-time work,
health insurance and workers compensation
schemes.

• There is a need to re address the general

socio-economic, cultural and environmental
conditions of the society.
Conclusion…

• The Governments of the developing

countries must design strategies to address
the changes in population structure and
disease pattern with due attention to the
inequalities/inequities in health status within
the country as a whole and across
population groups.