{ china’s health transitions diseases of poverty and affluence tina phillips johnson, phd saint...
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{
China’s Health Transitions
Diseases of poverty and affluence
Tina Phillips Johnson, PhDSaint Vincent CollegeOctober 27, 2013
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Medical transitions are changes in the field of medicine.
Health transitions are changes in the health of populations.
Comprised of: Demographic transition: patterns of
fertility and mortality Epidemiologic transition: patterns of
disease
Health transitions
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Direct health action Traditional and modern medicine Medical systems
Social determinants of health Political stability Economic growth Literacy Education
Health transitions shaped by:
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Data sources are variable by time and place
Insufficient transparency National-level focus Skewed data
Disease epidemics Invasion, war, conflict Famine
Problems with data
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Population tripled in 20th century Estimated 430 million 1900; 1.3 billion
2000 Birth and death rates dropped 1950-2000 Population policy 1970-79:
Voluntary “late, long, few” policy Fertility rate halved from 5.2 to 2.9
Due to: Universal education Improved child survival Greater gender equality
China’s 20th-century demographic transition
Wang 2011
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Skewed sex ratio 1.06 in 1979 1.11 in 1988 1.17 in 2001
Problems? Trafficking of girls Commercial sex work industry STDs
Demographics (cont.)
Davin 2007
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Aging population 5% >65 years in 1982 7.5% >65 years in 2012 >65 expected to rise to more than 15% by
2025
Rural-urban migration 12% urban in 1950 50% urban in 2012
Demographics, cont.
Davin, 2007
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Figure 3 – Age structure of China (1950, 2010, 2050)
Source:(United Nations 2011)
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Shifts in burden of disease
High fertility, high mortality (pre-transition)
Characterized by infectious disease High fertility, low mortality (transition)
Medical advances prolong life expectancy Low fertility, low mortality (post-
transition) Increased life expectancy, medical
advances, chronic disease
Epidemiologic Transition
Omran 1970
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1950
1960
1970
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
0
5
10
15
20
25
30
35
40
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
Crude Birth Rate Crude Death Rate % urban population
One child policy
Crude birth rate (‰), crude death rate (‰) and % urban population
Chen 2013
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Africa East MED SEA Europe Americas Western Pacific
0
100
200
300
400
500
600
0
10
20
30
40
50
60
70
80
49
62 6367
7171
Communicable diseases NCDsInjuries Life Expectancy
Burden of Disease (DALYs) in world regions, 2004(Low- and middle- income countries grouped by WHO region, 2004)
DALY: Disease-adjusted life year; The overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.
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China’s double burden of disease
Infectious diseases and epidemics Chronic and man-made non-communicable
diseases
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Questions?
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Works Cited
Chen L. China’s Exceptional Health Transitions: Overcoming the Four Horsemen of Apocalypse. 2011.
Davin D. Marriage Migration in China and East Asia. J Contemp China. 2007;16(50):83–95.
Ho CS, Gostin LO. The Social Face of Economic Growth: China’s Health System in Transition. JAMA. 2009;301(17):1809–11.
Liu Y, Yang G, Zeng Y, Horton R, Chen L. Policy dialogue on China’s changing burden of disease. The Lancet. 2013;381:1961–62.
Omran, AR. The epidemiologic transition. A theory of the epidemiology of population change. Milbank Memorial Fund Quarterly. 1970; 49.4:509-38.
Wang F. The Future of a Demographic Overachiever: Long-Term Implications of the Demographic Transition in China. Popul Dev Rev. 2011;37 (Supplement):173–90.
Yang G, Zeng Y, Gao GF, et al. Rapid health transition in China, 1990-2010: findings from the Global Burden of Disease Study 2010. The Lancet. 2013;381:1987–2015.