Epidemiologic Transition:Epidemiologic Transition:Russian examplesRussian examples

Abdel Omran. The Epidemiologic Transition: A Abdel Omran. The Epidemiologic Transition: A Theory of the epidemiology of population Theory of the epidemiology of population change. Milbank Quarterly.change. Milbank Quarterly. 1971;49:509-538 1971;49:509-538

http://www.who.int/docstore/bulletin/pdf/2001/issue2/http://www.who.int/docstore/bulletin/pdf/2001/issue2/vol.79no.2.159-170.pdfvol.79no.2.159-170.pdf

Faina Linkov, PhD, University of Pittsburgh

Questions to be discussed at the end Questions to be discussed at the end of the lectureof the lecture

Can Omran’s theory be applied to changing Can Omran’s theory be applied to changing mortality patterns in Russia?mortality patterns in Russia?

Epidemiologic transition in Russia: did it Epidemiologic transition in Russia: did it take place?take place?

Reversal of transition in Russia. How does Reversal of transition in Russia. How does it relate to Omran’s theory?it relate to Omran’s theory?

Epidemiologic transition: DefinitionEpidemiologic transition: Definition

The epidemiologic transition is that process by The epidemiologic transition is that process by which the pattern of mortality and disease is which the pattern of mortality and disease is

transformed from one of high mortality among transformed from one of high mortality among infants and children and episodic famine and infants and children and episodic famine and epidemic affecting all age groups to one of epidemic affecting all age groups to one of

degenerative and man-made diseases (such as degenerative and man-made diseases (such as those attributed to smoking) affecting principally those attributed to smoking) affecting principally

the elderly. the elderly.

Encyclopedia BritanicaEncyclopedia Britanica

Stages of Epidemiological TransitionStages of Epidemiological Transition

Age of Pestilence and FamineAge of Pestilence and Famine Age of Receding PandemicsAge of Receding Pandemics Age of Degenerative and Man-made Age of Degenerative and Man-made

diseases diseases

Age of Pestilence and FamineAge of Pestilence and Famine

Characterized by high Characterized by high mortality rates, wide mortality rates, wide

swings in the mortality swings in the mortality rate, little population rate, little population growth and very low growth and very low

life expectancylife expectancy

Traditional society, chronic shortage of food, Traditional society, chronic shortage of food, poor sanitary conditions, high MCH morbidity poor sanitary conditions, high MCH morbidity and mortality, environmental problems, young and mortality, environmental problems, young

populationpopulation

Peter I, the first emperor of RussiaPeter I, the first emperor of Russia

Age of Receding PandemicsAge of Receding PandemicsEpidemics become less frequent, Epidemics become less frequent,

infectious diseases in general infectious diseases in general become less frequent, a slow rise in become less frequent, a slow rise in

degenerative diseases begin to degenerative diseases begin to appear, improved life expectancy, appear, improved life expectancy,

organized health services, increased organized health services, increased proportion of older people proportion of older people

Alexander III, the last Russian Alexander III, the last Russian Emperor to die from natural causesEmperor to die from natural causes

Age of Degenerative and Man-made Age of Degenerative and Man-made diseases diseases

Chronic diseases, cheap calories, morbidity Chronic diseases, cheap calories, morbidity overshadows mortality, rise in living overshadows mortality, rise in living

standards, dramatic decline in fertility, standards, dramatic decline in fertility, comprehensive healthcare comprehensive healthcare

Mickhail Gorbachev, the first and the last President of the USSR

Infant Mortality Rate in Russia: Infant Mortality Rate in Russia: 1940-19931940-1993

Theory criticisms

Applications of Omran’s Theory to Applications of Omran’s Theory to Russia: Difficulties in Applying the Russia: Difficulties in Applying the

General RulesGeneral Rules

Increased morbidity associated with WWI Increased morbidity associated with WWI and WWII, famines, and political and WWII, famines, and political repressionsrepressions

Reverse transition in 1990’sReverse transition in 1990’s Excess mortality for Russian malesExcess mortality for Russian males

Russia’s transition in 1990’sRussia’s transition in 1990’s

Net Migration and Natural Increase in Russia, 1980–2001

Russia: decreasing populationRussia: decreasing population

The health care principles upon which The health care principles upon which the Soviet health care system was to the Soviet health care system was to

be based (Nikolai Semashko):be based (Nikolai Semashko): government responsibility government responsibility

for healthfor health universal access to free universal access to free

servicesservices a preventive approach to a preventive approach to

“social diseases”“social diseases” quality professional carequality professional care a close relation between a close relation between

science and medical practicescience and medical practice continuity of care between continuity of care between

health promotion, treatment health promotion, treatment and rehabilitation.and rehabilitation.

Next steps following the Next steps following the establishment of the “Semashko” establishment of the “Semashko”

model in 1918model in 1918 The health care system was under the The health care system was under the

centralized control of the state, which centralized control of the state, which financedfinanced services by general government revenues as services by general government revenues as part of national social and economic part of national social and economic development plans. development plans.

All health care personnel became employees of All health care personnel became employees of the centralized state, which paid salaries and the centralized state, which paid salaries and provided supplies to all medical institutions.provided supplies to all medical institutions.

The main policy orientation throughout this The main policy orientation throughout this period was period was to increase numbers of hospital to increase numbers of hospital bedsbeds and medical personnel*and medical personnel*..

Next steps following the Next steps following the establishment of the “Semashko” establishment of the “Semashko”

model in 1918 model in 1918 (cont.)(cont.)

Russia made massive strides in arresting the Russia made massive strides in arresting the spread of infectious diseases. spread of infectious diseases.

Drastic epidemic control measures were Drastic epidemic control measures were implemented, particularly in the cases of implemented, particularly in the cases of tuberculosis, typhoid fever, typhus, malaria and tuberculosis, typhoid fever, typhus, malaria and cholera. cholera.

These involved community prevention These involved community prevention approaches, routine check-ups, improvements in approaches, routine check-ups, improvements in urban sanitation and hygiene, quarantines, etc.urban sanitation and hygiene, quarantines, etc.

The period until 1991The period until 1991

Life expectancy (both sexes)Life expectancy (both sexes)

32

43

59

47

63

47

01020304050607080

1900 1938

Russia

France

USA

The period until 1991The period until 1991

Life expectancy in 1965Life expectancy in 1965

64.373.4 74.7

66.873.7

67.3

01020304050607080

Men Women

Russia

France

USA

A campaign against alcoholA campaign against alcohol By the 1980s, the gap between Russia and Western By the 1980s, the gap between Russia and Western

countries in life expectancy at birth came to about 10 countries in life expectancy at birth came to about 10 years for men and 6 years for women, mostly due to years for men and 6 years for women, mostly due to high death rates among those of working age (6). In high death rates among those of working age (6). In the mid-1980s, the government made an attempt to the mid-1980s, the government made an attempt to address this problem address this problem (9)(9). It was by then generally . It was by then generally understood that potentially avoidable human losses understood that potentially avoidable human losses were mostly attributable to excess adult age mortality were mostly attributable to excess adult age mortality from particular causes such as injuries, accidental from particular causes such as injuries, accidental poisoning, suicide, homicide, sudden cardiac death, poisoning, suicide, homicide, sudden cardiac death, hypertension and other conditions closely related to hypertension and other conditions closely related to alcohol abuse and its consequences.alcohol abuse and its consequences.

Life expectancy related to Life expectancy related to CampaignCampaign

61.764.9

74.473

404550556065707580

1984 1987

Male

Female

But….But….

Russia failed to maintain this record, Russia failed to maintain this record, however: by 1987 the USSR was no however: by 1987 the USSR was no longer able to enforce the anti-alcohol longer able to enforce the anti-alcohol campaign and death rates rapidly campaign and death rates rapidly resumed their upward trend from 1988 resumed their upward trend from 1988 onwards. The anti-alcohol campaign was onwards. The anti-alcohol campaign was largely prohibitive and did not affect the largely prohibitive and did not affect the attitude of the majority of Russia’s attitude of the majority of Russia’s population towards alcohol.population towards alcohol.

The period after 1991The period after 1991

The health status of the Russian The health status of the Russian population declined precipitously population declined precipitously following the collapse of the Soviet following the collapse of the Soviet Union in late 1991. By all accounts, in Union in late 1991. By all accounts, in the last decade Russia has been the last decade Russia has been experiencing a shock unprecedented experiencing a shock unprecedented in peacetime to its health and in peacetime to its health and demographic profiles. demographic profiles.

Life expectancy in Russia, maleLife expectancy in Russia, male

61.764.9

57.661.39

59.15 58.5

404550556065707580

1984 1987 1994 1998 2000 2001

Life expectancy in Russia, femaleLife expectancy in Russia, female

74.4 74.471.2 72.96 72.4 72.173

404550556065707580

1984 1987 1990 1994 1997 2000 2001

The leading causes of death in The leading causes of death in the Russia Federationthe Russia Federation

Cardiovascular diseases with rates that Cardiovascular diseases with rates that are the highest in the European Region are the highest in the European Region

External causes of injury and poisoningExternal causes of injury and poisoning

CancerCancer

Causes of the mortality crisisCauses of the mortality crisis

Major social and economic shock and Major social and economic shock and income stratification in a population income stratification in a population already vulnerable because of:already vulnerable because of:

Poor diet, high levels of smoking, and Poor diet, high levels of smoking, and weak systems of social support, in which weak systems of social support, in which alcohol and, increasingly, intravenous alcohol and, increasingly, intravenous drugs, are easily available.drugs, are easily available.

Health care system is poorly equipped to Health care system is poorly equipped to respond to challenges.respond to challenges.

Questions to be discussed at the end Questions to be discussed at the end of the lectureof the lecture

Can Omran’s theory be applied to changing Can Omran’s theory be applied to changing mortality patterns in Russia?mortality patterns in Russia?

Epidemiologic transition in Russia: did it Epidemiologic transition in Russia: did it take place?take place?

Reversal of transition in Russia. How does Reversal of transition in Russia. How does it relate to Omran’s theory?it relate to Omran’s theory?