Mortality and Health Transitions
Mortality Decline in Europe
Pre-Industrial Demographic Regimes
2017
2016
2013
2012
2011
EPIDEMIOLOGIC TRANSITION (Omran 1971)
, Epidemiology: the branch of medicine that deals with the incidence, distribution and control
of disease.
‘An epidemiologic transition has paralleled the demographic and technologic transitions in
the now developed countries of the world and is still underway in less-developed societies.’
3 stages of epidemiologic transition:
1) Age of pestilence and famine; high, fluctuating mortality; no population growth; low
life expectancy (20-40)
2) Age of receding pandemics; progressive mortality decline; reduction in the frequency
of epidemics; life expectancy at birth ≈ 50; population growth begins to describe an
exponential curve
3) Age of degenerative and man-made diseases; mortality stabilises at a low level; life
expectancy ≈ 50; fertility becomes the crucial factor in population growth
The major categories of disease determinants:
1) Ecobiologic: the complex balance between disease agents, the level of hostility in the
environment and the resistance of the host. ‘…it is relatively certain that with the
possible exception of smallpox, the recession of plague and many other pandemics
in Europe was in no way related to the progress of medical science.’
2) Socioeconomic, political and cultural: standard of living, health habits, hygiene and
nutrition
3) Medical and public health determinants: public sanitation, immunization and the
development of decisive therapies. ‘Medical and public health factors came into play
late in the western transition but have an influence early in the accelerated and
contemporary transitions.’
Western transition predominantly socially determined, currently developing world
significantly influenced by medical technology.
Three distinctive patterns: Classical/Western Model (e.g. England/Wales/Sweden),
Accelerated Transition Model (e.g. Japan) and Contemporary/Delayed Model (e.g.
Chile/Ceylon)
Classical model: gradual, progressive transition from high mortality (>30/1000) and
high fertility (>40/1000) to low mortality (<10/1000) and low fertility (<20/1000).
Relatively slow speed of this transition (in comparison to the
accelerated/contemporary models) determined by the absence of developed
medical science at the beginning of transition
Accelerated model: medical and public health factors came into play late in the
western transition but have an influence early in the accelerated and contemporary
transitions
Contemporary model: characterised by some slow/unstable decline in mortality at
the beginning of the 20th century followed by rapid and substantial declines after
WWII. Mortality has declined while fertility remains at substantially high levels.
‘Internationally sponsored medical package’. Variation: most countries in Latin
Mortality Decline in Europe
Pre-Industrial Demographic Regimes
2017
2016
2013
2012
2011
EPIDEMIOLOGIC TRANSITION (Omran 1971)
, Epidemiology: the branch of medicine that deals with the incidence, distribution and control
of disease.
‘An epidemiologic transition has paralleled the demographic and technologic transitions in
the now developed countries of the world and is still underway in less-developed societies.’
3 stages of epidemiologic transition:
1) Age of pestilence and famine; high, fluctuating mortality; no population growth; low
life expectancy (20-40)
2) Age of receding pandemics; progressive mortality decline; reduction in the frequency
of epidemics; life expectancy at birth ≈ 50; population growth begins to describe an
exponential curve
3) Age of degenerative and man-made diseases; mortality stabilises at a low level; life
expectancy ≈ 50; fertility becomes the crucial factor in population growth
The major categories of disease determinants:
1) Ecobiologic: the complex balance between disease agents, the level of hostility in the
environment and the resistance of the host. ‘…it is relatively certain that with the
possible exception of smallpox, the recession of plague and many other pandemics
in Europe was in no way related to the progress of medical science.’
2) Socioeconomic, political and cultural: standard of living, health habits, hygiene and
nutrition
3) Medical and public health determinants: public sanitation, immunization and the
development of decisive therapies. ‘Medical and public health factors came into play
late in the western transition but have an influence early in the accelerated and
contemporary transitions.’
Western transition predominantly socially determined, currently developing world
significantly influenced by medical technology.
Three distinctive patterns: Classical/Western Model (e.g. England/Wales/Sweden),
Accelerated Transition Model (e.g. Japan) and Contemporary/Delayed Model (e.g.
Chile/Ceylon)
Classical model: gradual, progressive transition from high mortality (>30/1000) and
high fertility (>40/1000) to low mortality (<10/1000) and low fertility (<20/1000).
Relatively slow speed of this transition (in comparison to the
accelerated/contemporary models) determined by the absence of developed
medical science at the beginning of transition
Accelerated model: medical and public health factors came into play late in the
western transition but have an influence early in the accelerated and contemporary
transitions
Contemporary model: characterised by some slow/unstable decline in mortality at
the beginning of the 20th century followed by rapid and substantial declines after
WWII. Mortality has declined while fertility remains at substantially high levels.
‘Internationally sponsored medical package’. Variation: most countries in Latin
