Take Home Exam:
New Biosciences/New Society
Week 1-4 (Biology)
Author: Juweriya Jamal Salah
Student number: i6245651
Course number: MGH4003
Number of words: 1782
Maastricht, 23 November 2020
, Elaboration question 1
In the 1900s, the global health profile was profoundly similar across the world: the battle
against communicable diseases (CDs) and premature death. During the 20 century, this
th
transitioned to a lower mortality rate, a longer life expectancy, and a higher burden of non-
communicable diseases (NCDs) (Jacobsen, 2018). While many high-income countries
succeeded this shift gradually, the historical transitions of low and middle-income countries
have been vastly different. India is currently experiencing its demographical and
epidemiological transition at a notable speed (Yadav & Arokiasamy, 2014). Nevertheless, the
country’s health changes of the last 50 years have been pivotal for present times.
The defining feature of the 'demographical transition' is that of which a population shift
from a high pattern of fertility and mortality to a lower rate (McCracken & Phillips, 2017). In
the 1970s, India experienced a rapid decline in its mortality rate (Yadav & Arokiasamy,
2014). Similarly, the country witnessed a remarkable decrease in the infant mortality rate
(IMR) in the last 50 years; from 129 to 26.6 per 1.000 live births (Yadav & Arokiasamy,
2014; Worldometer, 2020). In addition to this the fertility rate reduced considerably from 5.7
to 2.2 live births per woman in half a century (Worldometer, 2020). Much like other factors,
the progress in socioeconomic conditions and maternal and child health interventions in 1990,
1996, and 2002 played a crucial role in lowering the IMR and fertility rate (Narayana &
Mahadevan, 2011; Goli & Arokiasamy, 2013). An additional factor was the government's
health spending that increased manifold during those years (Goli & Arokiasamy, 2013).
However, the decline in mortality rate and the country’s increasing industrialization caused
India’s population growth of 204% (WorldData.info, 2019). 'Economic growth’ specifically
resulted in a striking shift in life expectancy dominated by old-age mortality (Yadav &
Arokiasamy, 2014). This increased from an average of 49.7 years in 1970 to 70.4 years in
2020 (Worldometer, 2020; Chaurasia, 2010).
However, the increase in life expectancy has been met by the mounting burden of
morbidity (Yadav & Arokiasamy, 2014), which requires the examination of the country’s
‘epidemiological transition’. This theory explains the changing disease patterns over time.
More specifically, the transition from CDs to NCDs (Yadav & Arokiasamy, 2014). In contrast
to HICs, India’s transition has been categorized by the double burden of disease (Yadav &
Arokiasamy, 2014). Around the 1970s, CDs were the most prominent cause of death.
However, health improvements suchlike sustained vaccination programs, better sanitation,
and housing resulted in the successful eradication of many CDs (Narain, 2016). These
improvements also added to the progressive change in IMR. Nonetheless, the country has
again been challenged with CDs containing high disability-adjusted life-years (DALYs) such
as diarrhea, lower respiratory infections, tuberculosis, and neonatal disorders for the past
decades (IHME, 2020). For example, the delayed detection and treatment of tuberculosis
followed by inadequate surveillance and poor notification systems accounted for 3.35% of
total DALYs in 2019. It is noteworthy that India has the highest tuberculosis burden in the
world (India State-Level Disease Burden Initiative Collaborators, 2017). Without replacing
the burden of CDs, the rise of NCDs has been contributing to 60% of all deaths in the country.
In 2005, NCDs accounted for 44% of all DALYs (Reddy et al., 2005). Moreover, NCDs are
more common among older people which affirms that the morbidity is expected to increase
(Yadav & Arokiasamy, 2014). Other risk factors of NCDs such as 'tobacco use, harmful use
of alcohol, unhealthy diet, and lack of physical activities' (Narain, 2016), contributed to nearly
25% of the DALYs in 2016; which was double the contribution in 1990 (India State-Level
Disease Burden Initiative Collaborators, 2017). Additionally, the country’s environmental
2
New Biosciences/New Society
Week 1-4 (Biology)
Author: Juweriya Jamal Salah
Student number: i6245651
Course number: MGH4003
Number of words: 1782
Maastricht, 23 November 2020
, Elaboration question 1
In the 1900s, the global health profile was profoundly similar across the world: the battle
against communicable diseases (CDs) and premature death. During the 20 century, this
th
transitioned to a lower mortality rate, a longer life expectancy, and a higher burden of non-
communicable diseases (NCDs) (Jacobsen, 2018). While many high-income countries
succeeded this shift gradually, the historical transitions of low and middle-income countries
have been vastly different. India is currently experiencing its demographical and
epidemiological transition at a notable speed (Yadav & Arokiasamy, 2014). Nevertheless, the
country’s health changes of the last 50 years have been pivotal for present times.
The defining feature of the 'demographical transition' is that of which a population shift
from a high pattern of fertility and mortality to a lower rate (McCracken & Phillips, 2017). In
the 1970s, India experienced a rapid decline in its mortality rate (Yadav & Arokiasamy,
2014). Similarly, the country witnessed a remarkable decrease in the infant mortality rate
(IMR) in the last 50 years; from 129 to 26.6 per 1.000 live births (Yadav & Arokiasamy,
2014; Worldometer, 2020). In addition to this the fertility rate reduced considerably from 5.7
to 2.2 live births per woman in half a century (Worldometer, 2020). Much like other factors,
the progress in socioeconomic conditions and maternal and child health interventions in 1990,
1996, and 2002 played a crucial role in lowering the IMR and fertility rate (Narayana &
Mahadevan, 2011; Goli & Arokiasamy, 2013). An additional factor was the government's
health spending that increased manifold during those years (Goli & Arokiasamy, 2013).
However, the decline in mortality rate and the country’s increasing industrialization caused
India’s population growth of 204% (WorldData.info, 2019). 'Economic growth’ specifically
resulted in a striking shift in life expectancy dominated by old-age mortality (Yadav &
Arokiasamy, 2014). This increased from an average of 49.7 years in 1970 to 70.4 years in
2020 (Worldometer, 2020; Chaurasia, 2010).
However, the increase in life expectancy has been met by the mounting burden of
morbidity (Yadav & Arokiasamy, 2014), which requires the examination of the country’s
‘epidemiological transition’. This theory explains the changing disease patterns over time.
More specifically, the transition from CDs to NCDs (Yadav & Arokiasamy, 2014). In contrast
to HICs, India’s transition has been categorized by the double burden of disease (Yadav &
Arokiasamy, 2014). Around the 1970s, CDs were the most prominent cause of death.
However, health improvements suchlike sustained vaccination programs, better sanitation,
and housing resulted in the successful eradication of many CDs (Narain, 2016). These
improvements also added to the progressive change in IMR. Nonetheless, the country has
again been challenged with CDs containing high disability-adjusted life-years (DALYs) such
as diarrhea, lower respiratory infections, tuberculosis, and neonatal disorders for the past
decades (IHME, 2020). For example, the delayed detection and treatment of tuberculosis
followed by inadequate surveillance and poor notification systems accounted for 3.35% of
total DALYs in 2019. It is noteworthy that India has the highest tuberculosis burden in the
world (India State-Level Disease Burden Initiative Collaborators, 2017). Without replacing
the burden of CDs, the rise of NCDs has been contributing to 60% of all deaths in the country.
In 2005, NCDs accounted for 44% of all DALYs (Reddy et al., 2005). Moreover, NCDs are
more common among older people which affirms that the morbidity is expected to increase
(Yadav & Arokiasamy, 2014). Other risk factors of NCDs such as 'tobacco use, harmful use
of alcohol, unhealthy diet, and lack of physical activities' (Narain, 2016), contributed to nearly
25% of the DALYs in 2016; which was double the contribution in 1990 (India State-Level
Disease Burden Initiative Collaborators, 2017). Additionally, the country’s environmental
2
