5.3 Causes of death and epidemiological transition

Causes of death have shifted dramatically over time, reflecting changes in society, healthcare, and the environment. This shift, known as the epidemiological transition, marks a move from infectious diseases to chronic conditions as leading killers.

Understanding these changes is crucial for grasping mortality trends. It helps explain why people die from different causes in different parts of the world, and how economic development impacts health outcomes across populations.

Causes of Death Across Populations

Major Categories of Death Causes

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• Major causes of death categorized into three main groups communicable diseases, non-communicable diseases, and injuries
• Global Burden of Disease (GBD) study assesses mortality and disability from major diseases, injuries, and risk factors worldwide
• Infectious diseases shifted from primary cause of death globally due to advancements in medical care and public health measures
• Low-income countries still face significant mortality from communicable diseases, maternal and perinatal conditions, and nutritional deficiencies
• High-income countries predominantly face mortality from non-communicable diseases (cardiovascular diseases, cancers, and neurodegenerative disorders)

Age-Specific and Socioeconomic Factors

• Age-specific mortality rates vary significantly with different causes of death prominent in different age groups
  • Infants more susceptible to congenital disorders and infectious diseases
  • Adolescents and young adults face higher risks from accidents and injuries
  • Older adults more likely to die from chronic diseases (heart disease, cancer)
• Environmental and socioeconomic factors determine prevalence of specific causes of death within populations
  • Air pollution contributes to respiratory diseases in urban areas
  • Limited access to clean water increases risk of waterborne diseases in developing regions
• Income inequality correlates with disparities in cause-specific mortality rates
  • Lower-income groups often experience higher rates of preventable deaths
  • Higher-income groups have better access to healthcare and preventive services

Epidemiological Transition and Its Stages

Omran's Theory and Stages

• Epidemiological transition theory proposed by Abdel Omran in 1971 describes changing patterns of population health and disease over time
• Theory outlines three main stages:
  1. Age of Pestilence and Famine characterized by high mortality rates, low life expectancy, and predominance of infectious diseases
  2. Age of Receding Pandemics marked by declining mortality rates and increased life expectancy due to improved sanitation and medical care
  3. Age of Degenerative and Man-Made Diseases features low mortality rates and high life expectancy with chronic diseases as leading causes of death
• Later additions include fourth stage Age of Delayed Degenerative Diseases and potential fifth stage addressing re-emerging infectious diseases
• Transition characterized by shift from high mortality rates due to infectious diseases and malnutrition to lower mortality rates dominated by chronic and degenerative diseases

Driving Factors and Criticisms

• Factors driving epidemiological transition:
  • Improvements in living conditions (better housing, clean water)
  • Enhanced nutrition (increased food security, diverse diets)
  • Advancements in sanitation (sewage systems, waste management)
  • Medical progress (vaccines, antibiotics, surgical techniques)
• Pace and timing of epidemiological transition vary significantly between countries and regions influenced by socioeconomic development and healthcare systems
  • Developed countries experienced transition earlier and more gradually
  • Many developing countries undergoing rapid transition with overlapping stages
• Critics argue theory oversimplifies complex health transitions and may not accurately represent experiences of all populations
  • Fails to account for reversals in health improvements (HIV/AIDS epidemic)
  • Overlooks persistent health inequalities within countries

Mortality Patterns and Economic Development

Impact of Economic Growth on Health

• Economic development correlates with improved healthcare infrastructure leading to better management and prevention of infectious diseases
  • Increased funding for hospitals and clinics
  • Greater access to medical technologies (MRI machines, advanced diagnostics)
• Public health interventions significantly reduce mortality from communicable diseases
  • Vaccination programs (polio, measles)
  • Improved sanitation (clean water initiatives, proper sewage disposal)
• Rise in life expectancy and shift towards aging population increase prevalence of age-related chronic diseases
  • Dementia and Alzheimer's disease become more common
  • Osteoporosis and arthritis affect larger portions of population

Urbanization and Globalization Effects

• Urbanization accompanying economic development leads to changes in lifestyle factors influencing disease patterns
  • Increased sedentary behavior due to office jobs and public transportation
  • Altered diets with more processed foods and less traditional, locally-sourced meals
• "Double burden of disease" describes simultaneous challenge of addressing both infectious and non-communicable diseases in developing countries
  • Malaria and diabetes coexist as major health concerns in some regions
• Environmental changes from rapid industrialization introduce new health risks
  • Air pollution-related respiratory diseases in rapidly growing cities (Beijing, Delhi)
  • Occupational hazards in manufacturing sectors
• Globalization and international trade influence disease patterns through spread of unhealthy commodities and lifestyle choices
  • Increased tobacco use in developing countries due to marketing
  • Adoption of high-calorie, low-nutrient "Western" diets in traditional societies

Implications of Changing Cause-of-Death Patterns

Health System and Policy Adaptations

• Health systems must adapt to address increasing prevalence of chronic diseases requiring shift from acute care models to long-term management and prevention strategies
  • Development of chronic disease management programs
  • Integration of mental health services into primary care
• Rising costs of treating chronic diseases necessitate new approaches to healthcare financing and resource allocation
  • Exploration of value-based care models
  • Increased focus on preventive services to reduce long-term costs
• Public health policies focus on preventive measures targeting modifiable risk factors for non-communicable diseases
  • Anti-tobacco campaigns and smoking bans
  • Promotion of healthy diets through food labeling and sugar taxes
• Education systems promote health literacy and empower individuals to make informed health decisions
  • Inclusion of health education in school curricula
  • Community-based health promotion programs

Social and Individual Responses

• Urban planning and environmental policies become increasingly important in creating health-promoting environments
  • Design of walkable cities to encourage physical activity
  • Implementation of green spaces to reduce stress and improve air quality
• Aging population resulting from improved life expectancy requires new social support systems and healthcare services
  • Development of age-friendly communities
  • Expansion of home care and assisted living options
• Individual behaviors and lifestyle choices become more critical in determining health outcomes emphasizing need for personal responsibility in health management
  • Adoption of regular exercise routines
  • Adherence to preventive health screenings and vaccinations