1. A network describes orderly flows of information, goods, or people that circulate between the various nodes in the system’s domain. In this way it describes regular patterns of mobility between a set of determinate places.

2. Network describes regular patterns of mobility between a set of determinate places. These patterns of movement describe how flows of information, goods, or people diffuse from place to place along preexisting routes or linkages that direct these flows in orderly and predictable directions.

3. Because a network is defined as a functional system of nodes and linkages, or places and routes, it implies that each of these parts are interdependent on one another to keep flows of information, goods, or people circulating within the network.

4. If one node or linkage breaks down, the entire flow of the network is also likely to become disrupted

5. The network concept implies a system of relations between different places, so each is spatially situated in a unique position relative to others. For instance, a place or node located closer to the middle of the network could be said to be more centrally located than a place or node located on the periphery

6. Networks are particularly relevant tools for describing spatial interactions in a globalized era because they are capable of representing complex, functional interrelationships and interdependencies among a growing number of places scattered across the globe

7. For instance, whereas all the parts for an automobile might have been manufactured in one factory 50 years ago, today the various parts of an automobile might be manufactures in dozens of different factories around the world

8. A network diagram would be capable of demonstrating how an automobile’s chain of production flows through many different factories in a globalized system of automobile manufacturing.

9. During a globalized era in which personal and professional social ties are becoming more distantiated and less place-based, virtual social networks provide an effective approach for understanding the spatial complexities of any particular individual’s social linkages

10. With the rise of industrialization, it has become possible for attributes of place to become mass-produced in developed societies

11. For example, before industrialization in the United States, homes were individually crafted and built by hand so that no two were exactly alike

12. Following industrialization, residential building components began to be mass-produced, resulting in the homogenization of home designs in the United States

13. This homogenization could support the idea of placelessness because it results in the dwindling uniqueness of certain features of places, like homes

14. With the growth of mass communications, popular cultures, which exist across national and international scales, can be seen to be replacing vernacular or folk cultures, which previously existed across local and regional scales

15. The distinctiveness of different places has diminished as cultural tastes and preferences have become more popularized and mainstream

16. For instance, because of the widespread diffusion of mass communications such as the television, evidence suggests that local and regional dialects are becoming less common and standard dialects more common

17. This supports the idea of placelessness because it suggests that one could travel to different regions of a developed society, such as the United States, and not get a sense of the distinctions that previously gave different places and regions a unique sense of identity

18. With processes of globalization, places spread out across the globe generally are becoming more interdependent and interrelated socioeconomically

19. As a result of globalization, it is now possible to travel to different world cities and find the same transnational corporate enterprises such as restaurants, retail stores, banks, and hotels

20. One can conceivably be in Tokyo or New York and frequent the same corporate establishments, which, from the inside, are virtually indistinguishable

21. With an increase in mobility in highly developed societies, people are less rooted to particular places than in the past

22. Whereas 100 years ago the average person spent his or her entire life in one place, now it is not uncommon for the average person to relocate several times throughout her or his lifetime

23. This general increase in mobility has arguably weakened the strong attachments to home and an attendant sense of place

24. In general these four developments of industrialization, widespread popular cultures, globalization, and an increase in mobility may all be used to support the theory that a sense of placelessness is becoming a more common way that people relate to their surroundings in highly developed, modern societies

25. Epidemiologic Transition: Changes of fertility and mortality with modernization
Abdel Omran. The Epidemiologic Transition: A Theory of the epidemiology of population change. Milbank Quarterly ;49:
Omran has writen several classic papers on the epidemiologic transition. For NCD epidemoilogy important insight can be gained by understanding this model.

26. The epidemiological transition model suggests that the cause of death changes in a society from communicative diseases to degenerative diseases over time

27. The first stage experiences high and fluctuating mortality rates due to epidemic diseases and famine. Life expectancy at birth is low during this stage at approximately 30 years

28. The second stage experiences less frequent pandemics, and as a result mortality rates decline. Life expectancy during the second stage increases to around 50 years and population growth begins to increase exponentially

29. The third stage is when mortality is mostly caused by degenerative and man-made diseases, such as high blood pressure, lung cancer, and cardiovascular disease

30. In this stage, mortality rates continue to decline until reaching low stable levels. Average life expectancy increases to 70 years or more

31. At this stage, fertility and birth rates are the major factor in population growth, which is stable and either slowly increasing or even decreasing

32. Abdel Omran
Evolution of Disease
Charles Darwin
Evolution of Species

33. Longer life expectancies at birth can be attributed to many factors, including better access to health care, improved nutrition, and increased sanitation. Decreased exposure to environmental pollution can also contribute to longer life expectancies

34. Stouffer’s law of intervening opportunities suggests that migration to a new location is directly proportional to the opportunities at the destination

35. Therefore, the place of departure has fewer opportunities than the destination

36. Intervening opportunities are factors that persuade a migrant to settle en route instead of continuing to the original destination

37. Intervening opportunities offer opportunities complementary to the ones originally sought at the planned destination, such as jobs, land, education, and political or religious freedom

38. Additionally, intervening obstacles could result in settlement en route because of language barriers, international boundaries, or anxieties about the planned destination

39. Push and pull factors can be physical, demographic, economic, social, or political. Push factors are reasons to leave a homeland and migrate elsewhere

40. Some examples of push factors include natural disasters, famine, lack of work, overcrowding, war, and political instability

41. Pull factors are reasons to migrate to a new location

42. Examples of pull factors include labor demand, higher wages, religious freedom, better living conditions, education opportunities, and political stability

43. Pull factors are not always real and can be imaginary reasons, such as the rumors that American streets were paved with gold to entice new immigrants from Europe during the 19th century

44. Epidemiology Psychiatric Epidemiologists Diabetes Epidemiology
Cardiovascular Epidemiology
Cancer Epidemiology
Infectious Disease Epidemiology

45. Instead at looking at individual diseases, we need to look at the patterns of diseases

46. Mortality is the fundamental factor in the dynamics of population growth and causes of death.
Mortality has no fixed upper limits. Thus if fertility approached its upper maximum, depopulation would still occur.
It is mortality, not fertility that determines population growth. SES, mortality, and mobitity are tied together in a system of disease and population growth. To understand the system, it is essential to understand the total interrelationships.

47. During the epidemiologic transition, a long-term shift occurs in mortality and disease patterns whereby pandemics of infection are replaced by degenerative and man-made diseases...
Omran argued that we can not view diseases in isolation. It is critical to look at the pattern of disease, not a single disease.

48. Age of Pestilence and Famine
Characterized by high mortality rates, wide swings in the mortality rate, little population growth and very low life expectancy
During the age of pestalence the population on a reoccuring basis is being decimated by epidemics of infectious diseases. The mortality rates drive the system. Life expectancy is low, fertility is high, but the high fertility rates are off set by very high mortality rates.

49. Age of Receding Pandemics
Epidemics become less frequent, infectious diseases in general become less frequent, a slow rise in degenerative diseases begin to appear
In this era, the epidemics of TB, plague, malaria, etc. begin to subside. The death rate goes down with little change to the fertility rates, thus population growth occurs. During this time one sees the beginning of non-communicable diseases.

50. The shifts in disease patterns in the 19th century were primarily related to changing SES. With the 20th Century more related with disease control activities independent of SES: e.g. Mexico, China
In the early stages of the transition in the 19th century, the changing mortality patterns are closely associated with improvements in SES. However, in the 20th century major advances have been made by countries with a low socioeconomic status but with an effective public health system.

55. Epidemiologic Transition in Developing and Developed Countries
World wide this century has seen a very rapid improvement in life expectancy. With this improvement there has been major shifts in the causes of death.

56. 14 years
35 years

60. Increasing Life Expectancy and
Causes of Death
100
Other 80 60
Violence
CHD 40 CA
One of the most striking predictions by Omran is that given countries have the same life expectancy, there is very little difference in the causes of death. 20
Infection 40 44 48 52 56 60 64 68 72 76
Population Life Expectancy

62. Global Homogenety of
Mortality Patterns

65. Infectious Diseases
NCD
Mortality Rates
Epidemiologic Transition

66. Death Rates for TB in England and Wales

67. Death Rates for TB in England and Wales
TB Bacillus
Identified
Chemotherapy
BCG Vaccination

68. Death Rates for Measles in Children in England and Wales

69. Death Rates for Measles in Children in England and Wales
Immunization begun

70. NIDDM
CHD
Trauma CA
Mortality Rates
Epidemiologic Transition

76. Importance of
Geographic Patterns

77. Incidence of Stomach CA Males
With stomach cancer there is over a 20 fold relative risk. What might be causing the difference?

78. Breast Cancer Incidence Females
For breast cancer there is a 10 fold variation across countries, but the total known relative risk is What does this imply about the geographic differences?

79. CHD Death Rates Males, aged 45-54
Evaluation of geographic differences are very interest. For CHD, there is over a 20 fold differnce in mortality. This is exciting as each know risk factor is associated with CHD with a RR of 3-4. Thus geographic difference are the most powerful risk factor for develop a diease. This also implies that risk factors cluster in populations.

80. Cirrhosis Death Rates, Males, aged 45-54
Assessment of the mortality rates for cirrhosis has provided important clues as to the etiology of cirrhosis. There is a strong ecologic correlation between alcohol consumption and cirrhosis.

81. High Incidence of NCDs in Developing Countries
Possible Infectious Etiology
Macronodular Cirrhosis
Hepatocellular Carcinoma
Rheumatic Heart Disease
Iron deficiency anemia
Related to Nutrition Deficiency
Endemic Goiter
Malnutrition Related Diabetes.
Developing countries have a very different pattern. Their diseases are primarily associated undernutrition and infection, whereas developing countries are related to overnutrition.

82. High Incidence of NCDs in Developed Countries
Cardiovascular
CHD
Deep Vein Thrombosis
Respiratory
Emphysema
Lung CA
Female Genital
Endometriosis
Endometrial CA
Breast
Breast CA
Fibrocystic Disease
Male Genital
Prostrate CA
Metabolic
NIDDM
There is a pattern of diseases for non-communicable diseases in developed countries in contrast with developing countries.

83. Back to Nature A Healthier Diet, less saturated fats, more fiber
Improved Physical activity
A Healthier Diet, less saturated fats, more fiber
Less Stress
We have heard how we should get back to the goodold days…
But how good were they?

84. Nomads Farmers Urban 45 yrs 60 yrs 70 yrs Transition
The good old days of nomadic existence had a remarkably lowlife expectancy.

85. USA 1960 Urban Rural rural urban Developing Countries
In 1960, in developing countries most people lived in rural areas.
Developing
Countries
USA

86. USA 2006 Urban Rural urban rural Developing Countries
Nowthis has dramatically changed, the “mega” cities of developing countries, such as Mexico City, and Sao Paulo have rapidly emerged.
Developing
Countries
USA

87. Causes of Death Developed Developing Age 15-44 Age 45-54 Age 15-44
Accidents CA
CHD
Age 45-54
Age 15-44
Accidents
CHD CA
Age 45-54
If one looks that the most productive segments of society in developing and developed countries, the causes of death are virtually the same.