1. EPIDEMIOLOGICAL TRANSITION
Shiv Chandra Mathur
Director
State Institute of Health and Family Welfare, Rajasthan,
Jaipur, India
Shiv Chandra Mathur is a public health specialist working for developing human resources for health. His current assignment involves him consistently in organizing in-service trainings for health professionals. Present paper is a conceptual analysis of the epidemiological transition occurring in the developing world with particular reference to India.
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Shiv Chandra Mathur

2. Health Transition in Sweden
Year Life Expectancy IMR
Sweden is a prototype of developed world. But 100 years back, its health indicators were worst then what we in India have today. There is a need to understand the interventions launched in Scandinavian or for that matter in Europe and north America during twentieth century. If we apply them with efficiency and lethargy, we can cope up the race for reaching to Millennium Development Goals.
12/7/2018
Shiv Chandra Mathur

3. EPIDEMIOLOGIC TRANSITION
HEALTH TRANSITION
DEMOGRAPHIC TRANSITION
LIFESTYLE TRANSITION
HEALTH-CARE TRANSITION
ECOLOGICAL TRANSITION
To get a holistic view of epidemiological transition, we need to understand different dimensions of it, starting from health, demography, life-style, healthcare and environment.
Similarly the quest for new economy is putting pressure on the environment creating new challenges to conserve it.
Since the voyage for new economic order was started (early nineties), there is a rapid and tremendous change in the lifestyle of people in the most populous countries like China, India, Pakistan and even Banladesh.
Shiv Chandra Mathur

4. The epidemiological transition dynamics
STAGE: Overlap of stages Overlap of stages Merging with… Future Stages…
Pestilence and Receding Degenerative, stress, Declining CVD Aspired quality of
famine pandemics and man-made mortality, ageing & life with persistent
diseases emerging diseases inequalities
Determinants of disease and mortality charge
Health transition
Changing patterns of : O
Health
Survival
Disease, and Mortality
Continued dynamic
Change with chronicity plus
Emerging diseases
Accroding to transition model:
Decline in CVDs: actual (West)
Of potential in non-western
models
QUALITY OF LIFE FOR ALL
Fertility
High then declines
Age structure,
Young then older.
DEMOGRAPHIC
TRANSITION
&
AGENING
Determinants of fertility decline
Reference: World Health Statistics Quarterly,51(No.2/3),1998
Lifestyle and education transition
Health Care transition
Technical transition
Environmental factors
Flow of the Transition can be disrupted or reversed under crises or
 The Transition may accelerate under strikingly favorable conditions

5. DETERMINANTS OF MORTALITY DECLINE
Improvement in Nutrition
<infectious diseases/ advances in agriculture
Improvement in Personal cleanliness
Washing hands/ cloths
Ecological Recession of Diseases
Plague/ Scarlet Fever
Better Housing
Ventilation/ waster disposal
Reduction in reproductive risks
Shiv Chandra Mathur

6. Will Infectious Diseases Ever Be Extinguished?
REGRETS!
New Viruses/ mutation of old viruses.
Encroachment on Jungles – new wild viruses.
Obstinate resistance to existing drugs.
Continuous threat to immunity compromised.
the aged; Chronically ill; Prematurely born; malnourished; hospitalized; disadvantaged; high risk group .
Developing world and a country like India is heavily investing to mitigate the infectious diseases but there is a need to ponder on this issue.
Shiv Chandra Mathur

7. DISEASES CAUSING MICROBES
1973 Rotavirus Infantile Diarrhea
1977 EBOLA Haemorrhagic fever
1980 HTLV – 1 Leukemia
1983 HIV AIDS
1983 Helicobacter pylori Peptic Ulcer
Shiv Chandra Mathur

8. DISEASE CAUSING MICROBES
1988 Hepatitis E epidemic hepatitis
1989 Hepatitis C chr liver infection
1993 SIN NOMBRE Virus ARDS
1995 HHV – 8 associated with kaposi’s Sarcoma in HIV/AIDS
Shiv Chandra Mathur

9. PERCEIVED CHALLANGES TO HEALTH Indirect
ISSUES
Trade/ Markets Colonial networks Liberalized/ Global
Transport Ship, rail Air and Car
Population Growth Ageing, Refugees
Displaced
Communications Radio TV-electronics
Approach to UN- growth of civil
international end of period Society Groups
Cooperation of global conflict
3.4.05
Shiv Chandra Mathur

10. PERCEIVED CHALLANGES TO HEALTH
ISSUES IN
HEALTH CARE
Predominant
diseases pattern Communicable Non-communicable
INTERVENTIONS
Drugs Promising and inexpensive Resistance
Technology Limited Sophisticated
Shiv Chandra Mathur

11. GLOBAL HEALTH COOPERATION
I TRADITIONALIST VIEW
health development
II ESSENTIALIST VIEW
Trans-border disease control
co-ordination of global system
III SOCIAL JUSTICE VIEW
reintegrate health policies with development strategies
Shiv Chandra Mathur

12. 4 invisible PERILS in the Future of Mankind
VIRUSES mutation
change in virulence
ATOMIC ENERGY
GENOME RESEARCH
POPULATION GROWTH
Shiv Chandra Mathur

13. Transition Transition Stages in the developing Countries
< 20th/Early 20th Century / /
TRIPLE HEALTH BURDEN
Unfinished old set
Communicable disease
Reproductive morbidity
Nutritional deficiency
Rapid population growth
Rapid change since mid 20th Century
Old set of morbidity
Communicable disease
* epidemics
* endemic
Reproductive morbidity and mortality
Nutritional deficiency
Poor sanitation and housing
Poor personal hygiene
High child mortality
High disability Adjusted Life years Lost (DALYS) due to early death
Poverty
Rising new set
Cardiovascular disease
Malignancy and diabetes
Stress (depression)
Ageing and diseases of the elderly
Accidents (graffic, work)
Emerging and resurgent diseases
Transition
Reference: World Health Statistics Quarterly,51(No.2/3),1998
Lagging health care
Health systems and medical training ill-suited for the rising chronic and continuing acute diseases plus long-term care for the aged, the disabled and the mentally ill.
Recession of epidemics
Preventable disease burden LE
Shiv Chandra Mathur

14. Core functions WORLD HEALTH Positive Supportive functions
Established market
Economies
Industrialized
Countries in transition
Advanced developing
Countries
Other developing
Countries in crisis
Supportive
functions
Development continuum
Thus transition demands that interventionists should understand the need for supportive functions on which more energy and resources are to be invested, concurrently sustaining the pace of core functions.
Negative
Importance of care and supportive functions according to economic circumstances
Shiv Chandra Mathur