1. MEDICAL DEMOGRAPHY & HEALTH CARE
Elena A. Abumuslimova
Ph.D., Associate Professor
Department of Public Health and Health Care,
Northern-West State Medical University named after I.I. Mechnikov, Saint-Petersburg

2. Demography is the scientific study of human population
Demography studies 3 aspects of a population
Changes in population size
Composition of population
Distribution of population on the territory

3. Demography studies numerical structure of the population;
shares of the population according to gender, age, social and professional groups;
accommodation and movement of the population around the territory;
causes and effects of changes in population structure;
interrelation of socio-economic factors and the changes.

4. Before we plan any health intervention or programs for the community we should know the size and composition of the community
We also need to know the changes that will occur to the size and composition to the population

5. IMPORTANCE OF DEMOGRAPHIC STATISTICS:
Estimation of health indices of the population (birth rate, death rate, average life expectancy, final parameters of reproduction);
Estimation of laws and regularity of population reproduction forming structure;
Planning, accommodation and forecasting of staff network of public health service on the basis of amount and structure of the population;
Estimation of efficiency of planning and forecasting of medico-social actions;
Deep statistical analysis of its health condition, activity of medical institutions, precisely to plan their work.

6. DEMOGRAPHY DYNAMICS STATICS
MECHANICAL MOVEMENT
NATURAL MOVEMENT
STATICS

7. STATICS studies amount and structure of population according to age, gender, profession, etc.

8. Sources of Demographic information
Population census
Vital statistics
Migration

9. POPULATION CENSUS
is the main method for estimation of population static.
POPULATION CENSUS is the special scientifically organized state statistical operation for account and analysis the size of the population, its structure and distribution around the territory.

10. Features of population census
Periodicity (in the majority of the countries PCs are carried out in every 10 years, in economically advanced - in 5 years).
Generality (scope of all population).
Unity of a technique (presence of the uniform program of census as census sheet).
Single character (the population is taken into account for the certain moment when the population conducts the most settled way of life).
Collecting data by method of interrogation by means of copyists without obligatory documental confirmation.
Centralized method of data processing.

11. Importance of population census
perspective population calculations;
planning development of branches of national facilities (economy), including public health service;
estimation of sanitary condition of the population and calculation of various parameters of health;
estimation of sanitary - epidemic condition of area, for development of forecasts of an epidemic situation, etc.

12. Population size
refers to the number persons in the population.
By the beginning of the 21st century, world population reached 6 billion. Most of the growth has occurred in the past 200 years.

13. World population
About ¾th of world population lives in the developing countries
China and India are the two most populous countries in the world
The world population growth rate was at the peak in 1970
About 95% of the population growth is occurring in the developing countries

14. Amount of World-Population 500CE-2150 (United Nations Statistics Division)

15. Total population in Russia

17. World Population Growth

18. Enumerated of the world population (United Nations Statistics Division)
An estimated persons (89% of the estimated world population) have been enumerated in the 188 censuses conducted as of 1 September 2012 (this figure is based on the projected population for the year 2010 as estimated by the UN World Population Prospect Revision 2010, Medium Variant). At the end of the first year of the 2010 census round, 2005, an estimated 5.5% of the world's population had been enumerated (see Fig. 3). At the end of 2009 this proportion increased to 21%. The single year with the highest number of persons enumerated is 2010, when 42 countries or areas (including China) with a population of over million (33.2% of the world population) conducted a census. The single year with the greatest number of censuses is 2011 when 62 countries or areas conducted a population census in that year. At the end of the census round in 2014, 96.3% of the world population will have been enumerated (based on the current census schedule).

19. The unprecedented population growth of modern times heightens interest in the notion of doubling time. Calculation of population doubling time is facilitated by the Law of 70.

20. Low of 70
If a population is growing at a constant rate of 1% per year, it can be expected to double approximately every 70 years
If the rate of growth is 2%, then the expected doubling time is 70/2 or 35 years.
The unprecedented population growth of modern times heightens interest in the notion of doubling time.
Calculation of population doubling time is facilitated by the Law of 70.

21. Structure is the distribution of population among its sex & age groupings
The age-sexual structure has great importance for the characteristic of health and reproduction status of the population.
Prevalence of any age-sexual group in structure of the population determines death rate, birth rate, the reason of death, and reason of death of work-able persons, invalid age, average duration of a forthcoming life.

22. Age-sex composition of a population
Depicted by the Population Pyramid
“Young” population: pyramid is triangular
“Ageing” population: pyramid becomes more and more rectangular

23. Age-Sex Composition of a population
Refers to the proportion of males & females in different age-groups.
It has a direct bearing on social, economic, health needs of communities or countries.
In an “old” population, for example, the society has to arrange for the care of the elderly, & the country’s health system must be organized accordingly.
In a “young” population, on the other hand, the country has to provide more schools, immunizations, & economic support for the young

24. “Ageing” population Elderly rises more than 20% of total population
Due mainly to low fertility
“Young-old” versus “old-old”
More and more elderly women
More chronic & degenerative diseases
Multiple health problems are common in elderly people

25. Age-sexual structure of the population
The ages groups
The type of age structure of population
Regressive
Stationary
Progressive
Till 14 years (A)
A < C
A = C
A > C
From 15 to 49 years (B)
~ 50%
50 years old and older (C)
C > A
C < A

26. Distribution refers to the arrangement of the population in space at a given time

27. Global population density

28. DEMOGRAPHY DYNAMICS STATICS
MECHANICAL MOVEMENT
NATURAL MOVEMENT
STATICS

29. Mechanical movement It includes:
It is understood as a process of population migration.
Depending on duration, migration is divided into constant and seasonal.
It includes:
Emigration;
Immigration;
Urbanization;
Movement of population in depend on socio-political and others courses

30. Migration
Involuntary: slavery, ethnic persecution, wars, natural disasters, famines
Voluntary: to seek jobs (skilled or unskilled), to get an education, because of marriage, upon retirement
Internal migration: within a country e.g. rural to urban
International migration: skilled professionals to other countries

31. Migration & Health
Migrants (workers, prostitutes, truck drivers) may spread infectious diseases e.g. HIV/AIDS, TB, diphtheria
Jet travel speeds up disease transmission
Migrants often live in urban slums and experience adjustment problems (these can affect their physical or mental health)

32. Urbanization
It is a demographic process which is characterized by growth of number of cities;
increasing in their capacity;
prevalence of a share of city dwellers among all population.

33. Urbanization level in the world

34. Natural movement of the population
It is a set of such demographic phenomena as birth rate, death rate, a natural increase of the population, infantile death rate, the data on marriages, divorces, average duration of a forthcoming life, which registered in medical institutions and establishments of civil registration.

35. Index of average duration of a forthcoming life / life expectancy
It is hypothetical number of years which should be lived by the given generation born or to number of contemporaries of the certain age if on all extent of their life death rate in each age group will be the same it was that year for which calculation was made.

36. Life expectancy
Life expectancy is the average number of years which a person of a particular age may expect to live
It is one of the best indicators of a country’s level of development and overall health status
The life expectancy of people all over the world has been increasing

37. Life expectancy
This parameter characterizes viability of the population as a whole: it does not depend on features of age structure of the population and is suitable for the analysis in dynamics and comparisons of the data of different countries.

38. Life expectancy ≠ middle age of died people
Life expectancy ≠ middle age index of the population

39. Parameters of reproduction of the population
Birth rate
Death rate
Index of natural increase

40. Birth rate
Birth rate is the major component of natural movement of the population.
Recently was marked significant decrease of birth rate level in all economically advanced countries that entails a lot of undesirable consequences:
increase of deficiency of a manpower,
decrease in rate of population growth,
change of its age structure (population ageing and reduction of a share of fertile age women),
increase the quantity of the single-child families, etc.

42. Developed countries have low birth rates because
It is expensive to look after large families
More women prefer to concentrate on their careers
Increasing sexual equality has meant women have more control over their own fertility
There is a ready availability of contraception and family planning advice

43. Profound characteristic of birth rate
General birth rate
Fertile index
Age-specific birth rate
Factor of total prolificacy
Gross – factor
Net - factor

45. THE FACTORS INFLUENSING BIRTH RATE
social position of women,
- their employment in manufacture,
- level of satis­faction of their material needs,
- cultural level,
- living conditions,
- degree of legislation security,
- level of children's death rate,
- provision of pensions,
- urbanization,
- national features,
- psychological and religious factors,
- ageing of population,
- State demographic policy, ets.

46. T.R. Malthus,
English clergyman, Thomas Robert Malthus, was the first person to draw widespread attention to the two components of natural increase, births and deaths (fertility and mortality).

47. In his “Essay on the Principle of Population”, initially published in 1798, Malthus postulated that population tended to grow geometrically while the means of subsistence (food) grew only arithmetically.
The Malthusian Trap:
Arithmetic growth (food): 1, 2, 3, 4, 5, 6, 7, 8, 9, 10…
Geometric growth (population): 1, 2, 4, 8, 16, 32, 64, 128, 256, 512…

48. This gap could not persist indefinitely.
Malthus argued that the difference between geometric and arithmetic growth caused a tension between the growth of population and that of the means of subsistence.
This gap could not persist indefinitely.
Owing to war, disease, hunger, and vice, mortality would serve as a positive check on population growth.
Malthus is a giant in intellectual history. For example, his thinking strongly influenced Charles Darwin and Alfred Russel Wallace in formulating their respective theories of natural selection. Immensely popular and provocative, the Essay appeared in multiple editions, with the last one being published posthumously.

49. Definition of Key Words
Size refers to the number persons in the population
Distribution refers to the arrangement of the population in space at a given time
Structure is the distribution of population among its sex & age groupings

50. Solution to the Malthusian Trap
Preventive checks: birth control through
later age at marriage.
abstinence from sex outside marriage.
(Malthus opposed artificial methods of birth control on moral grounds. Viewed contraception as a vice)

51. Population Explosion
Contrary to Malthus’s prediction, mortality has not yet risen to curb world population growth.
< 1 billion people in 1800 / 6 billion by the end of the 20th century
Why was Malthus unable to foresee the population explosion (also known as the population bomb)?

52. He did not recognize the force of the Industrial Revolution, which produced exponential growth in the means of subsistence.

53. The demographic transition
This refers to the change from:
High rates (births and deaths) to
Low rates (births and deaths)
Death rates drop before birth rates: therefore, there is a period of rapid population growth. This ends when birth rates finally drop.

54. The demographic transition
Falling death rates are due to better nutrition and higher standards of living
Falling birth rates are due to social and economic changes:
1) Women stay in school longer
2) More women work outside the home
3) Women marry later
4) Women postpone childbearing
5) People choose to have fewer kids

55. Demographic Transition Framework
Source: Ian R.H. Rockett. Population and Health: An Introduction to Epidemiology. Second edition. Population Reference Bureau 54(4); 1999: 9

56. Death rate
Death rate of the population is regarded as the major demographic index revealing sanitary conditions of the population.

57. Medical death certificate
Medical registration of the reasons of death is physician responsibility.
The medical death certificate is the legal and medical document certifying the fact and the reason of death.

59. Developing countries have high death rates because
Dirty, unreliable water supplies
Poor housing conditions
Poor access to medical sevices
Endemic disease in some countries
Diets that are short in calories and/or protein
Developed countries have low death rates because
Good housing conditions
Safe water supplies
More than enough food to eat
Advanced medical services which are easy to access
Some developed countries have a high death rate as they have an ageing population with many older people.

60. Structure of the death reasons
Blood circulation system.
Malignant tumours.
Traumas and poisoning

61. Infantile death rate
Index of infantile death rate is considered as operative criterion for an estimation of sanitary well-being of the population, level and quality of the medical-social help, an overall performance obstetrical and pediatric service.

62. Criteria of foetus (newborn) viability recommended by the WHO
term - 22 weeks and more,
body weight- 500 g and more,
body height – 32 sm and more.

63. Live-born criteria: extra-uterine lung breath, palpitation,
pulsation of large vessels,
reduction of separate groups of muscles.

64. Infant mortality rate

66. Infantile death rate during the various periods of child
- Early neonatal death rate
- Late neonatal death rate
- Neonatal death rate
- Post-neonatal death rate, etc.

67. The structure of reasons of infantile death rate
some causes of perinatal period , mainly intrauterine hypoxia of a fetus
congenital developmental of anom­alies
respiratory organ diseases
infection diseases
traumas and poisoning
otheres

68. Thank you for your attention!