1. Epidemiologic Transition: Changes of fertility and mortality with modernization Abdel Omran. The Epidemiologic Transition: A Theory of the epidemiology of population change. Milbank Quarterly. 1971;49:509-538 http://www.who.int/docstore/bulletin/pdf/2001/issue2/vol.79no.2.1 59-170.pdf

2. Lecture n Epidemiologic Transition n Geographic Studies, what do they tell us?

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

4. Epidemiology  Psychiatric Epidemiologists  Diabetes Epidemiology  Cardiovascular Epidemiology  Cancer Epidemiology  Infectious Disease Epidemiology

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

6. 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.

7. 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...

8. Age of Pestilence and Famine Characterized by high mortality rates, wide swings in the mortality rate, little population growth and very low life expectancy

9. Age of Receding Pandemics Epidemics become less frequent, infectious diseases in general become less frequent, a slow rise in degenerative diseases begin to appear

10. 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

15. Epidemiologic Transition in Developing and Developed Countries

16. 35 years 14 years

20. 40444852566064687276 Population Life Expectancy 0 20 40 60 80 100 Infection CA CHD Other Violence Increasing Life Expectancy and Causes of Death

25. Epidemiologic Transition Mortality Rates Infectious Diseases NCD

26. Death Rates for TB in England and Wales

27. TB Bacillus Identified Chemotherapy BCG Vaccination

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

29. Immunization begun

30. Epidemiologic Transition Mortality Rates CA CHD NIDDM Trauma

36. Importance of Geographic Patterns

37. Incidence of Stomach CA Males

38. Breast Cancer Incidence Females

39. CHD Death Rates Males, aged 45-54

40. Cirrhosis Death Rates, Males, aged 45-54

41. High Incidence of NCDs in Developing Countries ] Possible Infectious Etiology Macronodular Cirrhosis Macronodular Cirrhosis Hepatocellular Carcinoma Hepatocellular Carcinoma Rheumatic Heart Disease Rheumatic Heart Disease Iron deficiency anemia Iron deficiency anemia ] Related to Nutrition Deficiency Endemic Goiter Endemic Goiter Malnutrition Related Diabetes. Malnutrition Related Diabetes.

42. High Incidence of NCDs in Developed Countries Cardiovascular Cardiovascular CHD CHD Deep Vein Thrombosis Deep Vein Thrombosis Respiratory Respiratory Emphysema Emphysema Lung CA Lung CA Female Genital Female Genital Endometriosis Endometriosis Endometrial CA Endometrial CABreast Breast CA Breast CA Fibrocystic Disease Fibrocystic Disease Male Genital Male Genital Prostrate CA Prostrate CA Metabolic Metabolic NIDDM NIDDM

43. Back to Nature  Improved Physical activity  A Healthier Diet, less saturated fats, more fiber  Less Stress

44. Transition  Nomads  Farmers  Urban 45 yrs 60 yrs 70 yrs

45. 1960 Urban Rural USA Developing Countries ruralurban

46. 2006 Urban Rural USA Developing Countries rural urban

47. Causes of Death n Age 15-44 Accidents Accidents CA CA CHD CHD n Age 45-54 CHD CHD CA CA Accidents Accidents Age 15-44 Accidents CHD CA Age 45-54 CHD CA Accidents DevelopedDeveloping