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Population and Public Health

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Title: Population and Public Health


1
Population and Public Health
  • ENVRE 115
  • Oct. 9, 2007

2
Announcements
  • Send in student biographies
  • Assignment 2 due
  • Graduate Student Projects
  • Groups have been assigned
  • Encourage you to use discussion board to
    communicate with team mates
  • Require topic approval by Tues., Oct. 30th
  • Make appointment to meet with Molly

3
Agenda
  • Demographic Tools
  • Drivers of population growth
  • Development Epidemiological Transition
  • Demographic Dividend

4
World population milestones
World population in billions World population in billions
Population and year Time taken to add a billion
1 billion in 1804 1,001,804 years
2 billion in 1927 123 years
3 billion in 1960 33 years
4 billion in 1974 14 years
5 billion in 1987 13 years
6 billion in 1999 12 years
7 billion in 2012 13 years
8 billion in 2026 14 years
8.9 billion in 2050 26 years
5
World Population Growth Through History
12
Billions
11
2100
10
Future?
9
Modern
Age
Old
8
Iron
Middle
Bronze
Stone
Age
New Stone Age
Age
Ages
Age
7
6
2000
5
4
1975
3
1950
2
1900
1
1800
Black Death

The Plague
A.D.
A.D.
A.D.
1000
2000
3000
4000
5000
6000
7000
1 million
A.D.
A.D.
A.D.
B.C.
B.C.
B.C.
years
2000
1000
1
B.C.
B.C.
B.C.
B.C.
3000
4000
5000
Source Population Reference Bureau and United
Nations, World Population Projections to 2100
(1998).
6
Trends in Worldwide Population Growth
Population Increase and Growth Rate, Five-Year
Periods
Percent increase per year
Millions
Source United Nations, World Population
Prospects The 2004 Revision (medium scenario),
2005.
7
Projected Growth in World Population
UN Pop.Div(2004)WRI(2006) Earthtrends.wri.org
8
Introduction to Demographics
  • Terminology
  • Growth Rates
  • Population Pyramids

9
Terminology
  • Count The absolute number of a population
    occurring in a specific area in a specified time
    period. Provides raw data.
  • Census data (number of people in the US)
  • Rate The frequency of demographic events in a
    population divided by the population at risk
    during the same time period.
  • Birth rates (number of live births/number of
    women of childbearing age)
  • Ratio The relation of one population sub-group
    to the total population or to another subgroup.
  • Sex ratios (number of males/number of females)
  • Dependency ratio ( of under 15 of 65 and
    over/ of 15 to 64)

10
Census Data Population in US
11
Growth RatesBirths/Total Population
Deaths/Total Population)100 Rate of Natural
Increase
  • Examples of population growth rates (2003)
  • Belgium 0.1 (10,318,000)
  • United Arab Emirates 1.4 (3,800,000)
  • Uganda 3 (25,632,794)
  • How long would take for these populations to
    double?
  • Belgium ? 700 years
  • United Arab Emirates ? 50 years
  • Uganda ? 23 years
  • The Rule of 70 is used to calculate doubling
    time
  • Doubling Time 70/rate expressed as a percentage
  • Assumption of constant growth rate during the
    time frame

12
Math Behind Exponential Growth
  • The basic differential equation for exponential
    growth dN/dt rN, over the period from t0 to t
    the time period in question, where N is the
    quantity growing and r is the growth rate
  • The integral of this equation is Nt N0 x ert
    where N(t) is the size of a quantity after t
    intervals have elapsed, N(0) is the initial value
    of the quantity, e is the base of the natural
    logarithm, r is the average growth rate over the
    interval in question, and t is the number of
    intervals
  • If one knows the final and initial values of N
    and the average growth rate, one can find the
    time it takes at that average growth rate for the
    quantity to grow from its initial value to the
    final value
  • t ln N(t)/N(0) / r
  • A special case is the doubling time, which is the
    time when N(t)/N(0) 2. At that point rt ln
    2 0.69. If one knows the growth rate as a
    decimal fraction, then the Doubling Time 0.69 /
    r.
  • This can be further simplifiedif the growth rate
    is given in percent, then 0.69 must be multiplied
    by 100, and the doubling time 69/r. This can
    then be rounded up to 70 (which is why it is
    called the rule of 70)

13
Examples
Doubling Time
  • Familiar example- compound interest on your bank
    account
  • 1. How long would it take for your bank account
    to double when invested at 3.5

Time 70/3.5 20 years
2. You invest 100 at 7 interest. How long will
it take to have 200?
Time 70/7 10 years
14
Doubling Time
  • Consider a country with 100 people, growing at 7
    per year. In 10 years, the population will double
    to 200 people, in another 10 years it will double
    again to 400 people, etc (see graph)

3. How long will it take this country to reach 1
million?
t ln N(t)/N(0) / r
t ln (1,000,000/100)/0.07 t ln
(10,000)/0.07 t 9.2103/0.07 t 131.5 years
15
Doubling Time
  • 4. In a country where the GDP is growing at 4.5
    per annum and the population is growing at 1.0
    per annum, how long will it take for the per
    capita GDP to double?

Doubling time 70/(4.5-1 )
70/3.5 20 years
5. In 1971, global population was 3.8 million and
it is currently 6.8 million. What was the global
population growth rate during this time frame?
Time 70/rate() 36 years 70/rate rate
70/36 rate 1.9
16
Crude and adjusted rates
  • Crude rates are affected by population
    characteristics, particularly age structure
  • Adjusted rates allow for valid comparisons
  • In 2002 Swedens crude death rate was 11 per
    1,000 compared to Panamas crude death rate of 5
    per 1,000.
  • Does this mean Panama has a lower mortality
    rate?

No. Sweden has 18 of its population in the
65-year or older category where deaths are more
likely to occur compared to Panama where 6 of
its population are 65.
17
Population PyramidsWhat can they tell us?
  • Graphically displays a populations age and sex
    composition
  • Horizontal bars present the numbers or
    proportions of males and females in each age
    group.
  • The sum of all the age-sex groups in the
    population pyramid equals 100 percent of the
    population

18
What can we infer from this data?
19
Japan1995 Census
20
Drivers of Population Growth
  • Birth Rate/Fertility
  • Age structure of population
  • Mortality

21
1. Birth Rate
  • Birth rate is defined as the number of live
    births per 1,000 women aged 15-49 in a given year
  • Replacement level fertility
  • Net reproduction rate of 1
  • Every woman of childbearing age has 1 daughter
  • Total fertility rate of 2.1
  • Every woman of childbearing age has 2.1 children

22
Fertility Rates Are Declining
Average number of children per woman
Source United Nations, World Population
Prospects The 2004 Revision, 2005.
23
Four factors that influence fertility
  • The proportion of women of childbearing age who
    are married or in a sexual union
  • The percent of women using contraception and the
    level of abortion
  • The proportion of women of childbearing age who
    currently are unable to conceive a child (usually
    from postpartum infecundity from breastfeeding)
  • Educational attainment of girls and women

24
Age at Marriage
Median Age at First Marriage, Women 20 to 24 at
Time of Survey Years
Source Measure DHS STATcompiler accessed online
at www.statcompiler.com on June 2, 2006.
25
Trends in Contraceptive Prevalence of women in
union aged 15-49 who are using contraception
UNICEF Region 1990 2000 chg.
Sub-Saharan Africa 16 23 46
Middle East/North Africa 37 54 45
South Asia 39 48 25
East Asia/Pacific 71 84 20
Latin America/Caribbean 62 73 19
CEE/CIS and Baltic States 63 66 4
Developing countries 54 65 20
Least developed countries 18 32 80
Industrialized countries 71 78 9
World 57 67 18
Sources  UN Population Division database, data
available as of 1 March 2001.
26
Association Between Fertility and Education of
Girls
Percent of Girls Enrolled in Secondary School
Total Fertility Rate
Source Population Reference Bureau, Population
Economic Development Linkages 2007 Data Sheet.
27
Association Between Fertility and Female Labor
Force Participation
Female Labor Force Participation Rate 2004
Total Fertility Rate 2000-2004
Source United Nations, World Population
Prospects The 2004 Revision, 2005 International
Labor Organization, Yearbook of Labor Statistics
2006.
28
Association between fertility and wealth
Average Number of Children Born to a Woman During
Her Lifetime
Source ORC Macro, Demographic and Health Surveys.
29
Complex associations between female education,
economy, and fertility
30
2. Age Structure of a Population
  • A large proportion of young people guarantees
    that population will continue to grow even with
    declining fertility
  • Takes two or three generations (70-100 years)
    before each new birth is offset by a death
  • Referred to as population momentum

31
Women of Childbearing Age There is a growing
population of women in their childbearing years
that will contribute to future world population
growth even if fertility continues to decline
Source United Nations, World Population
Prospects The 2004 Revision (medium scenario),
2005.
32
3. Mortality
  • Death is the ultimate determinant of population
    growth
  • Falling mortality precedes a decline in fertility

Rate
Death rate
Time
33
Development and public healthEpidemiological
Transition
34
Systematic Shift in Disease Patterns
Type 2 Diabetes
Trauma
CHD
Cancers
Mortality Rates
Infectious diseases
Development
35
Global Burden of Disease Mortality
36
Global Burden of Disease DALYs
37
How To Shift Causes of Mortality
  • Improved sanitation and drinking water supplies
  • Medical advances (vaccination, antibiotics)
  • Social advances (improved nutrition, access to
    health care)
  • Occupational Health Safety (injury prevention,
    chemical safety)
  • Infrastructure Improvements (roadways, housing,
    energy)
  • Consumer Safety (injury prevention, chemical
    safety)
  • Economic growth

38
Demographic Transition
39
Public Health
  • Where disease, demographics and development meet

40
Premise
  • Fertility has a fixed upper limit but not
    mortality so mortality is the fundamental factor
    that controls population dynamics
  • Diseases and injuries control mortality
  • Investment in public health shifts the causes of
    death (Epidemiological Transition) and this will
    influence population structure where women and
    children benefit the most
  • During the late phase of the demographic
    transition when fertility and dependency rates
    fall countries can harness the demographic
    dividend when output per capita rises

41
Great Sanitary AwakeningCornerstone of Public
Health
  • Increased immigration to cities during the
    Industrial Revolution
  • Analysis of 19th century England revealed urban
    mortality rates were much higher than rural rates
    dubbed the Urban Penalty
  • The concept that a government had the moral and
    ethical responsibility to protect the general
    welfare of its citizens

Scourge of the Poor
42
Improved Sanitation and Municipal Water
SupplyVirtually eliminated typhoid fever and
cholera
Typhoid Deaths
Redirected sewage discharges away from drinking
water intake and water filtration went online in
1906 Philadelphia, USA
43
Public Health Benefits From Municipal Water Supply
  • In the United States from 1900-1940
  • Mortality from diarrheal disease decreases from
    140 to 20 per 100,000
  • Child mortality rates decrease from 130 to 60 per
    1,000 live births
  • Life expectancy at birth increased by 16 years
  • Typhoid fever one of the top 5 causes of death
    virtually eliminated
  • Cost-benefit analysis conducted by Cutler
    Miller, 2005
  • 123 cost-benefit ratio
  • Every life saved cost 500 resulting in 11,500
    gain

2002 US
44
Factors contributing to diarrheal disease
  • Access To Safe Water
  • The source is less than 1 kilometer away from its
    place of use and reliably produces at least 20
    liter per member of a household per day
  • 1.1 billion people in developing countries have
    inadequate access to water
  • Access To Sanitation
  • An excreta disposal system is considered adequate
    if it is private or shared (but not public) and
    if it can effectively prevent human, animal, and
    insect contact with excreta
  • 2.6 billion people in developing countries lack
    basic sanitation
  • Hygiene Practices
  • Increase water quantity allows for more frequent
    washing practices (hand, food, bathing) which
    blocks transmission of disease causing pathogens

45
Municipal water supplies are the cheapest source
of water for the consumer
UNDP, 2006
46
Advanced sanitation is the most expensive for the
consumer but has the most health benefits
Sanitary Ladder
Data from Peru Having a pit latrine in the home
lowers the incidence of diarrhea by 50
while having a flush toilet lowers the risk by 70
UNDP, 2006
47
Method of disposing of human excreta is one of
the strongest predictors of child survival
UNDP, 2006
48
Access to improved water source
WHO Global water supply and sanitation assessment
2000
Access to improved sanitation
49
Current Burden of Waterborne Disease
  • 2nd largest cause of global child mortality
  • 1.8 million children die from diarrhea each year
  • 4931 children a day
  • 3.4 children a minute
  • 410 children died during this lecture
  • Over half of the hospital beds in the developing
    world are occupied by people suffering from
    preventable waterborne disease

50
Inequalities in the Use of Health Services
Surveys 1992-2001 Average rich/poor ratio
50 countries
53 countries
47 countries
42 countries
53 countries
The average of the ratios of the richest quintile
to poorest quintile Not weighted for population
size and excluding countries with use less than 1
Source D.R. Gwatkin, S. Rutstein, K. Johnson,
E.A. Suliman, and A. Wagstaff, Initial
Country-Level Information about Socioeconomic
Differences in Health, Nutrition, and Population,
Volumes I and II (Washington, DC The World Bank,
November 2003).
51
Childhood Vaccination Coverage
Children 12-23 Months Receiving Full Basic
Coverage Percent
Source ORC Macro, Demographic and Health Surveys.
52
Annual Cost per Fully Immunized Child for the
Traditional Childhood VaccinesBy Immunization
Strategy, 2001BCG (TB), Diptheria, Tetanus,
Pertussis, Polio, Measles
Cost () Mean Cost of all strategies 17
Note Numbers are rounded. Mean values are used.
Costs are weighted by population. Source Disease
Control Priorities in Developing Countries,
second edition, 2006, Table 20.4
53
Peoples Republic of China
  • China began investing in social development
    projects including education and health care
    under Maoist Government
  • 1952-1982 Invested in rural health through
    network of clinics and barefoot doctors
  • Infant mortality decreased from 200 to 34/1000
    live births
  • Life expectancy rose from 35 years to 68 years
  • Fertility rates declined from 6 births/woman
    (1970) to 3 birth/woman(1979) to one child
    policy in 1980
  • Universal primary education
  • 1980s saw major economic reform characterized by
    deregulation and liberalization opened up their
    economies to international trade and attracted
    foreign investment.

54
  • People born in the 1965 cohort with improved
    health care and education are now in their 40s
    and in their productivity peak
  • Harnessed demographic dividend due to low ratio
    of dependents
  • 2005 GDP growth was 9
  • 1/3 of income growth per capita in SE Asia (about
    2 percentage points) during 1965-90 is
    attributable to the independent influence of
    changes in age structure

http//www.iiasa.ac.at/Research/LUC/ChinaFood/data
/anim/pop_ani.htm
Cover from the book by David Cork and Susan
Lightstone The Pig and the Python, How to
Prosper from the Aging Baby Boom
55
Period of Potential Demographic Bonus
  • Countries with increasing numbers of working-age
    adults relative to dependent elderly and children
    have an opportunity to increase employment,
    investment, and savings
  • Whether or not the demographic bonus is realized
    depends on economic policies and economic
    opportunities

Source Population Reference Bureau, Population
Economic Development Linkages 2007 Data Sheet.
56
Resources
  • Improving the health of the world's poor BMJ No
    7107 Volume 315
  • http//www.bmj.com/archive/7107/7107e1.htm
  • Population health in transition by John Caldwell
  • http//whqlibdoc.who.int/bulletin/2001/issue2/79(2
    )159-170.pdf
  • World Health Reports
  • http//www.who.int/whr/en/
  • Preventing disease through healthy environments
    Towards an estimate of the environmental burden
    of disease
  • http//www.who.int/quantifying_ehimpacts/publicati
    ons/preventingdisease.pdf
  • Health and Economic Growth Findings and Policy
    Implications. Edited by G. López-Casasnovas, B.
    Rivera and L. Currais. MIT Press
  • http//mitpress.mit.edu/catalog/item/default.asp?t
    type2tid10711
  • Why Has Chinas Economy Taken Off Faster than
    Indias? David E. Bloom, David Canning, Linlin
    Hu, Yuanli Liu, Ajay Mahal, and Winnie Yip
  • http//www.hsph.harvard.edu/pgda/Bloom_Canning_Chi
    na_India.pdf
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