Epidemiologic Transition

lOMoARcPSD|14019262 Epidemiologic Transition A. Concept of Epidemiologic Transition Epidemiology is the study of the determinants, dynamics and distribution of disease. B. Epidemiologic Transition Theory A general framework for understanding major changes in disease patterns over time (Omran, 1971). 1. Definition of Epidemiologic Transition Epidemiologic transition is a change in the distribution and associated causative factors that give rise to new epidemiologic problems. Epidemiological transition is a situation characterized by a change from mortality and morbidity that used to be caused more by infectious disease (infectious disease) or communicable disease (communicable disease) is now more often caused by diseases that are chronic or noncommunicable disease and degenerative diseases. 2. Characterized by changes in disease frequency patterns. Starting from a complex change in the pattern of health and the pattern of major diseases that cause death where there is a decrease in the incidence of infectious diseases (infectious diseases), while non-infectious diseases (noncommunicable diseases) are increasing. This occurs along with changes in lifestyle, socioeconomics and increased life expectancy which means increased risk patterns for degenerative diseases such as coronary heart disease, diabetes mellitus, hypertension, and so on. C. Transition Model 1. Classical model - Western countries a. Socio-economic and sanitation improvements b. Improved health services 2. Slow - developing countries a. Health care - little socio-economic improvement b. Less decline in fertility - population growth lOMoARcPSD|14019262 3. Accelerated – Japan a. Socio-economic improvement, sanitation improvement and health care improvement D. Epidemiologic Transition in Developed Countries The theory of demographic transition that has been experienced by various developed countries shows that at the beginning of its development, the state of fertility and mortality is rather stable and both are at relatively high rates. Population growth was rather stable because the high mortality rate was offset by the high birth rate. Subsequently, with the development and advancement of socioeconomic status, mortality rates began to fall, followed by a decline in fertility. At the end of the transition, both rates stabilized. E. Epidemiologic Transition in Developing Countries The decline in mortality rates in Europe took a long time, about two centuries, while in Indonesia this decline was quite rapid, starting in 1960. This is because Indonesia does not have to wait for an increase in its socioeconomic status to be able to produce technology in the field of immunization and antibiotics because it is available through advances in world health technology. Similarly, with the success of the family planning program developed by Indonesia, the process of reducing the fertility rate is quite significant because Indonesia does not need to look for contraceptives and methods. The decline in mortality rates means that many people experience survival, but it is necessary to pay attention to the quality of life, especially in poor families. In addition, the decline in mortality also resulted in an increase in the number of elderly people. This also means that the morbidity rate is also increasing in the elderly. With the development of the economy and technology, not only has the mortality rate transition decreased but it has also been followed by a shift in the causes of death and patterns of disease in society. lOMoARcPSD|14019262 Three phases of epidemiologic transition (Omran, 1971), namely: 1. The age of pestilence and famine, characterized by high and fluctuating mortality and life expectancy of less than 30 years, 2. The age of receding pandemics, an era in which life expectancy began to increase between 30-50 3. The age of degenerative and man-made disease, a phase where infectious diseases begin to decline but degenerative diseases begin to increase. Criticism from figures such as Rogers and Hackenberg (1987) and Olshansky and Ault (1986) led Omran to make slight revisions. For Western countries, the three models were added with two more: 1. The age of declining CVD mortality, ageing, lifestyle modification, emerging and resurgent diseases is characterized by life expectancy reaching 80-85, very low fertility rates, and increasing cardiovascular disease and cancer. 2. The age of aspired quality of life with paradoxical longevity and persistent inequalities that describes future expectations, with life expectancy reaching 90 years but with chronic morbidity characteristics, thus encouraging efforts to improve quality of life. Omran also revised the epidemiological transition model for developing countries by changing the third phase to "The age of triple health burden" which is characterized by 3 things, namely: 1. Unresolved classic health problems (infectious diseases), 2. Emergence of new health problems (non-communicable diseases) and 3. Lagging health services However, when it is associated with the type of disease, some experts replace the third burden with "New Emerging Infectious Disease".