MEDICAL DEMOGRAPHY

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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

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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

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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.

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• 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

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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.

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

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Sources of Demographic information

• Population census
• Vital statistics
• Migration

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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.

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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.

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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.

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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.

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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

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Amount of World-Population 500CE-2150(United
Nations Statistics Division)
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Total population in Russia
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World Population Growth
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Enumerated of the world population (United
Nations Statistics Division)
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• 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.

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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.

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Structure is the distribution of population among
its sex age groupings
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Age-sex composition of a population

• Depicted by the Population Pyramid
• Young population pyramid is triangular
• Ageing population pyramid becomes more and
  more rectangular

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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
  countrys 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

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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

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Age-sexual structure of the population
The ages groups The type of age structure of population The type of age structure of population The type of age structure of population
The ages groups Regressive Stationary Progressive
Till 14 years (A) A lt C A C A gt C
From 15 to 49 years (B) 50 50 50
50 years old and older (C) C gt A A C C lt A
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Distribution refers to the arrangement of the
population in space at a given time
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Global population density
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Mechanical movement

• 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

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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

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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)

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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.

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Urbanization level in the world
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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.

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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.

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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 countrys
  level of development and overall health status
• The life expectancy of people all over the world
  has been increasing

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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.

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• Life expectancy ? middle age of died people
• Life expectancy ? middle age index of the
  population

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Parameters of reproduction of the population

• Birth rate
• Death rate
• Index of natural increase

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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.

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• 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

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Profound characteristic of birth rate

• General birth rate
• Fertile index
• Age-specific birth rate
• Factor of total prolificacy
• Gross factor
• Net - factor

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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.

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T.R. Malthus, 1766-1834

• 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).

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• 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

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• 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.

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• 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

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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)

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Population Explosion

• Contrary to Malthuss prediction, mortality has
  not yet risen to curb world population growth.
• lt 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)?

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

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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.

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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

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

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

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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.

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• 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.

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Structure of the death reasons

• Blood circulation system.
• Malignant tumours.
• Traumas and poisoning

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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.

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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.

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Live-born criteria

• extra-uterine lung breath,
• palpitation,
• pulsation of large vessels,
• reduction of separate groups of muscles.

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Infant mortality rate
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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.

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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

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• Thank you for your attention!