The Epidemiological Transition Policy and Planning Implications for Developing Countries (1993) / Chapter Skim
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INTRODUCTION
INTRODUCTION
Pages 1-8
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This shift in demographic and disease profiles, often referred to as the epidemiological transition, is currently under way in most developing countries. The transition occurs at different paces in different places, depending on the rate of fertility changes, the distribution of risk factors that contribute to the incidence of disease, and the health system's ability to respond to the changing epidemiological profile.
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, ~1 ~ The populations of developing countries are gradually shifting from environments with greater exposure to infectious diseases (poor water and food quality, unhygienic sanitation practices) to areas with a higher prevalence of risk factors for noncommunicable diseases, such as motor vehicles, unsafe workplaces, and air pollution (Smith, 19901.
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. However, this approach raises concern about the relevance of mortality patterns of advanced developing countries or the historical experience of developed countries to the current experience of the world's poorest countries.
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In developed countries, about 6 to 10 percent of adults die between ages 15 and 60; in developing countries, it is often the case that 25 to 35 percent die during this age interval. The authors suggest that as many as one-third of the preventable deaths in developing countries are the consequences of infection and other conditions acquired during infancy and childhood.
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Kenneth Manton and Eric Stallard consider the issues related to projecting morbidity and mortality during the reproductive and postreproductive years by developing a dynamic model based on risk factor regressions and multivariate hazard functions. Combining data sources to produce longitudinal data that include the levels of risk factors in developing countries yields more accurate forecasts than using the generally available data from developed countries.
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The changing health environment raises questions of whether the "child survival" strategy is the best approach for improving children's health in the l990s and whether some of the goals can be achieved without improving health care infrastructure. As noted earlier, the demographic and epidemiologic changes that are taking place in developing countries are often aggregated into national-level numbers, but within each population are groups, in widely differing circumstances.
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CONCLUSION Although this volume covers a range of issues related to changing disease profiles in developing countries, it is clearly not an exhaustive account of how societies should adapt to these changes. The papers do not form a cohesive set of policy recommendations; rather they address a set of issues that health planners in developing countries will have to consider as the epidemiological profile of their populations change.
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Mosley, eds., Disease Control Priorities in Developing Countries. New York: Oxford University Press for the World Bank.
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