• complex change in patterns of health and disease
• the interactions between these patterns and the demographic, economic, and sociological determinants and consequences.

• pestilence and famine
• receding pandemics
• degenerative and man-made diseases

Life Expectancies as Measure of Health
Transitions

1900
1.
Influenza and pneumonia
2.
Tuberculosis
3.
Gastritis
4.
Diseases of the Heart
5.
Cerebrovascular Disease
6.
Chronic Nephritis
7.
Accidents
8.
Cancer
9.
Certain diseases of infancy
10. Diptheria
1998
1.
Heart Diseases (31.4% )
2.
Cancer
(23.3%)
3.
Cerebrovascular diseases (6.9%)
4.
COPD
(4.7%)
5.
Accidents (4.1%)
6.
Pneumonia and Influenza
(3.7%)
7.
Diabetes
(2.7%)
8.
Suicide (1.3%)
9.
Diseases of Arteries
(1.2%)
10. Nephritis (1.1%)

Developed countries
1.
IHD 22.6%
2.
CVD 13.7%
3.
Lung Ca. 4.5%
4.
Respiratory infections 3.7%
5.
COPD 3.1%
6.
Colon Ca 2.6%
7.
Stomach Ca 1.9%
8.
Self-inflicted injuries 1.9%
9.
Diabetes 1.7%
10. Breast Ca 1.6%
Developing countries
1. IHD 9.1%
2. CVD 8.0%
3. Respiratory infections 7.7%
4. HIV/AIDS 6.9%
5. Perinatal conditions 5.6%
6. COPD 5%
7. Diarrhoeal diseases 4.9%
8. Tuberculosis 3.7%
9. Malaria 2.6%
10. Road accidents 2.5%
Beaglehole and Yach. Lancet 2003

• Decreased fertility rates
• Decreased infant mortality rates
• Increased life expectancies at birth
• Reflect shifts in social and economic patterns
• Changes in health conditions
• Changes in health care

• technological change
• alterations in the environment
• alterations in food type, availability, production, preparation, and consumption
• alterations in patterns of energy expenditure
• interplay of environmental factors and the genetic pool of a community

Epistemological Framework of
Epidemiological Transitions

MULTIPLE EPIDEMIOLOGIC TRANSITIONS
• recent resurgence of infectious disease mortality marks a third epidemiologic transition
• characterized by newly emerging, reemerging, and antibiotic resistant pathogens in the context of an accelerated globalization of human disease ecologies

Human Determinants of Transitions REDUX
• technological change
• alterations in the environment
• alterations in food type, availability, production, preparation, and consumption
• alterations in patterns of energy expenditure
• interplay of environmental factors and the genetic pool of a community
• Social inequality? Where is it?

Indonesia: From an Ethnographic Point of
View
• Pembangunan – development, lit. “to wake up,” “to structure/form,” “to rise, “to model”
• Suharto’s New Order – pembangunan government
• 1990s – epi/health transition
– Cultural critique

Medical Pluralism, Modernity, & Health
Transitions

• a theory, a livelihood, or a health condition conjoined in expected and unexpected ways that sometimes are not easily contained by a globalizing “regime of modernity”
• process of global integration, a process coined as modernity, producing a “unified history of the world” that shapes “meanings and values as they are actively lived and felt” into now transnationally, globally shared “structures of feeling”
– All over progress?

Local & Global: The Irony of Progress

• Phenotype
• Age
• Gender
• “Race”

Age & Social Stratification:
Age as “difference”
• AGE-SETS, AGE GRADES, AGE MATES
• differentiation of social role based on age
• Age sets are a type of sodality
– nonresidential groups that cut across kinship ties and thus promote broader social solidarity
• Age grades may be marked by changes in biological state, such as puberty
– Or by socially recognized status changes such as marriage, the birth of a child, menopause, retirement
• Persons of junior grade may defer to those of more senior grade who in turn teach, test, or lead their juniors.

AGE-
SETS/GRADES & THE LIFE-CYCLE
• Age Sets
– ‘Childhood’
– ‘Youth’
– ‘Middle-aged’
– ‘Elderly’
• Age Grades/ Classes & Social Power
– Elderly & children – dependent
– Youth & Middle-Age – independent
• economic, political, social power
– Elderly -- dependent

• The social production and cultural construction of age & aging
• In class and state formation people’s functions in the division of labor come to be discernible with reference to categories of gender, age, and skill abstracted from their particular kinship connections and meanings

• Where people become identified independently of kinship as a constituent of class for example, biological differences or functions as defined in the culture rather than social identities become increasingly important

• "ageism" -- like other forms of bigotry such as racism and sexism
• a process of systematic stereotyping and discrimination against people because they are old.
• any prejudice or discrimination against or in favor of an age group

• Older persons are constantly "protected" and their thoughts interpreted.
• Older persons falter for a moment because they are unsure of themselves and are immediately charged with being 'infirm.‘
• Older persons forget someone's name and are charged with senility and patronized.
• Older persons are expected to 'accept' the 'facts of aging.'
• Older persons miss a word or fail to hear a sentence and they are charged with 'getting old,' not with a hearing difficulty.
• Older persons are called 'dirty' because they show sexual feelings or affection to one of either sex.
• Older persons are called 'cranky' when they are expressing a legitimate distaste with life as so many young do.
• Older persons are charged with being 'like a child' even after society has ensured that they are as dependent, helpless, and powerless as children."

• intensified by certain dominant values in
American culture
– individualist tradition
– Independence & dependence
– productive achievement

AGEISM, Social Mobility & Open Class System
• Ascribed status of age
• Achieved status and aging
– Viagra
– Working