EPIDEMIOLOGIC
TRANSITION
Epidemiologic Transition:
Changes of fertility and mortality
with modernization
Imhotep,
the "father of medicine". The word
"Imhotep" means "he who comes in
peace'
Prevention in Egypt
Herodotus, after his visit to Egypt in the
5th century B.C., stated that Egyptians
were, with the Libyans, the healthiest
people. This must have implied a good
deal of sanitation. Cleanliness, was
religious as well a hygienic obligation.
Medicine is a science from which one learns the states of
the human body with respect to what is healthy and what
is not, in order to preserve good health when it exists and
restore it when it is lacking
Ibn Sina
Abdel Omran
Evolution of Disease
Charles Darwin
Evolution of Species
The Theory Of Epidemiologic
Transition (Abdel Omran)
1.
The Age of Pestilence and Famine
2.
The Age of Receding Pandemics
3.
The Age of Degenerative and ManMade Diseases
The Age of Pestilence and Famine
Characterized by high mortality
rates, wide swings in the mortality
rate, little population growth and
very
low
life
expectancy,
vacillating betweeen 20 and 40
years
Age of Receding Pandemics
Epidemics become less frequent,
infectious diseases in general become
less frequent, a slow rise in
degenerative diseases begin to appear,
Average life expectancy increases
steadily from about 30 to 50 years
The Age of Degenerative and
Man-Made Diseases
Mortality continues to decline and
eventually approaches stability at a
relatively low level.
Instead at looking at individual
diseases, we need to look at the
patterns of diseases
Mortality is the fundamental
factor in the dynamics of
population growth
Mortality has no fixed upper limits.
Thus if fertility approached its
upper maximum, depopulation
would still occur.
During the epidemiologic
transition, a long-term shift
occurs in mortality and disease
patterns whereby pandemics of
infection are replaced by
degenerative and man-made
diseases...
The shifts in disease patterns in
the 19th century were primarily
related to changing SES
(Developed Countries)
With the 20th Century more
related with disease control
activities independent of SES
(Developing Countries)
Death Rates for TB in England
and Wales
4500
4000
3500
3000
2500
2000
1500
1000
500
0
1840
1855
1875
1895
1915
1935
1948
1958
1968
Death Rates for TB in England
and Wales
4500
TB Bacillus
Identified
4000
3500
3000
2500
2000
Chemotherapy
1500
BCG Vaccination
1000
500
0
1840
1855
1875
1895
1915
1935
1948
1958
1968
Death Rates for Measles in
Children in England and Wales
1400
1200
1000
800
600
400
200
0
1850
1870
1890
1910
1930
1950
1970
Death Rates for Measles in
Children in England and Wales
1400
1200
1000
800
600
Immunization begun
400
200
0
1850
1870
1890
1910
1930
1950
1970
Epidemiologic Transition in
Developing and Developed
Countries
80
70
60
50
Developing
Developed
40
30
20
10
0
1945
1960
1980
1995
High Incidence of NCDs in
Developing Countries

Possible Infectious Etiology
Macronodular Cirrhosis
Hepatocellular Carcinoma
Rheumatic Heart Disease
Iron deficiency anemia
 Related to Nutrition Deficiency
Endemic Goiter
Malnutrition Related Diabetes.
High Incidence of NCDs in Developed Countries
Cardiovascular
CHD
Deep Vein Thrombosis
Respiratory
Emphysema
Lung CA
Female Genital
Endometriosis
Endometrial CA
Breast
Breast CA
Fibrocystic Disease
Male Genital
Prostrate CA
Metabolic
NIDDM
Causes of Death


Developed
Developing
Age 15-44
Age 15-44
Accidents
CA
CHD
Accidents
CHD
CA
Age 45-54
CHD
CA
Accidents
Age 45-54
CHD
CA
Accidents
14 years
35 years
Changing Life Expectancies
20 yrs
80
75
70
65
60
55
50
45
40
5 yrs
US
Egypt
1945
1975
1995
Increasing Life Expectancy and
Causes of Death
100
Other
80
60
Violence
CHD
40
20
CA
Infection
0
40
44
48
52
56
60
64
68
Population Life Expectancy
72
76
Incidence of Stomach CA
Males
Japan
Columbia
Iceland
Finland
UK
US NW
US White
India
Nigeria
0
20
40
60
80
100
Breast Cancer Incidence
Females
US Whites
US NW
UK
Poland
Jamaica
Singapore
Brazil
Nigeria
Japan
0
5
10
15
20
25
30
CHD Death Rates
Males, aged 45-54
Finland
Scotland
UK
US
Bulgaria
Italy
Egypt
Japan
Guatamala
Thailand
0
500
1000
1500
Mortality Rates
Infectious Diseases
NCD
Epidemiologic Transition
Mortality Rates
NIDDM
CHD
Trauma
CA
Epidemiologic Transition
OMRAN THEORY
1.
2.
3.
The Age of Pestilence and Famine
The Age of Receding Pandemics
The Age of Degenerative and Man-Made Diseases
DEVELOPED COUNTRIES
1.
2.
3.
The Age of Pestilence and Famine
The Age of Receding Pandemics
The age of triple health burden
DEVELOPING COUNTRIES
The Age of Triple Health Burden
(Tiga Beban Ganda Kesehatan)
1.
Masih tingginya angka kesakitan penyakit
menular “klasik”.
2.
Tingginya angka kesakitan dan kematian
akibat Penyakit Tidak Menular (NonCommunicable Disease).
3.
Munculnya penyakit baru (new emerging
Infectious Disease)
Beban Penyakit 1
Penyakit ini merupakan masalah kesehatan yang
besar di hampir semua Negara berkembang
apalagi negara tersebut berada pada daerah tropis
dan sub-tropis
 Angka kesakitan dan kematian relatif cukup
tinggi dan berlangsung sangat cepat menjadi
masalahnya
ex :Tuberkulosis (TB), Kusta, Diare, DBD,
Filariasis, Malaria, Leptospirosis

Beban Penyakit 2



Masalah utamanya adalah angka kematian akibat
penyakit tidak menular (PTM) di Indonesia sudah lebih
tinggi daripada kematian akibat penyakit menular
Pada tahun 1995 kematian akibat penyakit tidak
menular sebesar 41,7 persen dan tahun 2007 meningkat
menjadi 59,5 persen, ini yang tercatat di pelayanan
kesehatan bagaimana dengan yang tidak tercatat ?
Ex
:Hipertensi,
Diabetes
Mellitus,
Penyakit
Cardiovaskuler (CVD), Ischemic Heart Disease, PPOK,
Kanker
Beban Penyakit 3
Penyakit ini rata-rata disebabkan oleh virus lama
yang berganti baju (bermutasi)
 Angka kesakitan dan kematian pada penyakit ini
sangat tinggi dan berlangsung sangat cepat
 Ex : HIV (1983), SARS (2003), Avian Influenza
(2004), H1N1 (2009)

Let' s We Make That Dream Come True
What ‘Dream"
To Make Indonesian Health
Back to Nature
 Improved Physical activity

A Healthier Diet, less saturated
fats, more fiber
 Less Stress
FINISH
THANK YOU
Importance of
Geographic Patterns