HSS4331A –
International Health
Theory
Feb 1, 2010
More Seminars
• There are several new and interesting
upcoming seminars on the class website
Current Events Quiz #2
• Feb 8, 2010
• This time, you have only one news source:
BBC radio:
– Bbc.co.uk/radio – the World News report
– Or download the podcasts:
www.bbc.co.uk/podcasts/series/globalnews/
– (each day, there are about 2 30-min podcasts)
– Podcasts are archived only 3 days, so don’t waste
till the last minute!
• Quiz will cover the days Feb 1-6 inclusive
Today….
• OVERPOPULATION
What is overpopulation
• For an area to be considered overpopulated;
its population reaches a point where it can't
be maintained without rapidly depleting
nonrenewable resources
• In short, if its current human occupants are
clearly degrading the long-term carrying
capacity of an area, then that area is
overpopulated
– Overpopulation by Ehrlich (1990)
Why Is Overpopulation Bad?
• Ecological degradation
– Food supply
– Water supply
– Land overuse
• Diminished food supply
• Greater economic demands
• Increased population density means easier spread of
communicable disease
• Potential for mass migration -> refugees
• Potential for border insecurity
Population Density
• number of people per unit of area
Population Density
• Of the Earth:
– pop density is 13/km2
• If you use the entire surface area of the Earth
– Pop density is 48/km2
• If you use the entire land area of the Earth
Other Measures of Population Density
• Arithmetic density: The total number of people / area of land
measured in km² or mi².
• Physiological density: The total population / the amount of
arable land.
• Agricultural density: The total rural population / amount of
agricultural land.
• Residential density : The number of people living in an urban
area / the area of residential land.
• Urban density: The number of people inhabiting an urban
area / the total area of urban land
• Ecological optimum: The density of population which can be
supported by the area's natural resources.
Most Populous Nations
100%
19.81%
17.52%
7.39%
4.55%
3.47%
2.81%
Source: UN, 2005
Nations With Highest Pop. Density
Source: UN, 2005
Where Do Some Of The Poorer Countries Rank?
Source: UN, 2005
Demographic Transition
• Idea developed by Warren Thompson in 1929
• A nation transitions from high birth rate and
high death rate to low birth rate and low
death rate, as it “evolves” from a preindustrial to post-industrial economy
Demographic Transition
• Defined in four stages
– 1) pre-industrial society, death rates and birth
rates are high and roughly in balance
– 2) death rates drop rapidly due to improvements
in food supply and sanitation, which increase life
spans and reduce disease
– 3) birth rates fall due to a variety of social factors
– 4) both low birth rates and low death rates
Demographic Transition
Demographic Transition
CBR = crude birth rate
CDR = crude death rate
Demographic Transition
• Stage 1
– In pre-industrial society, death and birth rates are
high and fluctuate according to natural
phenomena (drought, disaster, disease)
– Population is relatively young
– Cost of a child is the cost of feeding him (low)
– Economic contribution of child is high (working on
farm, etc)
– Net economic value of child is therefore high
– Majority of deaths concentrated in 5-10 year olds
Demographic Transition
• Stage 2
– Decline in death rate, but birth rate remains high
• Increased survival of children, so age distribution shifts
younger
– In Europe, initiated by Agricultural Revolution in
18th century
– Today: Yemen, Afghanistan, “Palestine”,
– Today: sub-Saharan Africa, before AIDS epidemic
– Agricultural improvements
• Crop rotation, selective breeding
– Public health improvements
• Vaccination, clean water, sewerage, maternal care
Demographic Transition
• Stage 3
– Decline in birth rate
– Fewer children suffice to maintain family
economic unit
– Increased urbanization
– Increased female literacy and education
– Improved contraception practices
– Some countries that have experienced fertility
decline of 40% since pre-industrial levels:
• India, Jamaica, Mexico, Sri Lanka, Egypt, Panama
Demographic Transition
• Stage 4
– “post transition” stage
– Birth rates more-or-less equal death rates
– Some countries with total fertility rates <2.5:
• Canada, USA, Argentina, New Zealand, Australia, China
Total fertility rate = total number of children a
woman will squeeze out in her lifetime
Demographic Transition
• Stage 5?
– Some people think a stage 5 is needed to describe
countries that have transitioned from
manufacture-based economies to informationbased
– Also called “de-industrialization”
– Fertility rates are below replacement rate
– Examples:
• Japan, Greece, Germany, Italy, Spain… pretty much all
the wealthy nations of the world
Replacement rate = national birth rate needed to
maintain the total population
Demographic Transition
• “Demographic Trap”
– During stage 3 –high birth rates, low death rates
– Failure to progress to stage 4
• Birth rates remain high, resulting in rapidly growing
population
– Country’s economic growth is used up to support
the exploding population, and not on promoting
economic and social development
• E.g. Yemen
Demographic Transition
Related concept…
Abdel Omran, 1971….
In very very very broad terms, historians
consider the history of human disease to
have occurred in 3 phases:
• Age of Pestilence and Famine
• Age of Receding Pandemics
• Age of Degenerative and Manmade Diseases
http://www.who.int/bulletin/archives/79%282%29159.pdf
Omran defined:
The Epidemiologic Transition
• a human phase of development witnessed by
a sudden and stark increase in population
growth rates brought about by medical
innovation in disease or sickness therapy and
treatment, followed by a re-leveling of
population growth from subsequent declines
in procreation rates
– Wikipedia
Demographic Trap
– Concept first discussed by WHO in 1988
– Fear that exploding population will lead to
ecological collapse
– Fear that this will lead to mass migration of
people
• Border insecurity
• Food depletion
• Population density leads to easier epidemics
http://www.enotes.com/public-health-encyclopedia/demographic-trap
Demographic Trap
• Dissenting voice:
– Demographic Trap mostly seen as a path to famine
– Nobel Prize-winning economist Amartya Sen
argues that most large famines are a result of lack
of access to food, rather than a lack of actual food
• therefore it’s a political issue, not necessarily a
scientific one
Demographic Transition
Criticisms of the model/theory
– Does not apply to current South, since model is
based and validated on the experiences of Europe
and North America, where data has been available
longest
– Does not account for unforeseen huge
developments, like AIDS, which disproportionately
affects the South
– The model paints an overly optimistic view of the
future of developing nations
Demographic Transition
Criticisms of the model/theory
– Peruvian economist Hernando de Soto:
subsistence farmers cannot transition into
industrial economies because of political barriers,
i.e. they do not own their land
– With globalization, the extreme gap between rich
nations and poor nations creates external
pressure to keep birth rates high to maintain
economic output
– Not enough consideration of social changes on
reproduction practices (religion, social roles of
women, etc)
For More Info
• Here’s a nice article on a socio-political take
on the Demographic Transition:
• http://www.globalchange.umich.edu/globalch
ange2/current/lectures/pop_socio/pop_socio.
html
Malthus
• Thomas Robert Malthus (1766-1834)
• Author of Essay on the Principle of Population
• Yet another economist
Malthus
• Food production accelerates in “arithmetic
progression”
– Farm twice as much land, create twice as much
food
• Population accelerates in “geometric
progression”
– Exponential growth
• Populations must always outgrow their food
supply, resulting in inevitable famine
–  leads to “Malthusian collapse” of society
Malthus
• Criticisms of Malthus
Malthus
• Criticisms of Malthus
– William Godwin (1820):
• There’s plenty of land to farm
• Reproductive rates will not necessarily be constant
• Due to attrition, population growth is not geometric
(Not an economist, but a journalist and philosopher)
Malthus
• Criticisms of Malthus
– Marx (1867): rising population is actually a
measure of wealth
Malthus
• In general, supporters of Malthus believe in
the land’s limited ability to sustain large
numbers of people
• In general, critics of Malthus believe in the
potential of the free market to create wealth
for everyone, and therefore the ability to
purchase resources
Strategies for Reducing Population Growth
The Nation of Deonandia…
Residents are in perfect reproductive health, in their early 20s and horny as heck
100
women
100
men
9 months later:
100 babies
The Nation of Deonandia…
100
women
99
men
9 months later:
100 babies
The Nation of Deonandia…
100
women
98
men
9 months later:
100 babies
The Nation of Deonandia…
100
women
1
Lucky
man
9 months later:
100 babies
The Nation of Deonandia…
99
women
100
men
9 months later:
99 babies
The Nation of Deonandia…
98
women
100
men
9 months later:
98 babies
The Nation of Deonandia…
1
Very
popular
woman
100
men
9 months later:
1 baby
The Lesson?
• Population fertility is determined mostly by
female fertility
• To address population fertility, one must
address female fertility
(Problems With That Analysis)
•
•
•
•
Not everyone has 100% fertility
Does not consider contraception
Does not consider abortion/miscarriage
Does not consider abstinence or other nonreproductive behaviours
• Does not consider twins, triplets, etc
• Does not consider social factors (monogamy,
religion, etc) that dictate reproduction
Female Reproductive Rights
• The right to reproduce
• The right to contraception
– Including abortion
• The right to education about reproductive
health
– STIs, contraception, etc
• Protection from reproductive alteration
– Genital mutilation
– Forced sterilization
Focus on Women
• “The World Bank has recognized that there is
no investment more effective for achieving
development goals than educating girls.”
• Relates to MDG #3 and #5:
– #3: promote gender equality and empower
women
– #5: improve maternal health
Why Is Female Education Important?
• Reducing women’s fertility rates. Women with formal
education are much more likely to use reliable family planning
methods, delay marriage and childbearing, and have fewer
and healthier babies than women with no formal education
– one year of female schooling reduces fertility by 10 percent.
(www.worldbank.org)
• Lowering infant and child mortality rates. Women with some
formal education are more likely to seek medical care, ensure
their children are immunized, be better informed about their
children's nutritional requirements, and adopt improved
sanitation practices
Why Is Female Education Important?
• Lowering maternal mortality rates. Women with formal
education tend to have better knowledge about health care
practices, are less likely to become pregnant at a very young
age, tend to have fewer, better-spaced pregnancies, and seek
pre- and post-natal care.
– one year of schooling for 1000 women prevents 2 maternal deaths.
(www.worldbank.org)
• Protecting against HIV/AIDS infection. Girls’ education ranks
among the most powerful tools for reducing girls’
vulnerability. It slows and reduces the spread of HIV/AIDS by
contributing to female economic independence, delayed
marriage, family planning, and work outside the home, as well
as conveying greater information about the disease and how
to prevent it.