Topic one: Demographic Transition

This refers to changes in birth and death rates as society transitions from a 'traditional' to a more 'modern ' society. I put those words in quotes because their direct meaning is not exactly representative of what is implied in this definition. As countries and societies develop, changes are usually seen in the population numbers.

Stage 1: High death rates and high birth rates- the population is thus fairly stable
Stage 2: The death rate begins to drop(possibly owing to accessibility and availability of better health services,people living longer due to better lifestyles). This leads to an increase in the population growth.
Stage 3: The birth rates begin to drop usually due to increased accessibility to family planning services, education, woman emancipation. The total population however continue to rise because the death rates are still continuing to drop.
Stage 4: The birth rates and death rates become constant leading to stabilization of the total population.
Stage 5: This is a projection where the death rate exceeds the birth rate i.e there is below replacement rate fertility. This would lead to a decline in the total population.

www.census.gov/international/data/idb/informationGateway.php

I think Uganda is in stage two. The death rate is decreasing significantly with a marked decline in the under 5 mortality(refer to able below) however the birth rates are still high hence population growth. As evidenced by the pyramid, there are still very high birth rates(large number 0-4yrs) with only a small fraction in the middle aged and elderly categories.

The demographic translation curve however does not put into account population decreases following immigration.

www.census.gov/international/data/idb/informationGateway.php

Australia is in stage 4. The above diagram reflects a decrease in birth rates, with low infant and under 5 morality. There are also visibly low death rates throughout the population . This is a stable population.

Demographic overview- Uganda (United states census bureau www.census.gov)

Demographic Indicators	1995	2005	2013	2015	2025
Population
Midyear population (in thousands)	19,640	26,917	34,759	37,102	50,692
Growth rate (percent)	2.2	3.3	3.4	3.3	2.8
Fertility
Total fertility rate (births per woman)	7.2	6.7	6.1	5.9	5.0
Crude birth rate (per 1,000 population)	52	48	45	44	37
Births (in thousands)	1,014	1,301	1,576	1,649	1,877
Mortality
Life expectancy at birth (years)	45	50	54	55	59
Infant mortality rate (per 1,000 births)	89	77	62	59	45
Under 5 mortality rate (per 1,000 births)	156	131	102	96	70
Crude death rate (per 1,000 population)	18	14	11	11	8
Deaths (in thousands)	350	381	393	397	420
Migration
Net migration rate (per 1,000 population)	-11	-1	-0	-1	-1
Net number of migrants (in thousands)	-224	-29	-0	-27	-27

Demographic overview Australia:(United states census bureau www.census.gov)

Demographic Indicators	1995	2005	2013	2015	2025
Population
Midyear population (in thousands)	17,976	20,232	22,263	22,751	25,054
Growth rate (percent)	1.2	1.3	1.1	1.1	0.9
Fertility
Total fertility rate (births per woman)	1.8	1.8	1.8	1.8	1.8
Crude birth rate (per 1,000 population)	14	13	12	12	12
Births (in thousands)	256	260	272	276	290
Mortality
Life expectancy at birth (years)	78	81	82	82	83
Infant mortality rate (per 1,000 births)	6	5	4	4	4
Under 5 mortality rate (per 1,000 births)	7	6	5	5	4
Crude death rate (per 1,000 population)	7	6	7	7	8
Deaths (in thousands)	125	131	156	162	199
Migration
Net migration rate (per 1,000 population)	4	6	6	6	5
Net number of migrants (in thousands)	80	124	130	129	122

The differences seen between the demographic transition witnessed in Uganda and Australia can be attributed to:
1. High death rates in Uganda due to high infant and under 5 mortality rates due to communicable diseases, many underlying issues of which have been addressed in Australia.
2. High fertility rates due to cultural perspectives concerning large numbers of children, religious and cultural perspectives affecting use of family planning services which are inaccessible in some places.

The demographic transition is important because it can lead to an increase in productivity and economic growth as the 'workforce population increases with respect to the 'dependant' population.

Epidemiological transition:
Stage 1: Pestilence and famine
Stage 2: Receding pandemics
Stage 3: Degenerative and 'man-made' conditions
Stage 4: Delayed degenerative conditions and re-emerging infections.

The epidemiological transition directly underlies the demographic transition as it explains the changes in mortality and birth rates.

According to Harper et al(2010), the epidemiologic transition initially explained by Aromran was in 3 stages which were gauged from the Palaeolithic baseline. Research suggests that people lived long(low death rates) and that the population was probably kept stable then because of the low birth rates. During the post Palaeolithic period, people began to keep animals and this led to emergence of new diseases(zoonoses etc) thus higher death rates. The fertility rates were also high as people began to settle and have larger families.
 - The next stage is characterised by receding of pandemics with technology advances. The stages listed above then follow.
The model was disregarded by epidemiologists as they prefer to focus on one disease at a time- it is too unspecific. However, it has value in guiding interventions as predictions can be made for anticipated problems e.g increase in diabetics, re-emergence of infections etc





Literature Reflections:
1. Sen, A(1999) Critical Reflection: Health in development, Bulletin of World Health Organisation, 77(8) 619-623.

• "Economic growth is not an end in itself"  but rather is supposed to facilitate betterment of life. The example of the comparison between the African Americans and Chinese and Indians of Kerla was very useful in illustrating this point. The African Americans have higher per capita incomes than the Chinese and Indians above however their mortality are higher.
• Work done by Sudhir Anand & Martin Ravallion which compared different countries showed that life expectancy and GNP(Gross National Product) are directly proportional only in two instances where the GNP affects: income of the poor and investment in health care.
• The effects on development on health are thus largely dependent on how the income is used.
• He also analysed how some countries with low incomes have improved their health through "support-led" processes. These focus on social support of health and education. In "growth-mediated" processes, success is dependent on economically growth which is then appropriately invested.