EPIDEMIOLOGIC EPIDEMIOLOGIC TRANSITIONTRANSITION

Epidemiologic Transition:Epidemiologic Transition:Changes of fertility and mortality Changes of fertility and mortality

with modernizationwith modernization

Imhotep,

the "father of medicine". The word "Imhotep" means "he who comes in peace'

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.

Prevention in Egypt

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

Charles DarwinEvolution of Species

Abdel OmranEvolution of Disease

The Theory Of Epidemiologic The Theory Of Epidemiologic Transition (Abdel Omran)Transition (Abdel Omran)

1.1. The The Age of Pestilence and FamineAge of Pestilence and Famine

2.2. The The Age of Receding PandemicsAge of Receding Pandemics

3.3. The Age of Degenerative and Man-The Age of Degenerative and Man-Made DiseasesMade Diseases

The The Age of Pestilence and FamineAge of Pestilence and Famine

Characterized by high mortality Characterized by high mortality rates, wide swings in the mortality rates, wide swings in the mortality rate, little population growth and rate, little population growth and very low life expectancyvery low life expectancy, , vacillating betweeen 20 and 40 vacillating betweeen 20 and 40 yearsyears

Age of Receding PandemicsAge of Receding Pandemics

Epidemics become less frequent, Epidemics become less frequent, infectious diseases in general become infectious diseases in general become less frequent, a slow rise in less frequent, a slow rise in degenerative diseases begin to appeardegenerative diseases begin to appear, , Average life expectancy increases Average life expectancy increases steadily from about 30 to 50 yearssteadily from about 30 to 50 years

The Age of Degenerative and The Age of Degenerative and Man-Made DiseasesMan-Made Diseases

Mortality continues to decline and Mortality continues to decline and eventually approaches stability at a eventually approaches stability at a relatively low level.relatively low level.

Instead at looking at individual Instead at looking at individual diseases, we need to look at the diseases, we need to look at the

patterns of diseases patterns of diseases

Mortality is the fundamental Mortality is the fundamental factor in the dynamics of factor in the dynamics of

population growthpopulation growth

Mortality has no fixed upper limits. Mortality has no fixed upper limits. Thus if fertility approached its Thus if fertility approached its upper maximum, depopulation upper maximum, depopulation

would still occur.would still occur.

During the epidemiologic During the epidemiologic transition, a long-term shift transition, a long-term shift

occurs in mortality and disease occurs in mortality and disease patterns whereby pandemics of patterns whereby pandemics of

infection are replaced by infection are replaced by degenerative and man-made degenerative and man-made

diseases...diseases...

The shifts in disease patterns in The shifts in disease patterns in the 19th century were primarily the 19th century were primarily

related to changing SESrelated to changing SES (Developed Countries)(Developed Countries)

With the 20th Century more With the 20th Century more related with disease control related with disease control

activities independent of SESactivities independent of SES (Developing Countries)(Developing Countries)

Death Rates for TB in England Death Rates for TB in England and Walesand Wales

0

500

1000

1500

2000

2500

3000

3500

4000

4500

1840 1855 1875 1895 1915 1935 1948 1958 1968

Death Rates for TB in England Death Rates for TB in England and Walesand Wales

0

500

1000

1500

2000

2500

3000

3500

4000

4500

1840 1855 1875 1895 1915 1935 1948 1958 1968

TB Bacillus Identified

Chemotherapy

BCG Vaccination

Death Rates for Measles in Death Rates for Measles in Children in England and WalesChildren in England and Wales

0

200

400

600

800

1000

1200

1400

1850 1870 1890 1910 1930 1950 1970

Death Rates for Measles in Death Rates for Measles in Children in England and WalesChildren in England and Wales

0

200

400

600

800

1000

1200

1400

1850 1870 1890 1910 1930 1950 1970

Immunization begun

Epidemiologic Transition in Epidemiologic Transition in Developing and DevelopedDeveloping and Developed

CountriesCountries

0

10

20

30

40

50

60

70

80

1945 1960 1980 1995

Developing

Developed

High Incidence of NCDs in High Incidence of NCDs in Developing CountriesDeveloping Countries

Possible Infectious EtiologyPossible Infectious Etiology

Macronodular CirrhosisMacronodular Cirrhosis

Hepatocellular CarcinomaHepatocellular Carcinoma

Rheumatic Heart DiseaseRheumatic Heart Disease

Iron deficiency anemiaIron deficiency anemia

Related to Nutrition DeficiencyRelated to Nutrition Deficiency Endemic GoiterEndemic Goiter

Malnutrition Related Diabetes.Malnutrition Related Diabetes.

High Incidence of NCDs in Developed CountriesHigh Incidence of NCDs in Developed Countries CardiovascularCardiovascular

CHDCHD

Deep Vein ThrombosisDeep Vein Thrombosis

RespiratoryRespiratory

EmphysemaEmphysema

Lung CALung CA

Female GenitalFemale Genital

EndometriosisEndometriosis

Endometrial CAEndometrial CA

BreastBreast

Breast CABreast CA

Fibrocystic DiseaseFibrocystic Disease

Male GenitalMale Genital

Prostrate CAProstrate CA

MetabolicMetabolic

NIDDMNIDDM

Causes of DeathCauses of Death

Age 15-44Age 15-44 AccidentsAccidents

CACA

CHDCHD

Age 45-54Age 45-54 CHDCHD

CACA

AccidentsAccidents

Age 15-44Age 15-44 AccidentsAccidents

CHDCHD

CACA

Age 45-54Age 45-54 CHDCHD

CACA

AccidentsAccidents

Developed Developing

35 years

14 years

Changing Life ExpectanciesChanging Life Expectancies

20 yrs

5 yrs

40

45

50

55

60

65

70

75

80

1945 1975 1995

USEgypt

40 44 48 52 56 60 64 68 72 76

Population Life Expectancy

0

20

40

60

80

100

InfectionCA

CHD

Other

Violence

Increasing Life Expectancy and Causes of Death

Incidence of Stomach CAIncidence of Stomach CAMalesMales

0 20 40 60 80 100

Nigeria

India

US White

US NW

UK

Finland

Iceland

Columbia

Japan

Breast Cancer IncidenceBreast Cancer IncidenceFemalesFemales

0 5 10 15 20 25 30

Japan

Nigeria

Brazil

Singapore

Jamaica

Poland

UK

US NW

US Whites

CHD Death RatesCHD Death RatesMales, aged 45-54Males, aged 45-54

0 500 1000 1500

Thailand

Guatamala

Japan

Egypt

Italy

Bulgaria

US

UK

Scotland

Finland

Epidemiologic Transition

Mor

tali

ty R

ates

Infectious Diseases

NCD

Epidemiologic Transition

Mor

tali

ty R

ates

CA

CHDNIDDM

Trauma

OMRAN THEORYOMRAN THEORY

1.1. The The Age of Pestilence and FamineAge of Pestilence and Famine

2.2. The The Age of Receding PandemicsAge of Receding Pandemics

3.3. The age of triple health burdenThe age of triple health burden

1.1. The The Age of Pestilence and FamineAge of Pestilence and Famine

2.2. The The Age of Receding PandemicsAge of Receding Pandemics

3.3. The Age of Degenerative and Man-Made DiseasesThe Age of Degenerative and Man-Made Diseases

DEVELOPED COUNTRIES

DEVELOPING COUNTRIES

The Age of Triple Health Burden The Age of Triple Health Burden (Tiga Beban Ganda Kesehatan)(Tiga Beban Ganda Kesehatan)

1.1. Masih tingginya angka kesakitan penyakit Masih tingginya angka kesakitan penyakit menular “klasik”.menular “klasik”.

2.2. Tingginya angka kesakitan dan kematian Tingginya angka kesakitan dan kematian akibat Penyakit Tidak Menular (Non-akibat Penyakit Tidak Menular (Non-Communicable Disease).Communicable Disease).

3.3. Munculnya penyakit baru Munculnya penyakit baru (new emerging (new emerging Infectious Disease)Infectious Disease)

Beban Penyakit 1Beban Penyakit 1

Penyakit ini merupakan masalah kesehatan yang Penyakit ini merupakan masalah kesehatan yang besar di hampir semua Negara berkembang besar di hampir semua Negara berkembang apalagi negara tersebut berada pada daerah tropis apalagi negara tersebut berada pada daerah tropis dan sub-tropisdan sub-tropis

Angka kesakitan dan kematian relatif cukup Angka kesakitan dan kematian relatif cukup tinggi dan berlangsung sangat cepat menjadi tinggi dan berlangsung sangat cepat menjadi masalahnyamasalahnya

ex :Tuberkulosis (TB), Kusta, Diare, DBD, ex :Tuberkulosis (TB), Kusta, Diare, DBD, Filariasis, Malaria, Leptospirosis Filariasis, Malaria, Leptospirosis

Beban Penyakit 2Beban Penyakit 2

Masalah utamanya adalah angka kematian akibat Masalah utamanya adalah angka kematian akibat penyakit tidak menular (PTM) di Indonesia sudah lebih penyakit tidak menular (PTM) di Indonesia sudah lebih tinggi daripada kematian akibat penyakit menulartinggi daripada kematian akibat penyakit menular

Pada tahun 1995 kematian akibat penyakit tidak Pada tahun 1995 kematian akibat penyakit tidak menular sebesar 41,7 persen dan tahun 2007 meningkat menular sebesar 41,7 persen dan tahun 2007 meningkat menjadi 59,5 persen, ini yang tercatat di pelayanan menjadi 59,5 persen, ini yang tercatat di pelayanan kesehatan bagaimana dengan yang tidak tercatat ?kesehatan bagaimana dengan yang tidak tercatat ?

Ex :Hipertensi, Diabetes Mellitus, Penyakit Ex :Hipertensi, Diabetes Mellitus, Penyakit Cardiovaskuler (CVD), Ischemic Heart Disease, PPOK, Cardiovaskuler (CVD), Ischemic Heart Disease, PPOK, KankerKanker

Beban Penyakit 3Beban Penyakit 3

Penyakit ini rata-rata disebabkan oleh virus lama Penyakit ini rata-rata disebabkan oleh virus lama yang berganti baju (bermutasi)yang berganti baju (bermutasi)

Angka kesakitan dan kematian pada penyakit ini Angka kesakitan dan kematian pada penyakit ini sangat tinggi dan berlangsung sangat cepatsangat tinggi dan berlangsung sangat cepat

Ex : HIV (1983), SARS (2003), Avian Influenza Ex : HIV (1983), SARS (2003), Avian Influenza (2004), H1N1 (2009) (2004), H1N1 (2009)

Let' s We Make That Let' s We Make That DDream ream CCome ome TTruerue

What ‘What ‘DDream"ream"

To Make Indonesian HealthTo Make Indonesian Health

Back to NatureBack to Nature

Improved Physical activityImproved Physical activity A Healthier Diet, less saturated A Healthier Diet, less saturated

fats, more fiberfats, more fiber Less StressLess Stress

FINISHFINISHTHANK YOUTHANK YOU

Importance ofGeographic Patterns