Epidemiologic Transition: Russian examples

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Epidemiologic TransitionRussian examples

• Abdel Omran. The Epidemiologic Transition A
  Theory of the epidemiology of population change.
  Milbank Quarterly. 197149509-538
• http//www.who.int/docstore/bulletin/pdf/2001/issu
  e2/vol.79no.2.159-170.pdf

Faina Linkov, PhD, University of Pittsburgh
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Questions to be discussed at the end of the
lecture

• Can Omrans theory be applied to changing
  mortality patterns in Russia?
• Epidemiologic transition in Russia did it take
  place?
• Reversal of transition in Russia. How does it
  relate to Omrans theory?

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Epidemiologic transition Definition

• The epidemiologic transition is that process by
  which the pattern of mortality and disease is
  transformed from one of high mortality among
  infants and children and episodic famine and
  epidemic affecting all age groups to one of
  degenerative and man-made diseases (such as those
  attributed to smoking) affecting principally the
  elderly.
• Encyclopedia Britanica

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Stages of Epidemiological Transition

• Age of Pestilence and Famine
• Age of Receding Pandemics
• Age of Degenerative and Man-made diseases

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Age of Pestilence and Famine

• Characterized by high mortality rates, wide
  swings in the mortality rate, little population
  growth and very low life expectancy

• Traditional society, chronic shortage of food,
  poor sanitary conditions, high MCH morbidity and
  mortality, environmental problems, young
  population

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Peter I, the first emperor of Russia
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Age of Receding Pandemics

• Epidemics become less frequent, infectious
  diseases in general become less frequent, a slow
  rise in degenerative diseases begin to appear,
  improved life expectancy, organized health
  services, increased proportion of older people

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Alexander III, the last Russian Emperor to die
from natural causes
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Age of Degenerative and Man-made diseases

• Chronic diseases, cheap calories, morbidity
  overshadows mortality, rise in living standards,
  dramatic decline in fertility, comprehensive
  healthcare

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Mickhail Gorbachev, the first and the last
President of the USSR
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Infant Mortality Rate in Russia 1940-1993
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Theory criticisms
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Applications of Omrans Theory to Russia
Difficulties in Applying the General Rules

• Increased morbidity associated with WWI and WWII,
  famines, and political repressions
• Reverse transition in 1990s
• Excess mortality for Russian males

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Russias transition in 1990s
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Net Migration and Natural Increase in Russia,
19802001
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Russia decreasing population
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The health care principles upon which the Soviet
health care system was to be based (Nikolai
Semashko)

• government responsibility for health
• universal access to free services
• a preventive approach to social diseases
• quality professional care
• a close relation between science and medical
  practice
• continuity of care between health promotion,
  treatment and rehabilitation.

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Next steps following the establishment of the
Semashko model in 1918

• The health care system was under the centralized
  control of the state, which financed services by
  general government revenues as part of national
  social and economic development plans.
• All health care personnel became employees of the
  centralized state, which paid salaries and
  provided supplies to all medical institutions.
• The main policy orientation throughout this
  period was to increase numbers of hospital beds
  and medical personnel.

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Next steps following the establishment of the
Semashko model in 1918 (cont.)

• Russia made massive strides in arresting the
  spread of infectious diseases.
• Drastic epidemic control measures were
  implemented, particularly in the cases of
  tuberculosis, typhoid fever, typhus, malaria and
  cholera.
• These involved community prevention approaches,
  routine check-ups, improvements in urban
  sanitation and hygiene, quarantines, etc.

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The period until 1991Life expectancy (both
sexes)
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The period until 1991Life expectancy in 1965
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A campaign against alcohol

• By the 1980s, the gap between Russia and Western
  countries in life expectancy at birth came to
  about 10 years for men and 6 years for women,
  mostly due to high death rates among those of
  working age (6). In the mid-1980s, the government
  made an attempt to address this problem (9). It
  was by then generally understood that potentially
  avoidable human losses were mostly attributable
  to excess adult age mortality from particular
  causes such as injuries, accidental poisoning,
  suicide, homicide, sudden cardiac death,
  hypertension and other conditions closely related
  to alcohol abuse and its consequences.

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Life expectancy related to Campaign
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But.

• Russia failed to maintain this record, however
  by 1987 the USSR was no longer able to enforce
  the anti-alcohol campaign and death rates rapidly
  resumed their upward trend from 1988 onwards. The
  anti-alcohol campaign was largely prohibitive and
  did not affect the attitude of the majority of
  Russias population towards alcohol.

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The period after 1991

• The health status of the Russian population
  declined precipitously following the collapse of
  the Soviet Union in late 1991. By all accounts,
  in the last decade Russia has been experiencing a
  shock unprecedented in peacetime to its health
  and demographic profiles.

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Life expectancy in Russia, male
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Life expectancy in Russia, female
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The leading causes of death in the Russia
Federation

• Cardiovascular diseases with rates that are the
  highest in the European Region
• External causes of injury and poisoning
• Cancer

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Causes of the mortality crisis

• Major social and economic shock and income
  stratification in a population already vulnerable
  because of
• Poor diet, high levels of smoking, and weak
  systems of social support, in which alcohol and,
  increasingly, intravenous drugs, are easily
  available.
• Health care system is poorly equipped to respond
  to challenges.

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Questions to be discussed at the end of the
lecture

• Can Omrans theory be applied to changing
  mortality patterns in Russia?
• Epidemiologic transition in Russia did it take
  place?
• Reversal of transition in Russia. How does it
  relate to Omrans theory?