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De Demo mograp raphy hy and and Glo lobal al Heal alth Global Health Challenges (GLHLTH 701) Jessica Y. Ho Department of Sociology Duke Population Research Institute (DuPRI) November 4, 2014 Demography 1) Mortality 2) Fertility 3)

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De Demo mograp raphy hy and and Glo lobal al Heal alth

Jessica Y. Ho Department of Sociology Duke Population Research Institute (DuPRI) November 4, 2014 Global Health Challenges (GLHLTH 701)

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Demography

1) Mortality 2) Fertility 3) Migration

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Demography

  • 1. Size of populations
  • 2. Population growth rate
  • 3. Population composition
  • Age
  • Sex

ex

  • Education
  • Race/ethnicity
  • Urban/rural
  • Employment
  • Marital status
  • …

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Part I: World Population Size and Growth

 Historical population growth  Current and future population size and growth

  • World
  • Regions
  • Countries

 Determinants of population size and growth

  • Mortality trends
  • Fertility trends

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1800 1800 130 30 13 14 12 12 13 13 13 Source: Carl Haub, Population Reference Bureau 2010; U.N. Population Division (UNPD) 2011

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Source: Carl Haub, Population Reference Bureau 2010; U.N. Population Division (UNPD) 2011

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The Demographic Transition

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Mortality Declines & Life Expectancy Gains

Deve velope loped Countr trie ies (~1 ~1750 750-1930) 1930)  1760-1880: Gradual improvements in living standards and nutrition, smallpox inoculation, public health measures (quarantine)  1880-1930: Public health measures (filtering and chlorinating water, building sewage systems, and pasteurizing milk), personal health practices (hand washing, safer food preparation, boiling and sterilizing milk bottles, and quarantining and isolating sick family members), and improvements in living standards and nutrition  1930-present: Sulfa drugs, penicillin, treatments for cardiovascular disease, behavioral change Deve velopi loping ng Countri ntries es (~1 ~194 945-pres present) ent)  Antimalarial campaigns, antibiotics, oral rehydration therapy for diarrheal diseases  Large-scale child immunization programs: smallpox, polio, and measles  Public health infrastructure (sanitation and water supply)

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Source: Wilmoth 2000

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Trends in Life Expectancy at Birth for Major World Regions, 1950 and 2010

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Source: Population Reference Bureau 2014

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Source: Lee 2003

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Fertility Declines

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Source: Guinane 2011

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Total Fertility Rate by Region, 1950-2010

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Source: UN 2013

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Factors Contributing to Fertility Declines

 Industrialization and urbanization  Shift towards individualism and self-fulfillment  Declines in infant mortality  Quantity-quality tradeoff  Changes in the benefits to childbearing (child labor laws, public social insurance systems, urbanization)  Family planning programs  Diffusion of information and new social norms about birth control  Rises in educational attainment and female labor force participation

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Highest and Lowest Total Fertility Rates in 2013 and 1970

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Source: PRB 2014

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Changes in Age Structure by Region

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Source: Population Reference Bureau 2014

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Nigeria India Chile UAE Denmark Japan

Source: http://populationpyramid.net/

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Source: Haub and Gribble 2011

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Part II: Challenges

 Population size and growth/decline  Urbanization  Mortality and life expectancy  Fertility  Age structure International migration

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Source: Lam 2011

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Source: Lam 2011

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Source: Population Reference Bureau 2014

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Urbanization

CONS

Poverty and urban slums Environmental degradation Conflict Congestion Sanitation and infrastructure Rapid spread of communicable diseases

PROS

Technological innovation Concentration of labor Economic growth Rapid diffusion of information Efficiency/productivity gains Higher incomes and standards of living

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Life Expectancy and Mortality

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Source: Reardon 2011

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Life Expectancy and Mortality

 Nutrition and epidemiological transitions

  • Dual burden of disease
  • Obesity

 Smoking  Health care system mismatches  Living arrangements and old-age support  Reverse transitions

  • HIV/AIDS
  • Russia and former Soviet countries
  • “New epidemics”: M/XDR-TB, Ebola, SARS, (avian) influenza

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Fertility

 Potential consequences of high fertility:

  • Maternal and child health
  • Education
  • Female labor force participation
  • Economic growth

 Unmet need for family planning (intended vs. unintended births or desired vs. attained family size)

  • Access to and cost of contraception
  • Social barriers to contraceptive use
  • Status of women

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Source: Bongaarts and Sinding 2011

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Fertility

 Skewed sex ratios and son preference  “Lowest low” fertility

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Source: Goldstein 2009; PRB 2014

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Age Structure

 Youth bulge

  • Jobs and education
  • Underemployment
  • Instability, conflict, and

violence  Tend to be:

  • Low- and lower-middle-

income countries

  • Countries in Africa and the

Middle East, as well as parts of South and Southeast Asia

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Source: International Data Base, U.S. Census Bureau

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Age Structure

 Population aging: a shift in the age distribution of a population towards older ages

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Ag Age Distributi tribution

  • n of Italy,

y, 2014 4 and 2050 0 (proj

  • ject

ected) ed)

Source: International Data Base, U.S. Census Bureau

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Population Aging

 The dominant demographic trend of the 21st century

  • Aging of the baby boomers
  • Societies are considered relatively old when the % aged 65+ > 8-

10%

  • % U.S. population aged 65+ in
  • 1900 – 4.1%
  • 2000 – 12.6%
  • 2030 – 20.0% (projected)

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Population Pyramids of More Developed Countries, 2010 and 2050 (projected)

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Source: United Nations 2012

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Challenges for Public Health & Economic Development

 Strains on health care system

  • Prevalence of disability, frailty, and chronic disease expected to rise

 Rising health care costs and bankruptcy of programs (e.g., Medicare)  Pressure on social security programs and pension programs

  • Rising costs and sustainability concerns

 Shrinking and aging labor force

  • Labor shortages, lower productivity, effects on GDP and economic growth

 Health and well-being of the elderly

  • “Feminization” of aging
  • Rise in older people living alone
  • Poverty

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Source: Bongaarts 2004

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Suggested Measures

 Increase fertility  Increase immigration  Increase labor force participation  Raise the age at retirement  Reduce public pension benefits

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Global Migration Flows

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Source: http://www.global-migration.info/

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International Migration

Process

  • National borders (South America/Mexico/U.S., North Africa/Greece/Italy)

 Destination

  • Assimilation, incorporation (residential segregation, discrimination)
  • Worker exploitation (World Cup)
  • Political and economic impacts (voting constituencies)

 Sending

  • Brain drains
  • Remittances

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