Geography of Mortality

key mortality indicators
1. Crude death rate
  1. Number of deaths per 1000 population in a given year
  2. limitations
    1. measure distorted by age structure variations
      1. Australia and Bolivia have similar crude death rates ~7 but for different reasons
        AUS lowest 40 IMR (4.43) vs Bolivia 57th highest IMR (38.61)
    2. various other factors e.g. natural disaster
  3. variations
    1. by country
      1. Highest: South Africa (17.49), Ukraine (15.72), Lesotho (14.91)
        Southern Africa region: HIV epidemic
        Ukraine: weak healthcare system
        non-communicable diseases account for 82% of deaths
        a third of Ukrainians die prematurely before 65
      2. Lowest: Kuwait (2.16), UAE (1.99), Qatar (1.53)
        Qatar
        world's richest country
        best and widely recognized healthcare systems in the world
    2. by region
      1. Largest drop in Africa: 15/1000 to 11/1000 in 2013
        Important to note variations within region
        Algeria: 4.3/1000
        one of the best healthcare systems in Africa
        nationwide electronic healthcare project
        simplifies administrative procedures and eliminates paperwork
        0.1% of sexually active population with AIDS/HIV
        Swaziland (14/1000)
        highest HIV prevalence: 26% among sexually active population
        reforms in health sector has majorly improved the health status of ppn
        90% Antiretroviral (ART) coverage
        IMR reduced from 100 to 79 per 1000 live births (2008-14)
        Maternal mortality rate reduced
        severe tuberculosis infection
        TB/HIV co-infection rate 80%
        1380 per 100,000 annually
        access to clean water and sanitation
        only 37% of rural population has access to safe water
        access to healthcare
        (2009) 0.17 physician density
        life expectancy fell from 63 (1990) to 49
  4. advantages
    1. indicates level of healthcare provision, water quality, sanitation and living conditions
2. standardised death rate
  1. indicates the CDR if population had same age and sex composition
  2. useful for comparative studies
3. Age-specific mortality rates
  1. Infant Mortality Ratio
    1. no. of infants who die within the first year of age per 1000 live births
    2. reflects level of healthcare provision, sanitation, water quality, nutrition and living conditions
    3. declining trend with improved medical and health services and better nutrition
      1. Bolivia's IMR( 38.61)>halved since 1990s
    4. highest: Afghanistan (117), Mali (104), Somalia (100), Niger (86)
      1. Afghanistan
        common causes: infections, diarrhoea, and dehydration
        most births done at home
        education: 12.6% female literacy rate - lack of midwives
        lack of skilled medical personnel
        0.19 physicians/1000
    5. lowest: Monaco (1.8), Japan (2.1), Singapore (2.53)
      1. Singapore
        (2012) 1st for IMR, 2nd for MMR, 9th for life expectancy
        universal health coverage at public hospitals and government polyclinics
      2. Monaco: 7.06 physicians/1000
  2. Child Mortality Ratio
    1. no. of children who die before age 5 per 1000
  3. Maternal Mortality Ratio
    1. annual no. of pregnancy-related deaths of women per 100,000 live births
    2. highest in South Sudan (>2,000)
      1. early marriage
      2. most women in rural areas give birth at home due to lack of knowledge or accessibility to proper health facilities
      3. only one midwife per 125, 000 women
        brain drain of skilled midwives
4. Life Expectancy at Birth
  1. average number of years a person is expected to live in his lifetime
  2. difficult to calculate as it is normally derived from national life tables
  3. Highest: Monaco (89), Japan (84), Singapore(84), San Marino (83)
  4. Lowest: Chad (49), South Africa (49), Swaziland (50)
Factors affecting Mortality
1. Demographics
  1. mortality higher for infant/child and old population
  2. gender
    1. women higher life expectancy
      1. 82.8 vs 79 for men
      2. narrowing gap
    2. men higher risk of heart attack than women
  3. ageing population higher risk of death from cardiovascular disease
2. Medical Technology
  1. access to healthcare
    1. physician density Niger: 0.02, Monaco 7.06
    2. Niger: 29% of births attended by skilled health personnel vs Czech Republic 100%
      Annotations:
      - Czech republic IMR 2.63 lowest 10 in the world Niger top 10 IMR (86)
  2. changes in health education
  3. improvements in medicine and treatment
    1. breakthroughs in cancer treatment
      1. cell research - how to block movement of cancer cells
      2. Singapore A*STAR scientists discovered early detection methods and personalized treatment for ovarian cancer
      3. discovery of drugs made from tree bark by the Cancer Research Campaign (CRC)
3. Public Health Measures
  1. Water andSanitation
    1. eliminate conditions favourable to the spread of diseases
    2. e.g. cholera and typhoid most easily controlled by purification of water ss
    3. Chad: only 6% of rural population and 31% of urban population use improved sanitation
    4. dysentery can be controlled with proper food hygiene
    5. unclean water and poor sanitation are the world's second biggest killer of children
  2. immunisation
    1. mid-1990 vaccines to provide 'basic' coverage for TB, polio, tetanus, pertussis, and measles averted 2 million deaths in 2002
      1. e.g. DTP-3 coverage
      2. e.g. significant progress of MEASLES coverage
        reduced measles mortality in Africa by 60% between 1999-2004
      3. polio cases decreased by 99% since 1988
    2. infant immunisation vital for improving infant and child survival
      1. African region lagging behind global immunisation coverage
        e.g. DTP-3 coverage
        coverage in Africa increased from 54% in 2000 to 74% in 2011
      2. e.g. DTP-3 coverage
    3. Smallpox
      1. endemic in Africa and Asia in 1960s
      2. Immunisation campaign by WHO eradicated smallpox by 1980
      3. deadly disease that threatened 60% of the world's population and killed every fourth victim
    4. Hepatitis B vaccine
      1. 1982
      2. 79% of infants in WHO's member states receive vaccination
4. Socio-economic Changes
  1. inverse r/s between socio-economic status and mortality
    1. High death rates and low life expectancies improving
      1. overall life expectancy in Africa increased from 51 (1990) to 59 (2013)
        reversed trend for countries affected with AIDS
        Annotations:
        Zimbabwe, Swaziland, Lesotho, South Africa, Botswana
  2. Rising living standards
    1. healthcare
    2. (environmental)sanitation and hygiene
    3. nutrition
      1. resistance to disease
        influenza
        pneumonia
        diarrhoea
        TB
  3. education
    1. knowledge about health and medical care
  4. changing pattern of diseases characteristic of modernisation
  5. Pollution
5. Political
  1. Ethnic cleansing
    1. Darfur in Sudan: 300,000 deaths
  2. civil war
    1. Sudan: 2mil deaths since 1983
    2. congo war: 3.3 million deaths between 1998-2002
      1. life expectancy ~56
  3. genocide
    1. Rwanda genocide 1994: 800 000 Tutsi minorities killed
    2. 6 million killed in Nazi Holocaust
6. Epidemics and Pandemics (morbidity)
  1. Botswana, Lesotho and Swaziland
    1. severe AIDS/HIV epidemic
    2. Romania: free ART treatment
  2. polio-endemic: Nigeria, Afghanistan
    1. affects children under 5
      1. Nigeria 124/1000 under-5 mortality ratio
  4. changing pattern of diseases characteristic of modernisation
    1. worldwide obesity has doubled since 1980
      Annotations:
      - increased intake of energy-dense foods high in fat; increasingly sedentary nature of work, with advancements in xportation and urbanisation
      1. leads to cardiovascular diseases, musculoskeletal disorders and cancer
      2. DCs and low-and-middle income countries
        vulnerable to inadequate nutrition low in cost but lower in nutritional quality
    2. chronic non-communicable diseases
  5. 2014 ebola outbreak
    1. death toll >2000
    2. Sierra Leone, Liberia and Guinea
7. environmental
  1. droughts
    1. 10,000 killed from heatwave in France in 2003
  2. floods
  3. natural disasters
    1. Indian Ocean tsunami caused >200k deaths
  4. pollution
    1. smog in China reduces average LE by 5.5 years

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Geography of Mortality

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	Created by joy peh over 9 years ago