Multiple faces of the health transition

Over the course of the twentieth century, life expectancy at birth in the Iran by more than 20 years for both men and women; and in some parts life expectancy at birth almost doubled in these years. Life expectancy is an important indicator of the level of mortality in a Population. In Iran, the life expectancy varies from state to state depending on their mortality levels’.
The objectives of the study to estimate disability free life expectancy for Iranian people in 2006.
Documentary method and secondary data are used for the study. The data was taken from 2006 National Population and Housing Census by statistical Centre of Iran (SCI) and National Organization for civil registration (ASDR). Statistical and demographic techniques are utilized for the analysis.
Finding: For all countries, DFLE values decline as age increases for both sexes, with a pronounced decline among women. life expectancy at birth for combined population was 76 years, for males it was 74 years and females 78 years, that means life expectancy of female was high than males. The proportion of expected life free of disability was lower for females than males particularly among older people.

Key words: Disability, life table and life expectancy

The objective of this study is to estimate the period age-specific prevalence of disability. The period prevalence of disability is the proportion of disabled among the survivors of a fictitious cohort subject to the actual age-specific conditions of entering and exiting the disability state based on information from the Survey carried out in Thiruvananthapuram, Kerala, India between 2004 and 2006. The survey was designed to study the process of ageing, in particular the evolution of functional health. The same people were interviewed in a cross-longitudinal survey of 2 waves. The IMaCh program has been used to compute the morbidity transition on estimated life expectancy. The results show that the probability of dying is much higher among the unhealthy than the healthy. It was found that at the younger ages if a person is unhealthy there was change of being recovering from the unhealthy state. But as age increases the chance of recovering is very low. A person attaining the age 60 can expect to live 17.5 years in the healthy state, given the initial condition, but the expectation is reduced to 16.7 years if unhealthy at the age of 60. The corresponding health expectancies for the unhealthy state are 4.2 and 4.9 respectively. The life expectancy in healthy and unhealthy state for women were higher than that of men.

The objective of this study is to estimate the healthy life expectancy using different measures of state of health, based on information from the Survey carried out in Thiruvananthapuram, Kerala, India. The Sullivan method is currently the one most commonly used for estimating healthy life expectancy by combining information on mortality and morbidity. The Sullivan health expectancy reflects the current health of a real population adjusted for mortality levels and independent of age structure. The results show that the percentage of difference in life expectancy with disability is larger than that of life expectancy free of disability. Women at age 60 had 25 per cent more years of life compared to men. The higher number of healthy years lost if there is a disability that limits daily activities. Women spent their remaining life after age 60 with disability was 151 per cent longer than men, while their gains in years free of disability were only 11 per cent more than men. The proportion of healthy years lost increases significantly with age and that, although females have higher life expectancy than males, they live proportionally less years in good health.

Providing basic health facilities especially to the socio-economically disadvantaged section of the society is a great challenge for large country like India. The country's health care programme is rural focused as about 70% of the population live in rural areas. But the country is urbanizing rapidly and the total size of the urban population is about 377 million(census 2011) out of which a significant proportion of population live in slums. The 2001 census shows that there was a total of 42.6 million slum population living in 8.2 million households which constitutes 15% of the total urban population. About half of the population in Mumbai and about a third of the population in Kolkata live in slums. Increasing slum population is an indication of urban poverty and declining urban quality of life. Most of the slum dwellers do not have access to basic health and sanitation facilities resulting in poor health conditions. The present study makes an attempt in understanding the water and sanitation facilities among the slum and non-slum households in three cities(Pune, Jaipur and Bhubaneswar) of India by using the data collected in a household survey covering approximately 2200 households in each city.

Early case detection and prompt treatment with artemisinin-based combination therapy (ACT) is one of the main malaria control strategies. The INDEPTH Network Effectiveness and Safety Studies on Antimalarials in Africa (INESS) was implemented in 7 Health and Demographic Surveillance Sites to identify bottlenecks of the ACT efficacy decay. This presentation will share findings on the systems effectiveness of artemether lumefantrine (ALu) in the Rufiji and Kilombero-Ulanga (KU) HDSS sites in rural Tanzania. Household and health facility surveys were conducted in low and high transmission seasons to determine access to an official ACT provider within 24h of fever onset, provider compliance, patient adherence and therapeutic efficacy. Access to an official ACT outlet was observed to be 37% in Rufiji and 42% in KU. Provider compliance was found to be 75% in Rufiji and 60% in KU. 65% of the patients from Rufiji and 71% of patients from KU adhered to treatment. This resulted in an overall systems effectiveness of 18% in Rufiji and 17% in KU. Health system factors contributing to this loss are suboptimal access and provider compliance. Well-designed system interventions are needed to strengthen the identified weaknesses in order to improve the effectiveness of ACTs as a malaria control strategy.

A notable mortality gap between East and West Germany that persisted for decades began to narrow rapidly right after the unification of the two states. Despite extensive research, the factors underlying the remarkable improvement in East Germany are still not fully understood. One of the reasons for that is a number of significant changes in the classification of causes of death as well as the changes in coding practices. These changes which happened to coincide in time with profound socioeconomic transformation of East Germany have complicated the interpretation of mortality trends and made the international comparisons difficult. In this paper, we explore the complex methodological issues related to the changes in the system of data collection and classification. Our ultimate goal is to obtain the detailed mortality series for East Germany which can be comparable across time and countries. We rely on the official mortality data and the method of a posteriori reconstruction of mortality trends. The method was successfully implemented for a number of countries including West Germany. The intended work continues this well-established research line. Its outcome is expected to contribute towards better understanding of the health changes observed in East Germany, and facilitate further research in this direction.

China’s excess of males, as a consequence of skewed sex ratio at birth for more than 30 years, has attracted much attention on the scale of marriage squeeze and the socioeconomic impact of the forced unmarried males, but studies on the death of unmarried males are underdeveloped due to the limitation of data. In this paper, we firstly develop life tables of the unmarried males and nuptiality tables of males in China. In addition, the mortality and life expectancy of the unmarried males and married males, unmarried males across education levels and health difference for the elderly by marriage status are compared. Secondly, we simulate a projection model to evaluate the influence of the relatively high mortality of unmarried males on the prediction of excess males in 21th century of China. We find that an overestimation of at least 16% to the number of unmarried males aged more than 50 could be generated if the excess mortality of the unmarried to the mortality of overall males not accounted. Finally, we pay special attention to the current social security system on the unmarried male elderly and the paper’s findings suggest a need to relax the age restriction and expand the coverage of social security programs to the unmarried males, especially in rural areas.

Adult lifespan variation has been stagnant since the 1960s in most countries, despite increases in longevity. We investigated the role that smoking has played in this stagnation using Finnish register data by occupational class (1971-2007). We expected stronger mortality compression in the absence of smoking and expected smoking-attributable mortality to explain divergences in compression by occupational group. Instead we only found a modest impact on lifespan variation from smoking, despite it having a large impact on longevity. Among men, diverging trends in lifespan variation by occupational class would have widened even further in the absence of smoking, while among women trends in lifespan variation were mostly unaffected by smoking. The maturation of the smoking epidemic is not expected to bring about strong reductions in the uncertainty in the timing of death, nor is it expected to reduce inequalities in this dimension by occupational class in Finland.

Fever remains a commonest symptom of malaria. This study was designed to investigate the fever prevalence and fever patterns in Rufiji Health and Demographic Surveillance System (HDSS).We conducted cross-sectional household survey from all population in HDSS site to enquire about fever and treatment behaviour in two weeks prior the survey. A logistic regression model was fitted to assess the factors associated with fever. A total of 63,706 people were interviewed and 3.3% reported having fever in the two weeks preceding the survey. The prevalence of fever was more common for under-five children at 6.5 % compared to 2.8% for the remaining population. Children less than five were more likely to be febrile than older children and adults (adjusted odds ratio (aOR) =0.40; 95%CI 0.36-0.45). Fever prevalence was more common for females compared to males (aOR=1.17; 95% CI: 1.07-1.28). Larger households were observed to be a risk factor for fever in the study (aOR=0.55; 95% CI: 0.43-0.74). Socio- economic status, availability of improved drinking water and toilet were not significantly associated with fever. Fever prevalence was observed to be low in the study area. As an important indicator of malaria, it reflects an encouraging development in malaria control efforts.

Previous research has examined individual characteristics to investigate disparities in body mass index (BMI). Employment status is a critical socioeconomic condition which has diverse influences on BMI. Workplace is a fundamental social context in which people develop regulatory social relationships and workers come to have healthy eating habits as a result. In addition, women in workplace are more disadvantaged in job security than males because of long-standing male-oriented social hierarchy system, so female workers may feel stronger psychological distress and unhealthy eating habits as a result. In the meanwhile, female workers may show lower BMI than male counterparts because females tend to regulate their eating habits to look attractive when they are involved in social community. Using 2010 Korean General Social Survey, the authors examine whether employment status is associated with body mass index(BMI) with adjustment for correlates. We also investigate whether gender moderates this association. Our findings reveal that being employed is associated with increased BMI with adjustment for confounders. Results of regression which tests an interaction term of employment status and gender demonstrate that female workers show lower levels of BMI than male workers.