Multiple faces of the health transition

Over the course of the last century, all regions across the globe unexceptionally witnessed major changes in the levels of mortality resulting to a steady rise in life expectancy at all ages. In recent decades, the pace of demographic and epidemiological transition has accelerated in India. Since Independence, India has made huge efforts, however fertility, mortality and morbidity still remain unacceptably high both compared to countries in the region and those at similar income levels. The impact of poverty on health care and vice-versa is significant. These improvements have been unequally distributed across regions among different strata of population. Such diversified health profile of the country raised the question: whether we learnt from the experiences of health transition from those of developed countries and if we are progressing in the right direction towards achieving the goal “Health for All”. Keeping this in perspective, this study made an attempt to understand the social, economic and demographic context of process of health transition at national and regional levels.

Based on life course perspective, using data of the death survey derived from 5 wave longitudinal questionnaire surveys conducted in rural China,this paper studied factors affacting child care to older parents at the end of life. Multi-level linear model revealed that care is affacted by the birth order of the child, physical distance and intergenerational exchange before death. End-of-life care is mainly provided by sons and by only son or only daughter. The eldest child’s care ranked secondly,and least is provided by the youngest child. The child coresiding with older parents before death provided most and those who lives in the same village ranked secondly. Physical distance will reduce care. Those children,especially sons, who have more frequent intergenerational exchange with parents before death, provided more end-of-life care. It is imply that child’s end-of-life care is droven by traditional "filial piety and fraternal duty" norm and mechanism of children’s care labor division confirms to the principle of optimizing needs through strategic allocation of resources throughout the family system. Migrant children face competing obligations,while negative effects of sharp decline in fertility on older parents seems not as bad as imagined. Migration counterbalanced gender division of children in terms of end-of-life care.

This paper tests a set of child health care indicators for predicting disparity, with applications to data from DLHS II (2002-04) and III (2006-07). The Index of Disparity (ID), has been used to compare several dimensions of child health care including breastfeeding, immunization and treatment received when ill. The ID is used to examine trends in disparity across states over time. Disparity is highest for children breastfed within one hour of birth (109.17 %) and the least for treatment sought for acute respiratory infection (ARI) (5.75 %) for the period 2002-04, followed by the period 2006-07 with change in magnitude. Across states, ID per child health care indicator varies. In Karnataka, the highest ID is among Vitamin-A receivers (19.4 %) and the least for treatment received when ill from ARI (10.2 %). In Tamil Nadu and Andhra Pradesh breastfeeding has been found with highest disparity and the least among Vitamin-A receivers (7.5 %) and treatment sought for Diarrhea (17.2 %). The ID simplifies to understand the variations and the need to emphasize on an approach to solve child health care problems.

The aim of the present study is to estimate the women empowerment index value in Bangladesh. Since women's empowerment is a matter of basic human rights which has during the last decade become a panacea for Third World development. For this purpose BDHS 2007 data have been used which reveals that empowerment level of women increases up to age group 30-34. Moreover, a mathematical model has been fitted to the mean score of women empowerment index which shows that women empowerment index follows a quadratic polynomial model. However, the role of women’s decision-making in reproductive health cannot be overemphasized. In this study, different dimensions of women’s decision-making autonomy and their relationship to maternal and child health-care are examined. The study shows that most autonomy indicators are important predictors of maternal and child health-care utilization although the strength and statistical significance vary by health-care utilization outcome and in some cases significance is lost when socio-economic indicators are held constant.

This study aimed to explore the relationship of perceived health with all-cause mortality among the older persons in Thailand. The data from the National Health Examination Survey III (NHES III) conducted in 2004 were linked to 2004-2008 death records from vital registration system using a unique personal identifier which existed in both data sources. The total samples of 17 439 older persons aged 60 years and older were analyzed using the Cox proportional hazard model. Survival time was calculated as the interval between interview date and date of death or until the date of 31st August 2008 if those older persons were still alive.

The findings indicated that mortality increased across bad health status. The older persons who had fair perceived health were 1.21 (95% CI 1.10-1.34) times more likely to die than very good/good health counterparts and the bad/very bad perceived health older persons were 1.66 (95% CI 1.46-1.88) times more likely to die than the very good/good health older persons.

This paper focused on the maternal characteristics on neonatal mortality in Uttar Pradesh. Data have been used from the District Levels Household Survey (2007-08). To calculate the neonatal mortality from DLHS-III data, exposure event (47 months) analysis was carried out. Logistic regression analysis is conducted to get odds ratio of survival of neonatal. From multivariate analysis we found that neonatal mortality is higher among low education of mother and lower income household. Distance of health facility also has negative impact on neonatal mortality. Mothers who received Tetanus injections have 15% lower risk of newborns. Babies born in household with highest wealth quintile family have 21% less chances of death. Neonates whose mothers have received antenatal care during pregnancy had 21% lower chances of mortality. Results suggests that certain socioeconomic factors like mothers education, caste, household wealth, residence and lack of health facility in village have significant impact on neonatal mortality.

Life expectancy at birth has been widely used as indicator of overall health of population. It is the only single indicator which captures the effects of multi-dimensional development in socio-economic and health aspects of a country in a real sense. Globally, life expectancy has increased commendably over the last few decades. India too has reserved pace with the other countries in health status performance. Decline in mortality in India from 1970-75 to 2001-06 resulted in gains in expectation of life for both males and females though the improvement in the male life expectancy was slightly higher. Over the last four decades, life expectancy in India has increased from 50 to 63 years. This paper examines: i) the levels and trends in life expectancy at birth in India and its major states during 1970-2006; ii) the effects of improvement in age-specific mortality rates on the gains in life expectancy at birth by sex and residence from 1970-75 to 2001-06 & iii) a panel regression analysis to assess the transition in life expectancy at birth and its determinants.

The rate of decline in child mortality is too slow in most African countries to achieve the Millennium Development Goal of reducing under-five mortality by two-thirds between 1990 and 2015. Effective strategies to monitor child mortality are needed to help Governments assess and report on progress and to target their child survival programs. We present results from a test of a mortality monitoring approach based on recording of births and deaths by specially-trained community health workers (CHW) in Malawi. Mortality data collected by randomly-selected CHWs in two districts are compared to those of a “gold-standard” mortality survey. Results indicate that CHW reports under-estimated child mortality by 24% to 49%, and the level of under-estimation increased over time. The approach appears to hold some promise, however, because the vital events that were reported by the CHWs were accurate and reliable. We are now investigating further to determine patterns of errors so that CHW performance can be improved and sustained.

Spouses of centenarians have a survival advantage compared to their birth cohort. However, less is understood about the pathways by which spousal similarity in exceptional survival exactly operates. This study investigates whether positive homogamy and/or shared environment are related to the resemblance among spouses and how it can explain why spouses of centenarians are more likely to achieve a very long life span. Our sample consists of 850 validated French-Canadian centenarians who died between 1985-2005, and their spouses. Using early-life family variables gathered from the 1901 and 1911 censuses and measuring the social level of the family, we investigate through homogamy models and logit models if there is a tendency to partner with individuals of the same social origin. Consideration will mainly be given to the Assortative Mating hypothesis, which argues that spousal concordance in health and longevity is largely a result of a selective process through which individuals choose partners based on a similar social origin and shared childhood characteristics, and to the Shared Resources Hypothesis. Results could shed light on the extent to which spousal concordance in longevity is channelled through social origin in early life and could put forward the impact of lifecourse events in achieving old-age mortality.

The concern for a further global rise of asbestos-related diseases is growing. A recent WHO study on global mesothelioma deaths reported between 1994 and 2008, shows an increase in mortality worldwide (Delgermaa, Takahashi et al. 2011). Because Belgian data have not been reported as a consequence of the regionalization process, Belgium was not included in this study.
With companies as Eternit, Belgium has been a top producer and a top consumer of asbestos worldwide. Nonetheless, asbestos-related mortality remained largely unexplored for Belgium.
Our aim is to improve the understanding of the impact of asbestos in an international perspective by providing a descriptive analysis of mesothelioma mortality in Belgium (1969-2008).
Compared to the results of the WHO study, Belgium ranks fourth in the world in age adjusted mortality rates, just behind the UK, Australia and Italy. The high male/female ratio points to occupational related hazards, a fact confirmed by our geographical analysis. Mesothelioma mortality is higher in areas with a history of industrial asbestos use. Finally, our results also suggest a further increase in asbestos-related mortality in Belgium.