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  • 00:00

    DR. GREG MARTIN: So in general, whenyou hear the term epidemiological transition,what people are referring to is this changein the burden of disease from infectious diseaseor communicable disease to non-communicable diseaseor chronic disease.And we're seeing this process at the momentpredominantly, in low and middle income countries.Now to understand this better, what we're going to do

  • 00:22

    DR. GREG MARTIN [continued]: is we're going to take a look at the historyof epidemiological transition.So, how do we get to where we are right now?And we're going to take a look at whatthe future has in store for us, because this process isfar from over.[MUSIC PLAYING]

  • 00:33

    SPEAKER: Please hang up and try again.

  • 00:35

    DR. GREG MARTIN: In 1971 Abdel Omran proposed his theoryas to how it is that patterns of mortalityhave changed over time.Omran proposed that there's been three phasesof epidemiological transition.So let's take a look at these.Phase one, pestilence and famine.From prehistory to the mid-18th century,infectious disease was the major cause of death,

  • 00:57

    DR. GREG MARTIN [continued]: especially when people started living in close proximityin city-states.Travel and trade between city-statesallowed for diseases like plague to have a devastating effecton the population.Plague killed about 25 million people.That's about 1/3 of the population in Europe,in just five years.And during this time there were of course,other important causes of death.Things like war and famine killed lots of people.And low standard of living, poor hygiene,

  • 01:19

    DR. GREG MARTIN [continued]: and no access to effective health carewere important drivers of death and disease at this time.Phase two, the age of receding pandemics.Between the middle of the 18th and the middleof the 20th century, with the Industrial Revolutioncame improved nutrition, sanitation and medical care.This resulted in massive reductionin the spread of infectious disease and epidemics.And this of course, didn't apply to all people.

  • 01:41

    DR. GREG MARTIN [continued]: Many people living in squalid conditions in citiesdied of diseases like cholera.Phase three, degenerative disease.As of the middle of the 20th century, due to vaccines,antibiotics, and improvement in the social determinantsof health, we've seen an increase in life expectancy.And with that, we've seen an increasein the diseases that are prevalent amongst the elderly,things like heart disease, stroke, cancer,

  • 02:02

    DR. GREG MARTIN [continued]: and other chronic diseases.A more sedentary lifestyle, together with dietary changes,have also contributed to an increase in obesity, whichitself is a risk factor for thingslike diabetes, heart disease, cancer, et cetera, et cetera.Just to give you a sense of the scale of the problem,non-communicable diseases today kills 40 million peopleevery year.That's about 70% of all deaths globally.

  • 02:23

    DR. GREG MARTIN [continued]: 15 million of these people are relatively young,between the ages of 30 and 69.And 80% of these premature deaths, many of whichare preventable, occur in low and middle-income countries.Tobacco alone accounts for 7.2 million deaths every yearand this is projected to increase over the coming years.Now the problem in many developing countriesis that this process of epidemiological transition

  • 02:45

    DR. GREG MARTIN [continued]: is taking place firstly very quickly.And secondly, is taking place at a time when there areexisting social disparities.And that means that what's happeningthere is we're seeing a double burden of disease.We're seeing existing infectious diseases,and that's still a problem.And we're seeing the emergence of huge numbersof chronic disease.And these countries' health systems

  • 03:06

    DR. GREG MARTIN [continued]: due to resource constraints, are justnot geared up to deal with this double burden of disease.For a country to address non-communicable disease,there's a couple of challenges.Let's take a quick look at why it's tricky.Patients require ongoing treatmentfor chronic conditions.So it's not as simple as just giving an antibioticand walking away.Prevention is difficult. And preventionrequires lifestyle changes.People living in poor countries often

  • 03:27

    DR. GREG MARTIN [continued]: live in extremely challenging circumstances.And they don't have the luxury to spend time on Wikipedia,figuring out how to design a lifestylediet low in trans fats.To manage chronic disease, you oftenneed multidisciplinary teams.And these often just don't exist in low resource settings.Managing chronic disease requiresself-management and education.And this has proved tricky even in rich countries.

  • 03:49

    DR. GREG MARTIN [continued]: Now this process of epidemiological transitionis far from over.It's going to continue.And it's going to continue in a very interesting way thatactually affects all of us, even people living in high incomecountries.So stay tuned, and find out more.So we've said that this process of epidemiological transitionisn't over.Let's take a look at what the future holds.I think that the most important changethat we're going to see in the medium to long term,

  • 04:10

    DR. GREG MARTIN [continued]: is the re-emergence of infectious disease,even in high-income countries.This is going to be driven by two things.Firstly, increasing anti-microbial resistance.And secondly, the increasing emergenceof novel zoonotic infections.So let's just take a look at each of these.Increasingly, we're seeing infectious diseasesthat are difficult, and in some cases, impossible

  • 04:31

    DR. GREG MARTIN [continued]: to treat with antibiotics and other antimicrobials.So in a sense, there's this ongoing racebetween humans trying to develop new drugs to treatinfectious disease, and microbes developingnew resistant strategies.And let's be clear, with respect to this particular race,we are on their turf.Microbes have evolved over billions of yearsto be very, very good at adapting to changes

  • 04:52

    DR. GREG MARTIN [continued]: in micro chemical environments.In 2016, we saw nearly half a million new casesof multidrug-resistant tuberculosis.We are seeing resistance emerging to HIV treatment,to malaria treatment.We are seeing increased incidenceof methicillin resistant staphylococcus aureusand carbapenemase is producing enterobacteriaceae and otherresistant organisms in hospitals.

  • 05:12

    DR. GREG MARTIN [continued]: Without question this increase in anti-microbial resistantorganisms is going to be one of the biggest public healthchallenges facing us in the future.And to make matters worse we are seeingan increase in the incidence of novel zoonotic infections.A zoonotic infection happens whena microbe jumps from an animal host to infect humans.And in just the last few decades, we've seen HIV,we've seen SARS, we've seen MERS-CoV, we've seen Ebola.

  • 05:34

    DR. GREG MARTIN [continued]: We've seen many, many novel zoonotic infectionsjump from animal hosts to humans,and then spread across country borders.And given existing and increasing population densityand the fact that in any one year,more than a billion people move from one place to another,we're likely to see more and moreof these novels zoonotic infectionsand other infections spread across country borders

  • 05:55

    DR. GREG MARTIN [continued]: and threaten global health security.And I have created a video on pandemics.So if you're interested in global health security,check that out.

Video Info

Series Name: Gregory Martin

Episode: 4

Publisher: Gregory Martin

Publication Year: 2018

Video Type:Tutorial

Methods: Epidemiology, Populations, Health data, Data sharing, Community-based research, Statistical inference

Keywords: chronic illness; disease incidence; epidemiologic data; epidemiologic factors; epidemiological concepts; epidemiology; global health; infectious disease; pandemics; zoonoses ... Show More

Segment Info

Segment Num.: 1

Persons Discussed:

Events Discussed:



Greg Martin, Editor-in-Chief, Globalization and Health, discusses the history of and the ongoing process of epidemiological transition.

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An Introduction to Epidemiological Transition

Greg Martin, Editor-in-Chief, Globalization and Health, discusses the history of and the ongoing process of epidemiological transition.

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