Changing care and prevention needs for global public health: In pursuit of a comprehensive perspective

Abstract

An assessment of changing care and prevention needs in the framework of global public health should not be just a technical exercise of ‘standard’ demographic and epidemiological analysis; rather, it should also involve a reflection on the conditions of the production of such knowledge. In this article, we start by outlining some key dimensions of change in demographic and epidemiological patterns as well as their drivers; second, we address in more depth the question of whether current scientific practice is generating all the questions needed to improve global health in the coming years, and define potentially effective strategies for positive change. Significant demographic changes (i.e., reductions in earlier mortality and fertility; ageing and urbanisation) are leading to the emergence of chronic diseases in the Global South, as well, although patterns are very diverse, and early mortality and disability will still remain high for a few decades in certain areas. Such inequality in health patterns seems to parallel globalisation processes, and results from the effects of social and structural determinants. To better understand those relationships, we must improve our thinking about causality as well as our standard views of what constitutes ‘good evidence’.

Keywords:

• epidemiology
• demography
• health systems
• development
• social change

Notes

1. The demographic dividend represents an opportunity derived from changes in the population's age structure, by which the rate of economic growth might be influenced by the increasing share of working age people in a population. During demographic transitions, low fertility initially leads to low youth dependency and a high ratio of working age individuals compared to the total population. However, in order to become an actual opportunity, proper interventions in health and education of younger age groups are required (Bloom et al. 2003).

2. The term compression of morbidity was coined by Fries (1980). According to his hypothesis, the onset of disabling diseases of elders might be postponed until they are quite close to death. ‘The compression of morbidity occurs if the age at first appearance of ageing manifestations and chronic disease symptoms can increase more rapidly than life expectancy… Absolute compression of morbidity occurs if age-specific morbidity rates decrease more rapidly than age-specific mortality rates. Relative compression of morbidity occurs if the amount of life after first chronic morbidity decreases as a percentage of life expectancy’ (Fries 2005, pp. 810–811).

3. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, NY, 19–22 June 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

4. ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’.