As world NIR slows and more countries move into stage 3 or 4 of the demographic transition, geographers increasingly turn their attention to the health of the record number of people who are alive. Countries in different stages of the demographic transition possess different resources to care for people who are sick.
Key Issue 3: Why Does Health Vary by Region?
A. Medical Services* PSO 2D1 which specifically contains the words medical care. ARGH
Medical Facilities
Health Care—higher per capita expenditures in developed countries
B. Health & Gender*
Mothers at Risk
a. maternal mortality rate—annual number of female deaths per 100,000 live births from
any cause related to pregnancy
Baby Girls at Risk*
a. sex ratio—number of males per 100 females in the population
b. “missing” females—gender-based abortion, killed in infancy, or sent to remote areas
C Health & Aging
Caring for Older People
a. life expectancy—average number of years an individual can be expected to live
b. potential support ratio (elderly support ratio) number of working age people (15–64)
divided by the number of persons 65 and older
Caring for Younger People
Comparing Young and Old
a. population pyramid—a bar graph that displays the percentage of a place’s population for
each age and gender
b. dependency ratio—number of people who are too young or too old to work (under 15 and
over 65)
D. Epidemiologic Transition
1 Terms
a. epidemiology—branch of medical science concerned with the incidence, distribution, and
control of diseases prevalent
b. epidemiological transition-focuses on distinctive health threats in each stage of the
demographic transition
2. Stages
a. Stage 1: Pestilence & Famine
i. epidemic—widespread occurrence of an infectious disease in a community at a
particular time
ii. pandemic—an epidemic that occurs over a wide geographic area and affects a very
high proportion of the population at the same time
b. Stage 2: Receding Pandemics
i cholera and John Snow—overlay showed relationship between cholera to
contaminated water pumps
c. Stage 3: Degenerative Diseases
d. Stage 4: Delayed Degenerative & Lifestyle Diseases
*indicates information specific to the text and is not in the AP Human Geography course
**indicates information is background or foundational to building further understanding and development
Key Issue 3: Why Does Health Vary by Region?
Medical Services Health conditions differ from country to country, and each country possesses different resources for people in need of health care. The different stages of the demographic transition affect the health care needs of individual countries.
Medical Facilities The state of medical facilities in a developed country mirrors the investment in health care. Most countries in Europe have more than 50 hospital beds per 10,000 people, compared to fewer than 5 in sub-Saharan Africa. Health care is available at little or no cost as a public service in most developed countries. In developing countries, private individuals bear the cost of health care. The United States, however, is an outlier among developed countries in that private individuals pay an average of 55 percent of their health care expenses.
Health Care Expenditures vary throughout the world. Per capita expenditures on health care are higher in developed countries than in developing countries.
Health & Gender Females the world over are exposed to a host of challenging health risks that deeply affect the size and composition of the population of individual countries and the world as a whole.
Mothers at Risk The maternal mortality rate is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). The rate in many countries of Africa and Asia exceeds 100 deaths per 100,000 mothers, while fewer than 10 deaths per 100,000 mothers in most European countries. The maternal mortality rate in the United States is higher than that in Europe.
Baby Girls at Risk Every year, around 700,000 female babies are “missing” in China and India, as a result of gender-based selection. Over the past several decades, it is estimated that 117 million females have gone “missing”. The number of males per 100 females in the population is the sex ratio. The standard biological level for humans at birth is approximately 105 male babies for 100 female babies. Developed countries have more females than males because on average women live seven years longer than men. The large number of male babies in countries like China and India has raised the possibility that a relatively large number of female fetuses are being aborted due to cultural preferences on the part of parents to have sons rather than daughters.
In order to address the imbalance of male to female births, the “root cause” of this sex selection, gender inequality (as defined by the United Nations), must be recognized.
Health & Aging A country’s stage of the demographic transition determines the proportion of people in different age groups. The varying number of people in different age groups reveals the specific health challenges a country faces.
Caring for Older People Life expectancy is the average number of years an individual can be anticipated to live, assuming current social, economic, and medical conditions remain in place. Life expectancy in Europe is about 81 years, while in developing countries in sub-Saharan Africa is only 60 years.
The “graying” of a country’s population places a burden on the working population to meet the needs of older people for income and medical care after they retire from their jobs. This burden can be analyzed using the potential support ratio (also known as the elderly support ratio) which is the number of working-age people (ages 15–64) divided by the number of persons 65 and older. As the ratio decreases, fewer working age people are supporting the elderly who have retired from work.
Caring for Younger People Countries in stage 2 of the demographic transition face challenges because higher CBRs, higher TRFs, and lower life expectancies result in a greater percentage of the population under age 15.
Comparing Young and Old One important way to compare age structure among countries is the population pyramid, a bar graph that shows the percentage of a place’s population for each age and gender. A broad base indicates a higher percentage of young people. Population pyramids help geographers identify which stage of the demographic transition a country occupies.
The dependency ratio shows the people who are too young and too old to work, compared to the number of people in their productive years. People who are 0–14 years of age or over 64 years old are normally classified as dependents. The large number of children in a poor country strains the ability of that country to be able to provide needed services such as schools, hospitals, and day care centers. Similarly, a large portion of an older population places a burden on the country to meet their needs for income and medical care after they retire from their jobs.
The Epidemiologic Transition Epidemiology is the branch of medical science concerned with the incidence, distribution, and control of diseases that are prevalent among a population at a specific time and are produced by some special causes not generally present in the affected place. The epidemiologic transition, conceptualized by Abdel Omran in 1971, focuses on distinctive health threats in each stage of the demographic transition. Geographic concepts such as scale and connection are used by epidemiologists to understand the distribution and method of diffusion of possible epidemics, and to develop control and prevention strategies.
Stage 1: Pestilence & Famine In stage 1 of the epidemiologic transition, infectious and parasitic diseases were the principal causes of human deaths. Accidents and attacks by animals and other humans were also prevalent causes of death at the time. History’s most violent stage 1 epidemic was the Black Plague (bubonic plague), which was probably transmitted to humans by fleas from migrating infected rats.
Stage 2: Receding Pandemics A pandemic is an epidemic of an infectious disease that occurs over a wide geographic area and affects a very high proportion of the population. Improved sanitation, nutrition, and medicine during the Industrial Revolution reduced the spread of infectious diseases. Death rates did not decline immediately and universally during the early years of the Industrial Revolution. Poor people crowded into rapidly growing industrial cities and had especially high death rates. An early example of geographic tools used to study epidemiology is the GIS created by Dr. John Snow to determine the source of cholera in London in 1854. Dr. Snow overlaid maps of addresses of cholera victims and the location of water pumps over a map of the Soho neighborhood, displaying a cluster of victims around a single pump on Broad Street.
Stage 3: Degenerative Diseases Stage 3 of the epidemiologic transition is characterized by a decrease in deaths from infectious diseases and an increase in chronic disorders associated with aging. Chronic disorders associated with aging include heart attacks and various forms of cancer. Sub-Saharan Africa and South Asia have the lowest incidence of cancer, primarily because of the relatively low life expectancy in those regions.
Stage 4: Delayed Degenerative Diseases The major degenerative causes of death—cardiovascular disease and cancers—linger, but the life expectancy of older people is extended through medical advances. Medical operations and healthier lifestyles increase people’s life expectancy in stage 4 of the epidemiologic transition. Behavioral changes such as better diet, reduced tobacco use, and increased exercise has improved health in stage 4 counties. Increased deaths related to opioids are a challenge currently faced in stage 4 countries.
2.3
Dependency ratio the ratio of the number of people not in the work force (dependents) and those who are in the work force (producers) - useful for understanding the pressure on the producers
Epidemic A widespread occurrence of an infectious disease in a community at a particular time.
Epidemiologic Transition distinctive causes of death in each stage of the demographic transition
Epidemiology The branch of medical science concerned with the incidence, distribution, and control of diseases that are prevalent among a population at a special time and are produced by some special causes not generally present in the affected locality.
Graying population a shift in population where older people (gray hair!) become a bigger portion, usually as a result of declining birth rates
Life expectancy the average number of years a person born in a country might expect to live
Medical revolution leap forward in medical technology and practices that have enabled people to live longer
Mortality the number of deaths occuring in a population