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Study material Population, Health & Place GEMPOPHP
Complete summary of the lectures of the course Population, Health & Place.
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Lecture notes Populati on, Health and PlaceLecture 1: Introduction and Organization
About the assignment:
Course aims 1,2 exam, 3,4,5 assignment
Lectures are recorded
Don’t use a lot of references app 6.
Make use of infobox (see slide 8)
Digital exam 20 questions 2 hours, open and closed questions
Cholera outbreak, in the west are a lot of people living there, so diseases spread easily. In the east
there is mostly desert and so there are not so many people living there.
Cholera dirty water
ZIKA migration and mosquitoes
Adolescence pregnancy cultural differences, political differences, education
Obesity economic development, genetics,
Micro level: relates to individuals, the individual level. Specific diseases or disabilities by persons
(caused by individual characteristics
Macro level:
Coleman’s bathtub: relation / effects between macro and micro level
Environment consists out of components natural environment (access to water), social
environment (gender, age, race, culture) and built environment (infrastructure, housing, healthcare
facilities, food desert)
Geographical concepts: location, what type of location, coordinates
Place: has a certain meaning, such as our home, can have a different meaning for people
Lecture 2: Global Health Differences and Changing Patterns of Disease
Short recap of last lecture
Introduction to the links between health, population and place. Examples of health outcomes in
different regions of the world multidimensionality of health geography
Geography, health, demographic processes affect each other different components of the
environment (natural, built, social environment)
Micro and macro level relationships and their influence on health (individual and population health)
Geographic approaches to health and schools geography (health geography, epidemiological
geography, new geography)
Learning outcomes of this lecture
- What is population health and how to measure it?
o Discussion of different health indicators
- Differences in population health in an international perspective
o Categorization and patterns of diseases
,Definition of health: a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity (WHO 1948). Often health is measured as the absence of a disease.
This definition is absolute and hardly achievable. The problem is ageing populations, increasing
burden of chronic diseases, self-perception of health. Therefore, the new definition of health is: the
ability to adapt and self-manage in the face of social, physical and emotional challenges
Definition of disease: refers to a medical conception of pathological abnormality which is indicated by
a set of signs and symptoms.
At the population level:
o Morbidity: the diseases that exist on the population level
o Mortality: number of deaths on the population level
Indicators for international variation in health
1. Mortality: life expectancy
o Overall mortality: various indicators such as absolute mortality number of deaths,
Crude death rate (number of deaths / average population such as deaths per 1000)
Crude death rate bias: not looking at the population age, in countries with
older populations the death risk is higher and therefore the death rate is
higher
o Life expectancy: the number of years we can expect to life at a certain age
o mortality by age: The risk of dying is dependent on the age, to reduce bias because of
this risk difference age standardization is used to compare countries.
o mortality by cause: Distribution of deaths in the world by cause-of-death group and
sex
2. Mortality & Morbidity
o Healthy life expectancy (HLE): also health-adjusted life expectancy (HALE), health
expectancy (HE), healthy life years (HLY). The definition is the average number of
years in full health a new born can expect to live based on current rates of ill-health
and mortality. It is a quite important measure because if the life expectancy
increases, the healthy life expectancy can show if these years gained are in a healthy
state or not.
o Global burden of disease study (GBD): Developed the DALYs, comparing countries in
terms of healthcare services or something like that (population health targets)
DALYs: disability-adjusted life years, the number of years someone spend
with disability. DALY = YLL + YLD. YLL: years of life lost due to premature
death. YLL= N * L = number of deaths * life expectancy at age of death in
years. YLD: years of life lost due to disability. YLD = I * DW * L = number of
incident cases * disability weight * average duration of the case until
remission or death
3. Morbidity
o Measures of disease, morbidity & disability
Disease: medical conception of pathological abnormality which is indicated
by a set of signs and symptoms, implies biomedical cause and often already
known treatment.
Consequences are:
Impairment: defective or missing body part (organ level)
Disability: inability to perform an activity (person level)
, Handicap: disadvantage that limits or prevents the fulfilment of a
role (societal level)
Distinction of disease types
o Acute or chronic
o Infectious/communicable/contagious disease: caused by
pathogens (viruses, bacteria, parasites) that invade the body
and spread from one person / species to another (direct or
indirect) vs non-infectious / non-communicable disease
o Communicable and non-communicable diseases
Illness: individual’s experience of ill-health, indicated by the person’s feelings
of pain, discomfort and the like, wide concept that may refer to temporary
mild problems to long lasting severe problems
Sickness: social consequences/ role attached to the (health) problem by
society at large, sick leave etc.
Why are there so any different indicators to measure mortality/morbidity?
The data/information is not always available in every country
In summary: there are large health differences at the global, national and regional level. Health
status of a population can be measured with a variety of indicators (mortality). Indicators for
observing changes over time, differences in environment etc.
Given the differentiation between acute/chronic and communicable/non-communicable diseases”
- Could there be an acute non-communicable disease? yes, heart attack
- Could there be a chronic communicable/infectious disease? yes, HIV, malaria, herpus
Measures of disease morbidity, disability for persons
1. Measures of disease and morbidity
a. Hospital admissions
b. Self-rated health
c. Medical assessment
d. Incidence, prevalence
, 2. Measure of disability
a. Activities of daily living (ADL)
i. Bathing/showering, dressing, eating, walking the stairs etc.
b. Instrumental activities of daily living (IADL)
i. Housework, shopping, telephone use etc.
Measures of disease: frequency or occurrence (macro level measures)
- Incidence: the number of new cases occurring in a population (at risk) during a specific period
of time. New cases, change, becoming
o Incidence proportion = cumulative incidence. New cases divided by number of
individuals at risk at the beginning of the period
o Incidence rate = incidence density. New cases divided by number of person-years at
risk
- Prevalence: the proportion of cases in a population at a particular point or period in time.
Existing cases, status, being
o Point prevalence
o Period prevalence
Incidence or prevalence?
- In total 34% of British women aged 30-36 years smoke cigarettes prevalence
- Out of the 100 people that ate the pudding 45% came down with diarrheal within the next 2
days incidence
In summary: measures of morbidity depend on the definition of health (remember complications
with WHO definition?). Absence of health measured specific or more holistic (subjective vs objective
health). On population level measured as incidence (number of new cases) or prevalence (number of
existing cases).
Answers to the learning outcomes
- What is health? general definitions vs different types of diseases
- How to measure population health? different measures for mortality and morbidity (e.g.
life expectancy, DALYs, incidence or prevalence of certain diseases)
- International differences in population health enormous disparities in health across space
and place (causes, age)
- Developing countries majority of deaths, vast majority of child deaths and global burden
of disease (double disease burden group I and group II diseases)
- Developed countries predominantly non-communicable diseases, old age disabilities
Lecture 3: Fertility, Demographic Transition and Maternal Health
Summary last lecture: population level health variations and indicators.
Mortality spatial mortality patterns (life expectancy, CDR, ASDR). Age an cause specific mortality
(Group I, II and III diseases)
Mortality and morbidity combination of years lived and years spend with diseases and disabilities
(HLE, DALY)
Concepts of health and classification of diseases communicable vs non-communicable, acute vs
chronic diseases. Prevalence and incidence as measures of morbidity.
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