The Determinants of Health
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The Determinants of Health book
Differences in health and longevity are important manifestations of socioeconomic differences between and within core and peripheral countries. There have been dramatic changes in the patterns of health and illness in the more developed countries. As described in Chapter 1, the original European health transition was triggered by improvements in sanitation and hygiene. The subsequent development of safe surgical procedures, immunization and modern drug therapies, especially antibiotics, sustained a gradual transition to a low incidence of infectious diseases. As increasing numbers survived until old age there was a relative increase in NCDs as a cause of death. Transitions such as those of East Asia occurred much more rapidly when a range of health measures, which had taken a century or more to be developed in Europe, were introduced almost Simultaneously. 1
In recent years it has become increasingly common for contemporary developing countries and countries in economic transition to experience a piecemeal health transition rather than to replicate the experiences of the industrialized countries. This is often related to a demographic transition that is also different from the European model, in that fertility is much slower to decline than mortality, so there is a longer period of population growth. Many contemporary countries are finding their sustained population growths are hindering economic development and limiting the availability of capital for investing in the improvement of living conditions and health services. This leads to uneven progress in health, with a mixed pattern of both infectious and NCDs as the major causes of death, and differing access to health facilities within countries.