Changes

Crude Death Rate (CDR) refers to the total number of deaths in a given year divided by the average (or midyear) total population, times 1000. The CDR does not take age into account, so a healthy country with many old people may have a higher CDR rate than an unhealthy country with a young population.  The CDR for the United States steadily declined from 17.2 deaths per 1000 in 1900 to 9.6 deaths per thousand population in 1950, then stayed frozen for 20 years. (Even though people were healthier, the population was getting older.) Since 1990 the CDR has been steady at about 8.5 deaths per 1000 per year.  

Crude Death Rate (CDR) refers to the total number of deaths in a given year divided by the average (or midyear) total population, times 1000. The CDR does not take age into account, so a healthy country with many old people may have a higher CDR rate than an unhealthy country with a young population.  The CDR for the United States steadily declined from 17.2 deaths per 1000 in 1900 to 9.6 deaths per thousand population in 1950, then stayed frozen for 20 years. (Even though people were healthier, the population was getting older.) Since 1990 the CDR has been steady at about 8.5 deaths per 1000 per year.  

===Age-specific death rate (ASDR)===  

===Age-specific death rate (ASDR)===

Age-specific death rate (ASDR) refers to the number of deaths each year for a specific age group, divided by the average number of people in that year of that age or the midyear total population. If two populations have different age distributions, the ASDR is better than the CDR to evaluate mortality. The calculation of the ASDR requires age data from the census in addition to vital statistics data. Assembling all the ASDR's together for every year of life produces a [[life table]].  

Age-specific death rate (ASDR) refers to the number of deaths each year for a specific age group, divided by the average number of people in that year of that age or the midyear total population. If two populations have different age distributions, the ASDR is better than the CDR to evaluate mortality. The calculation of the ASDR requires age data from the census in addition to vital statistics data. Assembling all the ASDR's together for every year of life produces a [[life table]].  

see [[Infectious Diseases (human)]]

see [[Infectious Diseases (human)]]

Infectious diseases are caused when an outside organism invades the body. Diseases caused by germs--that is, bacteria or protozoa. Although there are plenty of disease germs in the air, water and soil around us, disease can be prevented by sanitation and vaccines, and cured with antibiotics. Programs to vaccinate everyone against smallpox and measles, and to immunize against diphtheria, tetanus, German measles, and polio have been highly effective. (Smallpox is gone and polio will disappear very soon—once all the germs are dead the disease is finished forever.) Unfortunately, there are no cures for diseases caused by viruses, such as the common cold or AIDS.

Infectious diseases are caused when an outside organism invades the body. Diseases caused by germs—that is, bacteria or protozoa. Although there are plenty of disease germs in the air, water and soil around us, disease can be prevented by sanitation and vaccines, and cured with antibiotics. Programs to vaccinate everyone against smallpox and measles, and to immunize against diphtheria, tetanus, German measles, and polio have been highly effective. (Smallpox is gone and polio will disappear very soon—once all the germs are dead the disease is finished forever.) Unfortunately, there are no cures for diseases caused by viruses, such as the common cold or AIDS.

===HIV/AIDS===

===HIV/AIDS===

see [[AIDS]]

see [[AIDS]]

AIDS is a new disease that, like tuberculosis in the 19th century and cancer in the 20th century, became the focus of dread because of its devastating effects.  The disease originated in monkeys but jumped to humans in Africa in the 1950s. It spread slowly until the early 1980s, when it suddenly exploded as one of the deadliest and most horrible diseases in history. In 2006, worldwide 40 million people were infected with HIV and 2.9 million died.  More than 25 million people have died of AIDS since 1981, with the heaviest burden in Africa, where there are 12 million AIDS orphans.<ref> See UNAIDS/WHO data reported in November 2006 at [http://www.avert.org/worldstats.htm] </ref> The mortality is 100%, though in recent years drug therapies have been developed that slow its progress. AIDS is caused by the human immunodeficiency virus (HIV) virus. The virus spreads primarily via sexual intercourse (mostly heterosexual intercourse with prostitutes in Africa and Asia, and homosexual intercourse in the North America and Europe), and through the sharing of needles used to inject heroin. About 20-30% of children of infected mothers catch the disease. A peculiar characteristic of this disease is that the HIV virus usually lies dormant for five or ten years, then explodes into the AIDS disease, which attacks the T4 white blood cells and thereby destroys the body's immune system in one to three years' time. The public health problem is that people unaware they carry the HIV virus may spread the disease for years, thereby creating an epidemic. The number of cases in the United States peaked at one-half of one percent of the population. The annual number of deaths peaked in the  U.S. in 1995 at 42,500 and declined steadily to 14,000 in 2002. In 2003 the U.S. launched a 5-year program, spending $15 billion for prevention, treatment and care of AIDS patients in developing countries.  

AIDS is a new disease that, like tuberculosis in the 19th century and cancer in the 20th century, became the focus of dread because of its devastating effects.  The disease originated in monkeys but jumped to humans in Africa in the 1950s. It spread slowly until the early 1980s, when it suddenly exploded as one of the deadliest and most horrible diseases in history. In 2006, worldwide 40 million people were infected with HIV and 2.9 million died.  More than 25 million people have died of AIDS since 1981, with the heaviest burden in Africa, where there are 12 million AIDS orphans.<ref>[http://www.avert.org/worldstats.htm See UNAIDS/WHO data reported in November 2006 at]</ref> The mortality is 100%, though in recent years drug therapies have been developed that slow its progress. AIDS is caused by the human immunodeficiency virus (HIV) virus. The virus spreads primarily via sexual intercourse (mostly heterosexual intercourse with prostitutes in Africa and Asia, and homosexual intercourse in the North America and Europe), and through the sharing of needles used to inject heroin. About 20-30% of children of infected mothers catch the disease. A peculiar characteristic of this disease is that the HIV virus usually lies dormant for five or ten years, then explodes into the AIDS disease, which attacks the T4 white blood cells and thereby destroys the body's immune system in one to three years' time. The public health problem is that people unaware they carry the HIV virus may spread the disease for years, thereby creating an epidemic. The number of cases in the United States peaked at one-half of one percent of the population. The annual number of deaths peaked in the  U.S. in 1995 at 42,500 and declined steadily to 14,000 in 2002. In 2003 the U.S. launched a 5-year program, spending $15 billion for prevention, treatment and care of AIDS patients in developing countries.  

AIDS deaths are increasing in Africa and Asia. An estimated 34-47 million people carried the HIV virus in 2006, 60% of them in Africa, and 20% in South Asia.  In Africa six countries have adult infection rates over 20%.<ref>[https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html CIA Factbook 2007''] </ref> Estimates from 2003 show South Africa  has 5,300,000 cases; India has 5,100,000; and Nigeria has 3,600,000. The U.S. has 950,000 cases.<ref>[https://www.cia.gov/library/publications/the-world-factbook/rankorder/2156rank.html CIA Factbook 2007''] </ref>

AIDS deaths are increasing in Africa and Asia. An estimated 34-47 million people carried the HIV virus in 2006, 60% of them in Africa, and 20% in South Asia.  In Africa six countries have adult infection rates over 20%.<ref>[https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html CIA Factbook 2007'']</ref> Estimates from 2003 show South Africa  has 5,300,000 cases; India has 5,100,000; and Nigeria has 3,600,000. The U.S. has 950,000 cases.<ref>[https://www.cia.gov/library/publications/the-world-factbook/rankorder/2156rank.html CIA Factbook 2007'']</ref>

===Tuberculosis===

===Tuberculosis===

see [[Tuberculosis]]

see [[Tuberculosis]]

Tuberculosis (or "TB," "consumption," "scrofula," "white death") was in the industrial era a terrible scourge, reaching epidemic proportions. It is an infectious disease, spread by coughing; crowded living conditions facilitate its spread. Cattle can carry the disease and infected milk is a public health threat, solved by government inspection of cattle and mandatory pasteurization of milk, over the objections of dairy farmers. TB strikes people in their 20s and 30s. A century ago. as “consumption” it had a highly romantic connotation in novels and opera--the death of the young lover.  Since 1900, however, as “TB” it has been identified realistically with filth and squalor. Long term rest in special hospitals was the only cure before the arrival of highly effective antibiotics in the 1940s. TB cases have dropped steadily in the US, reaching a low of 15,100 new cases in 2002, over a third of them from immigrants. There were over 100,000 cases annually in the 1940s. The number of deaths fell to 800 in 2002, compared to 70,000 a year in the 1930s, and 150,000 a year in 1900-1910. In 1900 TB was the second leading cause of death, right behind pneumonia. Upwards of 10 or 15 million people in the United States today have latent TB; those most at risk of contracting the disease itself are HIV (AIDS) sufferers. In developing countries tuberculosis remains a major cause of death, especially in crowded slums.

Tuberculosis (or "TB," "consumption," "scrofula," "white death") was in the industrial era a terrible scourge, reaching epidemic proportions. It is an infectious disease, spread by coughing; crowded living conditions facilitate its spread. Cattle can carry the disease and infected milk is a public health threat, solved by government inspection of cattle and mandatory pasteurization of milk, over the objections of dairy farmers. TB strikes people in their 20s and 30s. A century ago. as “consumption” it had a highly romantic connotation in novels and opera—the death of the young lover.  Since 1900, however, as “TB” it has been identified realistically with filth and squalor. Long term rest in special hospitals was the only cure before the arrival of highly effective antibiotics in the 1940s. TB cases have dropped steadily in the US, reaching a low of 15,100 new cases in 2002, over a third of them from immigrants. There were over 100,000 cases annually in the 1940s. The number of deaths fell to 800 in 2002, compared to 70,000 a year in the 1930s, and 150,000 a year in 1900-1910. In 1900 TB was the second leading cause of death, right behind pneumonia. Upwards of 10 or 15 million people in the United States today have latent TB; those most at risk of contracting the disease itself are HIV (AIDS) sufferers. In developing countries tuberculosis remains a major cause of death, especially in crowded slums.

===Degenerative Diseases===

===Degenerative Diseases===

Diets are a factor. The Mediterranean diet with a low consumption of saturated fat, meat and milk, but a high consumption of fruit, vegetables and carbohydrates, is considered healthy. This diet probably explains why Albania, although a very poor country, has a high adult life expectancy. Diets have improved, from a medical standpoint, in the last 30 years for all groups and classes in the United States. This is especially true for high income people who used to eat too much fatty steak, and have now switched to more chicken and fish. The cardiovascular death rates for U.S. men and women are about double those reported from Japan and France, which is probably due to diets.

Diets are a factor. The Mediterranean diet with a low consumption of saturated fat, meat and milk, but a high consumption of fruit, vegetables and carbohydrates, is considered healthy. This diet probably explains why Albania, although a very poor country, has a high adult life expectancy. Diets have improved, from a medical standpoint, in the last 30 years for all groups and classes in the United States. This is especially true for high income people who used to eat too much fatty steak, and have now switched to more chicken and fish. The cardiovascular death rates for U.S. men and women are about double those reported from Japan and France, which is probably due to diets.

In the United States, the leading causes of death by social factors are:<ref> see AH Mokdad et al. "Actual causes of death in the United States, 2000" ''JAMA'' (2004) v. 291#10 pp 1238-45 [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15010446 online]</ref>

In the United States, the leading causes of death by social factors are:<ref>see AH Mokdad et al. "Actual causes of death in the United States, 2000" ''JAMA'' (2004) v. 291#10 pp 1238-45 [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15010446 online]</ref>

# tobacco (18.1% of total deaths)  

# tobacco (18.1% of total deaths)  

# poor diet and physical inactivity (15.2% of total deaths)  

# poor diet and physical inactivity (15.2% of total deaths)  

Worldwide, there are about 57 million deaths a year (with 6.5 billion people, this gives a CDR of 8.9 deaths per 1000). Life expectancy is about 65.  Nearly 11 million deaths in 2002 were among children under five years of age, and 98% of them were in the developing world. along with 83% of deaths at ages 15-59, and only 59% of deaths over age 70. The probability of death between birth and 15 years ranges from 22% in sub-Saharan Africa to 1% in the developed economies. Probabilities of death between ages 15 and 60 range from 7% for women in developed countries to 39% for men in sub-Saharan Africa. Worldwide in 1990, infectious disease accounted for 17.2 million deaths, degenerative diseases for 28.1 million deaths; and violence for 5.1 million deaths. The leading causes of death were heart disease (6.3 million deaths worldwide), strokes, (4.4 million deaths), lower respiratory infections (4.3 million), diarrhoeal diseases (2.9 million), perinatal disorders (2.4 million), chronic obstructive pulmonary disease ("COPD", includes emphysema and chronic bronchitis) (2.2 million), tuberculosis (2.0 million), measles (1.1 million), road-traffic accidents (1.0 million), and lung cancer (0.9 million).  

Worldwide, there are about 57 million deaths a year (with 6.5 billion people, this gives a CDR of 8.9 deaths per 1000). Life expectancy is about 65.  Nearly 11 million deaths in 2002 were among children under five years of age, and 98% of them were in the developing world. along with 83% of deaths at ages 15–59, and only 59% of deaths over age 70. The probability of death between birth and 15 years ranges from 22% in sub-Saharan Africa to 1% in the developed economies. Probabilities of death between ages 15 and 60 range from 7% for women in developed countries to 39% for men in sub-Saharan Africa. Worldwide in 1990, infectious disease accounted for 17.2 million deaths, degenerative diseases for 28.1 million deaths; and violence for 5.1 million deaths. The leading causes of death were heart disease (6.3 million deaths worldwide), strokes, (4.4 million deaths), lower respiratory infections (4.3 million), diarrhoeal diseases (2.9 million), perinatal disorders (2.4 million), chronic obstructive pulmonary disease ("COPD", includes emphysema and chronic bronchitis) (2.2 million), tuberculosis (2.0 million), measles (1.1 million), road-traffic accidents (1.0 million), and lung cancer (0.9 million).  

The decline in mortality in developing countries is due primarily to public health measures and the availability of cheap but powerful antibiotics and other drugs. How the decline takes place is best explained by the “Epidemiological Transition.”

The decline in mortality in developing countries is due primarily to public health measures and the availability of cheap but powerful antibiotics and other drugs. How the decline takes place is best explained by the “Epidemiological Transition.”

The sanitary conditions in practically all cities in the 19th century were breathtakingly bad. Thousands of newcomers crowded together, sharing the same water, sanitation and germs, leading to very high rates of communicable diseases. Infant mortality was 150-200 per thousand births. The rapidly growing industrial cities had very few old people. Thomas McKeown, a British historical demographer, has downplayed the role of medicine and health professionals in the epidemiological transition. Instead, he argues, rising incomes meant better nutrition and better personal hygiene. Crop failure no longer meant famine because cities could buy and ship food from far away. There have been no famines in Western Europe since the Irish "potato famine" of the 1840s. Other historians, however, point out that the just one disease, smallpox, accounted for 10 to 20% of all deaths in rural England in 1750, and for very few in 1800. The reason was the successful effort by physicians to promote mass inoculation in the villages of England (and in other parts of Europe as well). Inoculation meant injecting a mild form of smallpox to enable a person to build resistance; it certainly was an effective preventative. An alternative interpretation to McKeown, presented by Preston and Haines emphasizes the role of health personnel, especially physicians, nurses and public health workers. They used the new communications media and new prestige accorded science and experts to preach the advantages of personal and community hygiene.  

The sanitary conditions in practically all cities in the 19th century were breathtakingly bad. Thousands of newcomers crowded together, sharing the same water, sanitation and germs, leading to very high rates of communicable diseases. Infant mortality was 150-200 per thousand births. The rapidly growing industrial cities had very few old people. Thomas McKeown, a British historical demographer, has downplayed the role of medicine and health professionals in the epidemiological transition. Instead, he argues, rising incomes meant better nutrition and better personal hygiene. Crop failure no longer meant famine because cities could buy and ship food from far away. There have been no famines in Western Europe since the Irish "potato famine" of the 1840s. Other historians, however, point out that the just one disease, smallpox, accounted for 10 to 20% of all deaths in rural England in 1750, and for very few in 1800. The reason was the successful effort by physicians to promote mass inoculation in the villages of England (and in other parts of Europe as well). Inoculation meant injecting a mild form of smallpox to enable a person to build resistance; it certainly was an effective preventative. An alternative interpretation to McKeown, presented by Preston and Haines emphasizes the role of health personnel, especially physicians, nurses and public health workers. They used the new communications media and new prestige accorded science and experts to preach the advantages of personal and community hygiene.  

Physicians had very few effective drugs before the 1940s. Versatile sulfa drugs arrived in the 1930s to combat infectious diseases caused by bacteria. Even more powerful drugs, antibiotics arrived in the 1940s--penicillin, streptomycin, amoxicillin, tetracycline, and many others. They were effective treatments for diseases caused by bacteria, and immediately had a major impact on infectious diseases. Highly effective, quick streptomycin therapy replaced long-term bed-rest as a cure for tuberculosis in the 1940s. Death rates plunged from tuberculosis and pneumonia. Operations became much safer thanks to antibiotics and the use of blood transfusions. Developing countries  

Physicians had very few effective drugs before the 1940s. Versatile sulfa drugs arrived in the 1930s to combat infectious diseases caused by bacteria. Even more powerful drugs, antibiotics arrived in the 1940s—penicillin, streptomycin, amoxicillin, tetracycline, and many others. They were effective treatments for diseases caused by bacteria, and immediately had a major impact on infectious diseases. Highly effective, quick streptomycin therapy replaced long-term bed-rest as a cure for tuberculosis in the 1940s. Death rates plunged from tuberculosis and pneumonia. Operations became much safer thanks to antibiotics and the use of blood transfusions. Developing countries  

The decline in mortality in developing countries is due primarily to public health measures and the availability of cheap but powerful antibiotics and other drugs. Accidents, especially involving automobiles, are fast becoming a major cause of death in the developing countries. Alcohol, poor highways, and bad driving behavior have been implicated.  

The decline in mortality in developing countries is due primarily to public health measures and the availability of cheap but powerful antibiotics and other drugs. Accidents, especially involving automobiles, are fast becoming a major cause of death in the developing countries. Alcohol, poor highways, and bad driving behavior have been implicated.  

see [[Infant mortality]]

see [[Infant mortality]]

Infant mortality rate (IMR) refers to the number of deaths in the first year of life per 1000 live births. In 2007 the rates ranged from a low of 2.3 in Singapore, to 4.8 in the European Union and 6.4 in the U.S., to a high of 184 in Angola. The world average was 43.5 deaths per 1000 births.<ref> [https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html  ''CIA Factbook 2007'']</ref>  

Infant mortality rate (IMR) refers to the number of deaths in the first year of life per 1000 live births. In 2007 the rates ranged from a low of 2.3 in Singapore, to 4.8 in the European Union and 6.4 in the U.S., to a high of 184 in Angola. The world average was 43.5 deaths per 1000 births.<ref>[https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html  ''CIA Factbook 2007'']</ref>  

The decline in infant mortality is one of the most impressive events of the 20th century. In 1900, one-fourth of American babies died before they reached age 5; today 99% survive to age 20. Today most of the deaths are perinatal (within one week of birth), and are caused by congenital abnormalities (birth defects), sudden infant death syndrome, respiratory distress syndrome and complications from very low birth weight. Historically infants and children under 6 were especially at risk for respiratory and gastrointestinal infections, which did not yield to medicine until antibiotics arrived.  

The decline in infant mortality is one of the most impressive events of the 20th century. In 1900, one-fourth of American babies died before they reached age 5; today 99% survive to age 20. Today most of the deaths are perinatal (within one week of birth), and are caused by congenital abnormalities (birth defects), sudden infant death syndrome, respiratory distress syndrome and complications from very low birth weight. Historically infants and children under 6 were especially at risk for respiratory and gastrointestinal infections, which did not yield to medicine until antibiotics arrived.