[From epidemiological transition to health transition].
The "Epidemiological Transition" concept proposed by Abdel Omran in 1971 was the first theory attempting to explain the extraordinary progess that industrialized countries have achieved in health since the 18th century. Within the broader framework of the demographic transition, an important implication of this concept was that life expectancy in modern societies would converge toward limits determined by the new epidemiological conditions. In the ensuing decades, however the convergence process appears to have stopped as a result of a number of setbacks including the health crisis in Eastern Europe and AIDS in Africa. These setbacks do not fundamentally contradict the theory. A much greater contradiction was the unexpected dramatic decrease in cardiovascular disease that began as early as the 70s and had a major positive impact on life expectancy. Based on the concept of "Health Transition" described by Julio Frenk et al., we propose a complete revision of the health implications of the demographic transition based the idea of successive cycles of divergences/convergences induced by the appearance and generalization of major breakthroughs in health technologies and strategies. Three such cycles can be clearly identified on an international level corresponding to control of infectious then cardiovascular diseases, and perhaps most recently to the initial successes achieved in the field of ageing.
Meslé
F
F
L'UR Mortalité, santé, épidémiologie, INED, Paris, France. mesle@ined.fr
Vallin
J
J
D002318:Cardiovascular Diseases / Q000401:mortality; D003141:Communicable Diseases / Q000401:mortality; D003906:Developing Countries; D014943:Global Health; D019456:Health Transition; D006801:Humans; D008017:Life Expectancy; D012499:Sanitation