Page 253 - The ISA Handbook in Contemporary Sociology

9781412934633-Chap-15 1/10/09 8:50 AM Page 224

224 THE ISA HANDBOOK IN CONTEMPORARY SOCIOLOGY

developed, least developed, and developing Since the early writings of its proponents, this
countries.) Basically, we focus on four factors – theory has undergone numerous modifications
economic development, income inequality, and critical appraisals (Caldwell, 1976,
public spending on health, and maternal 1986a; Friedlander et al., 1999). The theory
education – that are inextricably linked with has moved from being a descriptive device for
the process of globalization and mortality portraying declines in mortality and fertility
patterns. This chapter is largely descriptive in various parts of the world to an explanatory
rather than analytical and borrows heavily and predictive device of population change. In
from the existing literature on the subject. its initial formulations, the theory viewed
Much of the data comes from published societies moving from a stage where mortality
reports of the United Nations, World Bank, and fertility were high to a stage of transition
and Demographic and Health Surveys. We where mortality declined first and rapidly, was
begin with a brief description of the demo- then followed by fertility declines, and finally
graphic transition and epidemiological tran- reached a stage where both fertility and mor-
sition theories, which provide the rationale tality were at a low level. According to this
for the convergence hypothesis. Then we theory, within a country both mortality and
examine some selected measures of health, ill- fertility decline as a result of various struc-
ness, and mortality. Next, we examine the roles tural changes (urbanization, industrialization,
of the above-mentioned four factors in bringing a rise in women’s status, a rise in education, a
about the convergence, divergence, or stagna- decline in religiosity), commonly subsumed
tion in health and mortality patterns. under the rubric of ‘modernization’.
Essentially, we focus on the conflict and com- Building on the theory of demographic
petition between nations and groups for access transition, Omran (1971) proposed a theory
to scarce resources for improving health condi- of ‘epidemiologic transition’ according to
tions and reducing mortality. This study is which the ‘shifts in health and disease pat-
guided by the assumption that there is inherent terns ... are closely associated with the demo-
duality in all societies and in today’s competi- graphic and socioeconomic transitions that
tive world, nations, groups, and population seg- constitute the modernization complex’
ments which lack the skills, resources, or (Omran,1971: 527). The focus of the theory
opportunity to compete well, fall behind the is on ‘the complex changes in patterns of
more privileged and resourceful nations, health and disease and on the interactions
groups, and segments. The basic premise of the between these patterns and their demo-
discussion is that people and sections with graphic, economic, and sociological determi-
better social, economic, and political resources nants and consequences’ (Omran, 1971:
are better able to exploit the available resources 510). According to this theory, transition
at the expense of those with poorer resources. from high to low levels of mortality typically
The challenge for governments, donor agen- accompanies social development, as in the
cies, and international bodies is how to develop West, or a combination of medical develop-
cooperative strategies – an important ingredient ment and social changes as experienced by
of convergence – for the efficient allocation of many developing countries. The transition
scarce resources among competing sectors. emphasizes the secular and long-term shifts
Finally, we offer some implications of these from high infant mortality, primarily caused
processes for public policies. by infectious and communicable diseases, to
low levels of mortality, concentrated among
the elderly, due primarily to chronic, degener-
ative, and man-made diseases.
THEORETICAL CONTEXT According to the epidemiologic transition
theory, changes in disease patterns typically
The demographic transition theory is one of occur in three stages and Omran (1971,
the best known theories of population change. 1977) identified each stage by the major