Doctoral Dissertation Research: Assessing the Potential Causes of a Second Epidemiological Transition

人类学家，人口学家和其他社会科学家的工作有助于理解影响健康和福祉的因素。虽然公共卫生研究人员专注于确定疾病的直接生物学原因，但社会科学家也退后一步，研究介导人们疾病暴露和易感性的更大的文化，社会，经济和政治背景。从历史上看，这些因素导致了死亡率模式和健康结果的重大变化。其中一个转变与数千年前久坐不动的农业生活方式兴起后流行性传染病的增加有关。最近，工业化使传染病减少，婴儿和儿童死亡率大幅度下降。继第二次转变之后，现在又出现了第三次转变，非传染性疾病取代传染性疾病，成为成人死亡的主要原因。然而，有趣的是，这些变化背后的因素并不清楚。是个人卫生和一般卫生条件的改善吗？医学的进步？经济和政治稳定？已经提出了各种设想和因素。该奖项支持的研究利用了一个独特的机会，通过研究20世纪延迟转型的案例，确定了众多潜在驱动因素中最具影响力的一个。在密苏里州大学人类学家丽莎Sattenspiel博士的指导下，联合PI和博士生Dana M。施密特，将研究健康和死亡率的模式，相应的世纪工业化在纽芬兰和拉布拉多。她将重点关注目前该地区已知具有一定重要性的具体驱动因素，包括获得医疗保健、改善卫生设施、营养计划以及社会经济地位的总体改善，尽管城乡地区存在差异。研究问题包括：卫生条件的改善在多大程度上降低了传染病的流行率或死亡率？避孕药在预防疾病方面的效果如何？从农村到城市地区的有激励的移民是否提高了生活水平并对健康产生了积极影响？在历史人口中解决这一性质的问题，对社会政策的执行和评估其在改善健康和减少当前人口差距方面的效力具有实际意义。纽芬兰岛是一个理想的研究地点，以解决这些问题，因为该岛经历了重大的政治变化，因为它从一个挣扎的英国殖民地到自治的自治领，加拿大省在上半年的20世纪世纪。这些变化为人口带来了新的经济和社会气候，同时也对人口和健康产生了影响。研究人员将从生命统计记录、死亡登记册和纽芬兰和拉布拉多省档案馆的档案资源中收集数据，包括报纸文章、关于卫生政策和改革的政府文件以及日记。这些数据将使研究人员能够评估过渡的时间，速度以及观察到的健康变化的驱动因素。这项研究的结果将有助于了解非工业化国家和工业化国家的流行病学转变。通过研究社会政策的实施及其在改善健康和减少差距方面的功效，可以得出结论，这对研究政策与人口健康和福祉之间关系的任何背景下的学者都是有兴趣的。

The work of anthropologists, demographers, and other social scientists contributes to understanding the factors that influence health and well-being. While public health researchers focus on identifying the immediate biological causes of disease, social scientists also step back to examine the larger cultural, social, economic, and political context that mediates people's disease exposure and susceptibility. Historically, such factors have produced major shifts in mortality patterns and health outcomes. One such transition is associated with the rise of epidemic infectious diseases that occurred in the wake of the rise of a sedentary, agricultural way of life, millennia ago. More recently, industrialization saw a decline in infectious diseases and major reductions in infant and childhood mortality. This second transition has now been followed by a third, when non-communicable diseases replaced infectious ones as the major cause of human adult mortality. Interestingly, however, the factors underlying these shifts are not clear. Was it improvement in personal hygiene and general sanitary conditions? Advances in medical science? Economic and political stability? A variety of scenarios and factors have been proposed. The research supported by this award takes advantage of a unique opportunity to determine the most influential of these many potential drivers by looking at a case of delayed transition in the 20th. century for which there are a number of untapped data sources.With the guidance of University of Missouri anthropologist, Dr. Lisa Sattenspiel, co-PI and doctoral student Dana M. Schmidt, will examine the patterns of health and mortality corresponding to 20th century industrialization in Newfoundland and Labrador. She will focus on specific drivers known to be of some importance in the region at this time, including access to health care, improvements in sanitation, nutritional programs, and overall improvements in socioeconomic status although with variation in urban and rural locales. Research questions include: To what extent do improvements in sanitation reduce infectious disease prevalence or mortality? How effective were quarantines at preventing disease? Does incentivized migration from rural to urban areas improve living standards and have positive impacts on health? Addressing questions of this nature in a historical population has practical implications for the implementation of social policies and assessing their efficacy at improving health and reducing disparity in current populations. The island of Newfoundland is an ideal study location to address these topics because the island underwent significant political changes as it went from a struggling British Colony to self-governing Dominion to Canadian province during the first half of the 20th century. Such changes produced new economic and social climates for the population with concomitant demographic and health effects. The researchers will collect data from vital statistics records, death registers, and archival resources from the Provincial Archives of Newfoundland and Labrador, including newspaper articles, government papers regarding health policy and reform, and diaries. These data will allow the researchers to assess the timing of the transition, its pace, and the driving factors for observed health changes. Findings from this research will contribute to understanding epidemiological transitions in non-industrial and industrializing nations. By examining the implementation of social policies and their efficacy at improving health and reducing disparity in this case with its abundant data sources, conclusions can be drawn that will be of interest to scholars studying any context where the relation between policy and population health and wellbeing is of concern.