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幸福的因素。当公共卫生研究人员专注于确定疾病的直接生物学原因时，社会科学家也退后一步，研究更大的文化、社会、经济和政治背景，这些背景介导了人们的疾病暴露和易感性。从历史上看，这些因素造成了死亡模式和健康结果的重大转变。其中一个转变与几千年前久坐不动的农业生活方式兴起后出现的传染病流行有关。最近，工业化使传染病发病率下降，婴儿和儿童死亡率大幅下降。继第二次转变之后，现在又发生了第三次转变，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？人们提出了各种各样的情景和因素。该奖项支持的研究利用了一个独特的机会，通过观察20世纪延迟转型的案例，确定了这些潜在驱动因素中最具影响力的因素。世纪，其中有许多未开发的数据源。在密苏里大学人类学家Lisa Sattenspiel博士和博士生Dana M. Schmidt的指导下，他们将研究20世纪纽芬兰和拉布拉多工业化所对应的健康和死亡率模式。她将重点关注目前在该地区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、营养计划和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：卫生设施的改善在多大程度上降低了传染病的患病率或死亡率？隔离在预防疾病方面有多有效？受激励的从农村向城市地区的迁移是否提高了生活水平并对健康产生了积极影响？在历史人口中处理这种性质的问题，对执行社会政策和评估其在改善当前人口健康和缩小差距方面的效力具有实际意义。纽芬兰岛是解决这些问题的理想研究地点，因为该岛在20世纪上半叶经历了重大的政治变革，从一个苦苦挣扎的英国殖民地到自治自治领，再到加拿大的一个省。这些变化为人口创造了新的经济和社会气候，同时对人口和健康产生了影响。研究人员将从纽芬兰和拉布拉多省档案馆的生命统计记录、死亡登记和档案资源中收集数据，包括报纸文章、有关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这种转变的时间、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理解非工业国家和工业化国家的流行病学转变。通过审查社会政策的执行情况及其在改善健康和减少差距方面的效力（在这种情况下，有丰富的数据来源），可以得出结论，对于研究政策与人口健康和福祉之间关系的任何背景的学者来说，这些结论都是有意义的。

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.