Soc Mid Term

Demography Definition
The scientific study of human population.
The term was coined in 1855 by Achille Guillard, who used it in the title of his book Éléments de Statistique Humaine ou Démographie Comparée.

Demographer’s are concerned with
Population size
Population growth or decline
Population processes
Population distribution
Population structure
Population characteristics

Why do we need demographers?
b/c change happens. The world’s population will continue to increase for the rest of our lives. Even though virtually all of it will take place in developing countries (indeed, cities of those countries), we will experience the consequences and our lives will be different in the future than they are now as a result.

Why is Demography Important?
Nearly everything is connected to demography:

Demographic connections: Migration and Globalization
Search for “greener pastures”
Search for cheap labor

demographic connections: Social strife and regional conflict
E.g., Aggravated by the youth bulge in the Middle East and South Asia
E.g., Violence in sub-Saharan Africa that’s aggravated by high birth rates and issues arising from HIV/AIDS

demographic connections: Backlash against immigrants
Aggravated by xenophobia in the face of the need for workers in the richer, aging countries

demographic connections: Degradation of the environment
Can we feed everyone?
Can we pull everyone out of poverty?

Demographics of Politics
The Census of Population provides data for the apportionment of seats in the House of Representatives (we will look at this in Chap 4).
Social movements are related to 1960s : civil rights movement
Unemployed youth: Occupy Wall St
“Youth bulge” and the Arab Spring?

Demographics and Social planning
Local agencies use demographics to plan for services (education, fire, police, sanitation, economic development) for their communities.

Marketing Demographics
Segmenting markets – tailoring products and services to a specific demographic group
Targeting – aiming the advertising of a product or service to a specific demographic group
Cluster marketing – relating demographic information about people to information about where they live.

Chapter 1: History of Human Populations and Global Trends

Opening it up
Taking the history of mankind in its longue durée ( i.e. giving precedence to long-term historical structures over events), how do you think the three main components of the population equation, which are fertility (births), migration, and mortality (deaths), played a role in determining population size and its distribution in different epochs?

How long have humans been around
200,000 years

What was their existence characterized by?
For almost all of that time, humans were hunter-gatherers living a primitive existence marked by high fertility and high mortality, and very slow population growth.

Population/date of neolithic revolution
The population of the world on the eve of the Agricultural Revolution (a.k.a. Neolithic Agrarian Revolution) 10,000 years ago is estimated at about 4 million.

Agricultural revolution details
Many argue the Agricultural Revolution occurred because the growth of hunting-gathering populations pushed the limit of their carrying capacity.
Eventually people began to use the environment intensively, leading to the agricultural way of life which has characterized society for the past 10,000 years.

Between 8000 B.C. and 5000 B.C
. about 333 people were being added to the world’s population each year.

By 500 B.C.,
, as major civilizations were established in China and Greece, the world was adding about 100,000 people each year.

By 1 A.D.
there may have been almost 250 million people on the planet, increasing by nearly 300,000 a year.

In the 3rd through 5th centuries A.D
, increases in mortality led to declining populations in the Mediterranean area as the Roman Empire collapsed, and in China as the Han empire collapsed.

5th century to 14th century
population growth recovered

14th century
Population growth recovered until the plague arrived in Europe in the middle of the 14th century. decimated european population

middle of the 18th century
industrial revolution- the population of the world was approaching one billion and was increasing by about 2.2 million every year.

since the industrial revolution
Since the beginning of the Industrial Revolution approximately 250 years ago, the size of the world’s population has increased dramatically.

Doubling Time
The time required for a population to double if the current rate of growth continues.

Doubling time equation
The doubling time is approximately equal to 69 divided by the growth rate.
Thus, since the world’s rate of growth in the year 2011 is estimated to be 1.2% per year, the doubling time is 58 years.

Why Was Early Growth Slow?
During the hunting-gathering phase, life expectancy was very low (~ 20 years).
More than half of children born died before age 5.
The average woman who survived to the reproductive years would have to bear nearly 7 children to assure 2 survived to adulthood.

Why Are More Recent Increases So Rapid?
Acceleration in population after 1750 was due to declines in the death rate during the Industrial Revolution.
People were eating better, bathing more often and drinking cleaner water.
Continuing population increases are due to dramatic declines in mortality without a commensurate decline in fertility (even though fertility IS declining).

How Many People Ever Lived?
The formulas of Nathan Keyfitz suggest that a total of 62 billion people have been born over the past 200,000 years, of whom the 7 billion alive in 2011 constitute 11%. [Note: lower percentages shown in some sources assume more years of human history and/or higher birth and death rates in earlier periods of history.]

migration patterns
Migration I: flows from rapidly growing areas into less rapidly growing ones.

migration 1 in (14th to 20th centuries)
European expansion- Europe to North and South America
Africa to Latin America, Caribbean and North America

migration 1 in 20th-21st centuries
South to North migration (20th & 21st centuries)
Latin America and Asia to the United States
Asia to Canada
Africa and Asia to Europe

migration 2
urban revolution

In earlier decades, as population grew dense in a region, people moved to a less populated area, now they move to urban areas.
As recently as 1800, less than 1% of the world’s population lived in cities of 100,000 or more.
More than 1/3 of all humans now live in cities of that size, and more than half live in urban places of any size.
Urban populations grew in some countries even without industrialization, as places sprang up where goods and services were exchanged.

chapter 2: the demographic perspective

Finding answers to these Questions:
What are the causes of population growth or, at least, population change?
What are the consequences of population growth or change?
What is the relationship between socioeconomic “development” and demographic changes?
Does demography drive socioeconomic development or is it the other way round?

Doctrine vs. social theory

likely to imply certitude (and answers)
make reference to notions of absolute truth
may suggest to have been divinely inspired by a “higher power”
not tested empirically (in fact, may be untestable)
may aspire to make claims of having universal and timeless answers

modern social scientific theory
use evidence to provide explanations and interpretations of “social reality”
develops tentative explanations (theories and hypotheses) that sort out evidence to highlight patterns (of social behavior, social action, social structure/institutions etc.)
pays attention to context

Modern social demography as a field is (unashamedly) positivist,
i.e., it is empirical in that we use data [surveys, censuses (censi ?), ethnographic observation, etc.] to test theories and hypotheses, and then conclusions are drawn and sometimes new theories are formulated

Context Matters: Putting Population Doctrines and Theories at “their place”
Most theorists were explaining specific conditions (social, econ, political, and environmental ) of their time -albeit that fact was unbeknownst to some
Some were just justifying their social position (class interest)- again albeit unbeknownst to some

Premodern Doctrines

A potential for land scarcity.
A belief that land is the major generator of wealth (not labor or industry) 1700 – 1800
Population depends on land resources.
Foster free trade/laissez faire to increase returns to land productivity. Francois Quesnay (the Physiocrats)

Expanding empire.
Need to replace war casualties 50 BC

Poverty is not a product of population growth but a result of poor social organization (and capitalism) 1844
Marx –
Transform the social structure

More populous cities are more prosperous
14 C AD
Ibn Kaldun –
Population growth is good for economic growth

City-states growing too fast 340 BC
Aristotle –
Number of children should be limited by law

Tech progress is limitless (and will out-power population problems) 18th Century
Condorcet (Enlightenment)
People will rationally limit population growth if the need arises

~1,300 bc
Genesis—”Be fruitful and multiply.”

~500 bc
Confucius—Governments should maintain balance between population and resources.

~360 bc
Plato—Population quality is more important than quantity.

~340 bc
Aristotle—Population should be limited; abortion might be appropriate.

~50 bc
Cicero—Population growth is necessary to maintain the Roman Empire.

400 AD
St. Augustine—Abstinence is the preferred way to deal with sexuality; second best is to marry and procreate.

~1280 a.d.
St. Thomas Aquinas—Celibacy is not better than marriage and procreation.

~1380 a.d.
Ibn Khaldun—Population growth increases occupational specialization and raises incomes.

~1500- 1800
Mercantilism—Increasing national wealth depends on a growing population that can stimulate trade.

~1700- 1800
Physiocrats—Population size depends upon the wealth of the land, which is stimulated by free trade (so-called laissez-faire).

Modern Theories

Malthus 1798
Malthus—Population grows exponentially while food supply grows arithmetically; poverty is the result of the absence of moral restraint.

Neo-malthusians 1800
Neo-Malthusian—Birth control measures are appropriate checks to population growth.

Marx 1844
Marxian—Each society has its own law of population that determines consequences of population growth; poverty is not the natural result of population growth.

Demographic Transition in its Original Form—The process whereby a country moves from high birth and death rates to low birth and death rates.

Earliest studies suggesting the need to reformulate demographic transition theory.

1963-Theory of Demographic Change and Response
Theory of Demographic Change and Response—Demographic response made by individuals to population pressures is determined by the means available to them to respond; causes and consequences of population change are intertwined.

1968- Easterlin Relative Cohort Size Hypothesis —
Successively larger young cohorts put pressure on young men’s relative wages, forcing them to make a tradeoff between family size and overall well-being.

1971- present
Decomposition of the Demographic Transition into its Separate Transitions
health and mortality, fertility, age, migration, urban, and family and household.

Prelude to Malthus: Enlightenment
What characterizes the Age of Enlightenment?
Belief in rights of individuals vs the monarchy
The era that ushered in the French and then the American
The Enlightenment was extremely important in changing the way people thought about the world
and Malthus was a product of the Enlightenment though he didn’t completely agree with some of it, especially he viewed enlightenment ideas as too optimistic and somewhat utopian
E.g the idea of limitless human capacity, perfection of man etc

Enlightenment: Condorcet and Godwin
writings stimulated malthus to rebut them

believed that technological progress has no limits
at the interest of their own welfare (and that of their families and societies) people will limit their fertility if needed

scientific progress will stimulate food supply
the problems of the poor are a product of inequities of social institutions

Malthusian Perspective
As much as Malthus wanted to believe in the perfectibility of humans, he argued people have a natural urge to reproduce, the “passion between the sexes,” and the increase in the food supply cannot keep up with population growth.
The major consequence of population growth, according to Malthus, is poverty.
Within that poverty is the stimulus for action that can lift people out of misery.

Malthusian Perspective: Mathematical approach to population

Food production
Arithmetic sequences: the difference between consecutive terms is constant, grows at a constant rate, e.g., 1, 2, 3, 4..
Food production grows in this manner per Malthus
Partly because of limited land resources

population growth
Geometric sequence: the ratio between consecutive terms is constant, the growth is multiplicative, like 1,2,4,8…
Population grows in this manner, e.g., if one woman produces two children each of whom produces 2 children each as well, then the second generation has 4 more people …

Population control: according to malthus

positive checks
Raise death rates: hunger, disease and war;

Preventive checks.
Lower birthrates: postponement of marriage, celibacy

Only acceptable preventative check according to Malthus
Moral restraint was the only acceptable preventive check according to Malthus
Delay marriage, and be chaste in the meanwhile

Critiques of his theory
Assertion that food production could not keep up with population growth.
Conclusion that poverty was an inevitable result of population growth. What do you think?
Belief that moral restraint was the only acceptable preventive check. Enough said…

Neo-Malthusian Perspective
See the potential a Malthusian Collapse but do not believe that moral restraint is the only way to limit population growth

Neo-Malthusian: E.g Paul Erlich
E.g Paul Erlich – Population Bomb (1968) thesis
Heavily debunked by fertility declines observed everywhere in world in the last few decades
Note: Erlich is a biologist

Marxian Persepctive
Each society at each point in history has its own law of population that determines population growth.
For capitalism, the consequences are overpopulation and poverty.
For socialism, population growth is readily absorbed by the economy with no side effects.
Ergo: Population problems would be non-existent in socialism

Critiques of Marx
Major critique: no guidance for how to get to a socialist model.
Demographic trends in Soviet Russia didn’t not “absorb” population problems as suggested by Marx
In fact, Soviet Russia, jut like in capitalist industrialized countries, the working class experienced disproportionately high death rates relative to the rest of the population
China, another society inspired by Marx-Leninist ideas, rejected the notion that the socialist system would take care of population problems

Prelude to Demographic Transition Theory

John Stuart Mill
Basic thesis was the standard of living is a major determinant of fertility levels.
The ideal state is that in which all members of a society are economically comfortable, rather than seeking excessive wealth. At this point the population will stabilize and people will progress culturally, morally, and socially.

Arsène Dumont
Late 19th century French demographer who felt he discovered a new principle of population called “social capillarity”.
The desire of people to rise on the social scale, to increase their individuality as well as their personal wealth.
To ascend the social hierarchy requires to sacrifices be made, one of them being avoiding child bearing

Émile Durkheim
Based an entire social theory on the consequences of population growth.
Population growth leads to greater societal specialization, because the struggle for existence is more acute when there are more people.

Chapter 2: part b

Theory of Demographic Transition
Emphasizes the importance of economic and social development.
Leads first to a decline in mortality and then to a commensurate decline in fertility.
Based on the experience of the developed nations and derived from the modernization theory.

What is the demographic Transition
Original model divided roughly into three stages.

stage 1: demographic transition
Stage 1: Birth and death rates are high and so are birth rates

stage 2: demographic transition
Stage 2: Transition from high to low birth and death rates. The growth potential is realized as the death rate drops before the birth rate drops, resulting in rapid population growth.

stage 3: demographic transition
Stage 3: Death rates are as low as they are likely to go, while fertility may continue to decline to the point the population might decline.

Modernization Theory Underlies the Demographic Transition at the Macro-Level
is macro-level theory that sees human actors as being buffeted by changing social institutions
Individuals did not deliberately lower their risk of death to precipitate the modern decline in mortality.
Society wide increases in income and improved public health infrastructure brought about this change.
Controversially, modernization theory explanations would suggest that all countries will eventually follow the demographic path experienced by Western European nations
Assumes all societies follows a linear path from a “traditional” to a “modern” society

Modernization Theory is at Times Flawed
Attempted to universalize regional/culture-specific historical experience of early western Europe.
The tradition/modernity dichotomy is false (both analytically and historically or chronologically)
Path dependence
History matters. The mere occurrence of an event (or a sequence of events) may limit its re- occurrence (by the virtue of the mere fact of the knowledge of it having happened before)
History rarely repeats itself exacty

Reformulating the DT: The Princeton European Fertility Project Highlighted the Role of Modernization, Ideational Changes, and Diffusion

Contiguous societies (in Europe) followed similar paths of transition even though they differed in the level of urbanization and development
The Princeton Project showed that in fact distinct society with a shared cultural trait (e.g., a lingustic one) were more likely to follow a similar transition in spite of whether they had different economic levels

Ideational Changes
E.g. Secularization: “an attitude of autonomy from otherworldly powers and a sense of responsibility for one’s own well-being” (Weeks p 94)
Emergence of new reproductive and family norms
Mass education

Rational Choice
Rational Choice Theory (RCT): human behavior and action is a result of calculated cost-benefit analysis of different choices (course of action) available
The choice that minimize cost and maximize benefit is the one adopted

Core of rational choice
The core of rational choice is the conception of human beings as homo economicus (economic man) who pursues self-interest (sole motive) to obtain the highest possible well-being for himself at the least possible costs given available information about opportunities and constraints on his ability to achieve his goals.
This is referred to as “rationality.”

Assumptions of rational choice
Individuals are seen as motivated by the wants or goals that express their “preferences”
They act on the basis of the information that they have about the conditions under which they are acting
It is not possible for individuals to achieve all of the various things that they want

Assumptions of rational choice (Continued)
They must make choices in relation to both their goals and the means for attaining these goals
Rational choice theories hold that individuals must anticipate the outcomes of alternative courses of action and calculate that which will be best for them
Rational individuals choose the alternative that is likely to give them the greatest satisfaction (utility)

Strengths of Rational choice theory
Rational choice approaches combine a “scientific” emphasis on rigorous analytical models with a strong theoretical focus on human values
Human preferences, interests, and objectives are used as the basic explanatory and predictive variables of human behavior
Rigorous “scientific” techniques borrowed from the natural sciences, ranging from statistical techniques to mathematical modeling, are employed to provide scientific explanation

Weaknesses of Rational choice theory
RCT that the decision maker is able to compare all of the alternatives (completeness), and that these comparisons are consistent (transitive). This is often not true in real world.
RCT assume near perfect certainty in outcomes (cost, benefit). If uncertainty is involved, then more assumptions have to be made in addition to rational preferences.

Weaknesses of rational choice theory
Rationality can also mean that the decision maker always chooses the most preferred option, which is often not true in the real world.
Sometimes herd mentality prevails
To simplify calculation and make prediction, some rather unrealistic assumptions are made about the world. These can include:

Rational Choice explanations of demographic transitions

RCT explanation 1: The Wealth Flow Explanation
In a labor-intensive society children are a source of wealth, i.e., they are labor units
Wealth flow is from children to parents and thus “demand” for children is high.
Modernization of production ( capital-intensive) simultaneously decreases the demand for children (labor) and in fact also increases the cost of them (e.g., the need to educate them) leading to lower fertility

RCT 2: The Theory of Demographic Change and Response Asks What Happens at the Micro (Family) Level
Death rates decline and more children survive;
Parents work harder, put children to work;
Not enough local jobs to go around as children grow up, so they migrate elsewhere;
When they get to urban areas, in particular, they are forced to think about family size and wind up limiting the number of children: change their preferences
They may even adopt new norms: about gender, sexuality, and authority

RCT explanation 3: Easterlin Relative Cohort Size Hypothesis
The standard of living you experience in late childhood is the base from which you evaluate your chances as an adult.
If you can improve your income as an adult compared to your childhood level, you are more likely to marry early and have several children.
Conversely, a cohort squeeze (a large relative,e.g., cohort resulting from increasing survival) will result in delayed marriage and smaller family sizes.

cohort squeeze
(a large relative,e.g., cohort resulting from increasing survival)

Kingsley Davis Generational Relative Status Explanation
Response to population pressure depend on what means individuals have to respond to given demographic changes
Response is often for personal goals (national policies have only a small effect)
1st generation: the response to generation pressure is non-demographic
E.g. work harder, longer; migrate unwed children etc.
2nd generation: more difficult to put more pressure on dwindling resources
To maintain social status similar to or higher than their parents’ (which is the typical aspiration), children reduce family size
Here Davis echoes Dumont and Mill and contradicts Malthus since the motivation here is the prospect of rising social status as opposed to fear of poverty .

demographic transition is a whole set of transitions

Transitions that comprise the overall demographic transition
Health and Mortality Transition – Shift from deaths at younger ages due to communicable disease to deaths at older ages due to degenerative diseases.
Fertility Transition – The shift from natural (and high) to controlled (and low) fertility.
Age Transition – The changing numbers and percentages of people at each age and sex as mortality and fertility decline, and as migrants flow in and out. The “master transition” because it forces change in societies.
Migration Transition – Growth in the number of young people in rural areas will lead to an oversupply of young people looking for jobs, which encourages people to leave in search of economic opportunity
Urban Transition – Begins with migration from rural to urban areas and morphs into urban “evolution” as most humans are born in, live in, and die in cities.
Family and Household Transition – Diversity in family and household composition and structure brought about by changes that accompany longer life, lower fertility, an older age structure, and urban instead of rural residence.

2nd demographic transition
Characterized by:
Below-replacement fertility
Postponement of marriage
Rise in single living
Cohabitation in lieu of marriage
Prolonged stay into parental (childhood) household

Chapter 3

World’s 10 most populous countries
People’s Republic of China
United States

Global Demographic Contrasts
The previous maps illustrate the North-South divide.
The south has higher birth rates, higher death rates, and younger populations than the north.
These differences, and the variability within the south in these differences, will drive the future.

Vital Statistics Data
Data collected on births and deaths, and sometimes on marriages, divorces, and even abortions.
In the U.S. these data are collected by the National Center for Health Statistics, which is part of the Centers for Disease Control.

Administrative Data
Data collected for purposes other than demography, but useful for demographic analysis, such as:
Immigration data
Social Security data
School Enrollment data
Tax Returns
Moving Companies data
Utility Hook-ups and Disconnects

Data collected in the census, by the vital statistics registration system, or derived from administrative records may have the following problems:
They are usually collected for purposes other than demographic analysis and do not reflect the theoretical concerns of demography.
They are collected by many different people using different methods and may be prone to numerous kinds of error

Sample surveys
Used frequently to gather demographic data.
However, they provide less extensive geographic coverage than a census or system of vital registration.

U.S. Demographic Surveys (besides the ACS):
Current Population Survey
Survey on Income and Program Participation
American Housing Survey
National Survey of Family Growth
National Health Interview Survey

Historical Sources
Parish records and local documents
Gravesites (including excavations of ancient burial sites)
Old censuses, vital statistics, and administrative records

Geographic Information Systems (GIS)
Computer-based system which brings maps together with data in innovative ways.
Geo-referencing data to places on the map means different types of data can be combined for the same place, and for more than one time.
Increases the ability to visualize and analyze demographic changes over time and space.

Chapter 4: Census, Counting People, Politics, Identity

Sources of demographic data: censuses
Censuses have a long history, but have been systematically collected only since the late 18th century.
First US Census in 1790
They have a tendency to be contentious when different groups use their numbers for political purposes.
But, they are also the richest available source of demographic information.

Why Does the U.S. Have a Census?
“Representatives … shall be apportioned among the several states, according to their respective numbers.”

Who Should Be Included in the U.S. census?
“Representatives shall be apportioned among the several states according to their respective numbers, counting the whole number of persons in each state.”
[No reference to citizenship, legal status, race, ethnicity, age, sex or anything else.]

Citizenship, the right to vote, and being counted in the census are very different things
14th Amend, Sec 1 (1868): “All persons born or naturalized in the United States and subject to the jurisdiction thereof, are citizens of the United States.” [Why was this important?]
Who can vote:
Citizens aged 18+ (since 1971)
Regardless of race (15th Amend 1870 + Voting Rights Act of 1965)
Regardless of sex since 1920 (19th Amend)
All American Indians since 1924 (Indian Citizenship

Who Is Included in a Census?
De Facto Population
De Jure Population
People Included in the Census on the Basis of Usual Residence

De Facto Population
People who are in a given territory on census day.

De Jure Population
People who legally “belong” to a given area, regardless of whether they were there on the day of the census

People Included in the Census on the Basis of Usual Residence
Roughly defined as the place where a person usually sleeps.

Census Errors: Non-Sampling
Content Error
Coverage Error [Very contentious]

Content error
Problems with the accuracy of the data obtained in the census.
Includes non-responses to particular questions on the census or inaccurate responses if people do not understand the question.

Coverage Error [Very contentious]
People who are missed or who are counted more than once.

Defining the Health and Mortality Transition
Health and death are two sides of morbidity and mortality.

refers to the prevalence of disease in a population.

refers to the pattern of death

The health and mortality transition
refers to the shift from prevailing poor health and high death rates from infectious diseases occurring especially among the young, to prevailing good health and low deaths rates from infectious diseases, with most people dying at older ages from degenerative diseases.

Epidemiologic Transition
Societal-level transition from having high prevalence of infectious diseases to having high prevalence of chronic, degenerative, and non-communicable diseases

Changes over time
For virtually all of human history, early death was commonplace.
Beginning about 200 years ago, however, we have been steadily pushing death to older ages.

The survival of more people to ever older ages is a key contribution to the demographic transition.

rectangularization of mortality
As a result, the variability by age in mortality is compressed, This means most people now survive to advanced ages and die pretty quickly.

life expectancy for most of history
20-30 years fluctuated

infant and child mortality
About 2/3 of babies survived to their first birthday, and about 1/2 were still alive at age five.
High infant and child mortality

At the other end of the age continuum
around 10% of people made it to age 65 in a premodern society.

Roman Era
Life expectancy in the Roman era is estimated to have been 22 years.
People who reached adulthood were not too likely to reach a very advanced age.

The Middle Ages
The plague, or Black Death, hit Europe in the fourteenth century, having spread west from Asia.
It is estimated 1/3 of the population of Europe may have perished from the disease between 1346 and 1350.
It appears to be the same disease that still exists in the world today—we don’t really know why it was so fatal back then.

The Columbian “Exchange”
Refers to the fact that Columbus and other European explorers took diseases (along with horses and guns) to the Americas (and then brought back new foods and a few new diseases).
Their immunity to the diseases they brought, compared with the devastation the diseases wrought on indigenous populations, is one explanation for the relative ease with which Spain dominated Latin America after arriving there around 1500.

Industrial Revolution to the Twentieth Century
By the early 19th century, after the plague and Little Ice Age had receded and as increasing income improved nutrition, housing, and sanitation, life expectancy in Europe and the U.S. was approximately 40 years. [Was population growth a cause or effect of rising standards of living?]
There were as many deaths to children under 5 as there were at 65 and over.
Infectious diseases were still the dominant reasons for death, but their ability to kill was diminishing.

Key Elements in Decline Mortality in Young Ages 19th Century:
Improved nutrition
Clean water
Sewerage in cities
Small pox vaccinations
Validation of germ theory

Germ Theory
Germ theory states that specific microscopic organisms are the cause of specific diseases which emerged mid 19th C.

Humoral Theory
Contrary to humoral theory that was dominant before: The human body was thought to contain a mix of the four humors: black bile (also known as melancholy), yellow or red bile, blood, and phlegm. Each individual had a particular humoral makeup, or “constitution,” and health was defined as the proper humoral balance for that individual.

Key Elements in Decline Mortality in Young Ages 20th Century:
Health as a social movement
Labor rights, the Welfare State
More vaccinations
Oral rehydration therapy for infants
Advanced diagnoses, drugs and other treatments for degenerative diseases to keep older people alive longer

Millennium Development Goal (MDG) # 4 :
Reduce deaths of children under the age of 5 by two thirds by 2015.Worldwide mortality in children younger than 5 years has dropped from 11·9 million deaths in 1990 to 7·7 million deaths in 2010,

infant deaths globally:
33·0% of deaths in children younger than 5 years occur in south Asia and 49·6% occur in sub-Saharan Africa, with less than 1% of deaths occurring in high-income countries.
Across 21 regions of the world, rates of neonatal, postneonatal, and childhood mortality are declining.

Postponing Death
by Preventing and Curing Disease

Nutrition Transition
It used to be that the poor were skinny because only the rich could afford to be fat—not any more.
Nutrition transition is a worldwide shift toward a diet high in fat and processed foods and low in fiber, accompanied by less exercise, leading to increases in degenerative diseases. Two of the theories of the rise of obesity
Increased consumption of food (of saturated fats and processed sugars, for example)
Lack of physical activity: “cave man appetite, modern man physical activity”

Life Span
Life span is the oldest age to which human beings can survive[Is it 122?]
Life span is almost entirely a biological phenomenon. [Choose your parents carefully!]

Longevity is the age at which we actually die. [Currently about 70 for all humans.]has biological and social components.

Populations with high mortality
are those with high morbidity.

Age Differences in Mortality
Humans are like most other animals with respect to the general pattern of death by age—the very young and the old are most vulnerable, whereas young adults are least likely to die.
After the initial year of life, there is a period of time, usually lasting at least until middle age (essentially the reproductive ages), when risks of death are relatively low.
Beyond middle age, mortality increases, although at a decelerating rate.

Declining Infant Mortality is a Key to Population Growth
Attributable especially to the development of oral rehydration therapy (ORT), a solution of salts and sugars taken orally that treats diarrhea, a major cause of death in young children.
ORT was developed in labs and tested in the field, especially in Bangladesh.
It is new enough that one of its founders, Dr. Richard Cash, still holds a teaching position at Harvard School of Public Health.

Mortality by Sex (Gender)
Women (sex) have a lower probability of death at every age from the moment of conception…
…unless society intervenes with a lower status for women (gender) that gives them less food, less access to health care, etc.

missing women
a shortfall in the number of women in Asia relative to the number that would be expected if there were no sex-selective abortion or female infanticide or if the newborn of both sexes received similar levels of health care and nutrition.
About 60 -100 million women “missing” in India
National decline from 945 to 927 in the number of girls per 1,000 boys aged 0-6 between 1991 and 2001 on India
Source: UNFPA, Missing: Mapping the Adverse Child Sex Ratio in India, – See more at:
The phenomenon has led to skewed sex ratio in China

Causes of Poor Health and Death
1. Communicable diseases
bacterial [e.g. tuberculosis]
viral [e.g. measles]
protozoan [e.g. malaria)
maternal conditions
Lack of prenatal care
Delivering somewhere besides a hospital
Seeking an unsafe abortion
perinatal (“surrounding birth”—just before and just after birth) conditions
nutritional deficiencies
non-communicable diseases

The “Real Causes” of Death in Low-Mortality Societies
Diet and Activity Patterns
Alcohol Misuse
Infectious Diseases
Toxic Agents
Motor Vehicles

Measuring Health and Mortality

Crude Death Rate (CDR)
The crude death rate (CDR) is the total number of deaths in a year divided by the average total population. In general form:
CDR=(d / p) x 1,000

Known as a crude measure because:
Does not take into account differentials in sex and age.

Age/sex-specific Death Rate (nMx or ASDR) easuring Mortality
Mortality at each age and sex.
ASDR is measured as follows:
ASDR or nMx =( ndx / npx ) x 100,000
Where ndx is number of deaths in year for people aged n to n+x (typically 5 year intervals), npx is the population

The life tables
Statistical tables that summarizes survival rates at different ages (also know as actuarial tables)
Based on survival probabilities at different age intervals (based on ASDR)

Expectation of Life at birth
or more generally life expectancy, is derived from the life table.
Definition: Life expectancy of a person aged x, ex, means the number of years a person aged x is expected to live assuming that mortality experience (causes of death at every age) remain constant throughout her/his life.
Life expectancy is specific to a given age
The most used one is the life expectancy at birth, e0.

Disability-Adjusted Life Years (DALY)
1 DALY One DALY can be thought of as one lost year of ‘healthy’ life. The sum of these DALYs across the population, or the burden of disease, can be thought of as a measurement of the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disease and disability.”
Source: World Health Organization (WHO)

Health and Mortality Inequalities
Urban and Rural Differentials
Urban now better than rural.
Neighborhood Inequalities
“Bad” neighborhoods are bad for your health
Educational Differentials
The better educated live longer.
Social Status Differentials
The rich live longer.
Race and Ethnicity Differentials
Being different will be used against you.
Marital Status
Being married is good for your health.

Race, Ethnicity and Mortality
In societies with more than one racial or ethnic group, one group will tend to dominate, leading to disadvantages for the subordinate group(s) that can result in lower life expectancies.
In the U.S., African-Americans and Native Americans have historically experienced higher-than-average death rates

Mechanism: Structural Violence
Paul Farmer’s idea of structural violence
“Historically given (and often economically driven) processes and forces which conspire to constrain individual agency” of certain social categories (Paul Farmer, 2001, Infections and Inequalities : The Modern Plagues p 82)
Think of harms that are a result of social injustices, for instance
Results from low symbolic capital (e.g., being a member of a “stigmatized” identity) leading to a higher risk of “symbolic violence”
So for example

Chapter 6: Fertility
Shift from high fertility, with minimal individual control, to low fertility, which is entirely under a woman’s control.
Involves a delay in childbearing and an earlier end to childbearing.
Frees women and men from unwanted parenthood and allows them to space their children.

Fecundity—the Biological Component
A fecund person can produce children; an infecund (sterile) person cannot.

Couples who have tried unsuccessfully for at least 12 months to conceive a child are usually called “infertile” by physicians.

How many children could you have?
Assume the couple is fecund
First pregnancy at age 15
Little less than 9 months per pregnancy (to account for some pregnancy loss)
18 months between the end of one pregnancy and the start of the next
Thus, a woman could have a child every 2.2 years between ages 15 and 49
Which equals 16 live births.
And could lead to more than 16 children if some of the births are multiple (i.e., twins, triplets…)

“Natural fertility”
may be closer to 6 or 7 children per woman (matching the high mortality).

11 children per woman in the 1930s:
Early age at marriage, good diet, good medical care, regularly engaged in intercourse without contraception or abortion.

For most of human history: high fertility
For most of human history, fertility was high because of the need to replenish society, especially to combat high infant mortality.
Motivating women/couples to have children:
Children as security and labor
Lower status for women leads to a desire for sons
Children as essential for status and prestige
Accomplished by
Having children early and often (requires control over women)
No tolerance for contraception/abortion/infanticide

Preconditions for a Substantial Fertility Decline (Ready, Willing, and Able)
Acceptance of calculated choice as a valid element in marital fertility (ideational changes—the enlightenment, secularization).
Perception of advantages from reduced fertility (motivation for limiting fertility).
Knowledge and mastery of effective techniques of birth control (controlling reproduction).

Explaining Motivations for Fertility with the Supply-Demand Framework
The Easterlin and Becker economic framework emphasizes the need of households to balance the demand for children (what are they good for) with the supply of them.
When the supply begins to exceed the demand, then the motivation to limit fertility emerges.
Mortality declines and children cannot be afforded.
And/or the opportunity costs of children rise
Opportunity cost: the opportunity (benefit) forgone by making a particular choice

Beyond Supply-Demand: The Innovation/Diffusion and “Cultural” Perspective
Two theories of social stratification have strong implications for fertility behavior:
Cultural innovation takes place in higher social strata as a result of privilege, education, and resources; lower social strata adopt new preferences through imitation.
Rigid social stratification or closure of class or caste inhibits downward cultural mobility.

Family Control in the “Old Days”
Dealing with Unwanted Children
Infanticide, or general neglect (abandonment) or inattention that leads to early death.
Fosterage of child by another family that needs or can afford it.
Orphanage – involves abandoning a child so she or he is likely to be found and cared for by strangers.

Proximate Determinants of Fertility (main one are highlighted in red)
I: Factors affecting exposure to intercourse (intercourse variables)
A. Determinants of formation and dissolution of unions
1. Age of entry into sexual unions
B. Determinants of exposure to intercourse within unions
III: Factors affecting exposure to conception – “conception variables”
7. Fecundity or infecundity from involuntary causes including breastfeeding (postpartum amenorrhea)
8. Use or non use of contraception
III. Factors affecting gestation and successful parturition – “gestation variables”
11. Voluntary fetal mortality (induced abortion)

Period measures include:
Measure fertility at a specified period
Crude birth rate
General fertility rate
Child-woman ratio
Fertility Index
Age-specific fertility rate
Total fertility rate
Gross reproduction rate
Net reproduction rate
Cohort measure: Measures fertility of a group of people ( a cohort)
Cumulated Cohort Fertility Rate
Children ever born
Fertility intentions: measure people’s lifetime fertility intentions
Avoid drawbacks of period measures, which are influenced by timing and tempo of births .

Crude Birth Rate
# of births in a year/ mid year population
often multiplied by 1,000 and expressed as per 1000 in the population
CBR is “crude”
Doesn’t take into account the “population at risk” of giving birth
Ignores age structure

General Fertility Rate
Births in a year/ # of women at childbearing age (15-44)

The GFR is also often multiplied by 1,000 and expressed per 1,000 in the population
Takes into consideration the at-risk-population

Child-Woman Ratio
Number of children (aged 0-4)/ # of women in childbearing age

Note: CWR age limit is higher than GFR’s because some of the children would have been born up to five years prior to the census
CWR is especially useful if comprehensive vital statistics are not available

Fertility Index (If)
Useful for making comparisons across societies
If = Im X Ig
Where Im is the proportion of female population that is married, and Ig is the index of marital fertility
Index of marital fertility is the ratio of marital fertility (live births per 1000 married women) to the marital fertility of Hutterites in 1930s
highlights changes overtime in fertility due to proportion of women who are married (marriage rates) from changes over time due to shifts in reproduction within marriages.

Age-Specific Fertility RatesASFR
number of births occurring in a year to mothers age x to x + n (nbx) per 1000 women of that age (nFx)

Total Fertility Rate (TFR)
The most commonly used measure
TFR is the total number of children women are expected to have if they completed their reproductive circle
Uses a “synthetic cohort,” i.e., data available currently from ASFRs
TRF is computed from ASFR
With an assumption that women in the future would bear children at the same rates as predicted by ASFRs today
Note parallel with Age Specific Mortality Rates (ASMR) and Life expectancy
TFR is then just a summation of all ASFR multiplied by the length of age interval (n) specified by the ASFR
TFR = ∑ASFR x n

Variants of TFR
Parity specific fertility rates
Women at parity , p
Parity = number of children that a woman has
Marital fertility rates
Limited to married women

Gross Reproduction Rate (GRR)
The number of female births an average woman would have if she lived through the end of her reproductive span.

Net Reproduction Rate (NRR)
The average number of daughters that female members of a birth cohort would bear during their reproductive life span if they were subject to the observed age-specific maternity rates and mortality rates through their lifetimes.
NRR is always less than GRR (because some women die before completing their reproduction cycle)
NRR is a measure of generational replacement.
NRR=1 equals exact replacement fertility
NRR < 1 potential population decline Note: population growth can still happen if NRR<1. E.g., in the US in 2006 NRR was only barely greater than 1 even though population was increasing by more than 2.6 million people a year . How come?

Replacement fertility rate
at which women would roughly replace themselves and their partner (and thus their generation)
2 children in their life time.
Though replacement fertility rate is adjusted to take into account the fact that not all women would complete their reproduction, therefore, it slightly greater than 2
in industrialized nations is estimated to be 2.1.

Cohort Fertility Measures

Cumulated Cohort Fertility Rate (CCFR):
measures births to date for a given birth cohort
E.g., women born in 1915 had given birth to 890 babies per 1000 by 1940

Children ever born (CEB)
: number of children ever born to a cohort of women

Fertility Intention
Captured through surveys
People are asked:
About their ideal family size
Number of children they would like to have
Number of children they plan to have

Parity Progression Ratio
Parity Progression Ratio
Estimates number of children women would have after having had n children
Measured by proportion of women with a given number of children (parity) who progress to have another child
PPRi= number of women at parity i + 1 or more
number of women at parity i or more

Proportion of a cohort who had at least i live births who went on to have at least one more
As fertility declines (transition to low fertility) parity progression ratios decline at every parity

Variation in the Transition
Can we tell that the transition has happened?
Coale’s preconditions need to kick in: Readiness, Willingness, and Ability to control fertility
Increase of the age at which women have their 1st child
Parity progression ratios
Since couples do make fertility decisions one child at a time
Sign of transition: if the likelihood of having another child decreases as parity increases

Lowest-Low Fertility
Fertility at or below a TFR of 1.3.
Usually characterized by delayed childbearing
Potential Causes
Demographic distortion of period measures
tempo and compositional distortions lower TFR below the associated level of cohort fertility.
Socioeconomic changes
“increased returns to human capital and high economic uncertainty in early adulthood—have made late childbearing a rational response for individuals and couples.”
Social interaction effects
“reinforce behavioral adjustment and contribute to large and persistent postponement in the mean age at birth.”
Institutional Factors
The institutional setting in Southern, Eastern, and Central European countries (where most of the lowest-low fertility countries are located) “favor an overall low quantum of fertility.”
E.g. labor market conditions
Increased economic insecurity
“Postponement-quantum interactions”
amplifications of the consequences of the institutional setting factors when coupled with normative shifts in timing of child-bearing.
Think of these as

Case study I: England
Evidence of fertility control as early as late 17C
Through withdrawal (coitus interruptus)
After industrial revolution
Delayed marriage
Rising living standard in late 19th C
Low fertility

Case study II: China
At the time of the communist revolution (1949) an average Chinese woman was having around 6.2 children
Instituted one-child policy 1978
Aimed to attain Zero Population Growth (ZPG)
Told people to delay marriage
Promote one child family through government incentives
Socioeconomic factors (in addition to one-child policy) explain Chinese fertility trends
Chinese TFR is above one

Case Study III: USA
Early adoption of fertility control similar to other regions of the world
Function of class, income, education etc
Migrants have always brought in different fertility preferences, typically above natives
Sanger’s contraceptive revolutions in the 20th C
Baby boom
And baby busts, boomlets, and beyond
Remarkable differences in TFR among race/ethnic groups