Social medicine

0:02

S… Speaker 1 (Social medicine)

Today we're going to continue with the focus of medical demography. Just to remind you from the previous lecture, when we started speaking about public health, the three factors that determine public health are physical development, that's already discussed, demographic situation, medical demography, and incidence.

1:02

S… Speaker 2 (Social medicine)

This will put the basis for...

1:15

S… Speaker 1 (Social medicine)

Anyway, the topic is medical demography. Medical demography or demography in general is a public science. Demography can be studied in public universities. Demographers study human population.

1:51

S… Speaker 1 (Social medicine)

in terms of the size and the processes that occur leading to change the size. So to be the demographer doesn't mean that you need to graduate as a doctor for some bugs. The common link between demography and medicine is that we as medical doctors, we are not within the population. Was the number of people living in a certain area was their age.

2:27

S… Speaker 1 (Social medicine)

What's the education, what's the profession, what's the risk factors associated with the work and the residents? What kind of processes lead to change of this population? Because those processes are tightly related with health care as well. And that's why we define medical demography as a linking science between demography, as a general public science, and medicine.

3:05

S… Speaker 1 (Social medicine)

and also considered to be one of the three main pillars of Pound Hill. Why? Because with medical... ...about the subject of our science as population. With physical development, we were interested in the individual... ...and ability to adapt of people living in the country, in the area. With demography, now we're interested about those people...

3:51

S… Speaker 1 (Social medicine)

The classification of medical demography is pretty simple. Almost everything is divided in two. For the first division of medical demography divided in medical statics. I repeat statics on statics. Statics is mean something that is not changing, that's static. So, demographic static.

4:19

S… Speaker 1 (Social medicine)

In the demographic study, we're interested in studying what's the size and structure of the population of the last five years. We need time period to follow up what's happening. While with demographic dynamics, we are studying how this population is changing. This change can happen in two ways. The first number change is natural reason. There is a reason for the human population to change.

5:00

S… Speaker 1 (Social medicine)

if individuals are born or if individuals die. That's the most natural reason to change a population. People are born, people die. So, birth rate and death rates are the basic instruments, indices to measure the population dynamics. Besides the birth and death,

5:26

S… Speaker 1 (Social medicine)

There are two other natural events that may lead to change human population and these are marriages and divorces. From demographic point of view, speaking about marriages and divorces, we're not interested if those marriages are legally signed, submitted to this side, if they're religious marriages. We understand as a marriage when two people...

5:57

S… Speaker 1 (Social medicine)

decide to live together as a family, have children, home, future, etc. So from demographic point of view, speaking about marriages and divorces are not necessarily linked with the legal form of marriage and divorce. Try to understand it in a more broader way as marriage and divorce. So why marriages and divorces lead to a change of the population? You are now living and studying in Bulgaria.

6:30

S… Speaker 1 (Social medicine)

find mates, decide to have a family, and it's up to you to decide how your family and where your family will reside. In Bulgaria, in your home country, or the country of your mate. Inevitably this will lead for change, especially when you decide to have children. Those four processes are considered to be a natural way to change the population. Besides the natural change,

7:12

S… Speaker 1 (Social medicine)

Who would like to reach their residents, their place? Many people too. The first reason is if they are looking at some better future career or income, they have to do it otherwise they will die. Let's say for military wars, natural disasters, something that will totally change some personal opinion about their future and will make a huge difference.

7:52

S… Speaker 1 (Social medicine)

to decide to move to another place for different reasons related to work and education and forced war by natural disasters. Migration, the non-natural way of changing populations, subdivided into external and internal. External migration is when people cross country borders and internal migration is when people are changing their residence within a country.

9:10

S… Speaker 2 (Social medicine)

How do we collect information about medical demography? In my previous lecture when I was speaking about certain indicators

9:37

S… Speaker 1 (Social medicine)

will explain some health indicators related to the topic. So those health indicators, as I explained previous time, are used to follow up with the process over time so that we can observe the changes and trends and to compare this process with another region in another country.

10:00

S… Speaker 1 (Social medicine)

benchmarking, trying to achieve common level. About population statics, the main source of information are censuses. After a slide I'm going to explain more about censuses. And sources of information about medical democratic dynamics are registries. Two registries that exist in all countries historically

10:36

S… Speaker 1 (Social medicine)

These are the oldest registries that have existed in our registries for work and deaths. Even several thousands here ago, in ancient times, countries, governments in general, have been always interested in the population, their ruling. Why? Economically. To know how many men can be...

11:17

S… Speaker 2 (Social medicine)

gathered for the army. Irrespective of the general idea, these two registries are considered the oldest registries. These are the information about population dynamics. With those registries we know exactly how many newborns, how many new individuals appear in our population and how many individuals die. Besides those two registries, some important registries are immigration registries and residence registries.

12:03

S… Speaker 1 (Social medicine)

Depending on the country, one place in the country to another. They have to get a pre-approval by the police. People, especially in the European Union, may freely decide where to live. I work in Bulgaria, so they will bye to you, and somewhere in the European Union, without any... Why? It's not registered. That's a problem. Why, of course.

13:24

S… Speaker 1 (Social medicine)

lose information about official registries and data. If you decide to go in a country outside the European Union and ask for your ID, then your exit and entrance will be recorded. Every pass on the link is registered. It's very important because it provides us with data about number of people exiting the country, number of people entering. Why? Let's start with the graphic studies.

14:17

S… Speaker 1 (Social medicine)

As I told you, the practice statics, or population statics, is actually trying to estimate what is the size and structure of the population. Knowing how many people living there, what's their age, what's their sex, what are their needs. Healthcare services we must provide.

15:00

S… Speaker 2 (Social medicine)

So you, after graduation at this university, if you decide to create or open your private practice, I'm sure the first thing to do is just to get updated information about the demographic region town, city, village, where you're trying to open your practice. Why? Because you should know how many people are living there and what's their structure.

15:39

S… Speaker 1 (Social medicine)

And there is one way to graph the population pyramid. The population pyramid is considered a standard when it describes a city, or a country, or a continent. This graph, the population pyramid, the people who are sitting on the last row, and cannot read exactly what's on this slide, just looking at the population pyramid. This represents a new criteria, text and age.

16:45

S… Speaker 1 (Social medicine)

Here on the horizontal X are presented regarding their steps. On the left, males. On the right, females. If you feel something red, always red. The vertical X is from age groups. Two divided into five layers intergroups. The age groups are presented on the vertical X. You can tell two things about the approximate ratio between males and females. How?

17:48

S… Speaker 1 (Social medicine)

This figure is looking symmetrical, that means that approximately males are equal to females. This figure is Q to the left or to the right, that means they are more women than men. But in this situation where the base is larger than the top, majority of the population are young, is shaped from the population pyramid.

18:47

S… Speaker 1 (Social medicine)

defined as expensive type. Expensive type means that young people, much greater than the proportionate, may look in a different age groups, adults, seniors, absolutely equal. This type we defined as stationary type. This figure may look totally in the opposite way, flipped down, where the larger part is on the top and the smallest. Define this population pyramid as constructive type.

19:41

S… Speaker 1 (Social medicine)

that means that the majority of the population are seniors. The figure that you see here is actually the Population Pyramid in Bulgaria and it's a very nice animation showing the Population Pyramid since 1950

20:00

S… Speaker 2 (Social medicine)

19 to 2050. And I'm trying to play this. Population period is changing over time, starting in 1950 and ending in 2050. So, 1950 till 19 or 2000, what is the change in the population period? Slight tendency to the stationary. Yeah, and after year 2000, change is restricted. What does it mean?

21:14

S… Speaker 1 (Social medicine)

If a country has an expensive type of population, what's your conclusion? If you have a lot of young people, probably we can expect high growth rates, low growth rates, and positive mature increase. If we have stationary type of population, that means that, well, as burn rates and death rates are controlled, we cannot expect a significant amount. However, if we have a constant population, then a very negative situation with...

21:51

S… Speaker 1 (Social medicine)

of the public health, they require specific attention. If you let me remind you for this year, samples are the only surveys that are addressing the whole population. So, censuses are not done as we do samples in medicine, because with samples we extract samples from the general population, analyze it and try to inform the results of the general population.

22:45

S… Speaker 1 (Social medicine)

We examine the general population in its whole. And censuses, for that reason, are usually defined by laws. In each country in which there are censuses, that's the majority of the countries, with few exceptions, there is a specific law, adopted by the parliament of the country, defining the censuses. The Bulgarian legislation, there is such a law about censuses, requires that the government should organize and write censuses every 10 years.

23:17

S… Speaker 1 (Social medicine)

The last census in Bulgaria was in 2021. Each citizen of the country is obliged to participate in the census. If it creates some obstacles or problems, it will be fine. And censuses are always done in one and the same methodology that is created by the United Nations so that the way censuses are organized and conducted and analyzed.

23:53

S… Speaker 1 (Social medicine)

are the same among countries in the world. The information from censuses is always public available. In each country there is a specific dedicated website where citizens can get information about the census. Speaking about Bulgaria, the organization that usually, by law, can conduct and analyze the results from the censuses is the National Statistical Institute. More or less, it is the same situation in other European countries.

24:28

S… Speaker 1 (Social medicine)

And speaking about the collection of data, it's up to the country to decide how much data will be collected during a census. Especially in the case of Bulgaria, the Bulgarian government collects a lot of information, not only about the name, residence, age, relatives of the individuals, clinic disorders, but also data about education, economical status, health status.

25:00

S… Speaker 1 (Social medicine)

Expected perturbation of working capacity, home position, approximate range of income, the last census card. Let's say in the United States, in the US, the census card is just one page. They have decided to collect information only about name, address, age.

25:51

S… Speaker 2 (Social medicine)

for all sectors in the country. New school, industry, and all of it. Now let's speak about population dynamics. Population dynamics, as I told you, is divided into natural events and depression. Think about natural events, the four major, major events, or birth rate, death rate, or how to relate it. Later in the semester, when you study about hospitals, patient care, etc., you'll see them. They are only calculated by one part.

27:03

S… Speaker 1 (Social medicine)

And how do we calculate the birth rate of 15%? What does it mean? We have 15 newborns per 1,000 population. The same way we calculate the death rate. Death rate is calculated as the number of deaths per 1,000 population.

27:59

S… Speaker 1 (Social medicine)

percentile death rate. What does it mean? We have 20 deaths per 1000 population. 15 percentile birth rate and 20 percentile death rate. What will be the natural increase? Minus 5. It means that every year the population is decreasing with 5 people. Because 15 are born, 20 die. The difference is 5. Very simple.

28:37

S… Speaker 1 (Social medicine)

No extraordinary mathematical skills are required. All the mathematics in social medicine, abstraction, division, that we are going to study, of course, more in details after several weeks when we speak about, okay, but now we put the basis, are the factors which are responsible for the reproductive behavior or for the birth rate. That's very important because the death rate can be controlled to some extent.

29:26

S… Speaker 1 (Social medicine)

By improving, investing in the healthcare system, the social services, the same situation with the birth rate, control the birth rate. And for us, that's the most important element, how to understand which are the factors that determine the birth rate or determine the productive behaviour of the population. So according to you, which are the most important factors?

30:00

S… Speaker 1 (Social medicine)

Determine the reproductive behavior of the birth rate of the population. Safety. Income. Safety and income. Both factors, they affect the birth rate, but another most important one. Safety, I can give examples of countries with low level of individual safety, but with very high birth rate, let's say some African countries or...

30:29

S… Speaker 1 (Social medicine)

Pakistan even. I have not been in Pakistan, but based on stories. And about economical factors, usually they have negative impacts. When people start to receive more money, they decide to be selfish and adopt a dog, a kid, etc. Other suggestions? Education, religion. Our religion is related to the... I think one by one.

31:08

S… Speaker 1 (Social medicine)

Some religions are an important factor. Practically all religions, but I don't have a religion that asks the followers not to have children. It's very simple. Every religion requires more and more followers. For that reason, all religions, at least all religions that I know, would require people not to restrict their productive intentions. And why religion is such a...

33:33

S… Speaker 2 (Social medicine)

They changed a lot.

33:35

S… Speaker 1 (Social medicine)

My PhD 20 years ago, in the past 20-25 years, the model totally changed in Bulgaria, not only in Bulgaria, but also in European countries. 20 years ago, about 85% of couples decide marriage. Nowadays, but more or less, people decide to have a family and children nowadays. Cultural and traditional. Why?

34:47

S… Speaker 1 (Social medicine)

Yes, culture and tradition are considered a game factor. Why? Because people tend to...

35:00

S… Speaker 1 (Social medicine)

for the productive behavior of the parents and grandparents or the community living. Well, traditional and cultural factors are not so stable over time compared to religion, but still quite firm and it's affecting their productive behavior at least for several hundred years. Usually issues are required

35:38

S… Speaker 1 (Social medicine)

to change the reproductive behavior based on cultural characteristics of the area. So, in practice, those two factors, religion and tradition, and all the rest factors that you can guess, like health status, safety, they're just modifiers of the effect, not contributing significantly to the change of the reproductive behavior. In other words, if we decide

36:21

S… Speaker 1 (Social medicine)

change the reproductive model. We can change the reproductive model in two major directions. The first one is to try to increase the number of newborns, and the second is to try to decrease the number of newborns. Both practices. In some countries, governments are trying to increase the birth rates. In other countries, they are trying to decrease the birth rates. Well, how shall we proceed in this context?

37:04

S… Speaker 1 (Social medicine)

incentives or restrictive incentive or restrictions is the most popular way. But can we expect fast change under the productive model? No. Any intervention that we decide to organize in the population regarding the productive model, first, minor changes can be expected after one or two generations. Why? Because this reproductive model is very firm. It really requires a lot of time.

37:47

S… Speaker 1 (Social medicine)

Of course, the first instruments to change this are usually economic, by incentives or restrictions. The case with China was that they put restrictions on families, willing to have more than one child, while this structure of China became restrictive. As a result, the one-child policy is adopted for it. But in the end of the lecture, we're going to speak more about demographic policies. Now, let's continue with...

38:52

S… Speaker 1 (Social medicine)

Migration laws change the population, natural reasons, but some other reasons. As I already told you, we do external migration, but also internal, we be forced or both. Speaking about external migration, we have two other terms. These are emigrants or emigration. Immigrant is this way to remember is by associating the person.

39:33

S… Speaker 2 (Social medicine)

Letters and I will export import. Emigration. People are living in our country. We call them emigrants. People are coming in our country.

40:00

S… Speaker 1 (Social medicine)

We call them immigrants, with I. So what public health issues can be identified with emigration? What will happen to the public health system if we register difficult emigration processes?

Social medicine

ਸੰਖੇਪ

ਇਹ ਟਰਾਂਸਕਰੀਪਟ ਬਾਰੇ AI ਨੂੰ ਪੁੱਛੋ