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Organisational Meeting Of The IUSSP Committee On Emerging Health Threats (CEHT)

Max Planck Institute for Demographic Research (MPIDR) Rostock, 10-11 November 2000

Report

Committee members:
Mari Bhat (University of Delhi, India), Michel Caraël (UNAIDS, Switzerland), France Meslé (INED, France), Vladimir Shkolnikov (Chair of the Committee, MPIDR, Germany), Ian Timaeus (LSHTM, UK), Tapani Valkonen (University of Helsinki, Finland)

unable to attend:
Basilie Oleko Tambashe (International Health and Development, Côte d’Ivoire)

Vice-President of the IUSSP:
Jacques Vallin (INED, France)

AGENDA OF THE MEETING
1. Welcome by Jan Hoem, Co-Director of the MPIDR.
2. Self-introduction round the table.
3. Opening remarks by Jacques Vallin, Vice-President of the IUSSP, on the principles governing the work of IUSSP scientific committees and the role of the CEHT.
4. Background information on the idea, aims and main areas of activity of the CEHT by Vladimir Shkolnikov.
5. Comments by the Committee members on possible themes and scientific activities of the CEHT.
6. General discussion on the scientific programme. How to operationalise the broad range of research areas, which have to be addressed in a few seminars? What exact topics to choose? How many workshops? Where and when to be held?
7. Brief information by Vladimir Shkolnikov about session S18 on Emerging health threats at the XXIV General Population Conference of the IUSSP in Brazil (August, 2001).
8. Elaboration of a detailed agenda for the first workshop.
9. Outline ideas for the second and third workshops.

Vladimir Shkolnikov
Dr. Basilie Oleko Tambashe was unable to take part in the First Meeting because of the military putsch in Côte d’Ivoire. It would be good to arrange a meeting with him in the first half of 2001 in order to discuss possibilities for organising one of the CEHT seminars in an African country.

The initial idea, purposes and potential fields of scientific activities of the CEHT were outlined. These issues were also summarised in a background note by the Chair, which had been sent to the committee members ahead of the meeting (enclosed with this document). In light of unusual and unexpected mortality trends, which have occurred over the last two decades, the CEHT could include the following major themes in its working programme:

Reversals in mortality trends in industrialised countries with a special focus on Eastern Europe and the former Soviet union.
Socio-economic inequalities in health around the world.
Re-emergence of infectious diseases and the global epidemic of HIV/AIDS.
Environmental threats to health.- Global burden of injuries and violence.

The proposed main activities of the CEHT are the following:

1. Session on Emerging Health Threats
at the IUSSP General Conference in Brazil in August 2001.

Due to a substantial delay in the formation of the CEHT Vladimir Shkolnikov had to identify topics for the session on Emerging Health Threats himself (without asking other committee members, who had not been approved by the IUSSP Council). The following topics were proposed for the session:

Look also at: http://www.iussp.org/Brazil2001/programme.php

2. Workshop 1:
Inequalities in mortality and health between and within industrialised nations, 2002.

The following topics are proposed for the first workshop:

"Inventory" of unfavourable mortality trends in industrialised countries since the 1970s.
Socio-economic and socio-psychological factors underlying these changes. The role of recent economic shocks.- Changes for better and for worse: a new health divide between the former Soviet union and Eastern Europe. - Macro- and micro-social conditions of early death of the working-age population.- Factors of rising social inequalities in the face of death.
The role of relative deprivation and psychosocial stress.
Life courses and length of life.

3. Workshop 2:
Environmental threats. To be held in 2002.

4. Workshop 3:
Re-emergence of infectious disease and global epidemic of HIV/AIDS. To be held in 2002.

5. Workshop 4:
Global burden of injuries and violence. To be held in 2003.

It might be possible to incorporate the theme of injuries and violence in the programme of the first workshop. This would allow CEHT to hold three workshops instead of four.

CEHT workshops should result in publication of papers and seminar proceeding in scientific journals (special issues) or Internet journals. The final output can be published as a collective monograph "Emerging Health Threats in the Modern World: a Demographic Perspective".

The first workshop probably could be organised in London with the help of the ECOHOST/LSHTM or in Rostock with the MPIDR.

Jacques Vallin
The scientific programme of the IUSSP is implemented primarily through activities of its Scientific Committees and Working Groups. Scientific committees are free to organise their work according to their own plans. Basically, the aim is to encourage demographic research in a specific field and to produce a high-quality scientific outcome in the form of publications . Traditional work model includes several seminars, which should give the possibility to publish a book or books of selected papers.

usually, IUSSP can provide a partial financing for seminars. Hosting institutions and/or international funds contribute the rest Each seminar should be focused on a particular socio-demographic issue and include 20 to 40 papers.

It is important that an IUSSP committee should always work as a whole avoiding further division of the work between smaller groups or sub-committees.

usually it takes at least two years to produce a book from manuscripts. The waiting period from the moment when all materials in their final form enter the publishing house (Oxford University Press) is more than one year. It might be too late if only one book would be published at the end of the CEHT mandate. Special issues of journals and/or electronic journals can help to shorten the time between the first presentation of a study and its dissemination in the scientific community.

Initially there was an idea that one of new IUSSP committees would address adverse health trends in Eastern Europe and the former Soviet union. Later, the IUSSP Council has broadened the field of the CEHT by including demographic issues related to AIDS and environmental threats. The CEHT mandate has a duration of four years (three years from now). Jacques Vallin will serve as a liaison between the CEHT and the IUSSP Council.

The intention to organise four seminars, expressed in the background note by Vladimir Shkolnikov, is probably too ambitious in the light of past experience. It is more realistic to think of two or three seminars in addition to the EHT session at the next IUSSP General Conference.

London is probably not the best location for the first workshop. There are good reasons to think of one of the Eastern European cities or about Rostock.

France Meslé
The task of the CEHT is a difficult one because it has dispersed areas of interest. A challenge is to work out a more focused agenda by concentrating on most important population and health trends. The choice of topics and priorities can be structured according to the original Omran concept of epidemiological transition. First, Africa has not completed the first step because mortality from infectious diseases (AIDS, malaria, and other infections) is very high and still rising. Second, Eastern Europe and the former Soviet union failed in putting cardiovascular diseases under control. Third, dangers related to considerable changes in global environment justify the importance of environmental threats. Fourth, in respect to injuries and violence it is important to focus not only on homicide and suicide, but also on the growing threat of traffic accidents in Africa and other parts of the Third World.

One of the fundamental questions is what will be the next priority for developing countries. It is desirable, therefore, to connect what we know about developed countries to the future health trends in the Third World.

It would be reasonable to organise not more than three workshops:

1. East-West gap in mortality and socio-economic inequalities in mortality and health. These two topics can be combined as suggested in the Background note.
2. Gap between Africa and the rest of the developing world with a special focus on increasing mortality from infectious diseases.
3. Major health threats: what can be expected in the future? May include studies on environment degradation, injuries and man-made diseases.

The first two seminars should analyse existing trends in respect to non-communicable andcommunicable diseases. The third one should combine considerations of other and potential health threats and should project major health threats in the future.

London might be too expensive location for the first workshop given a considerable number of potential participants from Eastern Europe and developing countries.

Tapani Valkonen
Emerging health threats can be structured and ranked according to their objectively evident influence on mortality and ill-health. In this connection, the background note does not emphasise enough some very important health threats, which cause big losses of human life at present. These are: increases in mortality from non-communicable diseases in developing countries, high mortality from tuberculosis, new spread of malaria, high mortality from traffic accidents in developing countries, alcohol-related diseases and accidents.

Scientific activities of the CEHT can be classified along two principal dimensions: by causes of death and ill-health or by populations and population groups facing more problems than others. It is preferable to choose the second structuring approach by focusing on vulnerable populations. Empirical evidence of health effects of environmental threats is still "soft". The latter group of problems can not be considered or can be discussed better in terms of real health outcomes rather than only environmental factors as such.

It would be too hard to organise four CEHT workshops. It is more realistic to plan two, maximum three, workshops. They can be devoted to the following themes:

1. Vulnerable populations in the developed world.
2. Health threats in developing countries.
3. Future health threats. Causes of death and diseases not covered by the first two workshops.

Workshops should be held on the basis of invited papers, but should also provide an opportunity for a certain number of spontaneous papers.

It is hard to foresee future health threats. Today’s thinking about emerging health threats, in fact, takes into account only trends and patterns of today. Situations may change considerably even during the period of the CEHT mandate.

New infectious diseases as HIV, Ebola, Legionella, Hepatites E and C, etc. are only symbols of a problematic relationship between populations, socio-economic conditions, behavioural patterns, environments and pathogens.

In many cases economic determinants alone do not explain much. For example, Botswana has higher life standards than a majority of surrounding African countries but has 30% of HIV positive people among the population. Many factors affect health: population density, cultural patterns, demographic and household structures.

It is possible that a higher or lower proportion of circumcision in populations may influence very significantly spread of HIV.

It is preferable to keep environmental threats in the agenda of the CEHT.

There are good reasons to request the IUSSP Council to extend the mandate of the CEHT by one year. It would give an opportunity to organise three seminars in 2002-2004 while avoiding a "rush" by having one workshop per year.

For our considerations it is important to pay attention to determinants and pre-determinants of ongoing changes.

Previous experiences of IUSSP committees tell us that it is not necessary to have a very strict agenda. It might be better to formulate hypotheses and let researchers react to them. Hypothesis should capture the causations. The question could be: "Does a given explanation/hypothesis look plausible in light of existing evidence?"

It is also be important to distinguish our work from that done by the former Committee on AIDS. This committee focused on the effects of AIDS on mortality, socio-demographic impact of AIDS, partnership network analysis, proximate determinants of sexual behaviour.

It could be enough to organise just two seminars:

1. Health inequalities within and between countries including the problem of injuries and violence.
2. Return of infectious disease: an intersection of socio-economic and medical developments.

Mari Bhat
We should clearly define the area of the CEHT. Define what "emerging health threats" are and then classify them. The number of papers to be published has to be restricted according to a number of major issues. Accompanying text should suggest how demographers could contribute to the general knowledge on emerging health threats and their driving forces.

In general, India follows a classical route of health transition. Mortality from the a majority of infectious diseases and maternal mortality is decreasing. Mortality from the cancers, cardiovascular conditions and other chronic diseases is increasing. Mortality from accidents and violence is also increasing. At the same time, it is well recognised that the threats of HIV/AIDS and environmental degradations are growing. Different regions of India experience very different levels of mortality and ill-health.

It seems to be a good idea to include the issue of injuries and violence in the programme of the first workshop. The first workshop addressing inequalities in mortality and health should not concentrate exclusively on developed countries. Some studies from the developing world are desirable, although their number can not be big because of the lack of appropriate data.

Three seminars can cover the whole field. Provisionally, these are:

1. Growing inequalities in mortality and health.

WORK PROGRAMME DISCuSSED AND AGREED

The CEHT requests the IUSSP Council to extend its mandate by one year to cover the period of 2000-2004.

The CEHT members would like to have their second meeting in August 2001 in connection with the General Conference Brazil. This meeting will be devoted to detailed planning of the second workshop. All CEHT members will request their institutions and/or external foundations to pay expenses related to travel and accommodation. If necessary, CEHT will request the IUSSP for providing funds for 2 to 3 committee members, who will not be able to pay these costs.

In 2001-2004 the CEHT will organise the session on Emerging health threats at the General IUSSP Conference in Brazil (August 2001) and three workshops:

1. Determinants of diverging trends in mortality. June 2002 in Rostock
2. Global economic and socio-demographic trends and the re-emergence of infectious disease. June 2003 in Abidjan or another African city (?)
3. New health threats and their demographic consequences. March 2004 in New Delhi

Tentative agenda of Workshop 1.
Title: Determinants of diverging trends in mortality
Probable location: Rostock, Germany
Local organiser: Vladimir Shkolnikov
Tentative date: June 2002
Scientific Committee: all members of the CEHT
Format: 3-day workshop, 11 sessions, 25 presentations, about 35-40 participants.

CEHT requests James Vaupel and Jan Hoem, Co-Directors of the Max Planck Institute for Demographic Research, to host the workshop in Rostock in June 2002.

Invitations to speakers should be sent by June 2001.

Sessions and invited papers
Session 1:
Pathways of health transition in a changing world
- Concept of health transition re-visited. S.Horiuchi (USA)
- Convergences and divergences in global health transition. J.Vallin (France)

Session 2:
Determinants of long-term unfavourable mortality trends in Central and Eastern Europe.
- Comparative analysis of mortality trends. F.Meslé, V.Hertrich (France)
- Rising mortality from cardiovascular diseases. M.Bobak (Czech RePUBLIC)

Session 3.
Mortality trends after the fall of communism: country case-studies.
- Czech RePUBLIC. J.Rychtarikova
- Romania. V.Ghetau (Romania).
- Former Soviet union. V.Shkolnikov (Russia), D.Leon (uK)
- East Germany. R.Scholz, E.Nolte (Germany)

Session 4.
Health policies: adequacy of response to the health crisis.
- Health sector reforms in CEE countries. M.McKee+a co-author from a CEE country
- Response to emerging health challenges (violence, TB, AIDS and STDs). E.Varavikova (Russia)

Session 5.
Diverging trends in health transition in the South: country and regional case-studies.
- India. M.Bhat (India)
- Sub-Saharan Africa. B.O.Tambashe (Côte d’Ivoire)

Session 6.
Increasing socio-economic inequalities in mortality within countries-1
- Trends in socio-economic inequalities in Europe. J.Machenbach, A.Kunst (the Netherlands)
- Determinants of socio-economic differentials in mortality in the uK. J.Davey-Smith (uK)

Session 7. Increasing socio-economic inequalities in mortality within countries-2.
- Socio-economic inequalities in mortality in the developing world. An author would be proposed later by M.Bhat, J.Timaeus, M.Caraël
- Race, socio-economic status and mortality in the USA. I.Elo, S.Preston (USA)

Session 8.
Diverging regional trends in mortality within countries.
- Effects of income inequality on regional differences in mortality. J.Lynch (USA)
- Community disadvantage or population heterogeneity: determinants of Bulgarian mortality across space. I.Kohler (Bulgaria)

Session 9.
Loci of high mortality in metropolitan areas: contextual and socio-economic factors.
- Latin America case study. An author would be proposed later by F.Meslé and I.Timaeus.
- Africa case-study. An author would be proposed later by I.Timaeus
- Turin case-study. G.Costa (Italy) ??

Session 10.
Trends in health inequalities at old age.
- Increasing excess mortality among unmarried elderly. T.Valkonen (Finland)
- Mortality and socio-economic status in old people in France. E.Combois (France)
- Mortality and socio-economic status in old people in the uK and Denmark. E.Gjonca (Albania)

Final session
- Round table discussion
- Summary note by the Chair.

Reported by Vladimir Shkolnikov
12.12.2000