Beyond the ‘transition’ frameworks: the cross-continuum of health, disease and mortality framework

T he planning, development and sustainable implementation of health policies and health systems ought to be based on precise measurements and understandings of prevalence and incidence of communicable and non-communicable diseases, accidents and other disabilities, given past and current demographic and epidemiological profiles in societies as well as how they are predicted to change over time. Equally crucial is the need to understand and appreciate the underling mechanisms and influential factors of these changes, and their monetary and non-monetary costs and implications to individuals, families, communities and governments in the global context. In specific contexts, it may be the interactions between factors from different levels and categories of determinants, and their timing and sequencing during the life courses, which are critical to the health of individuals and populations and how the health care system responds to health problems. To advance knowledge and promote action, various theoretical perspectives, notably the epidemiological transition theory (1, 2), have been used in an attempt to both describe and understand local, national and global patterns in demographic and epidemiological profiles within and across societies, given the multiple domains of health (3). The epidemiological transition theory was first formulated by Abdel R. Omran (1) to describe quite accurately the shift in demographic and disease profiles reflecting historical experiences of populations in Europe and North America from the mid-18th century through the 1950s. Over the past four decades, the focus in numerous academic and research settings has been on this theoretical perspective for training and research. It has also been used extensively for research and discussion on the changing demographic and epidemiological profiles in developing countries. By and large, it has been used as a main conceptual framework in discussing how disease patterns change over time from predominantly infectious diseases to chronic non-communicable diseases. Since the 1980s, this theory has been challenged on its applicability in lowand middle-income countries (LMICs) where valid and reliable morbidity and mortality data over long time periods are often lacking or incomplete. The validity of Omran’s model has also been questioned for failing to recognize and analyze the importance of cultural and social beliefs and values, political forces and health policy in understanding epidemiological profiles, especially in developing countries. Understandably, with improvements in survival at early ages in tandem with increasingly growing proportions of adult and elderly populations as well as the emergence of new infectious diseases, such as HIV/AIDS and the re-emergence of old ones such as tuberculosis, cholera, polio and dengue fever, disease and mortality patterns in populations of LMICs have been changing in unprecedented ways. These countries are largely faced with scarcity of adequate data for health policy and planning, with the double burden of communicable and non-communicable diseases, with their health systems still mainly ill-prepared to face the challenges of quality care and affordable health care services, with a sizeable proportion of their populations living in chronic poverty and unmet basic needs, with no access to clean water, and with inexistent or sub-standard sanitation systems. Over the past 20 years or so, these compounding situations have given rise to renewed interest in the patterns of demographic and epidemiological profiles of developing countries and whether existing theoretical Global Health Action